RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-02964 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090830

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Tiltrotor Airframe Mechanic, medically separated for “insulin dependent diabetes” with a disability rating of 20%.

CI CONTENTION: In addition to the diabetes, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB). The complete submission is Exhibit A.

SCOPE OF REVIEW: The panel’s scope of review is defined in DoDI 6040.44. It is limited to review of disability ratings assigned to those conditions determined by the PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB to be not unfitting or non-compensable. Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records. The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate. The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence relevant to application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards for the unfitting medical condition(s) at the time of separation. The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions; that role and authority is granted by Congress to the Department of Veterans Affairs, which operates under a different set of laws. The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.

RATING COMPARISON:

SERVICE PEB - 20090602	VARD - 20091202	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Insulin Dependent Diabetes	7913	20%	Diabetes Mellitus Type I	7913	20%	20091008	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 20%	

ANALYSIS SUMMARY:

Insulin Dependent Diabetes. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI first noticed an increase in thirst and urination while deployed and lost 15 pounds. He was admitted to the ICU in mid-January 2009 and found to have a plasma glucose of greater than 700 (normal 100 - 125) and was started on insulin. The 1 April 2009 MEB narrative summary (NARSUM) examination, 6 months prior to separation, the examiner noted the CI was on insulin. The CI reported he felt fine, although he had blurred vision at times. Review of systems for cardiovascular, pulmonary, gastroenterology, musculoskeletal and neurologic symptoms were negative except for blurry vision. The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  The STR showed

no episodes of ketoacidosis or hypoglycemia requiring hospitalizations or frequent visits to a diabetic care provider (twice a month or more frequently). There was no evidence of diabetic complications.

At the 8 October 2009 VA Compensation and Pension (C&P) examination, 1 month after separation, the examiner recorded insulin use for control. The CI reported exercising regularly, and was training for a half marathon. There were no hospitalizations for ketoacidosis or hypoglycemia, and the examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. The physical examination was normal, showing no evidence of retinopathy, neuropathy or other complications of diabetes.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the diabetes condition 20%, coded 7913 (diabetes mellitus). The VA also rated the diabetes condition 20%, coded 7913, based on the C&P examination, citing a requirement for insulin and restricted diet. The panel agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating. Because there was no evidence of medically-prescribed regulation of activities, the next higher 40% rating was not justified. Furthermore, following initiation of treatment at the time of diagnosis, the STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalizations or frequent visits to a diabetic care provider (twice a month or more frequently), or complications that could support higher ratings. After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the diabetes condition.

BOARD FINDINGS: In the matter of the diabetes condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication. There are no other conditions within the panel’s scope of review for consideration. Therefore, the panel recommends no modification or re- characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20170326, w/atchs Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record

2	PD-2017-02964

DEPARTMENT OF THE NAVY
SECRETARY OF THE NAVY COUNCIL OF REVIEW BOARDS 720 KENNON STREET SE STE 309
WASHINGTON NAVY YARD, DC 20374-5023

IN   REPLY  REFER  TO :
1850
CORB: 003 20May20

From: 

Director, Secretary of the Navy Council of Review Boards 

Subj:  PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr dtd 1 May 19

1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation (reference (b)) to the Department of the Navy on 5 Mar 2020 for appropriate  action.

2.	On 20 March 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation  Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.