RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-03715
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20090928

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E5, Water and Fuel Systems Maintenance Craftsman, medically separated for “diabetes mellitus (DM) type II, not requiring insulin” and “proteinuria associated with DM,” rated 20% and 0%, respectively, with a combined  disability rating of 20%.  

CI CONTENTION:  “Review all conditions.”  The complete submission is at 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 Physical Evaluation Board (PEB) to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the Medical Evaluation Board (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 - 20090605	VARD - 20100308	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type II 	7913	20%	Diabetes Mellitus, Type II with Nephropathy and Hypertension	7913	10%	20100126	
Proteinuria, Associated with DM	7599-7502	0%					
Hypertension	Not Unfitting	No VA Placement	
Hyperlipidemia	Not Unfitting		
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM) Type II.  According to the service treatment record (STR) and the MEB narrative summary (NARSUM), the CI’s diabetes condition began in October 2006 and required diet restrictions and oral medications for control.  He was never placed on insulin therapy.  Although achieving limited improvement, his condition limited his deployability and he was referred to a MEB.  
The 13 March 2009 MEB NARSUM examination, 6 months prior to separation, noted that the CI was taking an oral hypoglycemic medication twice a day.  His hemoglobin A1C was elevated at 8.3.  His physical examination (PE) was normal.  Although the CI’s medication was increased, the provider did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.

At the 26 January 2010 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI reported not taking any medication for his diabetic condition.  Specifically, the provider noted, “The [CI] declines to take medication and states he wishes to try and control his diabetes with diet only.”  Additionally, it was noted that he had not received any medical treatment for his diabetes since June 2009.  His PE was normal and his hemoglobin A1C was 6.9.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913 (diabetes mellitus), citing the need for specific dietary considerations as well as complications of DM.  Utilizing the same code, the VA rated the diabetes condition 10%, citing symptoms controlled with restricted diet.  The panel agreed that the requirement for treatment with oral hypoglycemic agents as well as dietary restrictions justified a 20% rating.  The next higher rating of 40% was not justified due to the absence of insulin use or prescribed regulation of activities.  After due deliberation, considering all of 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.  

Proteinuria, Associated with DM.  According to the STR and the MEB NARSUM, the CI’s proteinuria condition was discovered as part of the initial evaluation for DM.  Although both pre and post separation clinical evaluations revealed persistent elevations in protein within the CI’s urine, the accompanied presence of casts was not detected.  All blood pressure recordings within the STR noted the diastolic pressure remained below 100 mm/mg and the systolic pressure remained below 160 mm/mg.  His PEs were consistent with those noted above in the DM summary.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the proteinuria condition 0%, analogously coded 7599-7502 (nephritis, chronic), citing the protein not accompanied by hyaline and granular casts or red blood cells.  The VA did not rate this condition, but it was specifically mentioned and documented in the C&P examination.  The panel agreed that the analogous VASRD code of 7502 was most appropriate given the parameters of the CI’s condition.  VASRD guidelines dictate that code 7502 be rated under the condition of renal dysfunction.  The minimum positive impairment rating under the condition of renal dysfunction includes either the presence of casts or red blood cells; or, transient or slight edema or hypertension at least 10% disabling under diagnostic code 7101 (hypertensive vascular disease).  In this particular case, the criteria of minimal hypertension or urinary derived casts were not present, and therefore a positive impairment rating was not met.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3, the panel concluded there was insufficient cause to recommend a change in the PEB adjudication for the proteinuria condition.

Contended PEB Conditions:  Hypertension and Hyperlipidemia.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended conditions were not unfitting.  Neither of the conditions were profiled, implicated in the commander’s statement, nor judged to fail retention standards.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at or near separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB’s fitness determination for either of the contended conditions, so no additional disability ratings are recommended.
BOARD FINDINGS:  In the matter of the diabetes condition and IAW VASRD §4.120, the panel recommends no change in the PEB adjudication.  In the matter of the proteinuria condition and IAW VASRD §4.104 and §4.115b, the panel recommends no change in the PEB adjudication.  In the matter of the contended hyperlipidemia and hypertension conditions, the panel recommends no change from the PEB determination as not unfitting.  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 20170509, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-03715.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

						Sincerely,

		

								XXXXXXXXXXXXXXXXXX
								Director
								Air Force Review Boards Agency

Attachment:
Record of Proceedings