RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-03859
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20061030

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Dental Assistant Journeyman, medically separated for “diabetes mellitus Type II, requiring insulin” with a disability rating of 20%.  

CI CONTENTION:  A higher rating for diabetes was requested as well as a review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  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 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 - 20060828	VARD - 20070321	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II, Requiring Insulin	7913	20%	Diabetes Mellitus, Type II	7913	20%	200611215	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Type II Diabetes Mellitus.  The CI developed Type II diabetes mellitus in February 2006 after presenting in the emergency department (ED) for symptoms of hyperglycemia.  Initial treatment consisted of dietary control, exercise, and three courses of oral medications before ultimately requiring treatment with insulin.  Following initiation of treatment at the time of diagnosis, the STR showed two ED visits related to diabetes for hyperglycemia.  Neither event resulted in hospitalization. There was no evidence of diabetic complications.  The physical profile serial report did not restrict activities.  

The 18 July 2006 MEB narrative summary (NARSUM) examination, 3 months prior to separation, noted that the CI was prescribed insulin (Lantus).  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. Physical examination revealed a healthy appearance.  The physician examiner reported no findings of diabetic complications including negative findings of diabetic retinopathy.    

At the 15 December 2006 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner reported that the CI was prescribed oral hypoglycemic medication (Glyburide and Avandia) with poor outcome and was then prescribed insulin.  The CI reported no functional limitations possibly related to diabetes.  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, vascular or other complications of diabetes.  Hemoglobin A1c was 13.2%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and the VA rated the diabetes condition 20%, coded 7913. The PEB stated “…the member’s condition is approximately rated at 20%.”  The VA cited the CI’s 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 CI’s Type II diabetes mellitus.  

BOARD FINDINGS:  In the matter of the Type II diabetes mellitus 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.  

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

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Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case NumberPD-2017-03859.

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.