RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03873 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20090815

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Aircraft Communications Systems Technician, medically separated for the Temporary Disability Retirement List (TDRL) for “Type II diabetes mellitus, insulin requiring” with a disability rating of 20%.

CI CONTENTION: “Diabetes is not static my treatment went from pill to shots to pumps.” 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 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 Physical Evaluation Board (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 - 20090610	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type II Diabetes Mellitus (DM)	7913	20%	No VA Examination Proximate to TDRL Removal in Evidence	
COMBINED RATING: 10%	COMBINED RATING OF ALL VA CONDITIONS: NA	

ANALYSIS SUMMARY:

Type II DM. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI presented to a civilian emergency room (ER) on 23 November 2002 with polyuria and polydipsia, and a blood sugar in the 1000 range. He presented to the camp ER the following day with the same symptoms and was found to have a blood sugar of 400. The CI was treated and referred to an internal medicine clinic where he treated with insulin and oral medications without control of the condition, but was never hospitalized.  The CI had some low

blood sugar readings after exercise. In 2003 he lost 50 pounds and had diabetic ketoacidosis (buildup of acids in blood in association with high sugar). A diagnosis of Type II DM was rendered and the CI was placed on TDRL 18 June 2004 with a rating of 40%.

The 23 May 2006 TDRL endocrinology examination noted no known complications and a diagnosis of Type I DM (antibodies negative) was rendered. Glucose was wide ranging, although current  glucose  was  in  good  control.  Testing  showed  evidence  of  ulcerative  colitis.   The 31 October 2008 TDRL reevaluation, 10 months prior to separation, noted no complaints due to DM, which required an insulin pump for management. The heart, skin and neurological system were normal. Urine and blood work taken the same day showed no evidence of diabetic kidney, eye, or nerve disease, nor ketoacidosis. Hemoglobin A1c was 7.3% (elevated), and an optometry examination on 29 October 2008 was normal.  The CI was released without limitations.

The 9 January 2009 TDRL endocrinology reevaluation, 7 months prior to TDRL removal, noted no complaints due to DM. Physical examination showed no evidence of diabetes complications. The examiner documented the CI’s A1C test for blood sugar was trending upwards and fasting sugar was elevated. The CI’s blood pressure and lipids (fat in blood) were under control and there was no evidence of diabetic retinopathy, neuropathy, nephropathy, or ketoacidosis. The CI was released without limitations. The 22 April 2009 JDETS noted the CI was working and attending college. Physical examination was within normal limits. Blood urea nitrogen and creatinine were good but HGB A1C was 7.4. The DM condition was noted as stable. An endocrinology examination on 20 May 2009, 3 months before separation, noted the CI had multiple hypoglycemic events in the past month; no hospitalizations were noted or found in STR evidence. The CI’s basal rates (pumped insulin) were adjusted and he was released without limitations.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the DM condition 20%, coded 7913, citing a requirement for insulin. Panel members agreed the requirement for treatment with insulin and restricted diet justified a 20% rating, and because there was no evidence of medically-prescribed regulation of activities, the next higher 40% rating was not justified. Furthermore, the STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalizations (proximate to TDRL removal) 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 DM condition.

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

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 <ltd 16 Aug  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 ofno 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.

PDBR