RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXX	CASE:  PD-2017-03908
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20090826

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E5, Petroleum Lab Specialist, medically separated for “diabetes mellitus” with a disability rating of 20%.   

CI CONTENTION:  Requested review of diabetes mellitus and knee condition.  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 - 20090519	VARD - 20101102	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus Type II with Chronic Renal Failure	7913	20%	20100212	
Patellofemoral Syndrome	Not Unfitting	Left Knee Chronic Strain	5260	0%	20100212	
		Right Knee Chronic Strain	5260	0%	20100212	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Diabetes Mellitus.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced dizziness associated with polyuria and polydipsia in early January 2009.  He presented to the emergency department on 12 January and was admitted for high blood sugar levels.  Laboratory data showed a glucose level of 618 mg/dL and hemoglobin level of 13.7%.  Lantus (10 units) at bedtime and Metformin (500 mg) twice a day was initiated, and dieting and exercise were recommended.  The CI was evaluated by endocrinology and determined to have Type 1 diabetes mellitus.  At a routine diabetic clinic follow-up on 24 February 2009, his glucose level was down to 82 mg/dL.

The permanent profile on 10 March 2009 allowed sit-ups, push-ups and an alternate aerobic event to satisfy physical fitness requirements.  During the 16 March 2009 MEB examination (recorded on DD Forms 2807-1 and 2808), 5 months prior to separation, the CI reported taking Lantus (insulin), and his fasting glucose was 98 mg/dL.  The 6 April 2009 MEB NARSUM examination noted he was using insulin glargine every morning and insulin aspart prior to meals, monitoring blood sugars 3-4 times a day, and responding well with significant improvement in hemoglobin A1C to 4.9% within normal range.  Physical examination noted ophthalmic, neurological and vascular system assessments within normal limits (WNL).  Glucose, BUN and creatinine were also WNL [98 md/dL (74-118), 1.1 mg/dL (0.7-1.2), 16 mg/dL (8-26), respectively], as was the glomerular filtration rate.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.

The 12 February 2010 VA Compensation and Pension (C&P) examination, 5 months after separation was not in evidence, however the 2 November 2010 VA Rating Decision provided the necessary information for rating purposes.  The CI reported being hospitalized for one episode of ketoacidosis, but denied inpatient care for hypoglycemia.  He was on a restricted diet and insulin to control symptoms, and there was no evidence of a diabetic eye condition.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes mellitus 20%, coded 7913 (diabetes mellitus), citing insulin requirement and restricted diet. The VA also rated the diabetes mellitus 20%, coded 7913, based on the C&P examination, citing restricted diet and insulin to control symptoms.  There was a question regarding renal failure and a C&P addendum dated 25 April 2011 stated there was normal kidney function and no evidence of renal disease secondary to diabetes.  Panel members 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 mellitus.  

Contended PEB Conditions:  Patellofemoral Syndrome.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  The right knee was profiled L2, however the MEB examination cited bilateral knees.  The profile allowed all functional activities pertaining to the knees, except the 2-mile run.  The physical fitness test scorecard showed the CI took three fitness tests with walking as the alternate aerobic event and passed all three (Nov 07, Feb 08 and Nov 08).  The MEB showed patellofemoral syndrome met retention standards.  There was no performance-based evidence from the record that any of the conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for any of the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the diabetes mellitus and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication.  In the matter of the contended bilateral knee condition, the panel recommends no change from the PEB determinations 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. 

	PD-2017-03908

AR20190011654, XXXXXXXXXXXXXXXXXXX 

Dear XXXXXXXXXXXXXXX

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

	PD-2017-03908