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
12 Feb 20

From: To:

Director, Secretary of the Navy Council of Review Boards 
PD-2017-03920

Subj:	PHYSICAL DISABILITY BOARD OF REVIEW  (PDBR)

Ref:	(a) DoDI 6040.44
(b) PDBR ltr of 27 Feb 19

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

2.	On 31 January 2020, the Assistant Secretary of the Navy took action in your case by accepting the correct recommendation of the PDBR.	Accordingly, your records will be corrected to reflect an increase in the disability rating awarded by the Physical Evaluation Board from 20 to 40 percent with assignment to the Permanent Disability Retired List.

3.	The Assistant Secretary's determination, which represents final action in your case by the Department of the Navy, was sent to the office of the Deputy Commandant, Manpower and Reserve Affairs, for correction of your records as stated above.	You will be notified once those changes are complete.

RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX		CASE: PD-2017-03920 BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20080630

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

CI CONTENTION:  No specific contention was made.  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 - 20080306	VARD - 20090109	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I Diabetes Mellitus	7913	20%	Diabetes Mellitus, Type I	7913	20%	20080815	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Type I Diabetes Mellitus. According to the service treatment record and MEB narrative summary (NARSUM), the CI’s diabetes condition began in February 2006 after he experienced weight loss, increased thirst, increased urination and blood sugar level greater than 400 mg/dL. Initial treatment was with oral medication (metformin) and diet; however, he did not achieve satisfactory blood glucose levels or A1C levels. He was transitioned over time to insulin along with diet and exercise, which moderately controlled the diabetes. On 16 January 2008 he was taking NovoLog insulin before meals and Levemir insulin twice a day. The CI was counseled to discontinue physical training as there was no guarantee he would always be able to monitor and treat  hypoglycemia.    The  22  January  2008  MEB  NARSUM  examination,  5  months  prior  to

separation, was within normal limits. The examiner noted the CI would need exogenous insulin for the remainder of his life to control his diabetes mellitus.

An endocrinologist wrote on 25 February 2008, 4 months prior to separation, the CI’s diet needed to be closely monitored and insulin dosed based on carbohydrate content along with consistent exercise. The endocrinologist further noted that “since exercise is sometimes associated with a variable glucose response, he should always have his meter and insulin supplies on hand. As such, the rigors of a military career preclude the day-to-day lifestyle changes he will need to make in order to care for his diabetes. In an addendum also dated 25 February 2008, a Navy medical officer wrote that the CI should avoid strenuous activities and monitor blood sugar with exercise due to hypoglycemic episodes. He noted examples of activities that should be regulated included, but were not limited to, yard work, running and manual labor.

At the 15 August 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported using an insulin pump and that he had no hospitalizations for hypoglycemia or diabetic ketoacidosis. He checked his blood sugars (average 100 mg/dL) six times a day, and was hypoglycemic (low blood sugar) twice a day. He stated he had increased urinary frequency during the day. He saw his healthcare provider every 3 months, watched his diet and exercised by swimming several times a week and riding a bicycle. While he was in the Service he stated he missed no days of work and denied activity restrictions. He stated he worked full-time in his own construction business. He denied any ophthalmologic, cardiac or renal complications and denied numbness and tingling in his hands or feet. Physical examination showed a well-developed, well-nourished male in no acute distress with clinical findings, including a neurologic evaluation, within normal limits. He walked with a normal gait and used no assistive devices. Laboratory tests were within normal limits except a glucose of 137 mg/dL (normal less than 100).

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 requirement of insulin and a restricted diet. The VA rater also stated that a higher evaluation of 40 percent was not warranted because the evidence failed to show regulation of activities.

The panel agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating, and carefully examined the evidence regarding the requirement for “regulation of activities” (avoidance of strenuous occupational and recreational activities) in this case, regulation of activities can justify a 40% rating. The CI was counseled that he was to discontinue physical training as there was no guarantee he would always be able to monitor and treat hypoglycemia. Furthermore, the endocrinologist addressed the need to exercise consistently, but also noted that exercise is sometimes associated with a variable glucose response, while the Navy Medical Officer noted the CI should avoid strenuous activities that included yard work, running and manual labor. Therefore, it appears that the criteria for regulation of activities was met prior to separation. At the VA examination the CI reported he checked his blood sugar six times a days and was hypoglycemic twice a day. Panel members considered the hypoglycemia twice a day as caused by either excess insulin, over activity, insufficient caloric intake, or a combination of the aforementioned. Since the CI was working in construction and not regulating his activities as recommended, the bouts of hypoglycemia suggest that restriction of activities was appropriately recommended and the less than adequate control marked by twice daily hypoglycemic episodes, despite use of an insulin pump and frequent glucose measurements, warrant a 40% rating. After due deliberation, considering all the evidence and mindful of VASRD
§4.3 (reasonable doubt), the panel recommends a disability rating of 40% for the type 1 diabetes, coded 7913.

BOARD FINDINGS: In the matter of the type 1 diabetes condition, the panel recommends a disability rating of 40%, coded 7913 IAW VASRD §4.119. There are no other conditions within the panel’s scope of review for consideration.

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:

CONDITION	VASRD CODE	PERMANENT RATING	
Type 1 Diabetes Mellitus	7913	40%