RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX.  	cASE:  PD-2017-04570
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060428

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

CI CONTENTION:  No specific contention 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 - 20060307	VARD – 20061122	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type II	7913	20%	Type I Diabetes	7913	20%	20061026	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM), Type II.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI experienced symptoms of urinary frequency, headache, increased thirst and food intake in February 2002.  His fasting blood sugar was 460 mg/dL (normal less than 100) and hemoglobin (Hgb) A1C was 12.7% (normal 3.9-6.1).  He was diagnosed with DM type II and started on oral medications.  When his glucose levels did not fall with the oral medication, he was prescribed insulin, the dose of which was steadily increased over time.  In October 2002, he was diagnosed with necrobiosis lipoidica diabeticorum by dermatology based on erythematous nodules of his lower extremities secondary to poorly controlled diabetes. 

At the 13 June 2003 MEB NARSUM examination, the CI was noted to be taking glargine insulin and metformin.  His HgbA1C was 9.3%.  On 30 August 2004 the CI was noted to have uncontrolled diabetes mellitus type I (glucose 350 mg/dL and HgbA1C was 11) with early neuropathy.  Aspirin, lisinopril (to prevent potential kidney damage from the diabetes), and Zocor (simvastatin to rated elevated lipids) were added to the diabetes treatment regimen of Humalog (insulin lispro-rapid acting).  The CI was seen in follow-up on 2 June 2005 and was referred to optometry, podiatry and endocrinology for follow-up.  

On 27 June 2005, the CI reported episodes of not only hyperglycemia, but also hypoglycemia.  Due to poor control with maximum oral antidiabetic medications and good control with insulin, the CI was felt to have type I diabetes.  Laboratory studies revealed an elevated GAD-65 antibody at 5 and a C-peptide which was low normal at 0.8, consistent with type I diabetes.  He was issued a P3 profile on 10 November 2005 that did not indicate avoidance of strenuous occupational or recreational activities; however, he required access to diabetic testing supplies and food at all times--as well as refrigeration and quarterly access to an endocrinologist and a laboratory.  The examiner noted, “His sugars are well controlled.”  However, on 15 December 2005 the CI’s glucose was 1000 mg/dL.  

At the 30 January 2006 MEB NARSUM examination, 4 months prior to separation, the CI reported taking Lantus (insulin glargine) and NovoLog (insulin aspart-rapid acting) after each meal.  His HgbA1C was 7.8% with a fasting blood glucose of 219 mg/dL.  There was no evidence of diabetic complications.  

At the 26 October 2006 VA Compensation and Pension (C&P) examination, 6 months after separation, the CI reported taking insulin, denied any hospitalizations because of hypoglycemia or diabetic ketoacidosis and had no restricted activities.  He indicated that since he was working the night shift, his blood sugar was off again.  He did not eat well or sleep properly and had a blood sugar of 28 mg/dL (hypoglycemia), which was corrected by eating.  Physical examination was normal, except for slight hyperpigmentation changes over the right lower leg and two, flat, nontender 2.5 cm lesions.  He had no evidence of retinopathy, neuropathy or other complications of diabetes except the skin changes on the leg.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DM condition 20%, coded 7913 (diabetes mellitus), citing fair control on insulin.  The VA also rated the DM condition 20%, coded 7913, based on the C&P examination, citing 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, 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).  The CI’s diabetes was poorly controlled as evidenced by a glucose of 1000 mg/dL, but the treatment for it was not present in the STR, or complications that could support a higher rating.  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 DM 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.  

The following documentary evidence was considered:

[AR Number], XXXXXXXXXX. 

Dear XXXXXXXXXX:

	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.