RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-04919
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20011031

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

CI CONTENTION:  “Diabetes, Hyperthyroidism, Graves’ Disease.”  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 - 20010723	VARD - 20021002	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus	7913	20%	Diabetes Mellitus Type II	7913	20%	STR	
Graves’ Disease	Not Unfitting	Graves’ Disease	7999-7900	10%	STR	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40%	

ANALYSIS SUMMARY:  

Diabetes Mellitus.  According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with diabetes in June 1999 and treated with insulin.  The 12 March 2001 MEB NARSUM examination, 8 months prior to separation, noted insulin therapy.  Current medications included insulin and Glucotrol XL.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  Physical examination was unremarkable.  Hemoglobin A1c was 9.0%.  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).  There was no evidence of diabetic complications.  The permanent profile restricted running, marching, jumping and pushups, but allowed unlimited walking, cycling and swimming.  There was no VA examination proximate to separation in evidence.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes 20%, coded 7913 (diabetes mellitus), citing insulin requirement.  The VA also rated the diabetes 20%, coded 7913, based on the STR, citing use of insulin, Glucotrol 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 diabetes.

Contended PEB Condition:  Graves’ Disease (Hyperthyroidism [Overactive Thyroid]).  The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting.  The contended condition was profiled, but not implicated in the commander’s statement or judged to fail retention standards.  The physical profile dated 15 October 1999 was prior to the CI’s ablation therapy (decrease thyroid function) in February 2000.  The MEB NARSUM examiner noted the CI underwent thyroid ablation and was initially placed on Synthroid (replacement thyroid hormone), but his thyroid function normalized and he was euthyroid (normally functioning thyroid) without any current medications.   There was no performance-based evidence from the record that the condition 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 the contended condition, so no additional disability rating is recommended.

BOARD FINDINGS:  In the matter of the diabetes and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication.  In the matter of the contended Graves’ disease, the panel recommends no change from the PEB determination 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.  

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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.
 
Sincerely,					      
						      					
Enclosure