RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05221
BRANCH OF SERVICE:  army 	SEPARATION DATE:  20060314

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Human Resources Specialist, medically separated for “uncontrolled diabetes mellitus” with a disability rating of 20%.

CI CONTENTION:  “Severe diabetic complications.”  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 - 20051128	VARD - 20061012	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Uncontrolled Diabetes Mellitus	7913	20%	Diabetes Mellitus	7913	20%	20060711	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:  

Uncontrolled Diabetes Mellitus.  The CI developed type II diabetes mellitus in 2004, which ultimately required treatment with oral hypoglycemic medication, dietary restriction and insulin.  
The 21 July 2005 MEB narrative summary (NARSUM) examination, 8 months prior to separation, noted the CI on high dose insulin.  Although the examiner stated the CI was unable to actively participate in military activities including deployment, the examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  In fact, it was noted that the CI was to continue with weight loss efforts and titration of exercise.

According to the 29 July 2005 MEB examination (recorded on DD Form 2807-1), 7 months prior to separation, the examiner noted the CI was on insulin and that his 13 July 2005 HgbA1C was 10.4 (poor control).  The 19 August 2005 MEB NARSUM, 7 months prior to separation, recorded a history of intermittent dysesthesias (sensory changes) to the bilateral hands and wrists, which were associated with high blood sugar levels.  However, neuropathy was not present.  The examiner noted the CI’s diabetes was not controlled and required increasing doses of insulin.  Evidence of diabetic retinopathy was absent and the CI had never had severe hypoglycemia.

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 stated: “No field rations.  No short or long-term assignments to areas without refrigeration due to insulin storage requirements.  Needs to be assigned to locations where definitive medical care is available.”  Although the profile restricted the APFT and unlimited aerobic conditioning activities, it did allow for upper body weight training and all aerobic activities at own pace and distance.
	 
At the 11 July 2006 VA Compensation and Pension (C&P) evaluation, 4 months after separation, the examiner recorded that the CI was taking insulin.  The CI reported that in the last year he visited the emergency room 50 times for hyperglycemia, which necessitated multiple hospital admissions.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  HgbA1C was 13.1%.  The examiner opined that the CI’s poor control was due to “inadequate therapy and possibly dietary indiscretion.”  The physical examination demonstrated normal motor strength and sensory function in all extremities, no evidence of significant vascular compromise in extremities, and no evidence of retinopathy or other complications of diabetes.

The panel directed attention to its rating recommendation based on the above evidence.  Both the PEB and VA rated the diabetes condition 20%, coded 7913, citing requirement for insulin.  The panel agreed that the CI’s requirement for insulin and restricted diet justified a 20% rating.  Because there was no evidence of significantly limiting medically prescribed regulation of activities, the next higher 40% rating was not justified.  The CI was able to engage in running, walking, biking and swimming at his own pace and distance, as well as participate in upper and lower body weight training.  Although the CI was seen in the emergency room for hyperglycemia, he was never hospitalized secondary to episodes of ketoacidosis, hypoglycemic reactions, or diabetic complications that could support higher ratings.  There was no evidence that he had weekly visits to a diabetic care provider or referral to such a provider (endocrinologist).  After due deliberation, considering all of 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 condition.  

BOARD FINDINGS:  In the matter of the diabetes and IAW VASRD §4.120, 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:

Exhibit A.  DD Form 294, dated 20170517, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Record 

AR20180007369, XXXXXXXXXXXXXXXXXX 

XXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXX

	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