RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05232
BRANCH OF SERVICE: NAVY	SEPARATION DATE: 20080101

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty O-2, Industrial Hygiene Officer, medically separated for “Type 1 diabetes mellitus” with a disability rating of 20%.

CI CONTENTION: “Review all conditions.” 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 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 - 20070727	VARD - 20080415	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Type I DM	7913	20%	DM	7913	20%	20080125	
Lateral Compartment Articular Cartilage Thinning	Cat III	Left Knee Patellofemoral Syndrome…	5024	10%	20080125	
Patellofemoral Pain, Improving	Cat III					
Hypertension	Cat III	Hypertension	7101	0%	20080125	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 30%	

ANALYSIS SUMMARY:

Type I DM. According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI developed Type I DM in 2006 which ultimately required treatment with insulin. He was initially hospitalized on 4 December 2006 for ketoacidosis and referred to nutritional medicine for dietary regulation on 20 December 2006. The 30 April 2007 MEB NARSUM examination, 8 months prior to separation, noted that the CI was on insulin (Lantus and Novolog). The CI reported he was unable to perform overnight duty for the command due to inability to reliably get meals, and resultant hypoglycemic episodes. The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.

According to the 18 May 2007 MEB examination (recorded on DD Form 2807-1), 7 months prior to separation, the examiner noted that the CI had been prescribed insulin but did indicate that avoidance of strenuous occupational and recreational activities was medically necessary.

Following initiation of treatment at the time of diagnosis, the STR showed no subsequent 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. It was noted that the limited duty (LIMDU) forms did not restrict activities.

At the 25 January 2008 VA Compensation and Pension (C&P) examination, one month after separation, the examiner reported that the CI was taking insulin (Lantus and Novolog). The CI reported he had no restriction of activity and the examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.

The panel directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the diabetes condition 20%, coded 7913 (DM). The VA based the rating on the STR and C&P examination, citing a 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, following initiation of treatment at the time of diagnosis, the STR showed no subsequent 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 condition.

Contended PEB Conditions: Lateral Compartment Articular Cartilage Thinning, Patellofemoral Pain, and Hypertension. The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting. None of the conditions were noted on LIMDU forms, implicated in the non-medical assessment, and did not fail 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 Type I diabetes mellitus condition and IAW VASRD §4.119, the panel recommends no change in the PEB adjudication. In the matter of the contended lateral compartment articular cartilage thinning, patellofemoral pain and hypertension conditions, 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.

The following documentary evidence was considered:

2	PD-2017-05232

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
10 Sep 20

From: Director, Secretary of the Navy Council of Review Boards To:	

Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) Ref:	(a) DoDI 6040.44
1.	Pursuant to reference (a), the PDBR reviewed your case and forwarded its recommendation to the Department of the Navy on 13 Aug 2020 for appropriate action.

2.	On 27 August 2020, the Assistant Secretary of the Navy (Manpower & Reserve Affairs) accepted the recommendation of the PDBR of no change to your characterization of separation or disability rating assigned by the Department of the Navy's Physical Evaluation Board.

3.	The Secretary's decision on your PDBR application is final and is not subject to appeal or additional review by the Board for Correction of Naval Records.