RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW
NAME:  XXXXXXXXXXXXXXXXXXXXXXXXX	CASE: PD-2017-05435
BRANCH OF SERVICE: MARINE CORPS	SEPARATION DATE: 20070601

SUMMARY OF CASE: Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E3, Rifleman, medically separated for “diabetes mellitus type 1” with a disability rating of 20%.

CI CONTENTION: Review requested of the diabetes and adjustment disorder. 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 - 20090610	VARD - 20080708	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type 1	7913	20%	Diabetes Mellitus Type 1	7913	20%	20080528	
Adjustment Disorder	Category IV	Adjustment Disorder…	9440	30%	20080520	
COMBINED RATING: 20%	COMBINED RATING OF ALL VA CONDITIONS: 40%	

ANALYSIS SUMMARY:

Diabetes Mellitus (DM). According to the service treatment record and MEB narrative summary (NARSUM), the CI was diagnosed with DM Type 1 in 2006. The 21 November 2006 MEB NARSUM, 6 months prior to separation, noted that he had fluctuating blood sugar levels, was compliant with a diabetic diet, and would need further titration of his insulin requirements. In the review of systems, he reported feeling well except for increased thirst and urination, which had improved. The general physical examination was normal, and blood work showed a recent hemoglobin A1C level of 11.6% (normal 5.7% and lower) and blood sugar at 176 mg/dL (normal 100 or less) in the morning. Medically-prescribed regulation of activities was not addressed. The CI was placed on limited duty for the DM from 21 November 2006 to 21 May 2007, and prohibited from marching, physical training, field duty, standing watch, and range activity. Recreational regulation of activities was not addressed.

The 28 February 2007 MEB NARSUM addendum, 3 months before separation, noted DM symptoms especially while participating in physical exercise. The CI required the use of insulin

and had to check his blood sugar frequently and make dietary modifications. The examiner noted that he was compliant, very willing to take measures to improve symptoms, and that he “had to regulate his activities on a daily basis to conform with diabetes management.” There was no history of diabetic complications of the eyes, kidneys, or neurological system, and the possible use of an insulin pump was recommended to improve blood sugar control.

The CI appealed the Informal PEB’s 20% rating for the DM, and requested a 40% rating since his diagnosis required restrictions from participating in physical training, standing duty, and taking physical fitness tests because he had to closely monitor blood glucose levels. He reported that after only about 10 minutes of “cardio activity” he would start sweating profusely, with severe shaking and dizziness (symptoms consistent with hypoglycemia). A JDETS addendum on 9 March 2007, 3 months prior to separation, referenced the member’s statement and commented that the CI needed to work with his doctor to optimize his insulin so cardiovascular activity did not cause these symptoms. The reconsideration PEB concurred with the IPEB findings.

The CI was admitted to the hospital on 12 September 2007, 3 months after separation, with poorly controlled diabetes and mild diabetic ketoacidosis (DKA). He reported he had run out of insulin 2 months earlier and had difficulty getting into the VA system. At discharge, referral for evaluation of treatment with an insulin pump was discussed. The CI was hospitalized again on 27 November 2007, 6 months after separation, with complaints of weakness, fatigue, and a 20- pound weight loss in 1 month although he had been taking his insulin and controlling his glucose. He was diagnosed with mild DKA and a suspected dental infection.

At the VA Compensation and Pension (C&P) examination on 28 May 2008, 12 months after separation, the CI reported no current diabetes complaints or symptoms, however, he later described hypoglycemic episodes occurring 1-2 times weekly that lasted 30 minutes, and were associated with sweating, tremors, lightheadedness, and muscle cramps. He treated the DM with diet and insulin therapy, and did calisthenics, yoga, and ran 3 miles several times a week. The examiner noted he had been hospitalized 3 times for uncontrolled diabetes, but not hypoglycemia, and had no history of weight instability, diabetic foot ulcerations, or need to restrict activities. A general physical examination was essentially normal.

The panel directed attention to its rating recommendation based on the above evidence. The PEB rated the DM 20%, coded 7913 (diabetes mellitus). The VA also rated the DM 20%, coded 7913, based on the C&P examination, citing prescribed insulin and restricted diet. Panel members noted that a 40% rating requires regulation of activities “described as avoidance of strenuous occupational and recreational activities…for diabetics who have great difficulty keeping blood sugar levels from dropping from extremely high to low levels.” The panel majority agreed that the CI met the requirement for this level of regulation based on the following evidence: The 21 November 2006 LIMDU listed no marches, physical training, field duty, standing watch, or range activity. The STR documented that he developed hypoglycemic symptoms when exercising and was officially limited from doing so. During the MEB NARSUM examination, he reported having to regulate activities for DM management, and the examiner did not refute this requirement, and also opined that he might require an insulin pump to more easily manage his DM. While regular exercise is routinely recommended as a lifestyle component of DM management, the panel majority agreed that proximate to separation, the CI regulated his activities in order to manage his inconsistent blood sugar levels, and evidence demonstrated that he was placed on light or limited duty, prohibited from participating in physical training, and that his newly diagnosed DM was not stable/regulated by the current medication regimen. The dissenting member agreed that a 20% rating was appropriate because there was no documented medical prescription for regulation of activities. Although the CI did experience two documented hospitalizations for DKA in the 12 months after separation, the panel agreed there was no evidence of diabetic complications or “progressive loss of weight and strength” to support a

higher 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 DM, coded 7913.

Contended PEB Condition: Adjustment Disorder with Depressed Mood. The panel’s main charge is to assess the fairness of the PEB determination that the contended condition was not unfitting. According to DoDI 1332.38, adjustment disorder is a condition that does not constitute a physical disability; therefore, the panel has no basis for recommending it as unfitting. 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 mellitus, the panel majority recommends a disability rating of 40%, coded 7913 IAW VASRD §4.119. The single voter for dissent recommends no change and did not elect to submit a minority opinion. In the matter of the contended adjustment disorder, the panel agrees it cannot recommend it for additional disability rating. 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	
Diabetes Mellitus Type 1	7913	40%	

The following documentary evidence was considered:

DEPARTMENT OF THE NAVY
SECRETARY OF TI-IE 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 Oct 20

From: To:

Subj:

Ref:

Director, Secretary of the Navy Council of Review Boards 
PHYSICAL DISABILITY BOARD OF REVIEW {PDBR)
{a) DoDI 6040.44
{b) PDBR ltr of 9 Jan 20

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 7 October 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.