RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-05644
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20090622

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

CI CONTENTION:  Review requested of the diabetes as well as additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).   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 PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the 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 – 20090313	VARD - 20090825	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I 	7913	20%	Diabetes Type II	7913	20%	20090528	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  20%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with DM about 4 years prior to separation.  He was not satisfactorily controlled on oral agents, and insulin was started in 2008 (10 months before separation).  Full control was still not achieved and he was referred for an MEB.  There was documentation in STR provider notes of dietary regulation, but no indication of any limitation of activities.  Diabetic eye disease, neuropathy, or other systemic complications of DM were excluded.  There was no evidence of hospital admissions, ketoacidosis, significant hypoglycemic episodes, or requirement for frequent (twice monthly) visits to a diabetic care provider.  
The 21 October 2008 MEB NARSUM examination, 8 months prior to separation, corroborated the above evidence and noted treatment with three oral agents and insulin.  The NARSUM (including an endocrinology addendum) documented dietary measures, but there was no mention of activity limitations.  The CI denied any impairment to performing his routine duties (corroborated in the commander’s performance statement).  The physical examination was normal, without evidence of retinopathy, neuropathy, or other diabetic complications.  The AF Form 469 duty limiting report in effect at separation specifically stated, “No physical activity restrictions.”  

The 28 May 2009 VA Compensation and Pension (C&P) examination, 1 month before separation, documented the same treatment and overall evidence as the NARSUM, “a specified diabetic diet” without note of activity limitations, and “occasionally” hypoglycemic episodes managed at home with no ketoacidosis or other clinical acuity.  The physical examination was normal.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DM 20%, coded 7913 (diabetes mellitus), citing application of the VASRD.  The VA conferred the same rating under the same code, based on the C&P examination, citing a requirement for insulin or oral hypoglycemic agents and a restricted diet with “no evidence of activity restrictions.”  Panel members 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 warranted.  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 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.  

BOARD FINDINGS:  In the matter of the diabetes mellitus 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.  

SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762

Dear XXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2017-05644.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.