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-2017-05715.

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.

RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXX	CASE:  PD-2017-05715
BRANCH OF SERVICE:  Air Force	SEPARATION DATE:  20070612

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E6, Munitions Craftsman, medically separated for “diabetes mellitus, requiring insulin” with a disability rating of 20%.

CI CONTENTION:  “Symptoms started after last anthrax shot.”  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 - 20070425	VARD - 20070921	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Requiring Insulin	7913	20%	Diabetes Mellitus, Type 1	7913	20%	20070801	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM).  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was diagnosed with DM Type II in 2001 and treated with multiple oral medications without control of the condition.  He was then treated with insulin starting in 2003, but never hospitalized.  Although he felt well, he was evaluated as part of his annual review in lieu of (RILO) MEB for continued military service, and his hemoglobin A1C (blood test which reflects average blood sugar over a period of approximately the last 3 months) was found to be elevated, indicating poor blood glucose control.  

The 8 January 2007 MEB NARSUM examination, 5 months prior to separation, noted no complaints due to DM, which required insulin and a controlled diet for management.  The examiner indicated the CI had a “regular exercise routine.”  Physical examination of the eyes, heart, skin, extremities and neurological system was normal.  Blood work in August 2006 showed no evidence of diabetic kidney disease, hemoglobin A1C was 9.3% (elevated) on 28 November 2006, and an optometry examination in January 2007 was normal.

At the 1 August 2007 VA Compensation and Pension (C&P) examination, 2 months after separation, the CI reported daily use of insulin and hypoglycemic symptoms approximately once per month, which improved with drinking orange juice or taking a sugar tablet.  He denied any episodes of ketoacidosis or hospitalizations, and reported being on a diabetic diet with no activity restrictions, and maintaining a stable weight for the past year.  Complete physical examination was again normal, and an eye examination that morning showed no retinopathy.  Blood glucose level and kidney function studies were normal.  Hemoglobin A1C was 10.6% (elevated), but there was no evidence of diabetic eye, kidney or neurologic problems.  The CI saw his diabetic care provider every 3 months for routine follow-up.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the DM 20%, coded 7913 (diabetes mellitus), citing a requirement for insulin.  The VA rated DM Type I 20%, coded 7913, based on the C&P examination, citing a requirement for insulin and restricted diet.  Members agreed that the requirement for treatment with insulin and restricted diet justified a 20% rating, but because there was no evidence of medically-prescribed regulation of activities, the next higher 40% rating was not justified.  Furthermore, 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 DM condition.  

BOARD FINDINGS:  In the matter of the diabetes mellitus requiring insulin 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.