RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05740
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20071013

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was an active duty E4, Bradley Linebacker Crewmember, medically separated for “diabetes mellitus, type 2” with a disability rating of 20%.  

CI CONTENTION:  “Please 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’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 - 20070906	VARD - 20080505	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type 2	7913	20%	Diabetes Mellitus, Type 2	7913	20%	20080102	
Hyperlipidemia	Not Unfitting	Hyperlipidemia	7099-7005	NSC	20080102	
Homocysteinemia	Not Unfitting	Homocysteinemia	7799-7704	NSC	20080102	
Obstructive Sleep Apnea	Not Unfitting	Sleep Apnea	6847	50%	20080102	
Post-Traumatic Stress Disorder	Not Unfitting	Post-Traumatic Stress Disorder	9411	NSC	20080102	
Anxiety Disorder	Not Unfitting					
Insomnia	Not Unfitting					
Back Injury	Not Unfitting	Mid Back, Spondylosis T6-T12	5242	10%	20080102	
Scalp-Eczema	Not Unfitting	No VA Placement	
Allergic Rhinitis	Not Unfitting	No VA Placement	
Obesity	Not Compensable	No VA Placement	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Diabetes Mellitus (DM), Type 2.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI was found to have elevated blood sugars during an evaluation for a headache in 2006.  He was diagnosed with DM, Type 2, and started on treatment with oral medications, diet and exercise.  The 11 April 2007 MEB narrative summary (NARSUM) examination, 6 months prior to separation, noted that the CI was prescribed an oral hypoglycemic medication with inadequate control, although he was early in the treatment regimen.  He also suffered from hyperlipidemia, homocysteinemia and obesity.  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.  There was no evidence of diabetic complications or manifestations of end organ damage, and activity regulation was not required.  
The CI was initially returned to duty despite having DM and 10 other conditions.  However, on 17 August 2007, insulin was added to his treatment and the endocrinologist recommended the PEB reconsider its fitness determination.  After informal reconsideration, the DM was found unfitting.  

At the 2 January 2008 VA Compensation and Pension (C&P) examination, 4 months after separation, the CI was taking oral hypoglycemic medication and insulin, and reported no problems with hypoglycemia.  On average, he visited the doctor 4 times per year for his diabetes.  He had no regulation of activity, progressive weight loss, tingling, numbness or incontinence.  The physical examination was normal, with no evidence of retinopathy, neuropathy or other complications of diabetes.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB and VA both rated the diabetes mellitus condition 20%, coded 7913 (diabetes mellitus).  The PEB cited that insulin, restricted diet, and oral hypoglycemic agents were required.  The VA cited the same, as well as “no end organ damage or regulation of activities.”  Members agreed 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, the STR showed no episodes of ketoacidosis or hypoglycemia requiring hospitalization, and no frequent visits to a diabetic care provider 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.  

Contended PEB Conditions:  Hyperlipidemia and Homocysteinemia.  The panel’s main charge is to assess the fairness of the PEB determination that the contended conditions were not unfitting.  Members noted that hyperlipidemia and homocysteinemia were abnormal laboratory findings rather than specific diseases, and although the MEB indicated that both failed retention standards, neither was implicated in the commander’s statement or carried profile restrictions.  There was no performance-based evidence from the record that either 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 either of the contended conditions, so no additional disability ratings are recommended.  

Contended PEB Conditions:  PTSD, Anxiety Disorder, Insomnia, Scalp-Eczema, and Allergic Rhinitis.  None of these conditions were profiled or implicated in the commander’s statement, and all met 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.  

Contended PEB Condition:  Back Injury.  The contended back condition met retention standards and was not profiled.  However, the commander mentioned it as a deployment-related issue and noted the CI continued to have problems, but no specific duty impairment from the back was recorded.  Thoracic spine X-rays on 14 February 2007 were normal, and in primary care on 20 February 2007, the CI had full, pain-free motion with a normal gait and neurological examination.  In follow-up on 26 March 2007, the gait was within functional limits, but ROM was reduced and painful.  At a primary care visit on 11 July 2007, tenderness and spasm were noted, but neurological findings were normal.  The performance-based evidence from the record does not show that the condition significantly interfered with satisfactory duty performance at separation to a level sufficient to overcome the PEB adjudication.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination, so no additional disability rating is recommended.

Contended PEB Condition: Obstructive Sleep Apnea (OSA).  The panel assessed the fairness of the PEB’s determination that obstructive sleep apnea was not unfitting.  Although the OSA was profiled and failed retention standards, it was not implicated in the commander’s statement, and there was no performance-based evidence from the record that it significantly interfered with satisfactory duty performance at separation.  The profile restrictions indicated the CI required access to a power source, and an environment without excessive dust.  The PEB determined that even though his condition failed retention standards, the OSA was not unfitting, stating that electricity for continuous positive airway pressure was available at most locations.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determination for OSA, so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the DM and IAW VASRD §4.120, the panel recommends no change in the PEB adjudication.  In the matter of the hyperlipidemia, homocysteinemia, PTSD, anxiety disorder, scalp-eczema, allergic rhinitis, back and obstructive sleep apnea, 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.  

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XXXXXXXXXXXXXXXXXX

DearXXXXXXXXXXXXXXXXXX

	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.