RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2017-05833
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20080402

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

CI CONTENTION:  “…the limitations and impact of diabetes mellitus type 1 meets the criteria for 40% disability based on diagnostic code 7913.” 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 - 20080402	VARD - 20080815	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I	7913	20%	Diabetes Mellitus Type I	7913	20%	20080530	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  30% 	

ANALYSIS SUMMARY:  

Diabetes Mellitus Type I.  The CI was diagnosed with diabetes mellitus in April 2007 and treated with Lantus (long-acting insulin) which “helped somewhat.”  He was subsequently referred to endocrinology, where he was started on short acting insulin.  The 3 October 2007 MEB narrative summary (NARSUM) examination, 6 months prior to separation, noted that the CI had never been hospitalized for diabetes, but had received the maximum treatment in outpatient care.  He reported “no trouble doing any activities,” but could not run far due to extreme blood sugar drops when doing so.  While hemoglobin A1c levels had improved, blood sugar was still elevated with significant glucose in the urine.  The medication profile listed prescriptions for short (Glargine) and long-term (Lispro/Humalog) insulin, and the examiner reported a stable condition that would require indefinite treatment with insulin.  The prognosis for return to constructive active military service was “considered guarded to poor.”  Hemoglobin A1c was 5.9% on 21 August 2007.  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.  

At the 30 May 2008 VA Compensation and Pension (C&P) examination, 2 months after separation, the examiner reported that the CI was taking Lantus at bedtime and a sliding scale of Humalog.  He reported no complications and was seeing his doctor about every 4 months.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary. The physical examination was normal, showing no signs of retinopathy, neuropathy or other complications of diabetes.  Hemoglobin A1c was 5.7%.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes 20%, coded 7913 (diabetes mellitus), citing the use of insulin.  The VA also rated the diabetes 20%, coded 7913, citing the requirement for insulin and a restricted diet.  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, 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 that there was insufficient cause to recommend a change in the PEB adjudication for the diabetes mellitus type I.  

BOARD FINDINGS:  In the matter of the diabetes mellitus type I 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.  

ARXXXXXXXXXXX, XXXXXXXXXXXXXXX 

Dear XXXXXXXXXXX:

	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.
 
						Sincerely,

Enclosure