RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXX	CASE:  PD-2017-06055
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20071003

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

CI CONTENTION:  The VA rating was higher and his diabetes should have made him eligible for medical retirement.  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 - 20070810	VARD - 20080711	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus Type I 	7913	20%	Diabetes Mellitus Type I 	7913	20%	20080303	
COMBINED RATING:  20%	COMBINED RATING OF ALL VA CONDITIONS:  40% 	

ANALYSIS SUMMARY:  

Diabetes Mellitus, Type I.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI’s diabetes condition was first diagnosed in Korea after a syncopal episode.  He was hospitalized and placed on oral medications of metformin and glipizide.  The family practice examiner noted poor control of the condition.  He was referred to a local civilian endocrinologist and diagnosed with Type I Diabetes Mellitus.  All oral medications were stopped and the patient was placed on Lantus and Novolog.  

At the 12 July 2007 MEB NARSUM examination, 3 months prior to separation, the examiner noted the CI was "in the green" in fitness and was able to run three times a week.  Physical examinations of the eyes, heart, skin, extremities and neurological system were normal.  Laboratory measurements included:  blood urea nitrogen 13 mg/dL, creatinine 1.2 mg/dL, total protein 7.3 g/dL, albumin 4.7 g/dL and hemoglobin A1c 9.0%.  

During the 3 March 2008 VA Compensation and Pension (C&P) examination, 5 months after separation, the CI reported a requirement of insulin and a restricted diet for diabetic control.  Physical examination of the eyes, feet, skin and the neurovascular system were normal.  The examiner did not indicate that avoidance of strenuous occupational and recreational activities was medically necessary.  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the diabetes condition 20%, coded 7913 (diabetes mellitus).  The VA also rated the diabetes condition 20%, coded 7913, based on the C&P examination, citing objective evidence showing a requirement for insulin and a restricted diet.  A higher evaluation of 40 percent is not warranted unless there is objective evidence showing a requirement for insulin, restricted diet and regulation of activities for diabetic control.  There was evidence of treatment with insulin and restricted diet to support a 20% rating under 7913, but no evidence to support a 40% rating for medically-prescribed regulation of activities.    Furthermore, following initiation of treatment at the time of diagnosis, the STR showed no subsequent 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 diabetes condition.  

BOARD FINDINGS:  In the matter of the diabetes condition 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-2017-06055.

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.