RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200974 SEPARATION DATE: 20030121 BOARD DATE: 20130213 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (13B10/Cannoneer/Assistant Gunner) medically separated for Diabetes Mellitus (DM). He was treated, but was not able to fully perform his military duties. He was issued a permanent P3 profile and underwent a Medical Evaluation Board (MEB). The MEB found the DM condition medically unacceptable, and referred him to a Physical Evaluation Board (PEB). No other conditions were listed on DA Form 3947. The PEB found the DM condition unfitting, and rated it 20% IAW the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with 20% disability. CI’s CONTENTION: “I have type 1 diabetes which has more complications than type 2 diabetes. I also have hypertension due to my diabetes. I am not overweight. I have had some complications as are written in VA records. I take insulin.” SCOPE OF REVIEW: The Board’s scope of review as defined in DoDI 6040.44 is limited to those conditions which were determined by the PEB to be specifically unfitting for continued military service; or, when requested by the CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The unfitting diabetes condition meets the criteria prescribed in DoDI 6040.44, and is accordingly addressed below. No other conditions are within the Board’s purview. Any condition outside the Board’s defined scope of review may be eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Army PEB – dated 200211001 VA (3 mos. Pre-Separation) – Effective 20030122 Condition Code Rating Condition Code Rating Exam Diabetes Mellitus 7913 20% Diabetes Mellitus 7913 20% 20021028 .No Additional MEB/PEB Entries. 0% x 1/Not Service Connected x 1 20021028 Combined: 20% Combined: 20% ANALYSIS SUMMARY: The Board acknowledges the sentiment expressed by the CI regarding the impairment with which his conditions continue to burden him, and the significant impact they have had on his quality of life. It is noted for the record that the Board is subject to the same laws for disability entitlements as those under which the military Disability Evaluation System (DES) operates. The DES has neither the role nor the authority to compensate the CI for future severity or potential complications of conditions. That role and authority is granted to the Department of Veterans Affairs (DVA). The Board evaluates DVA evidence in arriving at its recommendations, but its authority resides in evaluating the fairness of DES fitness and rating determinations at the time of separation. Compensation can only be granted for the degree of severity present at separation. The DVA, however, is empowered to re-evaluate a CI’s conditions for the purpose of adjusting the disability rating should the degree of impairment change over time. Diabetes mellitus (DM). In April 2002, the CI presented with malaise, polyuria, polydipsia, and anorexia. He was found to have elevated blood sugar and was diagnosed with DM. He was started on insulin and restricted diet. In May 2002, he was referred for an MEB. His MEB clinical evaluation was on 18 July 2002. At that time, the CI’s physical exam (PE) was normal. Blood pressure was 140/70. A recent laboratory evaluation had shown that hemoglobin A1C was reduced from 17.3% to 7.2%. His treatment plan included Insulin, restricted diet, and exercise. There was no mention of medically prescribed regulation of activities. In October 2002, the CI had a VA Compensation and Pension (C&P) exam. He reported that his symptoms had “settled” except for occasional chest pains and palpitations. The PE was normal. Electrocardiogram (ECG) showed frequent premature atrial contractions. Chest X-ray was normal. Stress test was normal, with 16.3 METs of exercise. Hemoglobin A1C was 6.2%. Once again, there was no mention of medically prescribed regulation of activities. The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The PEB and VA both chose the same coding and rating options for the DM condition. IAW VASRD §4.119, a rating of 20% is appropriate for DM requiring insulin and restricted diet. A higher rating of 40% would require medically prescribed regulation of activities (ROA). Regulation of activities is when a licensed healthcare provider prescribes or recommends that a diabetic patient avoid strenuous occupational or recreational activities. In the CI’s treatment record, there was not sufficient evidence that this was the case. After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (Resolution of reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the diabetes condition. BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or guidelines relied upon by the PEB will not be considered by the Board to the extent they were inconsistent with the VASRD in effect at the time of the adjudication. The Board did not surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD were exercised. In the matter of the DM condition and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication. There were no other conditions within the Board’s scope of review for consideration. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD CODE RATING Diabetes Mellitus 7913 20% COMBINED 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120606, w/atchs Exhibit B. Service Treatment Record Exhibit C. Department of Veterans’ Affairs Treatment Record XXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20130004069 (PD201200974) I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD PDBR) recommendation and record of proceedings pertaining to the subject individual. Under the authority of Title 10, United States Code, section 1554a, I accept the Board’s recommendation and hereby deny the individual’s application. This decision is final. The individual concerned, counsel (if any), and any Members of Congress who have shown interest in this application have been notified of this decision by mail. BY ORDER OF THE SECRETARY OF THE ARMY: Encl XXXXXXXXXXXXXXXXXX Deputy Assistant Secretary (Army Review Boards)