RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW NAME: XXXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1201036 SEPARATION DATE: 20021118 BOARD DATE: 20130219 SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (11B2P/Infantryman Rifle Team Leader), medically separated for Type I diabetes mellitus (DM) with Hemoglobin A1c (HbA1c) of 7.5. The CI’s condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was consequently issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The Type I DM condition was referred to the Physical Evaluation Board (PEB) as medically unacceptable IAW AR 40-510, 3-11b. No other conditions were submitted by the MEB. The PEB adjudicated the Type I DM condition as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals, and was medically separated with that disability rating. CI CONTENTION: "I’m getting a bit older, and my injuries/disease are (sic) getting worse.” SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in Department of Defense Instruction (DoDI) 6040.44 (Enclosure 3, paragraph 5.e.2) 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 rating for the unfitting Type I DM condition is addressed below. Any other conditions intended in request for Board consideration, or any condition or contention outside the Board’s defined scope of review, remain eligible for future consideration by the Army Board for Correction of Military Records. RATING COMPARISON: Service IPEB – Dated 20020726 VA (~2.5 Mo. Post-Separation) – Effective 20021119 Condition Code Rating Condition Code Rating Exam Type I Diabetes Mellitus With HgbA1C of 7.5 7913 20% Diabetes Mellitus, Type I 7913 20%* 20030204 .No Additional MEB/PEB Entries. Tinnitus, Bilateral 6260 10% 20030204 Hypertension Associated With Diabetes Mellitus, Type I 7101 10% 20030204 Not Service Connected x 1 20030204 Combined: 20% Combined: 40% *Note: Type I Diabetes Mellitus, 7913, increased to 40% effective 20050526 (combined 50%). ANALYSIS SUMMARY: The Board acknowledges the CI’s contention regarding the significant impairment with which his service-connected condition continues to burden him and has worsened; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs (DVA), operating under a different set of laws. The Board considers DVA evidence proximate to separation in arriving at its recommendations; and, DoDI 6040.44 defines a 12-month interval for special consideration to post-separation evidence. Post-separation evidence is probative to the Board’s recommendations only to the extent that it reasonably reflects the disability at the time of separation. Type I Diabetes Mellitus. The CI presented to the battalion aid station on 13 February 2002 with complaints of general malaise, frequent urination, and headache. Blood and urine samples were taken and glucose was 883 (normal less than 110) with an elevated glycosylated hemoglobin (HbA1c; indicator of long-term blood glucose control) of 12.1%. He was hospitalized briefly for initial blood glucose control and diagnosed with DM Type 1 (requiring insulin). The CI was managed with Insulin and dietary restrictions with good results. After stabilization on treatment there was no evidence of ketoacidosis or hypoglycemia requiring hospitalizations. His HbA1c decreased to 7.5% with normal fasting blood glucose in April 2002 which was considered to fall within the target range of desired values. The commander’s statement, 7 months prior to separation recommended retention and reclassification and indicated that the CI “scores a maximum of 300 on every Armed Forces Physical Readiness Test and can perform any recruiter related task to a high standard.” Three months after his diagnosis (6 months prior to separation) the CI was issued a permanent P3 profile that restricted his duty assignments so as to assure his access to medications, refrigeration, and appropriate medical care. The block three assignment limitations included “No airborne operations, all physical activity at own pace and duration,” while blocks five and seven had no restrictions, and the physical fitness test of the two mile run, push-ups and sit-ups were permitted. At the time of the MEB narrative summary, 5 months prior to separation, the CI was asymptomatic and doing well. There was no clinical evidence of diabetes associated conditions such as diabetic retinopathy, cardiopulmonary abnormalities, peripheral vascular abnormalities, or evidence of peripheral neuropathy. At the VA Compensation and Pension exam, 2 months after separation, the CI reported no symptoms and no restrictions. He was attempting to become a body builder and was working out 1-2 hours per day. The VA Rating Decision (VARD) of June 2005 indicated a civilian medical report indicating fluctuating blood sugars, increased insulin requirements and required regulation of activities due to diabetes. The VA increased their rating to 40% effective May 2005 (30 months after separation) based on that evidence. The Board directs attention to its rating recommendation based on the above evidence. The PEB rated the condition at 20% coded 7913 (DM) and the VA rated the condition at 20% coded 7913 proximate to separation. The 2005 VA rating increase was adjudged as post-separation worsening and not indicative of the CI’s condition proximate to separation. The Board adjudged that the profile restrictions and permissions, did not met the VASRD 7913 criteria for regulation of activities (avoidance of strenuous occupational and recreational activities). Upon deliberation it was agreed that the 40% rating criteria were not reasonably supported by the evidence at hand. There were no hospitalizations after initial stabilization for diabetes related problems prior to separation and there were no regulation of activity. Thus none of the 40%, 60% or 100% criteria were met at the time of separation. 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 of the Type I DM 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. In the matter of the DM Type 1 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 Type 1 7913 20% COMBINED 20% The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120508, w/atchs. Exhibit B. Service Treatment Record. Exhibit C. Department of Veterans Affairs Treatment Record. XXXXXXXXXXXXXXXXXXXXX, DAF Acting Director Physical Disability Board of Review SFMR-RB MEMORANDUM FOR Commander, US Army Physical Disability Agency (TAPD-ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557 SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXX, AR20130004070 (PD201201036) 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)