RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2013-01297
BRANCH OF SERVICE:  Army	BOARD DATE:  20150714
SEPARATION DATE:  20040902 

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-2 (Infantryman) medically separated for diabetes.  The condition could not be adequately rehabilitated to meet the requirements of his Military Occupational Specialty (MOS).  He was issued a permanent profile and referred for a Medical Evaluation Board (MEB).  The condition “insulin dependent diabetes type I” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  No other condition was submitted by the MEB.  The Informal PEB adjudicated “type I diabetes mellitus [DM]” as unfitting, rated 20%, citing criteria of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.  

CI CONTENTION:   The CI made no contention.

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44, Enclosure 3, paragraph 5.e. (2).  It is limited to those conditions determined by the PEB to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’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/Naval Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board 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, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON 

IPEB - Dated 20040730 | VA* - Based on Service Treatment Records (STR)
Condition | Code | Rating | Condition | Code | Rating | Exam
Type I Diabetes Mellitus | 7913 | 20% | Diabetes Mellitus | 7913 | 20% | STR
Other MEB/PEB Conditions x 0 (Not In Scope) | Other x 5 (equals SC, NSC & deferred)
RATING:  20% | RATING:  20%
*Derived from VA Rating Decision (VARD) dated 20041027(most proximate to date of separation [DOS]).  The earliest VA Compensation and Pension evaluation is dated 20100422 (5½ years post-separation). 

ANALYSIS SUMMARY: 

Diabetes Mellitus.  The service treatment record (STR) corroborates the history in the narrative summary (NARSUM) of an emergency presentation in February 2004 (six months pre-separation) which resulted in a diagnosis of DM (glucose 800) and hospitalization (one day).  The CI was placed on insulin (>1 dose daily) and dietary regulation.  There were a few episodes of hypoglycemia early on (two documented in STR) which were associated with running and did not require hospital admission. There were subsequently three documented emergency visits for treatment of hyperglycemia which did not result in hospital admission.  Later entries document adequate glucose control (100-120) and good exercise tolerance (walk and run at own pace); and, there were no further hypoglycemic episodes.  There is no documentation in the STR or NARSUM of hospital admissions other than the initial one, and no indication of semi-monthly visits to a diabetic care provider.  The NARSUM was conducted 10 June 2004 (11 weeks pre-separation), and documented the above clinical course; specifying the absence of any systemic complications of DM.  There was no temporally probative VA or other post-separation evidence in this case (see footnote, rating comparison chart).

The Board directed attention to its rating recommendation based on the above evidence.  The VASRD §4.119 language under code 7913 (diabetes mellitus) for the ratings under consideration is excerpted below for reader convenience. 
		Requiring insulin, restricted diet, and regulation of activities with 
			episodes of ketoacidosis or hypoglycemic reactions requiring one 
			or two hospitalizations per year or twice a month visits to a diabetic 
			care provider, plus complications that would not be compensable 
			if separately evaluated .........................................................................60% 
		Requiring insulin, restricted diet, and regulation of activities ........................40%
		Requiring insulin and restricted diet, or; oral hypoglycemic agent 
			and restricted diet ...............................................................................20% 
Both the PEB’s DA Form 199 and VA rating decisions cited the insulin requirement and dietary restrictions as the criteria for their 20% determinations.  The VA rater specifically excluded the need for regulation of activity (based on the same service evidence as that of the PEB).  Although it is clear that the CI had to temper strenuous activities such as running to avoid hypoglycemic reactions, the evidence indicates that routine activities were unaffected after the insulin requirement and dietary management were stabilized.  Members thus agreed that the 40% criterion of regulation of activities was not satisfied by the evidence.  Although some of the 60% criteria were in evidence, regulation of activity (as just addressed) is a requirement; and, the criteria for frequency of provider visits and separately compensable complications are not in evidence.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication of the 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.  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 diabetes mellitus 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 re-characterization of the CI’s disability and separation determination. 

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20130912, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

	

XXXXXXXXXXXXXXX 
President 
DoD Physical Disability Board of Review

	

SAMR-RB									

MEMORANDUM FOR Commander, US Army Physical Disability Agency 
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557

SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation for XXXXXXXXXXXXXXXXXXXX, AR20150015903 (PD201301297)

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						     XXXXXXXXXXXXXXXXXXXX
						     Deputy Assistant Secretary of the Army
						          (Review Boards)
						         
CF: 
(  ) DoD PDBR
(  ) DVA

PD-2013-01297