RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXX	CASE:  PD-2013-01802
BRANCH OF SERVICE: Army	BOARD DATE:  20140826
SEPARATION DATE:  20050324

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SGT/E-5 (92G/Food Service NCO) medically separated for diabetes mellitus (DM), Type 2.  The diabetes condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  The diabetes condition, characterized as “diabetes mellitus, type 2, requiring medication and insulin for control,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.  The MEB also identified and forwarded two other conditions.  The Informal PEB adjudicated “diabetes mellitus, type 2, requiring insulin and restricted diet” as unfitting, rated 20%, with application of the VA Schedule for Rating Disabilities (VASRD).  The remaining two conditions were determined to be not unfitting. The CI appealed to the Formal PEB (FPEB), which affirmed the PEB’s findings and rating.  The CI non-concurred with the FPEB and applied for Continuation on Active Duty; however, it was denied, and he was then separated.

CI CONTENTION:  The CI elaborated no specific contention in his application.

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 those conditions identified but not determined to be unfitting by the PEB when specifically requested by the CI.  The rating for the unfitting DM, Type 2 is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board.  Any conditions or contention not requested in this application, or otherwise outside the Board’s defined scope of review, remain eligible for future consideration by the Board for Correction of Military Records.

RATING COMPARISON:

Service FPEB – Dated 20040707 | VA - (5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Diabetes Mellitus, Type 2 | 7913 | 20% | Diabetes Mellitus, Type 2 | 7913 | 20% | 20050803
Other x 2 (Not in Scope) | Other x 13 | 20050503
Combined:  20% | Combined:  80%
Original VARD not in file and not forwarded when requested.  Used VARD of 20110926 which had data from original VARD in 2005.

ANALYSIS SUMMARY:

Diabetes Mellitus, Type 2.  The narrative summary prepared on 9 February 2004, 13 months prior to separation, notes the CI was found fit for duty by the PEB in 1998 for DM.  In May 2003, the CI started insulin due to decreasing control of blood glucose.  He was subsequently PCS’d to Korea; however, he was administratively returned due to his non-deployable potential.  He denied any difficulty or problems performing his MOS other than the insulin requirement and regular glucose testing which limited deployability.  He took an “alternate APFT to avoid the possibility of hypoglycemia with the run” (profiled since 1997).  Medications were NPH insulin, 20 units every morning; glyburide/metformin, Zocor for high cholesterol, Ramipril for hypertension and aspirin for non-occlusive coronary artery disease.  Physical examination found mild pes planus.  A note from a family medicine nurse practitioner updating the medical conditions for the PEB on 29 April 2004, 12 months prior to separation, noted the CI had been noted to have target organ disease of mild diabetic retinopathy, mild albuminuria and neuropathy of his toes.  The conditions impaired his vision and increased the risk of foot injury requiring specialized shoes.

On the 3 May 2005 Compensation and Pension (C&P) examination, 8 months prior to separation, the CI reported the diabetes did not cause any restriction of activities.  At the VA C&P exams performed on 3 August 2005, 5 months after separation, the CI reported numbness and tingling of his upper and lower extremities.  Physical examination was normal for the heart and lungs, normal peripheral nerve examination, normal reflexes, normal motor strength and normal sensation.  The diagnoses were DM, diabetic nephropathy, diabetic peripheral neuropathy and early nonproliferative diabetic retinopathy.  There examiner concluded that there were no functional impairments from the conditions, or time lost from work due to these conditions.

The Board directed attention to its rating recommendation based on the above evidence.  The Board considered VASRD diagnostic code 7913 (DM) used by both the PEB and the VA for a 20% rating.  The CI did not have any restrictions to the performance of his MOS, according to both his personal statement in rebuttal of the MEB findings and his commander’s statements.  The “regulation of activities” issue was discussed at length.  There were no documented episodes of ketoacidosis or hypoglycemic reactions in the record.  The examinations documented no functional impairments or time lost from work.  There were no self-reported or documented hypoglycemic episodes caused by any activity in the record.  He had no limitations or regulations of activities in the performance of his MOS, or later as a civilian after discharge per C&P examinations.  There was no documentation of any actual medical adverse event requiring regulation of activity due to DM for a possible higher rating.  The Board also determined the complications of diabetes including hypertension, diabetic nephropathy, erectile dysfunction, coronary artery disease and peripheral neuropathy, were not duty limiting by either commander’s statement, or personal statement, thus not separately ratable and did not provide a higher rating as an alternate code.  Thus, the Board could not find evidence for a higher rating in the CI’s favor.

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 for 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 DM condition and IAW VASRD §4.119 (schedule of ratings-endocrine system), the Board unanimously recommends no change in the PEB adjudication.

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 20131022, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

			
XXXXXXXXXXXX
President
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 XXXXXXXXXXXX, AR20150004684 (PD201301802)

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

PD-2013-01802