RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXX	CASE:  PD-2013-02660
BRANCH OF SERVICE:  Army	BOARD DATE:  20150428
SEPARATION DATE:  20051217

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-4 (Petroleum Supply Specialist) medically separated for diabetes mellitus (DM), Type I.  The DM condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty.  His profile allowed for the standard physical fitness test and no functional activity restrictions other than deployment to remote sites.  He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB).  “Diabetes mellitus 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 “diabetes mellitus, type I” as unfitting, rated 20%, with likely application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals and was medically separated.

CI CONTENTION:  “During my deployment in 2003, I went to the medic with dizzy spells and it was reported to me that my sugar level was over 700 and was medivac out of the combat zone due to my almost going into a diabetic coma.  I was very dehydrated and unable to move at one point.  My condition required, or requires, more than one daily injection of insulin, and decrease of activities so I could not do any strenuous occupational and recreational activities.  Currently, it is difficult for me to maintain employment due to conditions of the work environment, meaning I cannot work in a heated or outside in the heat.  I was hospitalize for about 2 months and had to see a diabetic care provider, once or twice a month up until I was medically boarded out.  I wasn’t required to come formation during my time in service during my time in service.  Because of my limitations to work I couldn’t report to work because of the heat.  I had some weight loss as well.  All my evidence is in my medical records and I hope that this will considered in the process.  My condition will never go away and only get worse.”

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 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 20050815	VA* - Based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Diabetes Mellitus, Type I (Insulin Dependent)	7913	20%	STR	
Other x 0 (Not In Scope)	Other x 0	
RATING:  20%	RATING:  20%	
*Derived from VA Rating Decision (VARD) dated 20070423 (most proximate to date of separation [DOS].

ANALYSIS SUMMARY:

Type I Diabetes Mellitus Condition.  While deployed to Iraq in 2004, the CI required a 3-day hospitalization for new-onset DM.  The condition responded well to a regimen that included insulin and nutritional education.  Review of the STR found no evidence of episodes of ketoacidosis or additional hospitalization for care of diabetes.

According to the narrative summary on 1 October 2004 (3 months prior to separation), the CI’s diabetes condition was well-controlled on insulin, which would likely be a life-long requirement.  The permanent profile on 7 January 2005 (11 months prior to separation) imposed no restrictions on physical activities.

At a VA clinic visit on 28 February 2006 (2 months after separation) the CI noted “occasional low blood sugars,” but hypoglycemic reactions or further hospitalizations were not reported.  He indicated that he was “taking a break” from exercising.  The provider noted that the diabetes condition was well-controlled, and counselled the CI on the benefits of regular exercise.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA each assigned a 20% rating under code 7913 (diabetes mellitus).  The Board agreed that the requirement for insulin and restricted diet justified the 20% rating.  Because there was no evidence of medically prescribed regulation of activities, and no ketoacidosis or hypoglycemic episodes requiring hospitalization or frequent visits to a diabetic care provider, a rating higher than 20% was not supported.  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 Type I 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 Type I 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 re-characterization of the CI’s disability and separation determination.

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20131211, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

XXXXXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150011449 (PD201302660)

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