RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXX	CASE:  PD-2013-02759
BRANCH OF SERVICE: AIR FORCE	BOARD DATE:  20140822
SEPARATION DATE:  20060905

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SSgt/E-5 (3E771/Fire Fighter) medically separated for diabetes.  The diabetes condition could not be adequately rehabilitated to meet the physical requirements of his Air Force Specialty or satisfy physical fitness standards.  He was issued a temporary P4 profile and referred for a Medical Evaluation Board (MEB).  The diabetes condition, characterized as “Type I diabetes,” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123.  The Informal PEB adjudicated “diabetes mellitus Type I, requiring insulin for control” as unfitting, rated 20%, with application of the VA Schedule for Rating Disabilities (VASRD).  The PEB also adjudicated two additional conditions noted on the narrative summary (NARSUM) as seasonal allergic rhinitis as Category II, a condition that can be unfitting but is not currently compensable or ratable; and hyperlipidemia as Category III, a condition that is not separately unfitting.  The CI made no appeals and was medically 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 diabetes condition 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.  IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations.  The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation.

RATING COMPARISON:

Service IPEB – Dated 20060718	VA - based on Service Treatment Records (STR)	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Diabetes Mellitus, Type I	7913	20%	Diabetes Mellitus, Type I	7913	20%	STR	
Other x 2 (Not in Scope)	Other x 0	STR	
Combined:  20%	Combined:  20%	
Derived from VA Rating Decision (VARD) dated 20080221 (most proximate to date of separation [DOS]); effective 20071212.

ANALYSIS SUMMARY:

Diabetes Mellitus, Type I Condition.  The CI was diagnosed with diabetes in February 2006 after experiencing a week-long history of excessive thirst and urination and blurred vision.  He did not require hospitalization and his condition was rapidly controlled with insulin.  Nutritional counseling regarding a diabetic diet was provided by a dietitian.  Review of the STR found no episodes of ketoacidosis or hypoglycemic reactions requiring hospitalizations, and no diabetic complications.  During the first month of stabilization on insulin, a few episodes of hypoglycemia were reported; however, after March 2006 there was no evidence of hypoglycemic episodes requiring twice-a-month visits to a diabetic care provider.  There was also no evidence of physician-directed avoidance of strenuous activities.  The NARSUM, prepared 3 months prior to separation confirmed the CI was using daily insulin and denied any symptoms of diabetes.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 20% rating under the 7913 code (diabetes mellitus).  The VA also assigned a 20% rating under the same code, but the rating decision was effective over a year after separation.  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; no ketoacidosis or hypoglycemic episodes requiring hospitalization or frequent visits to a diabetic care provider and no compensable complications of diabetes.  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 diabetes mellitus 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 diabetes mellitus Type I 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 20131219, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans’ Affairs Treatment Record

				
XXXXXXXXXXXXXXX
President
Physical Disability Board of Review

SAF/MRB

Dear XXXXXXXXXXXXXXX:

	Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. §  1554a), PDBR Case Number PD-2013-02759.

	After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

	I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

							Sincerely,

XXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings