RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXX	CASE:  PD-2014-01703
BRANCH OF SERVICE:  Army	BOARD DATE:  20150512
SEPARATION DATE:  20040522

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-1 (Cannon Crewmember) medically separated for diabetes.  The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS).  A profile allowed for an alternate aerobic event to satisfy physical fitness standards.  He was issued a permanent P3 profile and referred for an 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 (IPEB) adjudicated diabetes mellitus Type I as unfitting, rated 20%, with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).  The CI made no appeals, and was medically separated.

CI CONTENTION:  The applicant makes no specific contention in his application.  His complete submission is at Exhibit A.

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 condition 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 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:

Service IPEB – Dated 20040317 | VA* - (~5 Mos. Post-Separation)
Condition | Code | Rating | Condition | Code | Rating | Exam
Diabetes Mellitus Type I | 7913 | 20% | Diabetes Mellitus Type I | 7913 | 20% | 20041018
Other MEB/PEB Conditions x 0 (Not In Scope) | Other x 0
RATING:  20% | RATING:  20%
*Derived from VA Rating Decision (VARD) dated 20050107 (most proximate to date of separation (DOS))

ANALYSIS SUMMARY:

Diabetes Mellitus Type I.  In November 2003, the CI presented for evaluation of vomiting, blurred vision, thirst, increased urination, weight loss and weakness.  A diagnosis of new onset Type I diabetes mellitus was made.  Due to the presence of ketoacidosis, a short initial hospitalization was required.  The narrative summary (NARSUM) evaluation on 8 December 2003, approximately 5 months before separation, reported the CI was on an insulin regimen and regaining lost weight.  One episode of low blood sugar after skipping a meal was reported, but specific hypoglycemic symptoms were not described.  At a follow-up with nutritional medicine the following day, the CI reported that he “does a lot of exercise, eats balanced meals.”  Further dietary instruction was provided.  The permanent physical profile on 24 February 2004 allowed for walking, cycling, swimming and running at own pace and distance.  A NARSUM update on 3 March 2004 (3 months prior to separation) reported that the CI’s command had impacted negatively on his ability to maintain control of his diabetes by impeding access to food and medications.  Extreme high and low blood sugar levels were associated with mood swings and loss of military bearing that resulted in two Article 15s and reduction in rank.  The provider recommended close physician follow-up “for now at least two times per month.”

Laboratory evaluation by a civilian provider 3 months after separation showed that the CI’s diabetes was not well-controlled.  At the VA Compensation and Pension (C&P) exam on 18 October 2004 (5 months after separation) the CI reported no hypoglycemic episodes.  He was using insulin every day and reported a 2-month history of a slowly healing left leg ulcer.  The examiner stated there were no episodes of ketoacidosis and no functional impairment due to diabetes.  The condition did not cause restriction of any activities.  Based on laboratory results, the examiner concluded that the CI’s diabetes was uncontrolled.  At a follow-up with a civilian physician on 17 November 2004, the CI reported no complaints.  Home blood sugars were not in the hypoglycemic range.  The CI was advised to restart weight lifting.  On 22 April 2005 (11 months after separation) a hospital admission note recorded that the CI had now been hospitalized for the third time in recent months for diabetic ketoacidosis due to noncompliance with insulin administration.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB and the VA each assigned a 20% rating under the 7913 code (diabetes mellitus).  The Board agreed that the requirement for insulin and restricted diet justified the 20% rating.  Board members concluded however that the “regulation of activities” stipulation was not met in this case, and therefore no rating higher than 20% was justified.  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 20140420, 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 XXXXXXXXXXXXXXX, AR20150013456 (PD201401703)

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