RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02137
BRANCH OF SERVICE:  Army	BOARD DATE:  20150723
SEPARATION DATE:  20060331

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-3 (Infantryman) medically separated for diabetes.    The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty (MOS) and he was referred for a Medical Evaluation Board (MEB).  The “diabetes mellitus, type 1 (insulin dependent)” condition was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501.  The MEB also identified and forwarded “hyperlipidemia” as meeting retention standards, for further PEB adjudication.  The Informal PEB adjudicated “insulin dependent diabetes” as unfitting, rated 20%.  The PEB confirmed the hyperlipidemia condition as medically acceptable.  The CI made no appeals and was medically separated.    

CI CONTENTION:  “Diabetes, Nerve damage to both legs   Please consider all conditions”

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 20060225 | VA* - NO VA EXAM or RATING AVAILABLE
Condition | Code | Rating | Condition | Code | Rating | Exam
Insulin Dependent Diabetes | 7913 | 20% | N/A
Hyperlipidemia | Medically Acceptable | N/A
RATING:  20% | RATING:  N/A

ANALYSIS SUMMARY:  

Insulin Dependent Diabetes.  Treatment records evidence that the CI was diagnosed with diabetes mellitus in June 2005.  He was initially treated with oral medications without control.  He was started on insulin injections.  Laboratory results dated 30 June 2005 documented elevated urine ketones, acetone and glucose (normal is no ketones, acetone or glucose).  Hemoglobin (Hgb) A1C (a test which helps determine diabetic control) and blood glucose were elevated.  A treatment note dated 11 August 2005 documents an episode of diabetic ketoacidosis with hospitalization.  An eye examination performed on 20 October 2005 was normal.  An endocrine MEB evaluation in November 2007 documented activity restriction to include physical training (PT) at own pace; no formal PT when blood sugar is greater than 250mg/dL or less than 80mg/dL; no operation of any heavy machinery, trucks, aircraft, or working at heights; no scuba diving or security detail; and no consumption of meals ready to eat (MREs) as the only source of nutrition, and must have availability of three meals per day.  The examiner also noted reports of improvement of blurred vision with glucose control.  The physical examination was normal.  The examiner opined that an HgbA1c of 7.9 demonstrated fair control and noted that there was no evidence of diabetic complications (peripheral neuropathy, retinopathy, nephropathy or autonomic neuropathy).  The VA Compensation and Pension examination treatment note dated 2 June 2006 noted an HgbA1C of 12.4 (poor control), continued insulin use, and elevated blood sugar; which resulted in a referral to the emergency department without hospitalization.  A VA tele-imaging consult dated January 2007 noted no evidence of diabetic retinopathy.

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the unfitting diabetes mellitus Type 1 condition at 20% coded 7913 (diabetes mellitus).  The VA rating was not available.  The Board considered if the evidence supported a higher than 20% rating.  The Board noted that the CI’s regulation of physical activities was related to functioning in a field environment and the there was no evidence of physician prescribed regulation of activity at a 40% rating.  The Board also noted that the CI was hospitalized once within 12 months of separation for diabetic ketoacidosis; however, there was no evidence of diabetic complications for a 60% rating.  Considering the totality of the evidence and mindful of VASRD §4.3 (reasonable doubt), members agreed that a disability rating of 20% for the diabetes mellitus condition was appropriately recommended in this case.  

Contended PEB Conditions. The Board’s main charge is to assess the fairness of the PEB’s determination that hyperlipidemia was not unfitting.  The Board’s threshold for countering fitness determinations requires a preponderance of evidence, but remains adherent to the DoDI 6040.44 “fair and equitable” standard.  The hyperlipidemia was not profiled or implicated in the commander’s statement and not judged to fail retention standards.   All were reviewed and considered by the Board.  There was no performance-based evidence from the record that hyperlipidemia significantly interfered with satisfactory duty performance.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination regarding the hyperlipidemia contended condition and so no additional disability rating is recommended.

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.  In the matter of the contended hyperlipidemia condition, the Board unanimously recommends no change from the PEB determination as not unfitting.  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 20140509, 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 XXXXXXXXXXXXXXXXXXXX, AR20150014962 (PD201402137)

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)

PD-2014-02137