RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
NAME: XXXXXX BRANCH OF SERVICE: marine corps
CASE NUMBER: PD0900537 SEPARATION DATE: 20031230
BOARD DATE: 20110505
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was Sgt (1371, Combat Engineer) medically separated from the Marine Corps in 2003 for Diabetes Mellitus (DM) Type 1. He was started on the appropriate therapy, but did not respond adequately to treatment to perform within his military occupational specialty, was placed on limited duty and underwent a Medical Evaluation Board (MEB). DM was forwarded to the Physical Evaluation Board (PEB) as medically unacceptable. The Informal PEB adjudicated the DM condition as a single unfitting condition. The CI was placed on the Temporary Disability Retired List (TDRL) with ratings as reflected in the chart below. In 2007 the PEB judged the DM condition to be permanently unfitting, rated 20% IAW the VA Schedule for Ratings Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB) which upheld the earlier rating, and the CI was then medically separated with a 20% disability rating.
CI CONTENTION: “In 2003 the Marine Corps placed me on TDRL/with 60% [sic] disability rating. During the next 4 years my condition did not improve. I’m still insulin dependent. I still have to limit my activities and I continue to suffer from the effects of diabetes, when the board ruled that my percentage went from 60% down to 20%. I did not agree after appealing and going through a formal board. I had no choice but to accept their findings. I still do not agree with the 20% for a condition that will affect me the rest of my life. There is no cure and I will most likely get worst with time. Please reconsider the finding that now places me at 20%. Thank you for your time and giving me another opportunity to plead my case."
______________________________________________________________________________
RATING COMPARISON:
Initial (TDRL) IPEB – Dated 20031118 Final Service FPEB – Dated 20080102 |
VA* – All Effective Date 20040101 | |||||
|---|---|---|---|---|---|---|
| Condition | Code | Rating | Condition | Code | Rating | Exam |
| On TDRL – 20031230 | TDRL | Sep. | ||||
| DM | 7913 | 40% | 20% | DM | 7913 | 20% |
| No Additional MEB/PEB Entries | Not Service Connected x 4 | STR** | ||||
| Combined: 20% | Combined: 20% |
* VA rating based on exam most proximate to date of permanent separation. **Service Treatment Record
ANALYSIS SUMMARY:
Diabetes Condition. The clinical evidence at the time of TDRL and permanent separation was consistent with a 20% rating IAW VASRD §4.120 as determined by the PEB. The CI’s initial VA rating of 20% was based on his service treatment record. A VA rating examination performed one month prior to the FPEB and close to separation also resulted in a 20% rating. The VA examiner recorded that the CI denied a history of diabetic ketoacidosis or hospitalization for uncontrolled diabetes or hypoglycemic reactions. Treatment was diet and long acting insulin each evening. There were no current symptoms, restricted activities, weight instability, or exam findings consistent with complications of DM. The CI’s daily activities were not affected, nor were there any occupational effects due to DM. The CI’s requirement for insulin and restricted diet to control his DM is consistent with the VASRD criteria supporting a 20% rating. None of the criteria for higher ratings are supported by the evidence. There was no evidence of regulation of activities required for the next higher 40% rating. There were no hospitalizations for DM-related problems. Thus none of the 60% or 100% criteria were met either at the time of the initial TDRL rating or at the time of final adjudication. All evidence considered, there is not reasonable doubt in the CI’s favor supporting recharacterization of the PEB adjudication for the DM condition.
Remaining Conditions. Other conditions identified in the Disability Evaluation System (DES) file were lactose intolerance and chronic ring worm. Neither of these conditions were clinically active during the MEB period, was the basis for limited duty, or was implicated in the non-medical assessment. These conditions were reviewed by the action officer and considered by the Board. It was determined that neither could be argued as unfitting and subject to separation rating. Additionally several other non-acute conditions were noted in the VA rating decision proximal to separation as not service connected, but were not documented in the DES file. The Board does not have the authority under DoDI 6040.44 to render fitness or rating recommendations for any conditions not considered by the DES. The Board therefore has no reasonable basis for recommending any additional unfitting conditions for separation rating.
______________________________________________________________________________
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, the Board unanimously recommends a separation rating after TDRL of 20% coded 7913 IAW VASRD §4.120. The Board unanimously agrees that there were no other conditions eligible for Board consideration which could be recommended as additionally unfitting for rating at separation.
______________________________________________________________________________
RECOMMENDATION: The Board therefore recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:
| UNFITTING CONDITION | VASRD CODE | TDRL RATING | PERMINANT RATING |
|---|---|---|---|
| Diabetes Mellitus | 7913 | 40% | 20% |
| COMBINED | 40% | 20% |
______________________________________________________________________________
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20090912, w/atchs.
Exhibit B. Service Treatment Record.
Exhibit C. Department of Veterans' Affairs Treatment Record.
Deputy Director
Physical Disability Board of Review
MEMORANDUM FOR DIRECTOR, SECRETARY OF THE NAVY COUNCIL OF REVIEW
BOARDS
Subj: PHYSICAL DISABILITY BOARD OF REVIEW (PDBR) RECOMMENDATION
ICO XXXXXX, FORMER USMC
Ref: (a) DoDI 6040.44
(b) PDBR ltr dtd 15 Jun 11
I have reviewed the subject case pursuant to reference (a) and, for the reasons set forth in reference (b), approve the recommendation of the PDBR Mr. XXX’s records not be corrected to reflect a change in either his characterization of separation or in the disability rating previously assigned by the Department of the Navy’s Physical Evaluation Board.
Assistant General Counsel
(Manpower & Reserve Affairs)
AF | PDBR | CY2011 | PD2011-01116
The CI was then medically separated with a 20% disability rating. The two interim TDRL exams and PEB decisions were not in evidence for review and therefore the Board could not discern the reasoning for continuance on TDRL, but agreed if the recommendation was to remain on TDRL, the % criteria that allowed this was the 40% rating. In addition, the VA, in spite of the 13 February 2008 exam, did not rate diabetic neuropathy until a rating decision in 2010 with an effective date of 30...
AF | PDBR | CY2014 | PD-2014-02787
SEPARATION DATE: 20030912 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. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.
AF | PDBR | CY2010 | PD2010-00199
CI CONTENTION : The CI states: “I feel that my claim should be re-evaluated due to the severity of my disability and my additional disabilities found under VA evaluation should be considered. The Board therefore has no reasonable basis for recommending this condition as an additional unfitting condition for separation rating. I have carefully reviewed the evidence of record and the recommendation of the Board.
AF | PDBR | CY2014 | PD-2014-00434
The diabetes and stress fracture conditions, characterized as “diabetes mellitus type I” and “right tibial stress fracture,” were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. 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 directed its...
AF | PDBR | CY2009 | PD2009-00676
Independently rating the CI’s DM at separation, considering the evidence in the military and pre-separation VA records, absent any non-compliance deduction, and considering “complications that would not be compensable if separately evaluated” (by the military) the CI would best fit the 60% 7913 criteria of “Requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month...
AF | PDBR | CY2010 | PD2010-00448
CI’s CONTENTION : The CI states, “I respectfully request that the board re-evaluate the decision issued on 12 May 2009 by the Department of the Navy Physical Evaluation Board. As mentioned above, the Board must base its permanent disability rating recommendation on the CI’s medical condition at the time of separation from service. The Board therefore unanimously recommends that peripheral neuropathy be considered not unfitting at the time of separation from service.
AF | PDBR | CY2011 | PD2011-00624
The MEB found his Type 1 diabetes medically unacceptable, and referred him to a Physical Evaluation Board (PEB). A higher rating of 60% would require “insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated.” Since the treatment record does not show sufficient...
AF | PDBR | CY2013 | PD-2013-01487
No other conditions were submitted by the MEB.The PEB adjudicated “diabetes mellitus, type II, poor control, requiring insulin and restricted diet”as unfitting, rated 20%,referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated. RECOMMENDATION : The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination. Physical Disability Board of Review
AF | PDBR | CY2013 | PD-2013-02326
He denied hospitalization for diabetes or diabetic complications and had a full-time job.At a C&P exam on 13 June 2007(14 months after TDRL placement) the CI reported that if “he runs or does any type of activities he will have hypoglycemia.” He therefore restricted his activities. The Board directs attention to its rating recommendationbased on the above evidence.Both at the time of placement on the TDRL and at the time of permanent disability disposition and removal from the TDRL, the...
AF | PDBR | CY2014 | PD 2014 01466
SEPARATION DATE: 20090426 The CI was still taking oral medications only (no injected insulin) and had undergone surgery in March 2008 (Abdominoplasty) with continued high blood sugar levels (glucose 262 with normal 74-106) and high Glycosolated hemoglobin levels (A1C 9.5 with normal 4.2-7.0). I have carefully reviewed the evidence of record and the recommendation of the Board.