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AF | PDBR | CY2012 | PD2012 01207
Original file (PD2012 01207.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX        CASE: PD1201207
BRANCH OF SERVICE: Army  BOARD DATE: 20140212
SEPARATION DATE: 20030405


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty SPC/E-4 (75H/Personnel Services Specialist) medically separated for diabetes. In 2002, he experienced acute excessive urination, thirst and weight loss. Testing revealed high blood sugar and he was treated with intensive insulin therapy, which led to recuperation followed by outpatient managed care for diabetes. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty, so he was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The diabetes condition, characterized as “diabetes mellitus, type 1,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions (see rating chart below) for PEB adjudication. The PEB adjudicated “diabetes mellitus type 1” as unfitting, rated 20%, with likely application of the VA Schedule for Rating Disabilities (VASRD). The remaining conditions were determined to be not unfitting . The CI did not agree with the PEB findings but did request a formal hearing or submit an appeal, so his case was sent to the US Army Physical Disability Agency (USAPDA). After reviewing the case, USAPDA affirmed the PEB findings and the CI was medically separated.


CI CONTENTION: “An adverse reaction to Isoniazid (INH) caused me to be hospitalized and diagnosed with Type 1 diabetes, which is still not under control. Before my reaction I was in good health. I was told to take lNH even after I disagreed with the PPD test results. I started to have side effects from the medication within a week. I contacted the doctor about this, and was told to continue the medicine. The side effects got worse, stomach pains, light-colored stools and extreme fatigue. I stop taking the medication on my own, but the damage was done. Currently I take six to seven shots a day and still struggle to maintain control of my blood sugar levels.”


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. The history of positive reaction to purified protein derivative (PPD) is also addressed below. No other conditions are within the DoDI 6040.44 defined purview of the Board. Any conditions outside the Board’s defined scope of review may be eligible for consideration by the Board for Correction of Military Records.



RATING COMPARISON :

Service IPEB – Dated 20030108
 VA - (~3 wks. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus Type I… 7913 20% Diabetes Mellitus Type I 7913 20% 20030422
Hypertension Not Unfitting Hypertension 7101 10%
History of Positive PPD… History of Positive PPD… 6799-6723 NSC
No Additional MEB/PEB Entries
 Other x 5
Combined: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 30 514 .


ANALYSIS SUMMARY: The Board acknowledges the CI’s information regarding the significant impairment with which his service-connected condition continues to burden him; but, must emphasize that the Disability Evaluation System has neither the role nor the authority to compensate members for anticipated future severity or potential complications of conditions resulting in medical separation. That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.

Diabetes mellitus (DM). In January 2002, the CI was diagnosed with diabetic ketoacidosis. He was hospitalized and his blood sugar (BS) was stabilized. On discharge from the hospital, his DM was controlled with dietary restriction and insulin. In September 2002, an MEB was initiated. The MEB narrative summary (NARSUM) was dictated in October 2002. The examiner noted that the DM appeared to be well controlled. Hemoglobin A1c (HgbA1c) was in the target range and there had been no problems with recurrent hypoglycemia or hyperglycemia. On page four of the NARSUM, the examiner listed several limitations. These limitations included: “No operation of heavy machinery, trucks, or aircraft. No working at heights. No scuba diving or security card detail, and no physical training (PT) with BS greater than 250 milligrams per deciliter.” These limitations also appear on DA Form 3349 (physical profile) and are mentioned in the commander’s statement. As noted above, the CI was medically separated from service on 5 April 2003. Two weeks later he had a VA Compensation and Pension (C&P) exam. The DM was being treated with multiple insulin injections each day. The CI denied any restriction of activities and denied any visual problems or neurologic symptoms. BS was 237 and HgbA1c was 9.1%.

The Board carefully examined all evidentiary information available, and directs attention to its rating recommendation based on the above evidence. The PEB and VA both used VASRD code 7913 for the DM condition and both assigned a disability rating of 20%. For the reader’s convenience, the VASRD §4.119 language for diagnostic code 7913 (DM) is excerpted below:

Requiring insulin, restricted diet, and regulation of activities................................40
Requiring insulin, and restricted diet, or; oral hypoglycemic agent
and restricted diet……………………………………………………………….................................20
Manageable by restricted diet only ……… ................................ ................................1 0

IAW VASRD §4.119, a rating of 20% is appropriate for DM requiring insulin and restricted diet. A rating of 40% requires regulation of activities (ROA). Regulation of activities is when a licensed healthcare provider prescribes or recommends that a diabetic patient avoid or restrict strenuous occupational or recreational activities. In the CI’s treatment record, the only evidence of ROA were the limitations (quoted above) listed by the MEB NARSUM examiner 6 months prior to separation. At the April 2003 C&P exam, however, the CI denied any ROA. The Board deliberated at length on the matter of ROA. The Board determined that there was not sufficient evidence that the CI’s activities were being medically regulated at the time of separation from service. The limitations imposed by the NARSUM examiner 6 months prior to separation did not meet the intent of VASRD §4.119. 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 condition.

Other condition. The CI had a positive reaction to PPD. He was started on isoniazid (INH) prophylaxis. After taking INH for 2 months, he had an adverse reaction to the medication and was switched to Rifampin. The Army PEB adjudicated the history of positive PPD as “not unfitting, not rated.” This condition was not profiled, implicated in the commander’s statement, or judged to fail retention standards. The history of positive PPD was thoroughly reviewed by the action officer and was carefully considered by the Board. The Board’s main charge is to assess the fairness of the PEB’s adjudication that the condition was not unfitting. The Board’s threshold for countering fitness determinations is higher than the VASRD §4.3 (reasonable doubt) standard used for rating recommendations, but remains adherent to the DoDI 6040.44 “fair and equitable” standard. A thorough review of the record revealed insufficient evidence that this condition caused any significant interference with satisfactory performance of required military duties. After due deliberation 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 for the history of positive PPD. This condition was indeed “not unfitting” at the time of separation. The Board therefore concluded that this condition could not be recommended for additional disability 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 and IAW VASRD §4.119, the Board unanimously recommends no change in the PEB adjudication. In the matter of the positive PPD condition, the Board unanimously recommends no change in 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 recharacterization of the CI’s disability and separation determination, as follows:

UNFITTING CONDITION VASRD CODE RATING
Diabetes mellitus, Type 1, on insulin 7913 20%
COMBINED 20%



The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20120608, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                                   
XXXXXXXXXXXXXXXXXX, DAF
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 XXXXXXXXXXXXXXXXXX , AR20140013132 (PD201201207)

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                                                  XXXXXXXXXXXXXXXXXX
                                                      Deputy Assistant Secretary
                                                      (Army Review Boards)

CF:
( ) DoD PDBR
( ) DVA

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