RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY  
SEPARATION DATE:  20031113 

 
NAME:  XXXXXXXXXXXXX 
CASE NUMBER:  PD1200736 
BOARD DATE:  20130122   
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered  individual  (CI)  was  an  active  duty  SPC/E-5  (92Y10/Supply  Specialist),  medically 
separated for Type I diabetes mellitus (DM), requiring Insulin and restricted diet.  The CI was 
diagnosed with Type I DM by internal medicine after a referral from the neurologist who noted 
the CI had abnormal glucose levels.  The Type I DM condition remained uncontrolled despite 
efforts to improve compliance over a period of several months.  The CI stated that his duties 
affect  his  ability  to  maintain  compliance  with  his  Insulin  regimen,  and  did  not  improve 
adequately to meet the physical requirements of his Military Occupational Specialty (MOS) or 
satisfy  physical  fitness  standards.    He  was  issued  a  permanent  P3  profile  and  referred  for  a 
Medical  Evaluation  Board  (MEB).    The  MEB  forwarded  no  other  conditions  for  Physical 
Evaluation Board (PEB) adjudication.  The PEB adjudicated the Type I DM condition as unfitting, 
rated  20%,  with  application  of  the  Veteran’s  Affairs  Schedule  for  Rating  Disabilities  (VASRD).  
The CI made no appeals, and was medically separated with a 20% disability rating.   
 
 
CI CONTENTION:  “I feel I have always been entitled to the next higher VA rating due to the 
nature  of  my  Service  Connected  Disability.    I  have  to  take  shots  4  times  a  day,  strenuous 
activities  cause  me  to  have  periods  of  hypoglycemia  at  work  and  during  various  activities 
outside of work.  I have been going through these type issues since before I was released from 
the  army.    I  have  requested  VA  reevaluations  on  more  than  one  occasion  but  have  had  no 
success in obtaining a higher rating.”  The CI’s further contention on the DD 294 is summarized 
as  supporting  his  having  restriction  of  activities  secondary  to  hypoglycemic  issues  and  work 
restrictions  due  to  the  diabetes  condition,  and  also  contention  for  Narcolepsy,  Sleep  Apnea, 
hypertension, headaches and sore throats.   
 

I· find it somewhat annoying that the doctors within the VA state that my diet need to be restricted and I need 
to be careful with activities that I partake in. but when I request that an addendum be placed in my medical 
records to show that activities do need to be regulated, they refuse.  I'm then in turn offered a letter to take to 
work  that  states  or  indicates  I  need  specific  times  breaks  ....  etc  for  taking  medication  or  times  to  properly 
monitor my diabetes. If this isn't a regulation in activities I’m not sure what would classify this.  I've also have 
had as previously stated periods of hypoglycemia at work, to the point people have had to stop what they are 
doing  to  attend  to  me.    While  living  in  San  Antonio  Texas  in  2009  ,  I  had  a  incident  involving  hypoglycemia 
where I came into a state of confusion. while on the highway by myself. I was leaving from my mother’s house 
helping her move on the west side of San Antonio, I somehow ended up on the southside of San Antonio which 
is roughly an hour drive and had no recollection of how I got there. During this incident I stopped in the middle 
of an exit in the middle of the road, initially people began driving around me I was passed out for roughly 2 
hours before a business owner saw me out there and took me inside her used car dealership. She assisted me in 
getting my blood sugar up and called my mother to come pick me up and take me home. I have other incidents 
like this that I can recall, this is evidence that my activities should be regulated, as a Type I diabetic simple things 
like walking, exercising, heavy lifting or participating in work activities can cause and have caused Hypoglcemic 
episodes.  In my research of disability ratings it seems as if Type 1 and Type 2 diabetics are treated as equals, 
this condition ruined my military career and does not allow me to have a decent quality of life because I DO 
have to regulate my activities or what I can do in fear of being sick and having hypoglycemic episodes.  In my 
original determination letter there is a denial for service connected Narcolepsy.  When I originally went in to the 
hospital I went for a sleeping disorder, I reported to my command that I would frequently stop breathing in my 
sleep.  Initially I was diagnosed with Narcolepsy due to frequent daytime sleepiness and placed on a military 
profile.  I was restricted from going to weapons qualifications, driving a military vehicle and I was ordered to do 
Physical Training at my own pace. I then had a sleep study done a the civilian hospital in Killeen Texas while I 

 
 
SCOPE OF REVIEW:  The Board wishes to clarify that the scope of its review as defined in DoDI 
6040.44, Enclosure 3, paragraph 5.e.(2) is limited to those conditions which were determined 
by the PEB to be specifically unfitting for continued military service; or, when requested by the 
CI, those condition(s) “identified but not determined to be unfitting by the PEB.”  The ratings 
for unfitting conditions will be reviewed in all cases.  The unfitting diabetes mellitus condition 
as  requested  for  consideration  meets  the  criteria  prescribed  in  DoDI  6040.44  for  Board 
purview;  and,  is  addressed  below.    The  contended  narcolepsy,  sleep  apnea,  hypertension, 
headaches and sore throat conditions; and 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 Army Board for Correction of Military Records.   
 
 
RATING COMPARISON:   
 

Service PEB – Dated 20030911 

VA (3 Mos. Post-Separation) – All Effective Date 20031114 

Condition 

Type I Diabetes Mellitus 

Code 
7913 

Rating 
20% 

Condition 

Diabetes Mellitus Type I 

Code 
7913 

Rating 
20%* 

Exam 

20040229 

 

was stationed at Ft. Hood, and I was ordered a second sleep study at Darnell Army Medical Center on Ft. Hood. 
At the time of the the second sleep study a neurologist ordered some blood work which I proceeded to have 
done. While waiting for the results, I continued normal work activities such as guard duty at Darnell Hospital. I 
had just pulled a 24hr guard shift at the hospital, my platoon sergeant called me that morning and told me I 
need to get to the hospital asap.  When I got there the neurologist told me that I have diabetes, at first they 
started  me  out  on  metformin  but  those  made  me  sick,  then  I  was  switched  to  Insulin  shots.  I  never  heard 
anything further in reference to the sleep disorder, that part of what I was going through was ignored and to 
this  day  I  still  struggle  with  this.  I  recently  had  a  conversation  with  a  nurse  practitioner  at  the  VA  here  in 
Indianapolis and I described to her what types of symptoms I was having. We both came to agreement that 
through her knowledge and my research it seems to be Sleep Apnea.  This is the reason why I believe back in 
2001/2002 is why they said it seems to be narcolepsy cause daytime sleepiness is one of the symptoms of sleep 
apnea along with erratic blood sugars, hypertension, headaches and sore throats which I suffer from all these.  
These issues still remain unresolved from the time that I originally brought the up prior to being diagnosed with 
Type I Diabetes Mellitus to now. 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

Not Service-Connected x 3 

Combined:  20% 

*VARD 20031103 Voc Rehab, VARD 20060630; VARD 20120627 continued the 20% rating for Type 1 DM.   
 
 
ANALYSIS SUMMARY:   
 
Type I Diabetes Mellitus (DM) Condition.  At the MEB exam the CI reported having high and low 
blood sugar because of DM.  The CI also said that job duties interfered with his compliance with 
Insulin therapy.  The narrative summary (NARSUM) noted that the CI was poorly controlled on 
oral diabetic medications, required Insulin therapy, and was ultimately determined to be a Type 
1 diabetic.  The CI reported that within the first 2 weeks of Insulin therapy he experienced two 
episodes of relative hypoglycemia.  The NARSUM stated that there were multiple documented 
discussions with the CI regarding continued non-compliance with the diabetes control program.  
The MEB exam noted the CI’s urine was positive for glucose and the glycosolated hemoglobin 
(HA1C-representing long-term glucose control) had been rising up to 11.4% in July 2003 (normal 
DM target less than 6.5%).  At the time of the MEB exam the CI had been educated in diabetes 
control,  including  diet,  and  was  taking  Insulin  four  times  daily.    The  CI’s  P3  profile  indicated 
restrictions of: access to a refrigerator at all times for Insulin; aerobic conditioning at own pace 
and  distance;  and  physical  fitness  test  –  run,  push-ups,  and  sit-ups  permitted.    The  single 
emergency room visit was for high blood sugar early in the course of treatment.   
 

At the VA Compensation and Pension (C&P) exam approximately 3 months after separation, the 
CI  reported  not  following  the  diet  well;  “It  is  hard.”    It  was  noted  that  the  CI  was  “Never 
hospitalized for diabetes.  Never in coma, no hypoglycemia. … No diabetic complications.”  Labs 
were  abnormal,  with  a  blood  sugar  of  333  mg/dL  (normal  70-110),  a  HA1C  of  14.3%.    The 
diagnosis was “Diabetes Mellitus Type 1, without complications (poor compliance with the diet, 
loss of weight with good appetite).”   
The Board directs attention to its rating recommendation based on the above evidence.  The 
PEB rated the CI’s Type 1 DM, requiring Insulin and restricted diet coded 7913 DM at 20%.  The 
VA also rated this condition under VASRD code 7913 at 20%.  The only rating code in the VASRD 
for DM is 7913.  The possible criteria to consider for rating this CI are DM manageable by diet 
only,  DM  that  requires  medication  and  diet  restriction,  DM  requires  medication,  diet  and 
regulation of activity.  (The highest two ratings for DM under 7913 require either evidence of 
hospitalizations for diabetic ketoacidosis or hypoglycemia OR twice per month or more visits to 
a  diabetic  care  provider,  AND  complications  that  are  not  separately  compensable).    The  CI 
contended  that  he  requires  regulation  of  activity  in  order  to  control  his  DM.    VA  guidance, 
precedence and legal opinion on “regulation of activities” for DM is that they must be physician 
prescribed  “regulation  of  activities  (avoidance  of  strenuous  occupational  and  recreational 
activities)”  as  noted  in  the  7913  100%  rating  criteria.    The  evidence  in  the  record  does  not 
support any physician-directed requirement to regulate activities to control the DM condition 
proximate  to  the  date  of  the  CI’s  separation.    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 Type 1 DM condition.   
 
 
BOARD FINDINGS:  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 Type 1 DM 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 recharacterization of 
the CI’s disability and separation determination, as follows:   
 

UNFITTING CONDITION 

VASRD CODE  RATING 

7913 

COMBINED 

20% 
20% 

Type 1 Diabetes Mellitus 

 
 
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 
 
 
 
 
 
 
 

           XXXXXXXXXXXXXXXX, DAF 
           Director 
           Physical Disability Board of Review 

 

 

 
 
 

SFMR-RB 
 
 
 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB / XXXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation 
for XXXXXXXXXXXXX, AR20130002271 (PD201200736) 
 
 
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 
 
 
 
 

     XXXXXXXXXXXXXXXXX 
     Deputy Assistant Secretary 
         (Army Review Boards)