RECORD OF PROCEEDINGS 

PHYSICAL DISABILITY BOARD OF REVIEW 

BRANCH OF SERVICE:   ARMY 
SEPARATION DATE:  20020715 

 
NAME:    
CASE NUMBER:  PD1201445 
BOARD DATE:  20121128 
 
 
SUMMARY  OF  CASE:    Data  extracted  from  the  available  evidence  of  record  reflects  that  this 
covered 
individual  (CI)  was  an  active  duty  SSGT/E-6  (8N/Transportation  Management 
Coordinator), medically separated for Type I diabetes mellitus.  With onset in November 2001, 
requiring  multiple  doses  of  Insulin  daily  and  constant  monitoring  of  blood  sugar.    Type  I 
diabetes  mellitus  condition  could  not  be  adequately  rehabilitated.    The  CI  did  not  improve 
adequately with treatment and was unable 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).    Bilateral  knees,  retropatellar 
pain  syndrome  and  right  shoulder,  tendinitis  with  impingement  syndrome,  identified  in  the 
rating  chart  below,  were  also  identified  and  forwarded  by  the  MEB.    The  Informal  Physical 
Evaluation Board (IPEB) adjudicated the Type I diabetes mellitus condition as unfitting, rated 
20%, with application of the Veteran’s Affairs Schedule for Rating Disabilities (VASRD).  The CI 
appealed to the Formal PEB (FPEB) which affirmed the IPEB findings.  The USAPDA replied to a 
Congressional inquiry following the FPEB, but prior to separation, that the CIs FPEB adjudication 
had no error or injustice and affirmed the FPEB determination of 20% versus a requested 40% 
rating.  The CI was then medically separated with a 20% disability rating.   
 
 
CI CONTENTION:  “The 20% rating does not fit the disability, Type I Diabetes with controlled 
diet, restricted activities, and insulin dependent starts at the 40% rating.  My condition fits the 
40% to 60% category.”   
 
 
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  Type  I  diabetes  mellitus  condition 
requested  for  consideration  meets  the  criteria  in  DoDI  6040.44  for  Board  purview,  and  is 
accordingly addressed below.  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 FPEB – Dated 20020326 
Condition 

Code 
7913 

Rating 
20% 

Diabetes Mellitus, Type I 

Bilateral Knees w/Pain 
Syndrome 

Right Shoulder tendinitis 
w/impingement 
Syndrome 

Not Unfitting 

Not Unfitting 

VA (1 Mos. Post-Separation) – All Effective Date 20020716 

Condition 

Diabetes Mellitus 
Left Knee Retropatellar 
Syndrome 
Right Knee Retropetallar 
Syndrome 
Right Shoulder Impingement 
w/Tendinitis 

Code 
7913 
5260 

Rating 
40%* 
0%** 

Exam 

20020528 
20020528 

5260 

0%** 

20020528 

5201-5024 

10% 

20020528 

↓No Additional MEB/PEB Entries↓ 

Combined:  20% 

0% X 1 / Not Service-Connected x 3 

Combined:  50% 

 

*BVA  Decision  20070905  led  to  re-rating  DM  (7913)  from  20%  to  40%  effective  day  after  discharge.    **BVA  Decision  made 
knees SC w/0% disability eff 20020420.   
 
 
ANALYSIS SUMMARY.  The FPEB disability description was:  
 

Type  I  diabetes  mellitus,  onset  Nov  01,  requires  multiple  doses  of  injectable  insulin  daily  and 
constant (4x daily) monitoring of blood sugar.  No diabetic complications, has occasional episodes of 
hypoglycemia which do not require physicians care (emergency room visits), usually associated with 
prolonged arduous physical activity.  Able to perform at 7 to 8 METS such as jogging at 12 minute 
mile  pace  for  2  miles  and  walk  2.5  miles  under  30  minutes.  Hemoglobin  A1c  reported  at  6.5 
indicating good control.   

 
Diabetes  Mellitus,  Type  I  Condition.    The  narrative  summary  (NARSUM)  notes  CI  developed 
insulin dependent diabetes requiring hospitalization in November 2001.  The service treatment 
record (STR) shows his sugars stabilized on long and short acting injectable Insulin given three 
to four times a day.  His symptoms of blurred vision, polyuria and polydipsia resolved, but he 
experienced exercise and delayed meal related hypoglycemia episodes once or twice a week 
that required oral glucose, but no formal medical care.  He never completed another physical 
fitness  exam  after  his  diagnosis.    Workups  showed  normal  foot  and  eye  exams,  no  renal  or 
other end organ damage eight and 5 months prior to separation.  CI was compliant with Insulin 
therapies and serum glucoses ranged between 82 and 160.  At the MEB exam, 5 months prior 
to separation, the CI reported he “felt fine” except for symptomatic hypoglycemia with blood 
sugars in the 40s and 50s once or twice a week, usually related to delayed meals or exercise.  
The  MEB  physical  exam  noted  no  acute  abnormalities.    A  commander’s  statement  dated  5 
months  before  separation  noted  that  the  CI  could  not  deploy  due  to  need  for  refrigerated 
medications, was on a special diet (American Diabetes Association diet/ADA) and could still do 
fitness  training  except  in  the  early  morning  when  his  sugars  tended  to  fluctuate  (low).  
Additionally, he could not do shift work, reported for hospital glucose levels weekly, and was on 
the ADA diet and restricted from field rations.  He was unable to do most of his MOS except for 
administrative  work.    A  second  commander’s  statement  dated  3  months  prior  to  separation 
noted  all  of  the  above  restrictions,  but  also  noted  further  restricted  activities  from  carrying 
loads and pushing equipment due to hypoglycemia episodes.  The commander noted that the 
CI would have to leave his work area to eat an appropriate diet, take his shots, and could not do 
the shift work.  He could not work a 24 hour shift due to fatigue or stabilize his hypoglycemia 
episodes  trending  as  low  as  “in  the  50’s  and  60’s”.    The  commander  stated  the  CI  could  no 
longer do physical fitness without having hypoglycemia in “1&1/2 miles” and could not work on 
the airfield due to “his sugars can drop low before he notices and then goes rapidly and so it 
affects him and is unsafe for him…”  A permanent P3 profile 3 months prior to separation noted 
the  CI  required  “no  24 hour  duty  due to blood  glucose fluctuations.   No  deployment due  to 
diabetes, required access to insulin syringes, (refrigerated insulin), monitoring, hospital care as 
needed.  No assignment to units requiring ongoing consumption of field rations, requires ADA 
prescribed diet.”  The only aerobic conditioning exercise permitted was “Walk at own pace and 

   2                                                           PD1201445 
 

distance,” but the CI was permitted to do the physical fitness test walk (but not run) and could 
also march up to 2 miles.  The profile was signed by two physicians.  Under block 9, OTHER the 
profile  stated  “MEB  initiated.    Prolonged,  heavy  exertion  only  as  tolerated.    No  prolonged 
extreme  exertion.”    At  the  VA  Compensation  and  Pension  (C&P)  exam,  6  weeks  prior  to 
separation the CI reported “a multitude of hypoglycemic reactions,” and the use of three types 
of  Insulin,  but  no  diabetic  peripheral  neuropathy,  renal  disease  or  vascular  problems.”    His 
physical  exam  showed  a  weight  of  145  pounds,  reportedly  down  from  160  a  year  before,  a 
near-normal Hemoglobin A1C at 6.5 (4-6) and otherwise normal physical exam except for minor 
musculoskeletal findings outside this scope.  Post-separation VA records, including the Board of 
Veterans Appeals (BVA) decision dated September 5, 2007 demonstrated the CI had continued 
hypoglycemic episodes with activity and went on to develop hypoglycemic seizures with work 
and driving restrictions.  The CI’s symptoms came under better control when the CI was begun 
on an insulin pump in 2005 and symptomatic episodes and work restrictions decreased after 
2005.   
 
The Board directs attention to its rating recommendation based on the above evidence.  The 
FPEB  and  the  VA  chose  the  same  VASRD  code  7913  for  adjudicating  diabetes  mellitus.    The 
Board found no evidence of episodes of ketoacidosis or hypoglycemic reactions requiring one 
or  two  hospitalizations  per  year  at  the  time  of  separation  or  documented  diabetic 
complications  that  would  not  be  compensable  if  separately  evaluated.    Although  the  CI  was 
documented  to  “visit  the  hospital”  once  a  week  for  glucose  monitoring,  this  was  outpatient 
laboratory testing and not emergency department or inpatient treatment.  The CI was clearly 
on insulin and a restricted diet.  The deliberation of this case focused on whether the CI met the 
VASRD  criteria  for  “regulation  of  activities”  for  a  40%  rating  rather  than  a  20%  rating.    The 
VASRD  definition  of  regulation  of  activities  (avoidance  of  strenuous  occupational  and 
recreational  activities),  requires  physician-prescribed  restriction  per  VA  policy  and  legal 
precedence.    The  Board  deliberated  if  the  profile  restrictions  and  multiple  hypoglycemic 
reactions related to exercise or activity (not requiring medical treatment) rose to the level to 
more  closely  approximate  the  40%  rating  level.    There  was  no  exercise  tolerance  test  in 
evidence and the FPEB described ability “to perform at 7 to 8 METS” was adjudged to be an 
approximation most likely based on the CI’s fitness testing performance.  The overall picture of 
the  CI’s  DM  proximate  to  separation  was  of  good  glucose  control,  with  a  “brittle”  type  of 
picture with hypoglycemic episodes when activities were prolonged, heavy, or unscheduled.   
 
The Board found the physician-signed profile restrictions, restriction from early morning fitness 
training,  multiple  doses  of  insulin  for  control  and  noted  hypoglycemic  events  did  constitute 
regulation  of  activities  and  the  CI’s  disability  picture  at  the  time  of  separation  more  nearly 
approximated  the  disability  picture  of  the  40%  rating  criteria.    After  due  deliberation, 
considering  all  of  the  evidence  and  mindful  of  VASRD  §4.3  (reasonable  doubt),  the  Board 
recommends a disability rating of 40% for the diabetes mellitus 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, the Board unanimously 
recommends a disability rating of 40% coded 7913 IAW VASRD §4.119.  There were no other 
conditions within the Board’s scope of review for consideration.   
 
 

   3                                                           PD1201445 
 

RECOMMENDATION:  The Board recommends that the CI’s prior determination be modified as 
follows;  and,  that the discharge  with  severance pay  be  recharacterized to  reflect  permanent 
disability retirement, effective as of the date of his prior medical separation:   
 

UNFITTING CONDITION 

VASRD CODE  RATING 

7913 

COMBINED 

40% 
40% 

Diabetes Mellitus, Type I 

 
 
The following documentary evidence was considered: 
 
Exhibit A.  DD Form 294, dated 20020713, w/atchs 
Exhibit B.  Service Treatment Record 
Exhibit C.  Department of Veterans’ Affairs Treatment Record 
 
 
 
 
 
 
 
 

 

             
           President 
           Physical Disability Board of Review 

   4                                                           PD1201445 
 

 

 

 

a.  Providing a correction to the individual’s separation document showing that the 

b.  Providing orders showing that the individual was retired with permanent disability 

SFMR-RB 
 
MEMORANDUM FOR Commander, US Army Physical Disability Agency  
(TAPD-ZB), 2900 Crystal Drive, Suite 300, Arlington, VA  22202-3557 
 
SUBJECT:  Department of Defense Physical Disability Board of Review Recommendation  
 
1.  Under the authority of Title 10, United States Code, section 1554(a), I approve the enclosed 
recommendation of the Department of Defense Physical Disability Board of Review (DoD PDBR) 
pertaining to the individual named in the subject line above to recharacterize the individual’s 
separation as a permanent disability retirement with the combined disability rating of 40% 
effective the date of the individual’s original medical separation for disability with severance 
pay.   
 
2.  I direct that all the Department of the Army records of the individual concerned be corrected 
accordingly no later than 120 days from the date of this memorandum: 
 
 
individual was separated by reason of permanent disability retirement effective the date of the 
original medical separation for disability with severance pay. 
 
 
effective the date of the original medical separation for disability with severance pay. 
 
 
c.  Adjusting pay and allowances accordingly.  Pay and allowance adjustment will 
account for recoupment of severance pay, and payment of permanent retired pay at 40% 
effective the date of the original medical separation for disability with severance pay. 
 
 
medical TRICARE retiree options. 
 
3.  I request that a copy of the corrections and any related correspondence be provided to the 
individual concerned, counsel (if any), any Members of Congress who have shown interest, and 
to the Army Review Boards Agency with a copy of this memorandum without enclosures. 
 
BY ORDER OF THE SECRETARY OF THE ARMY: 
 
 
 
 
Encl 
 
 
 

 
     Deputy Assistant Secretary 
         (Army Review Boards) 

d.  Affording the individual the opportunity to elect Survivor Benefit Plan (SBP) and 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

   5                                                           PD1201445