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AF | PDBR | CY2013 | PD-2013-02207
Original file (PD-2013-02207.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2013-02207
BRANCH OF SERVICE: Army  BOARD DATE: 20150129
SEPARATION DATE: 20040402


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an activated National Guard E-5 (Health Care Specialist) medically separated for diabetes. The condition could not be adequately controlled enough to meet the physical requirements of his Military Occupational Specialty; however, he could take the physical fitness test. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The “diabetes type 2, without evidence of end-organ damage, but requiring insulin for control” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated his diabetes as unfitting, existed prior to service (EPTS), but rated it at 20%, citing application of 10 USC 1207a (8-year rule) and with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “Was raised to 80% on Sept 2011. Should be 100% as I cannot work because of vision issues and neuropathy.”


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 20040301
 VA* - (~63 Months Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus… 7913 20% Diabetes Mellitus… 7913 10% 20090709
Peripheral Neuropathy, RLE… 8599-8521 10% 20090709
Peripheral Neuropathy, LLE… 8599-8521 10% 20090709
Other x 0 (Not In Scope)
 Other x 0
RATING: 20%
 RATING: 10%
* Derived from VA Rating Decision (VA RD ) dated 200 90813 (most proximate to date of separation ( DOS ) ) .

ANALYSIS SUMMARY:

Diabetes. The first record in evidence for the diabetes mellitus (DM) condition is a primary care note from 30 January 2001. He was noted to be in improving control, but the treatment was not recorded. A note that May noted that he was on oral hypoglycemic agents (medications to reduce the blood sugar). His control was suboptimal for most of the next 2 years even with medications. However, the 3 September 2003 primary care note documented that he had lost weight and increased exercise resulting in better control even off medications although his fasting blood sugars remained high. He was activated on 12 October 2003 and reported increased symptoms. A hemoglobin A1C (HA1C), which indicates glucose control for the past 120 days, was markedly elevated at 12.8 (normal 4.2-5.9) when checked on 17 November 2003, a month after activation, indicating poor control for at least the past several months including the months leading up to activation. On 3 December 2003, 7 weeks after activation, the CI was issued a P3 profile and an MEB was initiated. The commander noted on 20 December 2003 that the CI was an outstanding soldier, but that he had not been able to control his DM on the Army’s diet. In fact, the CI demonstrated poor control prior to activation. At the MEB examination on 7 January 2004, the CI reported blurry vision for several years and that he now used reading glasses. The narrative summary was dictated 4 February 2004, 2 months prior to separation. It noted that the CI had presented to the troop medical clinic with excessive thirst, urination, and blurred vision and the above HA1C was obtained. The CI was restarted on oral medications which he had taken prior to activation. He had a normal ophthalmologic (eye) examination and was also seen by a podiatrist who made changes to the profile; further details were not recorded. The examiner noted that insulin and a second oral agent had been added to control the DM. The neurological, skin, and extremity examinations were normal. His blood sugar and HA1C remained elevated, but there was no microalbuminuria (an indication of kidney disease). He was permitted to run and walk at his own pace and distance, and normal physical fitness testing was authorized. Limitations in activity were not directed. The VA Compensation and Pension examination was not performed until 63 months after separation, well outside the normal 12-month window for high probative value.

The Board directed its attention to its rating recommendation based on the above evidence. The PEB rated the DM condition at 20% for the use of insulin (without regulation of activities) using the code 7913. The VA over 5 years later, used the same code and also rated the DM condition at 20% but deducted 10% for the EPTS contribution. The VA also rated the CI for a bilateral peripheral neuropathy which developed after separation. At the time of separation, the CI was taking insulin, but was without evidence of either end organ damage or regulation of activities. The Board found no route to a rating higher than the 20% adjudicated by the PEB. 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 DM 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 DM condition and IAW VASRD §4.120, 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 re-characterization of the CI’s disability and separation determination.
The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20130909, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record





                                   
XXXXXXXXXXXXXXXXXX
President
DoD 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, AR20150008356 (PD201302207)


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 of the Army
                           (Review Boards)
CF:
( ) DoD PDBR
( ) DVA

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