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AF | PDBR | CY2013 | PD-2013-02244
Original file (PD-2013-02244.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXX  CASE: PD-2013-02244
BRANCH OF SERVICE: Army  BOARD DATE: 20140801
SEPARATION DATE: 20091104


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty PFC/E-3 (15D1O/Aircraft Powertrain Repairer) medically separated for diabetes. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). Type I diabetes and hyperlipidemia were forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated diabetes mellitus Type I as unfitting, rated 20%, with application of the VA Schedule for Rating Disabilities (VASRD). The hyperlipidemia was determined to be not unfitting. The CI made no appeals and was medically separated.


CI CONTENTION: ”My Diabetes has changed my life in several ways. I am always feeling weak, irritated, upset, angry, my sugar levels are always going up and down making it (continued) hard for my daily living activities. I could not complete my schooling because of my diabetes ( I went in to DKA, diabetic ketoacidosis and got into an accident, therefore preventing me to finish school). I take my medication every day and still find it difficult to control and maintain my blood sugar.”


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 unfitting hyperlipidemia was not contended; thus, it is not within the DoDI 6040.44 defined purview of the Board and is not considered a disability regardless. Any other condition or contention not requested in this application, remain eligible for future consideration by the Board for Correction of Military Records. The Board acknowledges the CI’s information regarding the significant impairment with which her service-connected conditions continue to burden him. IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. The Board’s role is thus confined to the review of medical records and all evidence at hand to assess the fairness of PEB rating determinations, compared to VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as elaborated above) consistent with performance-based criteria in evidence at separation.


 RATING COMPARISON :

Service IPEB – Dated 20091009
 VA* - Based on Service Treatment Records (STR)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus, Type I 7913 20% Diabetes Mellitus, Type I 7913 20%** STR
Other x 1 (Not in Scope)
 Other x 0 STR
Combined: 20%
 Combined: 20%
*Derived from VA Rating Decision (VARD) dated 20100226 (most proximate to date of separation (DOS)) . **No change to ratings derived from subsequent C&P exams .


ANALYSIS SUMMARY:

Diabetes Mellitus, Type I. The CI was diagnosed with diabetes in a hospital emergency room on 26 April 2009 service following an unintentional 55 pounds weight loss in the prior few months with symptoms of excessive thirst, constant urination at night, blurry vision and hunger. He was found to have a significantly elevated blood glucose of 650 mg/dl (N=70-99). Treatment initially was with diet and an oral medication, but he was switched to an insulin regimen after he was found to have Type I diabetes. Markers for diabetes showed poor control with an initial hemoglobin A1C (a diabetic marker) of 18.2% (N=<5.7%), a fasting blood sugar of 272 mg/dl (N=70-99), and microalbuminuria (protein in the urine, an acute response in the case to the elevated blood sugar). He also had hyperlipidemia. He was referred to Disease Management/Diabetic Clinic for injection training, glucose monitoring and dietary management. However, his dietary compliance was problematic since he was eating at the mess hall. As a result, it was fairly difficult to control his blood sugar. He had no hypoglycemic (low blood sugar) episodes, but did note blurred vision which was attributed to lens swelling secondary to the elevated glucose levels; no retinopathy (damage to the retina of the eye) was present. A permanent P3 profile was issued on 23 July 2009 and noted the “Patient is on [a] Diabetic diet ...His medications require refrigeration.” Additionally, the CI was precluded from performing rushes under fire and unlimited running. However he could participate in running at his own pace and distance and unlimited walking, biking or swimming at his own pace and distance as well as all physical fitness training except the 2-mile run. The commander’s statement dated 11 August 2009 indicated the CI did not perform duties in his MOS and his medical condition prevented him from being a contributing member to any military unit since the he was required to maintain a specific diet, monitor his blood sugar daily and have access to insulin. At the MEB medical examination dated 21 September 2009, approximately 5 weeks before separation, the CI reported high blood sugar and his weight was stable (195 pounds baseline when not weight lifting). The MEB narrative summary (NARSUM) dated 29 September 2009, approximately a month prior to separation, reported an otherwise negative review of system and normal physical examination. The report indicated the CI’s “management would require complex alterations in every aspect of life, diet, exercise, calorie intake and a strict regimented lifestyle.”

The VARD dated 26 February 2010, most proximate to permanent separation, was based on the STR since the CI did not keep an examination appointment. He was assigned a 20% evaluation using code 7913 (diabetes mellitus) based on a requirement for insulin and restricted diet. A higher evaluation of 40% was not warranted as regulation of activities was not required. A VA Compensation and Pension Exam Report dated 13 January 2011, 14 months after separation, noted that the CI’s renal function was normal (no nephropathy was present) and that peripheral neuropathy (nerve damage) was not present, indicating that this was also his status at separation.

The Board directed attention to its rating recommendation based on the above evidence. The IPEB found the CI unfit for diabetes mellitus using code 7913 (diabetes mellitus) and rated his disability at 20% based on “requiring insulin and restricted diet,” while the hyperlipidemia referred by the MEB met retention standards and was not unfitting. The CI initially appealed the IPEB’s rating, based on the NARSUM conclusion, which indicated that he would “require complex alterations in every aspect of life, diet, exercise, calorie intake and a strict regimented lifestyle.” A 40% rating requires insulin, restricted diet and regulation of activities. While he was restricted from military duties including rushing under fire, the 2-mile run and unlimited running, he was permitted to participate in multiple other physical activities. The VARD likewise assigned a 20% rating using code 7913 and similarly addressed the requirements of a 40% rating. Case law (Camacho v. Nicholson, 21 Vet. App. 2007) held that “regulation of activities” is addressed in VASRD code 7913 in the 100% rating section as “avoidance of strenuous occupational and recreational activities.” While the CI was restricted from the aforementioned military duties, he was both permitted and encouraged to participate in physical activities. The action officer opined that the activity restriction imposed was typical of that given to any insulin dependent diabetic and did not rise to the level of “regulation of activities.” In addition, there were no sequelae from the diabetes such as retinopathy, neuropathy, or nephropathy and no hospitalizations, ketoacidosis (a response to “starvation” from the inability to use sugar in the absence of insulin) or hypoglycemic (low blood sugar) reactions recorded. 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 mellitus, Type I 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 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 re-characterization of the CI’s disability and separation determination.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20131106, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record








                          
XXXXXXXXXXXXXXXXX
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 XXXXXXXXXXXXXXXXX, AR20150002586 (PD201302244)

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

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