Search Decisions

Decision Text

AF | PDBR | CY2014 | PD 2014 01466
Original file (PD 2014 01466.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXX     CASE: PD-2014-01466
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20141003
SEPARATION DATE: 20090426


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty Air Force SSgt/E-5 (1C072/Aviation Resource Management Craftsman) medically separated for diabetes mellitus (DM), Type II, uncontrolled. The condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty or satisfy physical fitness standards. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). The DM, Type II, uncontrolled condition characterized as “Diabetes Mellitus Type II” and was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB adjudicated “diabetes Type II” as unfitting, rated 20%, referencing the Veterans Affairs Schedule for Rating Disabilities (VASRD). The CI appealed to the Formal PEB (FPEB), which affirmed the IPEB finding(s) and rating(s), and the CI was medically separated.


CI CONTENTION: “Diabetes is a progressive disease. I was diagnosed with Sleep Apnea about six months ago by Dr. P-- S--- at the Brain Institute of NM Alamogodo. He has suggested that I must have had on active duty. Sleep apnea can have a huge impact on fluctuating blood sugars. I have also suffered through depression since discharge. I would have given my life for my country. Please allow me to at least have my retirement.”


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 DM, Type II, uncontrolled condition is addressed below; and, no additional conditions are within the DoDI 6040.44 defined purview of the Board. 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 Board for Correction of Military Records.


 RATING COMPARISON :

Service FPEB – Dated 20090123
 VA - (3 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus, Type II, Uncontrolled 7913 20% Type II Diabetes Mellitus 7913 20% 20090609
Other x 0 (Not in Scope)
 Other x 12 20090609
Combined: 20%
 Combined: 60%
Derived from VA Rating Decision (VARD) dated 20091022; correction of VARD dated 20090710 most proximate to date of separation [DOS].






ANALYSIS SUMMARY:

Diabetes Mellitus, Type II, Uncontrolled, Condition: The narrative summary (NARSUM) and record indicated that the CI had a history of Type II DM in 2004 since April 2004 and was tolerating oral medications well. She had been on duty limitations (ALC-C – AF Form 469, Duty Limiting Condition Report [DLC]) for multiple years with multiple follow-ups. The DLC dated July 2008 was ALC-C3 and required specialty consultation reports. The CI was still taking oral medications only (no injected insulin) and had undergone surgery in March 2008 (Abdominoplasty) with continued high blood sugar levels (glucose 262 with normal 74-106) and high Glycosolated hemoglobin levels (A1C 9.5 with normal 4.2-7.0). She sometimes had mid-afternoon episodes of hypoglycemia (low sugar), which went away after eating a snack. She had not needed hospital visits due to those episodes. She was able to accomplish her normal duties, was not deployable and her prognosis was considered to be good. The treatment plan was “considering the likely need for the addition of lantus (insulin) injections …”

At the MEB exam, the CI reported no DM-related symptoms and exam demonstrated consistent high glucose and A1C levels. There was no diabetic retinopathy (eye findings), no peripheral nerve abnormalities and all other tests for significant DM-related end organ damage were negative. The CI had no restrictions from fitness testing or unit physical training. The CI was found unfit for duty due to DM with “chronically poor control of your diabetes in spite of near maximum dosages of medications, inability to consistently lower your weight to ideal levels …: be stationed near a facility with emergency services to prevent aggravation of symptoms … and … increased risk of complications.” The supporting documents for the FPEB noted the CI’s desire and supervisory and commander’s support for continuation on duty.

At the VA Compensation and Pension exam performed 2 months after separation, the CI reported taking oral DM medications without prior DM-related hospitalizations. The examiner noted the high glucose and A1C levels and noted no other DM-related physical findings. The CI included a memo from her physician dated 26 March 2014 which indicated that her DM “has proven difficult to control using multiple medication regimens including large amounts of insulin. Due to consistently elevated blood sugars she is having symptoms of paresthesias, pain, fatigue, and gastrointestinal problems that are getting progressively worse …”

The Board directs attention to its rating recommendation based on the above evidence. The FPEB rated the DM condition at 20% and the VA final DM rating was also 20%. The CI had restricted diet and required oral hypoglycemic agents. The Board considered that even if the CI’s chronically high glucose and A1C levels were interpreted as “required insulin,” that would not warrant a rating higher than 20%. There was no indication in the record for required regulation of activities, multiple hospitalizations, frequent visits to a diabetic care provider, or significant diabetic residuals to warrant any rating higher than 20% proximate to separation. The CI’s medical condition in 2014, nearly 5 years after separation, was considered post-separation worsening and not indicative of her disability level at the time of 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 DM, Type II, uncontrolled condition. The Board concluded therefore 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, Type II, Uncontrolled 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 20140325, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record



                 
XXXXXXXXXXXXXX
President
Physical Disability Board of Review


 SAF/MRB
Dear XXXXXXXXXXXXXX:

 Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-01466.
After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate. Accordingly, the Board recommended no re-characterization or modification of your separation.
         I have carefully reviewed the evidence of record and the recommendation of the Board. I concur with that finding and their conclusion that re-characterization of your separation is not warranted. Accordingly, I accept their recommendation that your application be denied.
                                                               Sincerely,
XXXXXXXXXXXXXX
Director
Air Force Review Boards Agency
Attachment:
Record of Proceedings

Similar Decisions

  • AF | PDBR | CY2012 | PD2012-00642

    Original file (PD2012-00642.pdf) Auto-classification: Denied

    RECORD OF PROCEEDINGS PHYSICAL DISABILITY BOARD OF REVIEW SEPARATION DATE: 20020731 NAME: XXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY CASE NUMBER: PD1200642 BOARD DATE: 20121025 SUMMARY OF CASE: Data extracted from the available evidence reflects that this covered individual (CI) was an active duty SPC/E-4, (31U, Communications Specialist) medically separated for Type II diabetes mellitus (DM). Pre-Separation) – Effective Date 20020801 Code Rating Condition Code Rating Exam Condition Diabetes...

  • AF | PDBR | CY2012 | PD2012-01445

    Original file (PD2012-01445.pdf) Auto-classification: Approved

    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. 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...

  • AF | PDBR | CY2011 | PD2011-01116

    Original file (PD2011-01116.docx) Auto-classification: Denied

    The CI was then medically separated with a 20% disability rating. The two interim TDRL exams and PEB decisions were not in evidence for review and therefore the Board could not discern the reasoning for continuance on TDRL, but agreed if the recommendation was to remain on TDRL, the % criteria that allowed this was the 40% rating. In addition, the VA, in spite of the 13 February 2008 exam, did not rate diabetic neuropathy until a rating decision in 2010 with an effective date of 30...

  • AF | PDBR | CY2013 | PD-2013-02242

    Original file (PD-2013-02242.rtf) Auto-classification: Denied

    Separation Date: 20050831 The MEB examiner documented that the CI could not do unlimited running, walking, biking or swimming and further opined that she should not be allowed to operate heavy equipment.The Board considered the 20% rating versus a 40% rating (requiring insulin, restricted diet and regulation of activities).After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board recommends a disability rating of 20% for the DM Type I...

  • AF | PDBR | CY2013 | PD-2013-01648

    Original file (PD-2013-01648.rtf) Auto-classification: Denied

    RECORD OF PROCEEDINGSPHYSICAL DISABILITY BOARD OF REVIEWNAME: XXXXXXXXXXXXXXCASE:PD-2013-01648BRANCH OF SERVICE: AIR FORCE BOARD DATE: 20140716 Separation Date: 20040608 I have carefully reviewed the evidence of record and the recommendation of the Board.

  • AF | PDBR | CY2014 | PD-2014-00957

    Original file (PD-2014-00957.rtf) Auto-classification: Denied

    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. Pre-Separation)ConditionCodeRatingConditionCodeRatingExam Diabetes Mellitus Type 1791320%Diabetes Mellitus I791320%20080923Other x 0 (Not In Scope)Other x1 Combined: 20%Combined: 20% *Derived from VA Rating Decision...

  • AF | PDBR | CY2011 | PD2011-00301

    Original file (PD2011-00301.docx) Auto-classification: Denied

    CI CONTENTION : The CI states: “After 6.5 years dedicated to the Service of the Air Force (4 at USAFA and 2.5 full-time active), I was determined unfit physically due to the onset of Type 1 Diabetes Mellitus. Unfitting Condition: DM Type I Condition . Therefore, the Board determined that neither condition could be argued as unfitting at the time of separation from Service and subject to separation rating.

  • AF | PDBR | CY2012 | PD2012-00736

    Original file (PD2012-00736.pdf) Auto-classification: Denied

    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. The PEB rated the CI’s Type 1 DM, requiring Insulin and restricted diet coded 7913 DM at 20%. The CI contended that he requires regulation of activity in order to control his DM.

  • AF | PDBR | CY2009 | PD2009-00630

    Original file (PD2009-00630.docx) Auto-classification: Approved

    Although no treatment record diagnosis of hypertension (HTN) was found in the records available to the Board, the MEB physical note indicated medication for blood pressure and the VA records indicated a diagnosis of HTN while in service in 2006 while on active duty. The Board deliberated what the CI’s HTN would rate under code 7101 (required for consideration in rating renal disease) and considered the evidence of likely in-service labile HTN, and that the VA HTN exam three months post...

  • AF | PDBR | CY2014 | PD-2014-01834

    Original file (PD-2014-01834.rtf) Auto-classification: Denied

    The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the VASRD standards to the unfitting medical condition at the time of separation. The Board reviews medical records and other available evidence to assess the fairness of PEB rating determinations, using the VASRD standards, based on ratable severity at the time of separation; and, to review those fitness determinations within its scope (as...