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AF | PDBR | CY2014 | PD-2014-00957
Original file (PD-2014-00957.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXX         CASE: PD-2014-00957
BRANCH OF SERVICE: Army  BOARD DATE: 20141212
SEPARATION DATE: 20081031


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty W-2 (AH 64D Attack Helicopter Pilot) medically separated for diabetes. The condition could not be adequately rehabilitated to meet the physical requirements of his Military Occupational Specialty. He was issued a permanent P3 profile and referred for a Medical Evaluation Board (MEB). The Informal PEB adjudicated diabetes mellitus (DM), Type 1 as unfitting rated 20% with likely application of the VA Schedule for Rating Disabilities (VASRD). The CI made no appeals and was medically separated.


CI CONTENTION: “I completed 14 yrs of service and was diagnosed with a condition that destroyed my career. Only having a 20% rating does not seem correct. Also, there should have been a percentage increase for Restricted Diet and exercise. I do not know of any diabetic that does not qualify on these. I lost my very bright and promising career to this disease, to which I have had to start all over again. I simply do not agree with a 20% rating.” His complete submission is at Exhibit A.


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.


R ATING COMPARISON :

Service IPEB – Dated 20080828
 VA* - (1.3 Mos. Pre-Separation)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus Type 1 7913 20% Diabetes Mellitus I 7913 20% 20080923
Other x 0 (Not In Scope)
 Other x 1
Combined: 20%
 Combined: 20%
* Derived from VA Rating Decision (VA RD ) dated 200 8110 3 (most proximate to date of separation (D OS ) )



ANALYSIS SUMMARY:

Diabetes Mellitus Type 1. The narrative summary (NARSUM) noted the CI developed clinical signs of DM with elevated blood glucose levels while in Iraq. He was treated with glucose and insulin and returned to CONUS. The diagnosis of DM was confirmed with blood testing (elevated HGB A1C) and treatment with oral hypoglycemic medication, injected insulin and dietary regulation was initiated. On his regimen, blood sugar levels were controlled with no subsequent diabetic episodes. A permanent profile, issued on 18 August 2008, allowed the CI to: run, walk, bicycle and swim at his own pace and distance; to take the unrestricted Army physical fitness test; and to participate in all military functional activities and body building exercises without restriction; except the “moving a 48 pound fighting load at least two miles.” At the MEB/NARSUM evaluation on 9 August 2008, 2 months prior to separation, the CI reported no symptoms of DM. The MEB physical exam was reported as normal demonstrating no complications of the DM condition.

At the VA Compensation and Pension exam performed on 23 September 2008, a month prior to separation, the CI reported being on a restricted diet and having no symptoms of DM or diabetic reactions. He noted no required avoidance of strenuous activities to prevent diabetic complications. The physical examination was normal with no sequellae of DM identified.

The Board directed attention to its rating recommendation based on the above evidence. The PEB and VA both rated the DM condition at 20%, coded 7913 (Diabetes Mellitus), IAW §4.119. This rating requires use of insulin and dietary restriction. A higher rating of 40% requires insulin use, dietary restriction (regulated) and regulation of activity. The Board undertook to determine if the 40% rating was indicated for “regulation of activity.” The Board noted that VASRD §4.119, defines regulation of activity for a diabetic condition as “avoidance of strenuous occupational or recreational activities.” The Board reviewed the permanent profile of 18 August 2008 with no activity restrictions as noted above accept the “moving of a fighting load.” The Board agrees that the single restriction of not “moving a fighting load of 48 pounds,” in the presence the multiple non-restricted activities on the profile did not meet the requirement of “regulation of occupational and recreational activities.” The Board found no other prescriptions for restriction of activity by any treating health care provider in the record in evidence. The Board noted no episodes of recurrent hypoglycemia/hyperglycemia (abnormal low blood sugar/abnormal high blood sugar) or other diabetic complications related to any physical activity prior to separation. The Board unanimously agreed the record in evidence reflected no impairment in ordinary conditions of daily life, and no medically prescribed avoidance of strenuous activities to prevent activity-related complications of the diabetic condition, and, thus, could not recommend the 40% rating. The Board found no other appropriate codes for rating consideration and no pathway to a rating higher than 20% for the DM condition. 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 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 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.


The following documentary evidence was considered:

Exhibit A. DD Form 294, dated 20140219, 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 , AR20150008697 (PD201400957)

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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