Search Decisions

Decision Text

AF | PDBR | CY2014 | PD-2014-02130
Original file (PD-2014-02130.rtf) Auto-classification: Denied
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME: XXXXXXXXXXXXXXXXXXXX       CASE: PD-2014-02130
BRANCH OF SERVICE: AIR FORCE     BOARD DATE: 20150120
SEPARATION DATE: 20030825


SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E-5 (Education and Training Craftsman) medically separated for diabetes mellitus (DM) Type I. The DM condition could not be adequately rehabilitated to meet the physical requirements of her Air Force Specialty (AFS) or satisfy physical fitness standards. She was issued a P4 profile and referred for a Medical Evaluation Board (MEB). “Diabetes Mellitus type I and II; insulin dependent” was forwarded to the Physical Evaluation Board (PEB) IAW AFI 48-123. No other conditions were submitted by the MEB. The Informal PEB (IPEB) adjudicated “Diabetes Mellitus type I requiring insulin and poor compliance with treatment” as unfitting, rated 20%, referencing application of DOD guidelines and the VA Schedule for Rating Disabilities (VASRD). The CI was previously found Fit for Duty by the PEB three times. The CI non-concurred but later concurred with the PEB findings and recommendations and was medically separated.


CI CONTENTION: “Please consider all conditions.”


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 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 :

Service IPEB – Dated 20030505
 VA - (~4 Mos. Post-Separation)
Condition
 Code Rating Condition Code Rating Exam
Diabetes Mellitus Type I 7913 20% Diabetes Mellitus 7913 20% 20031212
Diabetic Retinopathy w/ Lattice Degeneration 6007 10% 20031221
Diabetic Peripheral Neuropathy, LLE 8599-8520 10% 20031212
Diabetic Peripheral Neuropathy, RLE 8599-8520 10% 20031212
Other x 0 (Not in Scope)
 Other x 11
Rating: 20%
 Combined: 60%
Derived from VA Rating Decision (VA RD ) dated 200 40318 ( most proximate to date of separation [ DOS ] ).


ANALYSIS SUMMARY:

Type I Diabetes Mellitus. Initially diagnosed with gestational (pregnancy induced) DM in 1991, the CI’s blood sugars never returned back to normal after giving birth and her treatment remained with oral medication for a mixed condition of Type I and II DM. Eventually, in 1999 she was definitively diagnosed with uncontrolled Type I DM and treated with insulin and diet without activity restrictions. The service treatment record (STR) did not indicate any episodes of ketoacidosis, hypoglycemic episodes requiring hospitalizations, or neurosensory/vascular complications to any extremity. She did develop diabetic retinopathy diagnosed in 2002. The CI was issued a permanent profile that restricted her mobility and duty assignments. The commander’s statement reiterated her DM condition as having “…no negative impact on her ability to perform” according to her AFS or to “…deploy or mobilize.” The vast majority of the STR encounters focused upon laboratory analysis and the regulation of her prescribed insulin.

Neither the MEB on 11 February 2003 nor the VA Compensation and Pension (C&P) on 12 December 2003 noted findings on the physical examination that pertain to the VASRD rating of the diabetes condition to include any abnormal neurosensory parameters in the lower extremities. Although the C&P noted a history of “tingling in her feet,” the time period identified for such symptoms were nearly 3 years prior. Additionally, the VA exam noted the diagnosis of peripheral neuropathy secondary to DM as per findings from previously electro-diagnostic studies; however, such studies were not in evidence within the case file or historically dated as to their occurrence. There was no evidence of diabetic neuropathy in the feet prior to separation. There was no laboratory evidence that ketoacidosis or hypoglycemia were manifested at any time since her original diagnosis. Neither the physical profile nor commander’s statement, as presented above, provided evidence that any regulation of routine activities were imposed by the DM condition. The clinical evidence at that time remained consistent with a 20% rating IAW VASRD §4.120. All evidence considered there is not reasonable doubt in the CI’s favor to support a change from the PEB’s rating decision for the DM condition at the time of separation.

VASRD DM guidelines allow additional ratings of diabetes complications if such conditions are found to be separately unfitting. The Board considered both retinopathy and peripheral neuropathy as additional conditions for impairment ratings, but members agreed that the requisite link of either condition with functional impairment was not in evidence.


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 §4.119, 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 20140505, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans Affairs Treatment Record








                 
XXXXXXXXXXXXXXXXXXXX
President
DoD Physical Disability Board of Review


 SAF/MRB
1500 West Perimeter Road, Suite 3700
Joint Base Andrews, MD 20762
Dear XXXXXXXXXXXXXXXXXXXX :

 Reference your application submitted under the provisions of DoDI 6040.44 (Title 10 U.S.C. § 1554a), PDBR Case Number PD-2014-02130.
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,





XXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings

Similar Decisions

  • AF | PDBR | CY2013 | PD-2013-01802

    Original file (PD-2013-01802.rtf) Auto-classification: Denied

    The diabetes condition, characterized as “diabetes mellitus, type 2, requiring medication and insulin for control,” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The MEB also identified and forwarded two other conditions.The InformalPEB adjudicated “diabetes mellitus, type 2, requiring insulin and restricted diet”as unfitting, rated 20%, with application of the VA Schedule for Rating Disabilities (VASRD).The remaining two conditions were determined to be not...

  • AF | PDBR | CY2012 | PD-2012-00911

    Original file (PD-2012-00911.pdf) Auto-classification: Denied

    The MEB forwarded diabetes mellitus type I, requiring Insulin to the Physical Evaluation Board (PEB). Diabetes Mellitus Requiring Insulin Condition. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: VASRD CODE RATING 7913 COMBINED 20% 20% Diabetes Mellitus Requiring Insulin UNFITTING CONDITION The following documentary evidence was considered: Exhibit A. DD Form 294, dated 20120606,...

  • AF | PDBR | CY2014 | PD-2014-02137

    Original file (PD-2014-02137.rtf) Auto-classification: Denied

    The “diabetes mellitus, type 1 (insulin dependent)” condition was forwarded to the Physical Evaluation Board (PEB) as not meeting retention standards IAW AR 40-501.The MEB also identified and forwarded “hyperlipidemia” as meeting retention standards, for further PEB adjudication.The Informal PEB adjudicated “insulin dependent diabetes” as unfitting, rated 20%. The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for...

  • AF | PDBR | CY2013 | PD-2013-01132

    Original file (PD-2013-01132.rtf) Auto-classification: Approved

    Any conditions outside the Board’s scope of review may be eligible for consideration by the Board for Correction of Military Records. It is appropriately coded 7913, and IAW VASRD §4.119, meets criteria for the 60% rating level due to requiring insulin, restricted diet, and regulation of activities; with an episode of ketoacidosis, which required hospitalization, plus complications that would not be compensable if separately evaluated. In the CI’s treatment record, there was not sufficient...

  • AF | PDBR | CY2012 | PD 2012 01036

    Original file (PD 2012 01036.txt) Auto-classification: Denied

    The VA Rating Decision (VARD) of June 2005 indicated a civilian medical report indicating fluctuating blood sugars, increased insulin requirements and required regulation of activities due to diabetes. The VA increased their rating to 40% effective May 2005 (30 months after separation) based on that evidence. RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows: UNFITTING CONDITION VASRD...

  • AF | PDBR | CY2013 | PD2013 01127

    Original file (PD2013 01127.rtf) Auto-classification: Denied

    The condition, characterized as “diabetes type I requiring insulin” was forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501. The Informal PEB adjudicated “diabetes mellitus type I”as unfitting, rated 20%.The remaining condition was determined to be not unfitting and not rated.The CI made no appeals, and was medically separated. RECOMMENDATION : The Board, therefore, recommends that there be no recharacterization of the CI’s disability and separation determination, as follows:

  • AF | PDBR | CY2014 | PD-2014-01897

    Original file (PD-2014-01897.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. 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...

  • AF | PDBR | CY2009 | PD2009-00572

    Original file (PD2009-00572.docx) Auto-classification: Denied

    This condition is well-documented and associated with the CI’s diabetes. In the matter of the left knee condition or any other medical conditions eligible for Board consideration, the Board unanimously agrees that it cannot recommend any findings of unfit for additional rating at separation. I have carefully reviewed the evidence of record and the recommendation of the Board.

  • 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-2013-02244

    Original file (PD-2013-02244.rtf) Auto-classification: Denied

    IAW DoDI 6040.44, the Board’s authority is limited to making recommendations on correcting disability determinations. RATING COMPARISON : Service IPEB – Dated 20091009VA* - Based on Service Treatment Records (STR)ConditionCodeRatingConditionCodeRatingExam Diabetes Mellitus, Type I791320%Diabetes Mellitus, Type I791320%**STROther x 1 (Not in Scope)Other x 0STR Combined: 20%Combined: 20% *Derived from VA Rating Decision (VARD) dated 20100226 (most proximate to date of separation (DOS)). The...