IN THE CASE OF:	  

		BOARD DATE:	  25 March 2014

		DOCKET NUMBER:  AR20130008769 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests reconsideration of his earlier request to have his diabetes mellitus type II evaluated by a medical evaluation board (MEB) and a physical evaluation board (PEB).

2.  The applicant states that the PEB convened on 26 February 2008 was aware of his diagnosis for diabetes mellitus type II.  The Army knew of his diagnosis and should have referred him back through an MEB for a determination of whether he met retention standards for this medical condition and referral to a PEB if appropriate. 

3.  The applicant provides his Department of Veterans Affairs (VA) medical records.

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number AR20120001448 on 7 August 2012.

2.  The VA medical records he provided are new evidence that was not previously considered by the Board.

3.  He previously completed 1 year, 2 months, and 2 days of service in the North Carolina Army National Guard.  On 31 August 2000, he enlisted in the Regular Army.  On 3 May 2004, he immediately reenlisted.  He held military occupational specialty 68W (Health Care Specialist) for 7 years and 11 months.

4.  An MEB narrative summary, dictated on 21 December 2007, indicated his primary care manager initiated an MEB on 10 October 2007.  The summary
noted his past medical history of migraine headaches, gastroesophageal
reflux disease (GERD), and exercised-induced asthma.  The diagnosis for which he was undergoing an MEB was bilateral patellofemoral syndrome.

5.  On 24 January 2008, an MEB convened and determined his bilateral knee tendonitis was medically unacceptable under the provisions of chapter 3 of Army Regulation 40-501 (Standards of Medical Fitness).  His migraines were considered medically acceptable.  The MEB recommended he be referred to a PEB.  The findings and recommendation of the MEB were approved
on 19 February 2008.  There is no indication whether the applicant agreed with the findings and recommendation of the MEB.

6.  A PEB, convened on 26 February 2008, found the applicant unfit for duty for bilateral patellofemoral pain syndrome without neurologic abnormality.  The PEB stated his condition limited his ability to perform Army functional activities.  The PEB rated him as 20 percent disabled for this condition.  His migraine headaches, GERD, and exercised-induced asthma were not unfitting and not rated.  The PEB recommended a combined disability rating of 20 percent and that he be separated with severance pay if otherwise qualified.

7.  On 3 March 2008, the applicant concurred with the findings and recommendation of the PEB and waived his right to a formal hearing.  His PEB was approved by the Secretary of the Army on 20 March 2008.

8.  A Standard Form (SF) 600 (Chronological Record of Medical Care) from the Warrior Transition Unit Health Clinic at Fort Hood, TX, dated 21 March 2008, shows a diagnosis of hyperglycemia and he was placed on 10 units of insulin-glargine (Lantus) to be used as directed.  He was also provided education concerning use of insulin and education on the preparation and use of monitoring devices, including puncture (lancet) devices, and lancet disposal and control.

9.  A DA Form 3349 (Physical Profile), dated 21 March 2008, shows a  permanent P-3 profile for diabetes mellitus.  Block 2 of the form contains the codes E, F H, M.  According to the form, the applicant needed an MEB/PEB to determine if he met retention standards.  The profiling officer was a lieutenant colonel, family nurse practitioner.  However, the form does not contain an approving officer signature which is required to validate a profile.

10.  An SF 600 from the Warrior Transition Unit Health Clinic at Fort Hood, TX, dated 24 March 2008, documented a follow up examination with a diagnosis of diabetes mellitus.  It shows an increase of Lantus to 20 units daily.  Insulin glargine, human recombinant analog among his list of active medications.

11.  On 17 June 2008, he was discharged by reason of disability, severance pay, non-combat related under the provisions of Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation).  He completed
7 years, 9 months, and 17 days of net active service this period that was characterized as honorable.  His DD Form 214 (Certificate of Release or Discharge from Active Duty) contains the entry, "EXTENSION OF SERVICE WAS AT THE REQUEST AND FOR THE CONVENIENCE OF THE GOVERNMENT."

12.  A VA Compensation and Pension Examination, dated 25 March 2008, indicated the applicant was diagnosed with diabetes on 21 March 2008 and his current treatment was Lantus (insulin glargine), 20 units PM daily.  Follow up care in the diabetes clinic is not documented after the initial dosage change on 25 March 2008.

13.  A Compensation and Pension Examination for his eyes conducted by the VA, dated 14 May 2008, diagnosed him with variable refraction due to recently diagnosed and treated diabetes mellitus.

14.  The VA medical records he provided show insulin on his list of medications as early as 21 October 2008 up to 24 June 2013.  There are no additional pharmacy records showing an insulin prescription refill during active duty.

15.  On 18 March 2011, the Physical Disability Board of Review (PDBR) convened to review the applicant's disability rating accompanying his medical separation.  The PDBR unanimously recommended no change to the findings or recommendations of the applicant's PEB, dated 28 February 2008.  The PDBR noted it could not consider any conditions not listed on the PEB.

16.  Army Regulation 40-501, in effect at the time, provided information on medical fitness standards for induction, enlistment, appointment, retention, and related policies and procedures.  

	a.  Paragraph 3-11 (Endocrine and metabolic disorders) states diabetes mellitus, unless hemoglobin A1c can be maintained at less than 7% using only lifestyle modifications (diet, exercise) requires referral to an MEB.  

	b.  	Chapter 7 (Physical Profiling) stated the basic purpose of the physical profile serial system is to provide an index to the overall functional capacity of an individual.  It is used to assist the unit commander and personnel officer in their determination of what duty assignments the individual is capable of performing, and if reclassification action is warranted.  

		(1)  Four numerical designations (1-4) are used to reflect different levels of functional capacity in six factors (PULHES): P-physical capacity or stamina, U-upper extremities, L-lower extremities, H-hearing and ears, E-eyes, and S-psychiatric.  

		(2)  Numerical designator "3" under "P" indicates that an individual is unable to perform full effort except for brief or moderate periods.  

		(3)  Table 7-2, Profile Codes, provides the profile codes for block 2 of 
DA Form 3349.

* Code E:  No assignment to units requiring continued use 	of combat rations
* Code F:  No assignment to isolated areas where definitive 	medical care (U.S. Armed Forces hospital) is not available
* Code H:  No assignment where sudden loss of 	consciousness would be dangerous to self or others such 	as work on scaffolding, handling ammunition, vehicle 	driving, work near moving machinery
* Code M:  Limitations restricting exposure to high 	environmental temperature

17.  Army Regulation 635-40 establishes the Physical Disability Evaluation System (PDES) and sets forth the policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his or her office, grade, rank, or rating.  

	a.  It states commanders of medical treatment facilities (MTFs) who are treating Soldiers may initiate action to evaluate the Soldier’s physical ability to perform the duties of his or her office, grade, rank, or rating.  If the unfitness is of such a degree that a Soldier is unable to perform the duties of his office, grade, rank, or rating in such a way as to reasonably fulfill the purposes of his employment on active duty the commander will advise the Soldier’s commanding officer of the results of the evaluation and the proposed disposition.  If it appears the Soldier is not medically qualified to perform duty, the MTF commander will refer the Soldier to an MEB. 

	b.  MEBs are convened to document a Soldier’s medical status and duty limitations insofar as duty is affected by the Soldier’s status.  A decision is made as to the Soldier’s medical qualification for retention based on the criteria in Army Regulation 40-501, chapter 3.      

	c.  Paragraph 4-20f(2) states when additional medical evidence or an addendum to the MEB is received after the PEB has forwarded the case and the PEB determines that such evidence would change any finding or recommendation, the case will be recalled by the PEB and a new DA Form 199 (Physical Evaluation Board (PEB) Proceedings) issued.  Normal procedures apply following the preparation of a new DA Form 199.

DISCUSSION AND CONCLUSIONS:

1.  Although his PEB received final approval on 20 March 2008, he was not discharged until 17 June 2008.  He was diagnosed with diabetes mellitus prior to his discharge and he was taking insulin in March 2008.  The DA Form 3349, dated 21 March 2008, recommended he be referred to a MEB/PEB for diabetes mellitus.  However, there is no approving authority signature on the DA Form 3349.  Therefore, this form would be insufficient for referral to an MEB.

2.  There are no service medical records available for the period between 
24 March 2008 and 17 June 2008 showing continued treatment for diabetes mellitus or a requirement for the applicant to continue taking insulin.  Therefore, there is insufficient evidence to show he met the requirements of Army Regulation 40-501 for referral to an MEB.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF

________  ________  ________  GRANT PARTIAL RELIEF

________  ________  ________  GRANT FORMAL HEARING

___x____  ____x____  ____x___  DENY APPLICATION







BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case 
are insufficient as a basis to amend the decision of the ABCMR set forth in Docket Number AR20120001448, dated 7 August 2012.




      _______ _   _x______   ___
               CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.
ABCMR Record of Proceedings (cont)                                         AR20130008769



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ABCMR Record of Proceedings (cont)                                         AR20130008769



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