AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS 

RECORD OF PROCEEDINGS 

 

   

 

 

 
 

 

 
 
 

 

 
 
 

 

 
 
   

   
XXXXXXX 

 

HEARING DESIRED:  NO 

DOCKET NUMBER:  BC-2011-04080 
  
COUNSEL:  NONE 

IN THE MATTER OF: 
 
 
 
 
 
 
________________________________________________________________ 
 
APPLICANT REQUESTS THAT: 
 
Her records be corrected to show that she was disability retired 
with a 100 percent rating, rather that separated, with severance 
pay. 
 
________________________________________________________________ 
 
APPLICANT CONTENDS THAT: 
 
At  the  time  of  her  separation,  the  Air  Force  rated  her 
condition,  i.e.,  type  I  diabetes  mellitus,  at  20  percent, 
despite  the  fact  that  she  was  on  insulin;  whereas,  the 
Department  of  Veterans  Affairs  (DVA)  rated  her  condition  at  40 
percent  immediately  following  her  separation,  which  was 
subsequently increased to 60 percent with unemployability due to 
type I brittle diabetes mellitus. 
 
In  view  of  the  DVA  rating  decisions  and  the  severity  of  her 
condition, the disability rating awarded by the Air Force should 
have  been  higher  and  she  should  have  been  retired  by  reason  of 
physical disability.  She fully understands the requested change 
to  her  record  will  not  result  in  the  award  of  any  additional 
monies. 
 
In support of the appeal, the applicant submits a copy of her DD 
Form  214,  Certificate  of  Release  or  Discharge  from  Active  Duty 
and a 21 July 2010 DVA rating decision. 
 
The  applicant’s  complete  submission,  with  attachments,  is  at 
Exhibit A. 
 
________________________________________________________________ 
 
STATEMENT OF FACTS: 
 
The  applicant  is  a  former  enlisted  member  of  the  Regular  Air 
Force,  who  was  disability  discharged,  with  entitlement  to 
severance  pay  on  30  June  1993,  based  on  the  diagnosis  of  type  I 

 

 

 

 

diabetes  mellitus1  (insulin  dependent),  with  a  compensable 
disability rating of 20 percent. 
 
On  1  July  1993,  the  DVA  awarded  her  a  combined  compensable 
disability  rating  of  60  percent  for  type  I  diabetes  mellitus, 
with  peripheral  neuropathy,  diabetic  retinopathy  and  cataracts, 
rated  at  40  percent;  and  abdominal  hysterectomy,  with  right 
salpingo-oophorectomy, rated at 30 percent.   
 
On  24  November  1993,  the  DVA  awarded  her  a  combined  compensable 
disability  rating  of  100  percent  for  type  I  diabetes  mellitus, 
with  peripheral  neuropathy,  diabetic  retinopathy  and  cataracts, 
rated  at  100  percent;  and  abdominal  hysterectomy,  with  right 
salpingo-oophorectomy, rated at 30 percent. 
 
On  1  March  1994,  the  DVA  awarded  her  a  combined  compensable 
disability  rating  of  70  percent  for  type  I  diabetes  mellitus, 
with  peripheral  neuropathy,  diabetic  retinopathy  and  cataracts, 
rated  at  60  percent;  and  abdominal  hysterectomy,  with  right 
salpingo-oophorectomy,  rated  at  30  percent.    In  addition,  she 
was granted individual unemployability. 
 
On  12  March  1995,  the  DVA  awarded  her  a  combined  compensable 
disability rating of 100 percent under Title 38, Code of Federal 
Regulations,  Section  4.30,  for  convalescence  of  abdominal 
hysterectomy, with right salpingo-oophorectomy. 
 
On  20  March  1995,  the  DVA  awarded  her  a  combined  compensable 
disability  rating  of  100  percent  for  type  I  diabetes  mellitus, 
with  peripheral  neuropathy,  diabetic  retinopathy  and  cataracts, 
rated  at  70  percent;  and  abdominal  hysterectomy,  with  right 
salpingo-oophorectomy,  rated  at  100  percent;  and  mitral  valve 
prolapse, with tachy arrhythmia, rated at 10 percent. 
 
On  1  May  1995,  the  DVA  awarded  her  a  combined  compensable 
disability  rating  of  80  percent  for  type  I  diabetes  mellitus, 
with  peripheral  neuropathy,  diabetic  retinopathy  and  cataracts, 
rated  at  60  percent;  and  abdominal  hysterectomy,  with  right 
salpingo-oophorectomy,  rated  at  50  percent;  and  mitral  valve 
prolapse, with tachy arrhythmia, rated at 10 percent. 
 
Pursuant  to  a  favorably  considered  AFBCMR  application  (BC-1996-
01249),  a  Memorandum  for  the  Chief  of  Staff,  dated  13  January 
1998,  was  issued  correcting  the  applicant’s  records  to  reflect 
that she was not discharged on 30 June 1993, but was found unfit 
based  on  the  diagnosis  of  diabetes  mellitus,  moderately  severe, 
under  the  Veterans  Affairs  Schedule  for  Rating  Disabilities 

                     
1 A condition in which the pancreas produces little or no insulin, unlike type II 
where the body either produces insufficient amounts of insulin or the cells ignore the 
insulin. Ref, MayoClinic.com 
 

 

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(VASRD)  Code  7913,  rated  at  40  percent,  and  on  1  July  1993,  her 
name was placed on the Temporary Disability Retired List (TDRL). 
 
In  view  of  the  fact  that  in  accordance  with  law  the  maximum 
period  an  individual  may  remain  on  the  TDRL  is  5  years,  her 
reevaluation while on the TDRL was expedited. 
 
On  12  March  1998,  she  was  reevaluated  and  an  Informal  Physical 
Evaluation  Board  (IPEB)  recommended  that  she  be  discharged  with 
severance  pay,  with  a  compensable  disability  rating  of  20 
percent,  based  on  the  diagnosis  of  diabetes  mellitus  (insulin 
dependent).    Although  not  found  to  be  unfitting,  the  IPEB  also 
noted  that  even  if  her  mitral  valve  prolapse,  which  was 
diagnosed  while  she  was  on  the  TDRL,  had  been  worse  it  still 
would not have been ratable or compensable. 
 
On  3  April  1998,  she  concurred  with  the  recommended  findings  of 
the IPEB. 
 
Effective  30  April  1998,  she  was  removed  from  the  TDRL  and 
disability  discharged,  with  entitlement  to  severance  pay,  based 
on the diagnosis of diabetes mellitus (insulin dependent) with a 
compensable disability rating of 20 percent. 
 
On  22  April  2008,  the  DVA  awarded  her  a  10  percent  rating  for 
gastro  paresis  associated  with  diabetes  mellitus,  with 
peripheral neuropathy, diabetic retinopathy and cataracts. 
 
A  DVA  Rating  Decision,  dated  21  July  2010,  indicates  the 
following  conditions  were  neither  service-connected  nor  subject 
to compensation: 
 
 
 
 
 
 

Endometriosis   

No diagnosis 

Condition  

Reason(s) 

VASRD 

7629  

8100  

 

 

 

Not incurred/caused by 
service 

Migraine or other    
chronic headaches 
 
 
Post-traumatic Stress 
Disorder (Personal   
Trauma/Assault  
 

9411  
 
 
 
 

9432  
 
 
 
 

Bipolar Disorder 
(also claimed as 
Depression) 

Not incurred/caused by 
service 
 

 
 
 
 
 
 
 
 
In  accordance  with  the  VASRD,  the  following  ratings  are 
appropriate  for  diabetes  mellitus  under  code  7913,  for  the 
corresponding levels of severity: 
 
 
100  percent  -  Requiring  more  than  one  daily  injection  of 
insulin,  restricted  diet,  and  regulation  of  activities 
(avoidance 
recreational 

Not incurred/caused by 
service 
 

occupational 

strenuous 

and 

 
 
 

of 

 

 

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20  percent  –  Requiring  insulin  and  restricted  diet  or  oral 

10 percent – Manageable by restricted diet only. 

40  percent  –  Requiring  insulin,  restricted  diet,  and 

activities)  with  episodes  of  ketoacidosis  or  hypoglycemic 
reactions  requiring  at  least  three  hospitalizations  per  year  or 
weekly  visits  to  a  diabetic  care  provider,  plus  either 
progressive  loss  of  weight  and  strength  or  complications  that 
would be compensable if separately evaluated. 
 
 
60  percent  –  Requiring  insulin,  restricted  diet,  and 
regulation  of  activities  with  episodes  of  ketoacidosis  or 
hypoglycemic reactions requiring one or two hospitalizations  per 
year  or  twice  a  month  visits  to  a  diabetic  care  provider,  plus 
complications  that  would  not  be  compensable  if  separately 
evaluated. 
 
 
regulation of activities. 
 
 
hypoglycemic agent and restricted diet. 
 
 
 
All  compensable  complications  of  diabetes  should  be  evaluated 
separately  unless  they  are  part  of  the  criteria  used  to  support 
a 100 percent evaluation. 
 
________________________________________________________________ 
 
AIR FORCE EVALUATION: 
 
The  Senior  AFBCMR  Medical  Advisor  recommends  correcting  the 
applicant’s records to show that at the time of her removal from 
the  TDRL,  she  was  permanently  retired  by  reason  of  physical 
disability with a 40 percent rating, rather than discharged with 
severance  pay.    It  is  reasonable  to  consider  granting  such 
relief after collective consideration of the corrections actions 
by  the  Board  in  1998,  the  uncertain  evidence  that  her  brittle 
diabetes  has  actually  been  stabilized  on  insulin  in  1998,  the 
implicit  risks  for  continued  hypoglycemic  episodes  associated 
with  heavy  physical  activities  and/or  the  brittleness  of  her 
diabetes  due  to  her  nutritional  status,  and  the  inclusion  of 
retinopathy  and  peripheral  neuropathy  as  co-morbid  medical 
conditions  in  the  July  and  November  1993  and  March  1994  DVA 
rating  decisions  and  their  probable  co-existence  at  the  time  of 
the  1998  TDRL  re-evaluation.    The  evolution  of  the  applicant’s 
diabetes  was  initially  associated  with  her  pregnancy  in  late 
1991  and  early  1992  at  which  time  it  was  coined  as  gestational 
diabetes  following  her  delivery.    However,  by  June  1992,  her 
glucose  levels  became  erratic  and  oral  hypoglycemic  failed  to 
keep  it  under  control,  warranting  insulin  treatments,  which 
resulted  in  processing  through  the  Disability  Evaluation  System 
(DES),  resulting  in  her  discharge  with  severance  pay,  rated  at 
20  percent.    Three  years  later,  she  appealed  to  the  AFBCMR  and 
was successful in getting her records corrected to show that she 
was  placed  on  the  TDRL,  rather  than  discharged.    She  now  seeks 

 

4 

 

 

to  be  permanently  retired  by  reason  of  physical  disability  with 
at  least  a  40  percent  rating,  based  on  DVA  rating  decisions; 
none  of  which  well  below  40  percent.    Claims  for  a  higher 
rating,  based  on  “regulation  of  activities,”  are  common  and 
often  unsupported  by  objective  medical  evidence.    Most 
contentious  for  the  rating  agency  is  the  fact  that  38  CFR  does 
not  define  which  specific  “activities”  would  fall  under  this 
criterion.    However,  the  recently  published  DVA  Diagnostic 
Benefits  Questionnaire  for  Diabetes  does  clarify  the  reason  for 
“regulation  of  activities”  as  for  the  prevention  of 
hypoglycemia.    In  the  applicant’s  case,  although  she  has  a 
documented  history  of  episodes  of  recurrent  hypoglycemia,  at 
least  one  endocrinologist  has  indicated  this  may  have  been  due 
to  her  evening  insulin  dosage.    Nevertheless,  her  risk  of 
hypoglycemia  was  mentioned  as  a  risk  factor  for  insulin-
dependent  diabetes  in  2  April  1993.    As  such,  the  question 
before the Board is whether the medical evidence, at the time of 
her  removal  from  the  TDRL  in  April  1998  warranted  retaining  the 
40  percent  disability  rating  and  permanent  disability 
retirement.    The  reason  for  the  initial  disparities  in  the 
rating  determinations  between  the  DVA  and  AF,  based  upon 
determinations  made  on  the  same  body  of  medical  evidence,  are 
unclear.    However,  it  is  clear  that  after  the  AFBCMR  review,  it 
was  decided  that  her  condition  was,  or  should  have  been, 
interpreted  as  more  severe,  that  it  had  not  stabilized,  and 
justified her placement on the TDRL.  The DVA’s subsequent award 
of  at  least  a  40  percent  rating,  effective  the  day  after  her 
separation,  is  not  proof  that  at  the  time  of  her  separation  her 
condition  was  that  severe,  as  the  rating  decision  could  have 
been  rendered  months,  if  not  years  later.    However,  based  on 
subsequent  medical  evidence,  i.e.,  AF,  TDRL,  and  DVA,  the 
applicant  was  suffering  from  peripheral  neuropathy  and  possibly 
retinopathy,  at  least  by  1998;  such  that  if  rated  separately 
would  have  pushed  her  over  the  threshold  for  permanent 
disability  retirement,  when  combined  with  the  basic  20  percent 
rating  for  baseline  insulin-dependent  diabetes  mellitus.    The 
DVA  likely  considered  the  presence  of  these  co-morbid2  or 
associated  sequelae3  of  her  diabetes  in  its  disability  rating 
determinations,  notwithstanding  the  alleged  regulation  of 
activities; whereas, the Air Force did not. 
 
The  complete  Senior  AFBCMR  Medical  Advisor’s  evaluation,  with 
attachments, is at Exhibit C. 
 
________________________________________________________________ 
 
 
 
 

                     
2 Two or more diseases/conditions occurring simultaneously. Ref, MedicineNet.com 
 
3 A condition that is an aftereffect of a previous disease or injury. Ref, Merriam-
Webster Dictionary 

 

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION: 
 
While on the TDRL she suffered from complications of her brittle 
diabetes  mellitus,  i.e.,  peripheral  neuropathy,  diabetic 
neuropathy,  and  cataracts.    Although  peripheral  neuropathy, 
diabetic  neuropathy,  and  cataracts  are  not  compensable 
individually, gastro paresis, which was documented while she was 
on  the  TDRL,  is  compensable  by  itself.    She  was,  and  still 
remains,  a  brittle  diabetic  and  requires  21  units  of  Lantus 
insulin  twice  daily;  in  the  morning  and  at  night.   In  addition, 
her  mealtime  insulin  requirements  are  on  a  sliding  scale  which 
varies from 0 to 18 units per Novolog insulin shot three times a 
day,  for  a  total  of  5  insulin  shots  a  day.    Further,  within  the 
last  12-month  period,  she  was  hospitalized  on  three  occasions 
for hypoglycemic reactions, with glucose levels less than 30 and 
seen  in  the  emergency  room  (ER)  on  ten  occasions  with  blood 
glucose  levels  in  excess  of  500.    In  an  effort  to  avoid 
additional  episodes  of  diabetic  ketoacidosis,  her  doctors  have 
directed  that  she  report  to  the  ER  if  her  blood  glucose  levels 
are  over  450  and  advised  not  to  participate  in  any  type  of 
exercise  if  over  250.  Even  in  a  controlled  environment,  efforts 
to  control  her  blood  glucose  levels  were  unsuccessful.    Her 
latest  hemoglobin  A1c  (HbA1c)4  level,  dated  28  June  2012,  was 
9.4,  with  a  normal  reading  being  an  average  of  6.0.    Due  to  her 
condition,  she  is  currently  rated  100  percent  unemployable  by 
the DVA.  In view of this and given her widely fluctuating blood 
glucose  levels  that  is  well  documented  in  her  medical  records, 
her  disability  retirement,  with  a  100  percent  rating,  is 
justified. 
 
In  further  support  of  her  appeal,  the  applicant  submits  a  copy 
of  VASRD  7913  (previously  provided  by  the  Senior,  BCMR  Medical 
Advisor),  page  one  of  the  21  July  2010  DVA  rating  decision 
(previously provided in its entirety with original application), 
and  instruction  sheet  from  her  physician  concerning  Novolog 
dosages based on the sliding scale of her glucose levels. 
 
The  applicant’s  complete  response,  with  attachment,  is  at 
Exhibit E. 
 
________________________________________________________________ 
 
THE BOARD CONCLUDES THAT: 
 
1.  The  applicant  has  exhausted  all  remedies  provided  by 
existing law or regulations. 
 
2.  The  application  was  not  timely  filed;  however,  it  is  in  the 
interest of justice to excuse the failure to timely file. 
 

                     
4 HbA1c levels represent blood sugar attached to red blood cells for the past two-
three months or the lifespan of the cell.  Ref, MayoClinic.com 

 

6 

 

 

3.  Sufficient  relevant  evidence  has  been  presented  to 
demonstrate  the  existence  of  error  or  injustice  to  warrant 
correcting  the  applicant’s  records  to  indicate  that  at  the  time 
of  her  removal  from  the  TDRL,  she  was  permanently  retired  by 
reason  of  physical  disability  with  a  40  percent  rating,  rather 
than  discharged  with  severance  pay.    The  Senior  AFBCMR  Medical 
Advisor  has  thoroughly  reviewed  the  evidence  of  record  and 
provided  an  extensive  evaluation  of  the  merits  of  this  case,  in 
which  he  ultimately  recommends  that  she  be  permanently  retired 
by  reason  of  physical  disability,  with  a  40  percent  rating, 
retroactive  to  her  1998  separation.    We  agree  with  his  opinion 
and  recommendation,  which  is  supported  by  the  evidence  of 
record,  and  adopt  his  rationale  as  the  basis  for  our  conclusion 
the  applicant’s  records  should  be  corrected  to  the  extent 
indicated below.  However, we are not convinced that at the time 
of  her  removal  from  the  TDRL  in  April  1998,  the  severity  of  her 
condition  justified  a  rating  greater  than  40  percent.    It 
appears  the  applicant  believes  the  DVA's  subsequent  decision  to 
award  her  a  total  compensable  disability  rating  of  100  percent, 
justifies that she should have received a higher rating from the 
Air  Force.    However,  this  is  not  the  case.    In  this  regard,  we 
note  that  although  the  Air  Force  is  required  to  rate 
disabilities  in  accordance  with  the  DVA  Schedule  for  Rating 
Disabilities,  the  DVA  operates  under  a  totally  separate  system 
with  a  different  statutory  basis.    Under  Title  35  of  the  United 
States  Code,  the  DVA  rates  for  any  and  all  service-connected 
conditions,  to  the  degree  they  interfere  with  future 
employability,  without  consideration  of  whether  the  conditions 
rendered  the  veteran  unfit  for  continued  military  service.  
Under  Title  10,  the  Air  Force  rates  only  those  unfitting 
conditions  that  are  the  cause  of  the  termination  of  a  member’s 
military  career  and  then  based  on  the  degree  of  severity  at 
final disposition.  In the applicant’s case, the Air Force found 
the  only  unfitting  condition  preventing  her  from  continued 
military service was diabetes mellitus; whereas, the DVA awarded 
her a compensable disability rating for several conditions that, 
although service-connected, did not render her unfit, to include 
gastro paresis, retinopathy, and peripheral neuropathy. 
 
________________________________________________________________ 
 
THE BOARD RECOMMENDS THAT: 
 
The  pertinent  military  records  of  the  Department  of  the  Air 
Force  relating  to  APPLICANT,  be  corrected  to  show  that  at  the 
time  of  her  removal  from  the  Temporary  Disability  Retired  List 
on  30  April  1998,  her  condition  was  moderately  severe  and  rated 
at  40  percent,  rather  than  20  percent,  and  she  was  not 
disability  discharged  with  severance  pay  but  on  1  May  1998,  her 
name was placed on the Permanent Disability Retired List. 
 
________________________________________________________________ 
 

 

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The  following  members  of  the  Board  considered  AFBCMR  Docket 
Number  BC-2011-04080  in  Executive  Session  on  10  October  2012, 
under the provisions of AFI 36-2603: 
 

 
 
 

Panel Chair 
Member 
Member 

 
All  members  voted  to  correct  the  records,  as  recommended.    The 
following documentary evidence was considered: 
 
     Exhibit A.  DD Form 149, dated 12 Oct 11, w/atchs. 
     Exhibit B.  Applicant's Master Personnel Records. 
     Exhibit C.  Letter, BCMR Medical Consultant, 
 
     Exhibit D.  Electronic Mail, SAF/MRBR, dated 8 Aug 12. 
     Exhibit E.  Letter, Applicant, dated 11 Aug 12, w/atchs. 
 
 
 
 
                                    
                                   Panel Chair 
 

  dated 1 Aug 12, w/atchs. 

 

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