RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2011-02490 COUNSEL: HEARING DESIRED: YES _________________________________________________________________ APPLICANT REQUESTS THAT: His Servicemembers Group Life Insurance Traumatic Injury Protection (TSGLI) claim, dated 13 Oct 09, be approved. _________________________________________________________________ APPLICANT CONTENDS THAT: His disability qualifies him for TSGLI benefits because he was disabled for the number of days required by law. He was unable to perform activities of daily living (ADL) and required substantial assistance for a long period of time. His ADL was overlooked and constitutes an error in his records. His primary care physician was deployed when he first submitted his claim; however, he has since submitted the additional documentation provided by his physician. He continues to suffer significant impairment. In support of his request, the applicant submits copies of medical statements, a chart of events and impairments, his appeal of denial of benefits, letters from physicians, sworn statements and a traffic crash report. The applicant's complete submission, with attachments, is at Exhibit A. _________________________________________________________________ STATEMENT OF FACTS: In Jan 08, the applicant suffered a severe and life-threatening closed head injury which resulted in a traumatic brain injury. A review in Lieu of Medical Evaluation Board (MEB), dated 1 Jun 09, stated although the applicant made a remarkable recovery considering the magnitude of the trauma, he had an MEB processed in June of 08 for a refractory post-traumatic diabetes insipidus requiring Desamino-D-arginine vasopressin (DDAVP) therapy. It was recommended he continue DDAVP three times a day for the indefinite future with an annual endocrinology follow-up in Oct 09. On 31 Dec 09, the applicant was discharged for retirement. He served 27 years and 1 month on active duty. The remaining relevant facts pertaining to this application, extracted from the applicant’s military records, are contained in the letter prepared by the appropriate office of the Air Force at Exhibit C. _________________________________________________________________ AIR FORCE EVALUATION: HQ AFPC/DPWC recommends denial. On 11 Nov 09, DPWC received the applicant’s TSGLI claim for scheduled loss due to his inability to perform five of six (5 of 6) ADL for thirty (30) days due to Traumatic Brain Injury (TBI). The claim was forwarded to the Air Force medical representative (USAFSAM/OEHT) for assessment. USAFSAM/OETH concluded the applicant did not meet the TSGLI eligibility criteria. DPWC disapproved the applicant’s claim based on the medical assessment. On 25 Jun 10, the applicant appealed the denial of the claim and submitted additional documentation in support of his claim. DPWC forwarded the new claim to USAFSAM/OETH for assessment; however, the claim was again denied stating the applicant did not meet the TSGLI eligibility criteria. As part of the appeal process, the claim and medical documentation was reviewed by a physician assigned to AFPC/DPSD who also agreed the applicant did not meet the criteria for TSGLI payment. DPWC notes the applicant’s claim and available medical documentation was reviewed by two independent physicians. The physicians stated the applicant’s condition following his traumatic injury did not meet the TSGLI payment criteria as outlined in the TSGLI Procedures Guide, dated 23 May 11. The complete DPWC evaluation, with attachments, is at Exhibit C. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: The applicant did not provide the nursing notes for reconsideration of the TSGLI claim because he did not feel the notes provided sufficient detail to corroborate the life-altering event in his personal and professional life. The applicant also indicated he would not submit further information and accepts DPWC’s decision as a final denial of benefits. The applicant’s complete submission 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 timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. We took notice of the applicant's complete submission in judging the merits of the case; however, we agree with the opinion and recommendation of the Air Force office of primary responsibility and adopt its rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. 4. The applicant's case is adequately documented and it has not been shown that a personal appearance with or without counsel will materially add to our understanding of the issue involved. Therefore, the request for a hearing is not favorably considered. _______________________________________________________________ THE BOARD DETERMINES THAT: The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that the application will only be reconsidered upon the submission of newly discovered relevant evidence not considered with this application. _________________________________________________________________ The following members of the Board considered this application in Executive Session on 20 Mar 12, under the provisions of AFI 36- 2603: , Panel Chair , Member , Member The following documentary evidence was considered in AFBCMR BC- 2011-02490: Exhibit A. DD Form 149, dated 17 Jun 11, w/atchs. Exhibit B. Applicant's Master Personnel Records. Exhibit C. Letter, HQ AFPC/DPWC, undated. Exhibit D. Letter, SAF/MRBR, dated 19 Aug 11. Exhibit E. Letter, Applicant, dated 15 Sep 11. Panel Chair