RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-05143 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: His claim for Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) be approved. ________________________________________________________________ APPLICANT CONTENDS THAT: On 1 May 11 while on foot patrol in Ghormach District, Faryab Province, Afghanistan, he was severely wounded when he suffered a gunshot wound to his lower abdomen. The bullet traveled through his small intestine causing severe trauma. He had three surgeries in Afghanistan including a small bowel resection. He was shot by a 7.62 caliber bullet from an insurgent’s weapon during a heavy and close range ambush. His medical records reflect that he did not require physical or stand-by assistance performing the three Activities of Daily Living (ADLs) that he claimed in his TSGLI application. This is incorrect and he required physical and stand-by assistance for more than one month due to his lack of mobility and severe pain. Nursing staff and doctors were not present whenever he would perform the three ADLs of transfer, bathe or dress. Only his wife and mother were present and after his release from the hospital, most of the three ADLs were completed in the hotel room under no medical supervision and the doctors and nurses were not fully aware of the assistance he required. On 9 May 11, he was discharged from Brooke Army Medical Center (BAMC) and stayed in lodging while he finished his rehabilitation and other medical appointments. He departed BAMC on 19 May 11 and headed home to Fort Carson, CO. He was on convalescent leave through 10 Jun 11, to recover from his injuries. While on convalescent leave, he still required the physical assistance of his wife. His wife who is a college student had to drop her classes to help him with his recovery since he needed her full attention 24 hours a day. This caused a financial strain since they had to pay for the classes out of pocket. In support of his request, the applicant provides copies of his TSGLI claim, AF Form 988, Leave Request/Authorization; his appeal letter, letters of support from his wife and mother, extracts from his medical records and various other documents associated with his requests. The applicant’s complete submission, with attachments, is at Exhibit A. ________________________________________________________________ STATEMENT OF FACTS: The applicant is a Joint Terminal Attack Controller (JTAC) and is on active duty in the Regular Air Force. According to his medical history and physical examination report dated 7 May 11, while deployed to Afghanistan, he sustained a gunshot wound to his left flank/abdomen. He was medevac’d to Bagram AB, Afghanistan, and had surgery for small bowel resection and abdominal closure. On 3 May 11, he was medevac’d to Landstuhl Regional Medical Center (LRMC). On 7 May 11, he arrived at BAMC. On 9 May 11, he was discharged. On 5 May 11, Emergency Family Member Travel Orders for his wife and daughter to travel from Colorado Springs, CO to BAMC were issued. According to the Air Force General Surgery Flight Patient Restriction Form dated 18 May 11, the applicant was placed on a waiver through 1 Jul 11. His physician wrote that he could not lift more than 10 pounds until 15 Jun 11 and that he was not recommended to deploy for 3 months to allow recovery through mid-Aug 11. According to AF Form 988 dated 18 May 11, he was on convalescent leave from 19 May to 10 Jun 11. In his TSGLI application dated 19 Jan 12, he states that from 30 Apr to 1 Jun 11, he was unable to independently perform the three ADLs of bathing, dressing and transferring and required the assistance of his wife to perform these three ADLs. On 5 May 05, Public Law 109-13 established a traumatic injury program designed to provide financial assistance to service members during recovery from a serious traumatic injury (not necessarily as a result of combat). TSGLI is a rider to the SGLI policy. TSGLI pays a monetary benefit from $25,000 to $100,000 for covered losses that are incurred by the member as a result of traumatic injury. Code of Federal Regulations (CFR) Title 38 Para 9.20 prescribes that each service certifies whether a service member was insured under SGLI and whether they sustained a qualifying loss. The TSGLI loss criteria are prescribed in the TSGLI Procedures Guide. A member is considered to have a loss of ADL if the member requires assistance to perform at least 2 of 6 ADLs (eating, bathing, dressing, toileting, transferring and continence). ________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPFC recommends the applicant’s request for payment of the TSGLI benefit be denied. Based on the eligibility criteria outlined in the CFR Title 38 Para 9.20 and Emergency Supplemental Appropriations Act for Defense, the Global War on Terror and Tsunami Relief, 2005 (Public Law 109-13) and the recommendation of the physicians’ review of the original claim and appeal, the applicant’s claim does not meet the TSGLI eligibility criteria for payment of ADL loss for 30 consecutive days. DPFC reviewed the recommendation of the doctors providing assessments of the original claim and the appeal. While DPFC believes the applicant did receive assistance with some of his ADLs during his recovery period, the medical consensus was that he did not require the assistance of another person to perform the cited ADLs for 30 consecutive days. Approving the action would result in a $25,000 payment to the applicant. If the Board’s decision is to grant, DPFC is required to send a certification worksheet to the Office of Servicemembers’ Group Life Insurance to initiate payment. The complete DPFC evaluation, with attachment, is at Exhibit B. ________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: On 21 Mar 14, a copy of the Air Force evaluation was provided to the applicant for review and comment within 30 days (Exhibit C). As of this date, this office has not received a response. ________________________________________________________________ THE BOARD CONCLUDES THAT: 1. The applicant has exhausted all remedies provided by existing law or regulations. 2. The application was timely filed. 3. Sufficient relevant evidence has been presented to demonstrate the existence of error or injustice. We note DPFC states that the medical consensus was he did not require the assistance of another person to perform the cited ADLs for 30 consecutive days; however, we disagree. In this respect we note the applicant provides statements from his wife that discusses the specific limitations the applicant actually experienced and states the applicant indeed employed human assistance to perform the various ADLs (bathing, dressing and transferring) for over 30 consecutive days. Moreover, it is our opinion that the nature of the applicant’s injury, the physical profile limitations and the short duration of his hospital stay more likely than not prevented his physicians and occupational therapist from fully observing the daily care and assistance the applicant required in performing the various ADLs. As such, we find the nature of the applicant’s injury, the physical profile limitations and the short duration of his hospital stay coupled with the applicant’s wife’s first-hand account of the assistance she provided sufficient to grant the relief sought. Therefore, in the interest of justice we recommend the applicant’s records be corrected as indicated below. _______________________________________________________________ THE BOARD RECOMMENDS THAT: The pertinent military records of the Department of the Air Force relating to APPLICANT be corrected to show that his application for Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) was approved based on the determination that he suffered the loss of three Activities of Daily Living (ADL) for 30 days and he is entitled to payment in the amount of $25,000. ________________________________________________________________ The following members of the Board considered AFBCMR Docket Number BC-2013-05143 in Executive Session on 18 Sep 14, under the provisions of AFI 36-2603: , Panel Chair , Member , Member All members voted to correct the records as indicated. The following pertinent documentary evidence in AFBCMR Docket Number BC-2013-05143 was considered: Exhibit A. DD Form 149, dated 19 Oct 13, w/atchs. Exhibit B. Letter, AFPC/DPFC, undated, w/atch. Exhibit C. Letter, SAF/MRBR, dated 21 Mar 14.