RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER: BC-2015-02782

						COUNSEL:  NONE

						HEARING DESIRED:  NO 

APPLICANT REQUESTS THAT:

His Servicemembers’ Group Life Insurance Traumatic Injury Protection (TSGLI) application be approved.

APPLICANT CONTENDS THAT:

His shoulder was injured when he was working a belay line on an 1800 pound antenna removal from a 100 foot tower.  Strong winds caused a violent jerk on the belay line that caused his shoulder injury.  The determination of his application is an error and he qualifies under both provisions of the TSGLI requirement.

The applicant’s complete submission, with attachments, is at Exhibit A.

STATEMENT OF FACTS:

The applicant is currently serving in the Air National Guard in the grade of Chief Master Sergeant (CMSgt, E-9).

According to the DD Form 214, Certificate of Release or Discharge from Active Duty, the applicant served in support of OPERATION ENDURING FREEDOM (AL Udeid AB, Qatar) from 14 Aug 13 to 12 May 14.

The remaining relevant facts pertaining to this application are contained in the memorandum prepared by the Air Force office of primary responsibility (OPR), which is attached at Exhibit C.    

AIR FORCE EVALUATION:

AFPC/DPFCS recommends denial indicating there is no evidence of an error or an injustice.  Based on the facts available pertaining to the applicant’s mechanism of injury, medical records, traumatic event and other applicable definitions outlined in the TSGLI Procedures Guide pursuant to Code of Federal Regulations (CFR) Title 38 Part 9.20 and the medical analysis, the applicant’s mechanism of injury does not meet the TSGLI definition of a traumatic event.

On 18 Mar 14, the applicant reported he received a left shoulder injury while on duty at Al Udeid AB, Qatar.  On 12 Dec 14, he submitted a TSGLI claim for the inability to perform at least two Activities of Daily Living (ADL), due to other traumatic injury, for 120 days.

On 13 Jan 15, the Office of Servicemembers’ Group Life Insurance denied the applicant’s claim and on 26 Jan 15, the applicant appealed the decision.

On 4 Mar 15, after considering the medical consultant’s review, the appeal authority (AFPC/DPFD) denied the applicant’s appeal.

In order to qualify for TSGLI, the claimed loss must be the direct result of a traumatic event.

The criteria for the inability to perform at least two ADLs, due to other traumatic injury are:

ADL Loss - A member is considered to have a loss of ADL if the member REQUIRES assistance to perform at least two of the six activities of daily living. If the patient is able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.), the patient is considered able to independently perform the activity.

REQUIRES assistance is defined as:

•	Physical assistance - when a patient requires hands-on assistance from another person.

•	Stand-by assistance - when a patient requires someone to be within arm's reach because the patient's ability fluctuates and physical or verbal assistance may be needed.

•	Verbal assistance - when a patient requires verbal instruction in order to complete the ADL due to cognitive impairment. Without these verbal reminders, the patient would not remember to perform the ADL.

Without this physical, stand-by, or verbal assistance, the patient would be incapable of performing the task.

The AFPC/DPFDI Medical Consultant recommended denial indicating there is no objective evidence to link a specific injury to the left shoulder while the applicant was deployed.

The applicant is claiming Other Traumatic Injury (OTI) loss of ADLs for bathing, dressing, and eating from 24 Jun - 24 Oct 14.

The applicant’s electronic medical record theater notes document four clinic visits while deployed: three visits, dated 18 Mar 14, 26 Mar 14, and 7 Apr 14 were optometry appointments.  The fourth visit, dated 9 Apr 14, was the post deployment screen.  On this screen, the applicant indicated he was more than 100 meters from a blast and jammed his fingers while working.  Also, a vague mention of joint pain was noted.  No comments were made regarding the left shoulder. 

On 22 Apr 14, the applicant completed an AF Form 2697, Report of Medical Assessment, and indicated problems since his last medical assessment were joint pain, foot problems, and eye infection.  More specifically, injuries for which he did not seek medical care, he noted jammed finger, sprain knee, and foot pain.  No mention of a shoulder injury of any kind.

The applicant first mentioned a left shoulder injury on 21 May 14 during his original orthopedic consultation.  He indicated he was injured while hanging from a rope removing an antenna from the top of a building and pulled his left shoulder with the rope.

Although the applicant may have torn his left shoulder rotator cuff on 18 Mar 14 while deployed to Al Udeid, there is no objective evidence of this in theater documentation or on the post deployment screenings from 9 Apr 14 and 22 Apr 14.

A complete copy of the AFPC/DPFCS evaluation is at Exhibit C.

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant refutes virtually every point made by the OPR and argues that he does meet the criteria for TSGLI.  He indicates the injury in question occurred on 18 Mar 14, after his eye appointment as pointed out by the Medical Consultant.  Although his records only show the three visits to the eye doctor, he claims that he made more than 12 different visits to the clinics in Al Udeid and Bagram AB.  He is unsure why all of his visits are not documented but states that some are in his shot records as he received immunizations on multiple occasions.  

The applicant goes on to describe in detail how his injury occurred reiterating that a high wind violently jerked the rope that was wrapped around his left arm.  The sudden jerking of the rope lifted him from the ground and caused a violent impact and hyper extension of his left shoulder.  He went to the clinic the next day and spoke with the physician.  The physician told him that they did not have the equipment or facilities to complete a definitive test, however, he could go downtown which could eventually lead to him being sent to Germany for further care.  The physician also told him that he could have it taken care of when he returned back to the U.S., which is what he chose to do.  

The injury he suffered was due to no fault of his own and occurred while deployed in a certified war zone or hazardous duty location.  The loss of use was completely debilitating for a four month period which included ADL items like bathing and assistance with dressing himself.  In addition, on 11 Jan 15, while on temporary duty in Arkansas, he fell on ice and reinjured his shoulder.  

Additionally, the applicant notes that he located at least four BCMR decisions in the last three years resulting in payment for the same injury and surgery for shoulder rotator repair.  None of the cases indicated that tendons were completely torn off and retracted, yet loss payments were made as a result of the injuries.

Lastly, the applicant notes that on 12 Jul 12, the TSGLI Branch Chief in Army case number AR20140021530 ruled in his favor and authorized payment.

The applicant’s complete response, with attachments, is located 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 an error or injustice.  We took notice of the applicant’s complete submission, including his response, in judging the merits of the case; however, we agree with the opinion and recommendation of the Air Force OPR and adopt its rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice.  We note that in the Army case cited by the applicant, his TSGLI claim was approved for payment in the amount of $25,000 based on his inability to perform 2 ADLs for 30 consecutive days; however, we also note that the Army board recommended denying the applicant’s request because he provided no medical documentation indicating a physical incapacity of performing ADLs without assistance beyond 30 days.  In this case, there is no evidence to link the applicant’s left shoulder to his deployment.  Therefore, the applicant is not similarly situated to the applicant in the case he cites and similar consideration should not be conferred upon him.  Therefore, in the absence of evidence to the contrary, we find no basis to recommend granting the requested relief.

THE BOARD DETERMINES THAT:

The applicant be notified the evidence presented did not demonstrate the existence of material error or injustice; the application was denied without a personal appearance; and 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 AFBCMR Docket Number BC-2015-02782 in Executive Session on 16 Aug 16 under the provisions of AFI 36-2603:

					 , Panel Chair
					 , Member
					   , Member

The following documentary evidence pertaining to AFBCMR Docket Number BC-2015-02782 was considered:

	Exhibit A.  DD Form 149, dated 29 Jun 15, w/atchs.
	Exhibit B.  Pertinent Excerpts from Personnel Records.
	Exhibit C.  Memorandum, AFPC/DPFCS, dated 10 Dec 15, w/atch.
	Exhibit D.  Letter, AFBCMR, dated 30 Dec 15.
	Exhibit E.  Letter, Applicant, undated, w/atchs.

Pursuant to paragraph 1 of AFI 36-2603 (Title 32 Code of Federal Regulations, Part 865.1), it is certified that a quorum was present at the Board's review and deliberations, and that the foregoing is a true and complete record of the Board's proceedings in the above entitled matter.