RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER: BC-2015-03048

						COUNSEL:  NONE

						HEARING DESIRED:  NO 

APPLICANT REQUESTS THAT:

His Service-members’ Group Life Insurance Traumatic Injury Protection (TSGLI) claim for limb salvage of his right arm be approved.  

APPLICANT CONTENDS THAT:

The shrapnel injury to his right shoulder and subsequent medical treatment meets TSGLI criteria for limb salvage.  The limb salvage was qualified by the attending surgeon two times.

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

STATEMENT OF FACTS:

The applicant initially entered the Regular Air Force on 30 Jun 92.

The applicant received the Purple Heart medal for wounds received in action on 24 Dec 08.  

On 31 Aug 14, the applicant was furnished an honorable discharge, retired effective 1 Sep 14, and was credited with 22 years, 2 months, and 1 day of active service.   

The remaining relevant facts pertaining to this application are contained in the memoranda prepared by the Air Force office of primary responsibility (OPR), and AFBCMR Medical Consultant which are attached at Exhibits C and E.    

AIR FORCE EVALUATION:

AFPC/DPFC recommends denial indicating there is no evidence of an error or an injustice.  On 5 May 05, Public Law 109-13 was signed by President Bush establishing 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).  The insurance (TSGLI) is a rider to the member’s Service members’ Group Life Insurance (SGLI) policy.  TSGLI pays a monetary benefit from $25K to $100K for covered losses that are incurred by the member as a result of a traumatic injury.  The uniformed service will certify whether a service member, at the time of the traumatic injury, was insured under Service members' Group Life Insurance and whether they have sustained a qualifying loss.  TSGLI loss criteria are prescribed in the TSGLI Procedures Guide available on the Department of Veterans Affairs (DVA) website.  

Their review of this case revealed the applicant did have a serious life and limb threatening injury however, the subsequent medical treatment was not limb salvage as defined by the TSGLI regulation.  On 24 Dec 08, the applicant was injured by shrapnel from a 107mm rocket that detonated close to his position.  On 26 Mar 14, he submitted a TSGLI claim indicating that he met TSGLI criteria for inpatient hospitalization (15 consecutive days of inpatient hospitalization) and limb salvage of his right arm.  After a review of the claim form and medical records by a physician educated in TSGLI loss criteria, the claim was denied.  His records revealed he was an inpatient for only 13 days after the injury.  Additionally, the medical consultant determined that the limb salvage criteria were not met for the limb salvage loss claim.  On 4 Aug 14, the applicant submitted an appeal for his TSGLI claim, and again, after a different physician review of the claim, the appeal authority (AFPC/DPFD) denied the appeal citing that the surgeries performed on the right shoulder were not limb salvage as defined by the TSGLI regulation.  

Regarding the applicant’s contention that the attending surgeon qualified his TSGLI claim two times, they determined that the alleged attending surgeon who certified the limb salvage loss on the TSGLI claim form and wrote a memorandum in support of the limb salvage for the applicant’s TSGLI appeal was not the attending physician as he indicated on the DD Form 149.  On page 10 of the TSGLI claim form submitted by the applicant, the certifying surgeon says he was not the attending surgeon and that he reviewed the patient’s medical records [to come to his conclusion].

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

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 10 Dec 15 for review and comment within 30 days (Exhibit D).  As of this date, no response has been received by this office.

ADDITIONAL AIR FORCE EVALUATION:

AFBCMR Medical Consultant recommends denial indicating there is no evidence of an error or an injustice.  This opinion is rendered based solely on the evidence supplied by others in the case file, which includes the opinions of two medical professionals affiliated with HQ AFPC/DPFDC, who have been characterized as familiar with TSGLI policies, and the printed opinion of a vascular surgeon; the latter who is an advocate of the applicant’s petition.  
Interrupted arterial blood flow to an extremity is essential its viability.  Accordingly, it follows that the opinion of the vascular surgeon is that repairing the applicant’s injury to the major conduit of blood to the upper extremity, whether either referred to as the more proximal axillary artery or the brachial artery, constituted limb “salvage.”  The Medical Consultant concedes that, instead of emphasis on vascular injury, greater emphasis seems to be placed upon musculo-skeletal [bone and muscle] and soft tissue injury that is so severe that amputation is a justifiable “option,” but the “patient chooses salvage.”  

After reviewing the various definitions of “limb salvage” in previous advisory assessments and the TSGLI policies and law, the Medical Consultant is inclined to believe that the immediate medical and surgical interventions provided to the applicant represented the standard of care to prevent or interrupt impending exsanguinating hemorrhage that, indeed, ultimately risked the demise of the applicant and not just loss of the limb.  While avoidance of a prolonged tourniquet time or extended flight time mandated placement of a temporary shunt to restore blood flow could constitute “salvaging” the limb by some experts, the Medical Consultant opines this does not constitute “salvage” in the spirit of TSGLI implementation policy and law.  Therefore, he recommends denial of the applicant’s petition for the TSGLI benefit for his qualifying upper extremity injury.  

A complete copy of the AFBCMR Medical Consultant evaluation is at Exhibit E.

APPLICANT'S REVIEW OF ADDITIONAL AIR FORCE EVALUATION:

A copy of the additional Air Force evaluation was forwarded to the applicant on 28 Sep 16 for review and comment within 30 days (Exhibit F).  As of this date, no response has been received by this office.

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 in judging the merits of the case; however, we agree with the opinions and recommendations of the Air Force office of primary responsibility (OPR), and the AFBCMR Medical Consultant, and adopt their rationale as the basis for our conclusion the applicant has not been the victim of an error of injustice.  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-2015-03048 in Executive Session on 15 Nov 16, under the provisions of AFI 36-2603:

The following documentary evidence pertaining to AFBCMR Docket Number BC-2015-03048 was considered:

	Exhibit A.  DD Form 149, dated 16 Jul 15, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Memorandum, AFPC/DPFC, dated 23 Nov 15, w/atchs.
	Exhibit D.  Letter, SAF/MRBR, dated 10 Dec 15.
	Exhibit E.  Memorandum, AFBCMR Medical Consultant, dated
			  2 Sep 16.
	Exhibit F.  Letter, SAF/MRBR, dated 28 Sep 16.  

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.