RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER:  BC-2016-00987

						COUNSEL:  YES
								 
						HEARING DESIRED:  NO 

APPLICANT REQUESTS THAT:

His claim for Traumatic Servicemembers’ Group Life Insurance (TSGLI) benefits be approved.

APPLICANT CONTENDS THAT:

Counsel, on behalf of the applicant, contends he sustained injury to his left wrist and left knee resulting from a fall through an open storm drain while he was stationed in England.  The applicant had surgery on his left wrist on 8 Aug 07, which impacted his ability to independently perform activities of daily living (ADL) until completion of occupational therapy on 20 Dec 07.

The applicant’s initial TSGLI claim and subsequent appeal were denied; however, his injury fits the legal requirements for a TSGLI award.

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

STATEMENT OF FACTS:

On 16 Sep 03, the applicant initially entered the Regular Air Force.

On 24 Apr 07, the applicant fell into an open storm drain while walking in Brandon, England, and injured his left wrist and left knee.

On 23 Sep 13, the applicant was furnished an Honorable discharge and credited with 10 years, 0 months, and 8 days of active service.

On 14 Apr 15, through counsel, the applicant submitted a claim to TSGLI.  The claim was denied on 8 Jul 15.

On 25 Sep 15, through counsel, the applicant submitted an appeal to TSGLI.  The appeal was denied on 2 Dec 15. 

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 D.

AIR FORCE EVALUATION:

AFPC/DPFCS recommends denial, indicating there is no evidence of error or injustice.

The applicant’s initial claim, submitted through counsel, included a medical review by a provider often used by the legal firm, stating he did not observe the applicant’s loss, but did review the medical record.

The original claim was denied after the claim form and medical records were reviewed by a physician educated in TSGLI loss criteria.  The claim was denied for ADL loss for 120 consecutive days and lesser payment thresholds due to an absence of objective evidence in the medical record supporting the inability to perform the cited ADLs meeting the TSGLI program criteria.  Payment thresholds are 30, 60, 90, and 120 consecutive days.  TSGLI Program loss criteria for the claimed ADLs are:  

	Bathe – Patient is UNABLE to bathe independently if he/she requires physical, stand-by, or verbal assistance from another person to bathe more than one part of the body (via tub bath or sponge bath) or get in or out of the tub or shower.

	Dress – Patient is UNABLE to dress independently if he/she requires physical, stand-by, or verbal assistance from another person to get and put on appropriate clothing (i.e. dress for the correct season), socks or shoes (may have help tying shoes).

If the applicant was receiving assistance with ADLs at the 30th day after his injury, it was for convenience and not because it was medically necessitated due to his inability of performing the ADLs without assistance as required by the TSGLI Program criteria for ADL loss.

A separate medical review, by another physician, was performed upon receipt of the applicant’s appeal, submitted through counsel.  The appeal was denied.  Both physicians performing the initial and appeal reviews received training in TSGLI loss criteria conducted by one of the Department of Veterans Affairs’s TSGLI subject matter experts.

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

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 7 Mar 17 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 opinion and recommendation of the Air Force office of primary responsibility (OPR) and adopt its rationale as the basis for our conclusion 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 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-2016-00987 in Executive Session on 11 Jul 17 under the provisions of AFI 36-2603:

	, Panel Chair
	, Member
	, Member

The following documentary evidence pertaining to AFBCMR Docket Number BC-2016-00987 was considered:

	Exhibit A.  DD Form 149, dated 27 Feb 16, w/atchs.
	Exhibit B.  Excerpt from Personnel Records.
	Exhibit C.  Letter, Applicant’s Counsel, dated 7 Mar 16,
	w/atchs.
	Exhibit D.  Memorandum, AFPC/DPFCS, dated 1 Jul 16.
	Exhibit E.  Letter, Applicant’s Counsel, dated 15 Jul 16,
w/atchs.
	Exhibit F.  Letter, AFBCMR, dated 7 Mar 17, w/atch.

Pursuant to paragraph 1 of AFI 36-2603 (Title 32 Code of Federal Regulations, Part 865.1), it is certified a quorum was present at the Board's review and deliberations regarding AFBCMR Docket Number BC-2016-00987, and the foregoing is a true and complete record of the Board's proceedings in the above entitled matter.