Docket No. 3918-20 Ref: Signature Date Dear This is in reference to your application for correction of your naval record pursuant to Section 1552 of Title 10, United States Code. After careful and conscientious consideration of relevant portions of your naval record and your application, the Board for Correction of Naval Records (Board) found the evidence submitted insufficient to establish the existence of probable material error or injustice. Consequently, your application has been denied. A three-member panel of the Board, sitting in executive session, considered your application on 22 April 2021. The names and votes of the members of the panel will be furnished upon request. Your allegations of error and injustice were reviewed in accordance with administrative regulations and procedures applicable to the proceedings of this Board. Documentary material considered by the Board consisted of your application, together with all material submitted in support thereof, relevant portions of your naval record and applicable statutes, regulations and policies. In addition, the Board considered the advisory opinion contained in Director CORB letter 1770 CORB of 20 November 2020; a copy of which was previously provided to you for comment. The Board determined that your personal appearance, with or without counsel, would not materially add to their understanding of the issues involved. Therefore, the Board determined that a personal appearance was not necessary and considered your case based on the evidence of record. A review of your record shows that you entered active duty with the Marine Corps in April 2013. You suffered extensive facial injuries during a motorcycle accident on 24 September 2016 that resulted in surgery to treat your injuries and hospitalization through 12 October 2016. You filed a Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim in February 2017 requesting payment for facial reconstruction and 15 days of hospitalization. Your claim was partially approved with a payment of $25,000 for your hospitalization and $25,000 for repair to your lip. You subsequently filed for reconsideration requesting an additional $50,000 for facial reconstruction. This reconsideration request was denied based on a finding that your record lacked medical evidence that you suffered discontinuity defects as required by the TSGLI Procedures Guide. In the meantime, you were released from active duty on 27 February 2018 and placed on the Permanent Disability Retirement List. On 19 April 2019, you filed an appeal with the TSGLI Appeals Board requesting payment for facial reconstruction based on medical evidence of your extensive facial injuries and your medical provider’s certification on your original TSGLI application that you required facial reconstruction. The TSGLI Appeals Board denied your appeal on 29 November 2019 after determining that you failed to meet the criteria for payment due to facial reconstruction under the TSGLI Procedures Guide based on the medical evidence. The Board carefully considered your arguments that you deserve payment of an additional $50,000 for complex facial reconstruction repair. You assert that you meet the criteria for payment since you underwent surgery to correct avulsions of the face that caused discontinuity and that your medical provider certified your facial reconstruction treatment. Unfortunately, the Board disagreed with your rationale for relief. In making their findings, the Board substantially concurred with the advisory opinion in your case. The TSGLI Procedures Guide provides the criteria for payment of TSGLI claims. It allows for the payment of up to $75,000 for facial reconstruction to correct traumatic avulsions of the face or jaw that cause discontinuity defects. The guide notes that in order to meet the standard of facial reconstruction, the service member “must experience a penetrating facial injury (avulsion) and lose bone or tissue that without replacement would leave a ‘gap’ in the area of injury (discontinuity defect).” In reviewing your records, the Board found insufficient evidence to support a finding that you suffered bone or tissue loss that, without replacement, would have left a gap in the area of injury. As pointed out in the advisory opinion, the surgical notes from 27 September 2016 document that your extensive facial injuries were repaired by fixation, plating, and suturing with no evidence of bone or tissue replacement. Absent evidence of either, the Board concluded you do not meet the TSGLI Procedures Guide criteria for payment under facial reconstruction. While the Board understands your argument that your injuries appear to meet the definition of discontinuity of bone or tissue based on the extensive injuries you suffered, the Board determined your injuries did not meet the TSGLI Procedures Guide definition for discontinuity defects. Further, the Board concurred with the advisory opinion statement that your maxillofacial surgeon certification, by itself, is insufficient to support payment under TSGLI. While a medical provider certification is required to file a claim, the sum of all medical evidence, including the provider certification, is considered in determining whether a claim has merit. Since your surgical records do not support the certification issued by your provider, the Board determined his endorsement was insufficient evidence to support payment in your case. Accordingly, the Board found insufficient evidence of error or injustice to warrant a change to your record. You are entitled to have the Board reconsider its decision upon submission of new matters, which will require you to complete and submit a new DD Form 149. New matters are those not previously presented to or considered by the Board. In this regard, it is important to keep in mind that a presumption of regularity attaches to all official records. Consequently, when applying for a correction of an official naval record, the burden is on the applicant to demonstrate the existence of probable material error or injustice. Sincerely,