RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-01789 COUNSEL: HEARING DESIRED: NOT INDICATED APPLICANT REQUESTS THAT: His Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim be approved for the inability to perform at least two of six Activities of Daily Living (ADLs) for 90 consecutive days. APPLICANT CONTENDS THAT: He believes the decision to deny his initial TSGLI claim should be reversed. The applicant's complete submission, with attachments, is at Exhibit A. STATEMENT OF FACTS: The applicant is currently serving in the Air Force Reserve in the grade of technical sergeant. The remaining relevant facts pertaining to this application, extracted from the applicant’s military records, are contained in the letter prepared by the appropriate office of the Air Force at Exhibit B. AIR FORCE EVALUATION: AFPC/DPFC recommends denial. DPFC states on 26 June 2009, the applicant was involved in an automobile accident in Kearny, NJ. He began treatment for a back injury on 29 April 2010. The applicant submitted a TSGLI application claiming the inability to perform the ADLs of bathing and dressing (due to other traumatic injury (OTI)) for the period 10 June 2010 to 22 September 2010. The physician certifying ADL is used by the law firm to prepare the TSGLI claim form Part B. The physician indicates, on, the claim form, that he has not observed the patient's loss, but has reviewed the patient's medical records to determine the loss claimed. In order to qualify for TSGLI, there must be a traumatic event, as defined by the TSGLI law, which causes physical damage to the body resulting in a scheduled loss. In this case, there is no issue with the traumatic event element; however, the physicians that reviewed the original claim and appeal packages disagreed with the physician who certified ADL with regard to the patient meeting TSGLI criterion for ADL loss (bathe and dress) for any payable threshold. The burden of proof is on the applicant to demonstrate that he suffered a scheduled loss and the loss is a direct result of a traumatic event (vice illness/disease or treatment of an illness/disease) as defined by the TSGLI regulation. After reviewing the original claim and appeal, DPFC’s position remains firm that the applicant does not meet TSGLI criterion for ADL loss due to OTI for any payable threshold. Neither the original claim nor the appeal was arbitrarily denied. The evidence provided with the claim does not provide any clear evidence that his back condition was directly caused or aggravated by the automobile accident that occurred approximately 10 months before medical treatment began. In addition, the medical records lack evidence for the inability to bathe and dress without assistance. To the contrary, in addition to the physical therapy notes addressed in the appeal review by AFPC/DPFDI, at each lumbar epidural steroid injection procedure, the applicant was noted to have “walked to the operating room table and lay in a prone position” and after the procedure and recovery was noted to be ambulating without assistance.” Those procedures took place from 10 June 2010 to 8 September 2010. DPFC’s complete evaluation is at Exhibit B. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: On 30 September 2014, a copy of the Air Force evaluation was forwarded to the applicant for review and response within 30 days (Exhibit C). 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 is timely filed. 3. Insufficient relevant evidence has been presented to demonstrate the existence of error or injustice. After thoroughly reviewing the evidence of record and the applicant’s complete submission, we are not persuaded the record warrants the requested correction. The applicant’s contentions are duly noted; however, he has not provided evidence to override the rationale provided by the Air Force office of primary responsibility (OPR). Therefore, we agree with the opinion and recommendation of the OPR and adopt its rationale as the basis for our conclusion that the applicant has not been the victim of an error or injustice. In the absence of evidence to the contrary, we find no basis to recommend granting the relief sought in this application. 4. The applicant’s case is adequately documented and it has not been shown that a personal appearance with or without counsel will materially add to our understanding of the issues involved. Therefore, the request for a hearing is not favorably considered. THE BOARD DETERMINES THAT: The applicant be notified the evidence presented did not demonstrate the existence of an 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-2014-01789 in Executive Session on 5 February 2015, under the provisions of AFI 36-2603: The following documentary evidence was considered: Exhibit A. DD Form 149, dated 25 October 2013, w/atchs. Exhibit B. Letter, AFPC/DPFC, dated 6 June 2014. Exhibit C. Letter, SAF/MRBR, dated 30 September 2014.