RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS
IN THE MATTER OF: DOCKET NUMBER: BC-2011-02490
COUNSEL:
HEARING DESIRED: YES
_________________________________________________________________
APPLICANT REQUESTS THAT:
His Servicemembers Group Life Insurance Traumatic Injury
Protection (TSGLI) claim, dated 13 Oct 09, be approved.
_________________________________________________________________
APPLICANT CONTENDS THAT:
His disability qualifies him for TSGLI benefits because he was
disabled for the number of days required by law. He was unable
to perform activities of daily living (ADL) and required
substantial assistance for a long period of time. His ADL was
overlooked and constitutes an error in his records. His primary
care physician was deployed when he first submitted his claim;
however, he has since submitted the additional documentation
provided by his physician. He continues to suffer significant
impairment.
In support of his request, the applicant submits copies of
medical statements, a chart of events and impairments, his appeal
of denial of benefits, letters from physicians, sworn statements
and a traffic crash report.
The applicant's complete submission, with attachments, is at
Exhibit A.
_________________________________________________________________
STATEMENT OF FACTS:
In Jan 08, the applicant suffered a severe and life-threatening
closed head injury which resulted in a traumatic brain injury. A
review in Lieu of Medical Evaluation Board (MEB), dated 1 Jun 09,
stated although the applicant made a remarkable recovery
considering the magnitude of the trauma, he had an MEB processed
in June of 08 for a refractory post-traumatic diabetes insipidus
requiring Desamino-D-arginine vasopressin (DDAVP) therapy. It
was recommended he continue DDAVP three times a day for the
indefinite future with an annual endocrinology follow-up in
Oct 09.
On 31 Dec 09, the applicant was discharged for retirement. He
served 27 years and 1 month on active duty.
The remaining relevant facts pertaining to this application,
extracted from the applicants military records, are contained in
the letter prepared by the appropriate office of the Air Force at
Exhibit C.
_________________________________________________________________
AIR FORCE EVALUATION:
HQ AFPC/DPWC recommends denial.
On 11 Nov 09, DPWC received the applicants TSGLI claim for
scheduled loss due to his inability to perform five of six (5 of
6) ADL for thirty (30) days due to Traumatic Brain Injury (TBI).
The claim was forwarded to the Air Force medical representative
(USAFSAM/OEHT) for assessment. USAFSAM/OETH concluded the
applicant did not meet the TSGLI eligibility criteria. DPWC
disapproved the applicants claim based on the medical
assessment. On 25 Jun 10, the applicant appealed the denial of
the claim and submitted additional documentation in support of
his claim. DPWC forwarded the new claim to USAFSAM/OETH for
assessment; however, the claim was again denied stating the
applicant did not meet the TSGLI eligibility criteria. As part
of the appeal process, the claim and medical documentation was
reviewed by a physician assigned to AFPC/DPSD who also agreed the
applicant did not meet the criteria for TSGLI payment.
DPWC notes the applicants claim and available medical
documentation was reviewed by two independent physicians. The
physicians stated the applicants condition following his
traumatic injury did not meet the TSGLI payment criteria as
outlined in the TSGLI Procedures Guide, dated 23 May 11.
The complete DPWC evaluation, with attachments, is at Exhibit C.
_________________________________________________________________
APPLICANT'S REVIEW OF AIR FORCE EVALUATION:
The applicant did not provide the nursing notes for
reconsideration of the TSGLI claim because he did not feel the
notes provided sufficient detail to corroborate the life-altering
event in his personal and professional life. The applicant also
indicated he would not submit further information and accepts
DPWCs decision as a final denial of benefits.
The applicants complete submission is 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 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 and adopt its
rationale as the basis for our conclusion that 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 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 issue involved.
Therefore, the request for a hearing is not favorably considered.
_______________________________________________________________
THE BOARD DETERMINES THAT:
The applicant be notified that the evidence presented did not
demonstrate the existence of material error or injustice; that
the application was denied without a personal appearance; and
that 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 this application in
Executive Session on 20 Mar 12, under the provisions of AFI 36-
2603:
, Panel Chair
, Member
, Member
The following documentary evidence was considered in AFBCMR BC-
2011-02490:
Exhibit A. DD Form 149, dated 17 Jun 11, w/atchs.
Exhibit B. Applicant's Master Personnel Records.
Exhibit C. Letter, HQ AFPC/DPWC, undated.
Exhibit D. Letter, SAF/MRBR, dated 19 Aug 11.
Exhibit E. Letter, Applicant, dated 15 Sep 11.
Panel Chair
AF | BCMR | CY2010 | BC-2010-04721
He filed his first TSGLI claim for TBI in April 2009 and the second claim for inability to perform Activities of Daily Living (ADLs) in August 2009. _________________________________________________________________ THE BOARD DETERMINES THAT: The applicant be notified that the evidence presented did not demonstrate the existence of material error or injustice; that the application was denied without a personal appearance; and that the application will only be reconsidered upon the submission...
AF | BCMR | CY2014 | BC 2014 02007
The criteria for ADL loss as it is defined in the TSGLI procedures Guide follows: 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. Initial medical review of the claim the physician indicated that he would allow for the applicant requiring assistance for dressing but not bathing. A complete copy of the AFPC/DPFC evaluation is at Exhibit C. APPLICANT'S REVIEW OF AIR FORCE EVALUATION: Applicants...
AF | BCMR | CY2014 | BC 2014 01167
His medical provider certified his inability to perform at least 2 of the ADL for over 90 consecutive days and that he required the assistance of another person to help him bathe from 20 Feb to 20 Aug 08. His claim for the inability to perform the ADL due to traumatic injury was not approved as the medical documentation provided did not indicate the loss met the standards for TSGLI. He submitted a TSGLI application claiming the inability to perform the ADL of bathing and dressing for...
AF | BCMR | CY2011 | BC-2011-00095
His claim also qualifies for a loss of Activities of Daily Living (ADL) compensation, as his injuries involved a traumatic brain injury (TBI). The applicants complete submission was thoroughly reviewed and his contentions were duly noted; however, no evidence has been presented that convinces us the applicant met the eligibility criteria for traumatic injury protection under the TSGLI program. Therefore, we agree with the opinions and recommendations of the Air Force office of primary...
AF | BCMR | CY2014 | BC 2014 01054
________________________________________________________________ APPLICANT CONTENDS THAT: Due to his traumatic injury, he is entitled to TSGLI and he has provided the supporting documents indicating his inability to perform at least two of the six ADLs. ________________________________________________________________ AIR FORCE EVALUATION: AFPC/DPFC recommends denial indicating that after reviewing the applicants original claim and appeal, he does not meet TSGLI criterion for ADL loss due...
AF | BCMR | CY2013 | BC 2013 05480
RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-05480 ` COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: His Service Members Group Life Insurance Traumatic Injury Protection (TSGLI) claim be approved due to his inability to perform at least two of the six Activities of Daily Living (ADLs) for 60 consecutive days. While the Board notes the documentation submitted by the applicant in support of his contention that he...
AF | BCMR | CY2014 | BC 2014 01344
His medical provider documented that he was unable to perform 4 of the 6 ADLS for 60 days. The claim and medical records were reviewed and his request for loss of ADLs (bathe, dress, toilet) due to Other Traumatic Injury (OTI) from 10 Jul to 21 Aug 03 was approved and he was paid $25,000 on 5 Jun 13. 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...
AF | BCMR | CY2013 | BC 2013 05143
RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2013-05143 COUNSEL: NONE HEARING DESIRED: NO ________________________________________________________________ APPLICANT REQUESTS THAT: His claim for Servicemembers Group Life Insurance Traumatic Injury Protection (TSGLI) be approved. On 5 May 05, Public Law 109-13 established a traumatic injury program designed to provide financial assistance to service members during recovery from...
AF | BCMR | CY2014 | BC 2014 02977
RECORD OF PROCEEDINGS AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS IN THE MATTER OF: DOCKET NUMBER: BC-2014-02977 COUNSEL: NONE HEARING DESIRED: NO APPLICANT REQUESTS THAT: His claim under the Traumatic Servicemembers Group Life Insurance (TSGLI) Protection be approved. In this respect we note the applicant provides statements from two medical providers and his caregiver that discusses the specific limitations the applicant actually experienced and states the applicant indeed...
AF | BCMR | CY2007 | BC-2007-00224
The physician states the applicant could perform ADLs “with difficulty.” AFPC/DPFC certified the claim as not qualifying for a covered loss given the recommendation from his physician and accompanying medical documentation. The complete evaluation is at Exhibit C. _________________________________________________________________ APPLICANT'S REVIEW OF AIR FORCE EVALUATION: In response to the Air Force evaluation, the applicant’s wife provided a statement. The applicant’s complete response,...