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.  

________________________________________________________________ 

APPLICANT CONTENDS THAT:

On 1 May 11 while on foot patrol in Ghormach District, Faryab 
Province, Afghanistan, he was severely wounded when he suffered 
a gunshot wound to his lower abdomen.  The bullet traveled 
through his small intestine causing severe trauma.  He had three 
surgeries in Afghanistan including a small bowel resection.  He 
was shot by a 7.62 caliber bullet from an insurgent’s weapon 
during a heavy and close range ambush.  

His medical records reflect that he did not require physical or 
stand-by assistance performing the three Activities of Daily 
Living (ADLs) that he claimed in his TSGLI application.  This is 
incorrect and he required physical and stand-by assistance for 
more than one month due to his lack of mobility and severe pain.

Nursing staff and doctors were not present whenever he would  
perform the three ADLs of transfer, bathe or dress.  Only his 
wife and mother were present and after his release from the 
hospital, most of the three ADLs were completed in the hotel 
room under no medical supervision and the doctors and nurses 
were not fully aware of the assistance he required.

On 9 May 11, he was discharged from Brooke Army Medical Center 
(BAMC) and stayed in lodging while he finished his 
rehabilitation and other medical appointments.  He departed BAMC 
on 19 May 11 and headed home to Fort Carson, CO.  He was on 
convalescent leave through 10 Jun 11, to recover from his 
injuries.  While on convalescent leave, he still required the 
physical assistance of his wife.  His wife who is a college 
student had to drop her classes to help him with his recovery 
since he needed her full attention 24 hours a day.  This caused 
a financial strain since they had to pay for the classes out of 
pocket.  

In support of his request, the applicant provides copies of his 
TSGLI claim, AF Form 988, Leave Request/Authorization; his 
appeal letter, letters of support from his wife and mother, 
extracts from his medical records and various other documents 
associated with his requests.

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

________________________________________________________________ 

STATEMENT OF FACTS:

The applicant is a Joint Terminal Attack Controller (JTAC) and 
is on active duty in the Regular Air Force.  

According to his medical history and physical examination report 
dated 7 May 11, while deployed to Afghanistan, he sustained a 
gunshot wound to his left flank/abdomen.  He was medevac’d to 
Bagram AB, Afghanistan, and had surgery for small bowel 
resection and abdominal closure.  On 3 May 11, he was medevac’d 
to Landstuhl Regional Medical Center (LRMC).  On 7 May 11, he 
arrived at BAMC.  On 9 May 11, he was discharged.  

On 5 May 11, Emergency Family Member Travel Orders for his wife 
and daughter to travel from Colorado Springs, CO to BAMC were 
issued. 

According to the Air Force General Surgery Flight Patient 
Restriction Form dated 18 May 11, the applicant was placed on a 
waiver through 1 Jul 11.  His physician wrote that he could not 
lift more than 10 pounds until 15 Jun 11 and that he was not 
recommended to deploy for 3 months to allow recovery through 
mid-Aug 11. 

According to AF Form 988 dated 18 May 11, he was on convalescent 
leave from 19 May to 10 Jun 11.  

In his TSGLI application dated 19 Jan 12, he states that from 
30 Apr to 1 Jun 11, he was unable to independently perform the 
three ADLs of bathing, dressing and transferring and required 
the assistance of his wife to perform these three ADLs.   

On 5 May 05, Public Law 109-13 established 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). TSGLI is a rider to the SGLI 
policy.  TSGLI pays a monetary benefit from $25,000 to    
$100,000 for covered losses that are incurred by the member as a 
result of traumatic injury.  Code of Federal Regulations (CFR) 
Title 38 Para 9.20 prescribes that each service certifies 
whether a service member was insured under SGLI and whether they 
sustained a qualifying loss.  The TSGLI loss criteria are 
prescribed in the TSGLI Procedures Guide.  A member is 
considered to have a loss of ADL if the member requires 
assistance to perform at least 2 of 6 ADLs (eating, bathing, 
dressing, toileting, transferring and continence). 

________________________________________________________________ 

AIR FORCE EVALUATION:

AFPC/DPFC recommends the applicant’s request for payment of the 
TSGLI benefit be denied.  Based on the eligibility criteria 
outlined in the CFR Title 38 Para 9.20 and Emergency 
Supplemental Appropriations Act for Defense, the Global War on 
Terror and Tsunami Relief, 2005 (Public Law 109-13) and the 
recommendation of the physicians’ review of the original claim 
and appeal, the applicant’s claim does not meet the TSGLI 
eligibility criteria for payment of ADL loss for 30 consecutive 
days.  DPFC reviewed the recommendation of the doctors providing 
assessments of the original claim and the appeal.  While DPFC 
believes the applicant did receive assistance with some of his 
ADLs during his recovery period, the medical consensus was that 
he did not require the assistance of another person to perform 
the cited ADLs for 30 consecutive days.  

Approving the action would result in a $25,000 payment to the 
applicant.  If the Board’s decision is to grant, DPFC is 
required to send a certification worksheet to the Office of 
Servicemembers’ Group Life Insurance to initiate payment.     

The complete DPFC evaluation, with attachment, is at Exhibit B.   

________________________________________________________________ 

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

On 21 Mar 14, a copy of the Air Force evaluation was provided to 
the applicant for review and comment within 30 days (Exhibit C).  
As of this date, this office has not received a response.

________________________________________________________________ 

THE BOARD CONCLUDES THAT:

1.  The applicant has exhausted all remedies provided by 
existing law or regulations.

2.  The application was timely filed.   

3.  Sufficient relevant evidence has been presented to 
demonstrate the existence of error or injustice.  We note DPFC 
states that the medical consensus was he did not require the 
assistance of another person to perform the cited ADLs for 
30 consecutive days; however, we disagree.  In this respect we 
note the applicant provides statements from his wife that 
discusses the specific limitations the applicant actually 
experienced and states the applicant indeed employed human 
assistance to perform the various ADLs (bathing, dressing and 
transferring) for over 30 consecutive days.  Moreover, it is our 
opinion that the nature of the applicant’s injury, the physical 
profile limitations and the short duration of his hospital stay 
more likely than not prevented his physicians and occupational 
therapist from fully observing the daily care and assistance the 
applicant required in performing the various ADLs.  As such, we 
find the nature of the applicant’s injury, the physical profile 
limitations and the short duration of his hospital stay coupled 
with the applicant’s wife’s first-hand account of the assistance 
she provided sufficient to grant the relief sought.  Therefore, 
in the interest of justice we recommend the applicant’s records 
be corrected as indicated below. 

_______________________________________________________________

THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air 
Force relating to APPLICANT be corrected to show that his 
application for Servicemembers’ Group Life Insurance Traumatic 
Injury Protection (TSGLI) was approved based on the 
determination that he suffered the loss of three Activities of 
Daily Living (ADL) for 30 days and he is entitled to payment in 
the amount of $25,000. 

________________________________________________________________

The following members of the Board considered AFBCMR Docket 
Number BC-2013-05143 in Executive Session on 18 Sep 14, under 
the provisions of AFI 36-2603:

     , Panel Chair
     , Member
     , Member


All members voted to correct the records as indicated. The 
following pertinent documentary evidence in AFBCMR Docket Number 
BC-2013-05143 was considered:

    Exhibit A.  DD Form 149, dated 19 Oct 13, w/atchs.
    Exhibit B.  Letter, AFPC/DPFC, undated, w/atch.       
    Exhibit C.  Letter, SAF/MRBR, dated 21 Mar 14.