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 Member’s 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.



APPLICANT CONTENDS THAT:

He was paid TSGLI for the first 30 days after his injury, but his second 30-day claim was unfairly denied even though there was no change in his ability to accomplish ADLs.  The supporting documents provided to the TSGLI Appeals Board with his appeal package were somehow not included for review by the Board. 

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



STATEMENT OF FACTS:

The applicant served on active duty in the grade of Master Sergeant (MSgt) during the matters under review.  

On 25 Apr 08, the applicant received a wound to his left wrist while serving at Balad Air Base, Iraq, and was evacuated for medical treatment.  

On 29 May 08, the applicant submitted a TSGLI application claiming the inability to perform the ADLs of bathing and dressing for 30 consecutive days during the period 25 Apr 08 through 24 May 08.  His application was approved and the applicant received a $25,000 TSGLI payment.  

On 18 Jun 08, the Casualty Matters database was updated to document that the applicant was returned to duty, effective 9 Jun 08.  
On 16 Jul 08, the applicant submitted a second TSGLI application claiming the inability to perform the ADLs of bathing and dressing for in excess of an additional 30 consecutive day period from 25 May 08 through 24 Jun 08 (61 days total).  His second application for a TGSLI payment was denied.  

On 10 May 09, the applicant appealed the decision to deny his second TSGLI claim, but his appeal was also denied. 

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 C.    



AIR FORCE EVALUATION:

AFPC/DPPC recommends denial indicating there is no evidence of an error or an injustice.  On 5 May 05, Public Law 109-13 was signed by President Bush establishing a traumatic injury program designed to provide financial assistance to service members during recovery from serious traumatic injury (not necessarily as a result of combat).  The insurance (TSGLI) is a rider to the member’s Servicemember’s Group Life Insurance (SGLI) policy.  TSGLI pays a monetary benefit of $25K to $100K for covered losses that are incurred by the member as a result of traumatic injury.  In order to qualify, a service member must require assistance to perform at least two of six ADLs for a minimum of 30 days.   

On 19 Jun 08, the applicant was paid $25K for his TSGLI application due to his inability to perform two of six ADLs for at least 30 consecutive days.  On 16 Jul 08, the applicant submitted a second TSGLI claim for $25K for a second 30-day period claiming ADL loss of bathing and dressing through 24 Jun 08, 61 days from the start of his initial claim.  Casualty records indicate the applicant was returned to duty on 9 Jun 08 and AFMOA/SG3PF evaluated this claim and the applicant’s medical records and concluded “It is clear this patient was capable of bathing and dressing himself prior to 24 Jun 08.”  The applicant’s second claim was denied on 14 Aug 08.  In accordance with Code of Federal Register (CFR), Title 38, Part 9.20, an appeal must be submitted within one year of the date of a denial of eligibility.  This applicant received notification of his denial in Jul 09.  In addition, although the applicant argues that the supporting documents provided to the TSGLI Appeals Board with his appeal package were somehow not included for review by the Board, this statement is false.  All documents the applicant filed with the BCMR (except the 2013 letter from the spouse) were part of the second appeal documents on file.  It is clear the medical consensus was that the assistance the applicant received was not a medical necessity for the 60-consecutive days needed to reach the next TSGLI payment threshold.  Request the AFBCMR consider the lateness of the request in terms of the one-year limited set for the in the TSGLI legislation and the tardiness of this application.  

A complete copy of the AFPC/DPPC evaluation is at Exhibit C.



APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy of the Air Force evaluation was forwarded to the applicant on 9 Apr 14 for review and comment within 30 days (Exhibit D).  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 of injustice.  While the Board notes the documentation submitted by the applicant in support of his contention that he needed assistance with ADLs for 61-consecutive days, given that the applicant returned to duty on 8 Jun 08, prior to completion of the period for which he is applying for TSGLI benefits, we are not convinced the evidence presented is sufficient to undermine the determination of the Air Force physicians that assistance with ADLs claimed by the applicant was no longer medically necessary.  In addition, the applicant contends the documentation he submitted to the TSGLI Appeals Board was not considered, but we note that per AFPC/DPPC all the documentation the applicant submitted to the AFBCMR, other than the 2013 letter of support from his spouse, was on file and available to the TSGLI Appeals Board when they made their final denial determination.  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-2013-05480 in Executive Session on 23 Oct 14 under the provisions of AFI 36-2603:

	Panel Chair 
	Member
	Member

The following documentary evidence was considered:

	Exhibit A.  DD Form 149, dated 18 Nov 13, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Memorandum, AFPC/DPFC, dated 20 Mar 14.
Exhibit D.  Letter, SAF/MRBR, dated 9 Apr 14.

						






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