RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF: 			DOCKET NUMBER: BC-2014-01344
 					COUNSEL:  NONE
					HEARING DESIRED:  YES


APPLICANT REQUESTS THAT:

His Servicemembers’ Group Life Insurance Traumatic Injury 
Protection (TSGLI) appeal application be approved and he be paid 
an additional $25,000.  


APPLICANT CONTENDS THAT:

His doctor clearly annotated in his TSGLI application that he was 
unable to perform the Activities of Daily Living (ADL) for 
60 days.  He was unable to use his arm and required assistance for 
60 days.  

The military did not clear him for duty until 15 Sep 03.

He submitted this same package in Aug 13.  His medical provider 
documented that he was unable to perform 4 of the 6 ADLS for 
60 days.  

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


STATEMENT OF FACTS:

The applicant is a member of the Air Force Reserve.  

According to his DD Form 214, Certificate of Release or Discharge 
from Active Duty, he served on this period of active duty from 
1 Oct 02 to 11 Aug 05.  

According to a medical report dated 10 Jul 03, the applicant cut 
his right arm on 9 Jul 03 with a piece of glass from a broken 
tabletop.  He had 2 lacerations to his forearm and one over the 
radial aspect of the wrist.  Both wounds were sutured. 

According to the Hand Surgery Center, Operative Report dated 
14 Jul 03, he received surgery to repair the lacerations to his 
tendons, nerve and radialis in his right arm. 

According to a SF 600, Chronological Record of Medical Care, dated 
11 Jul 03, the applicant presented to flight medicine to report he 
injured himself in an accident on 9 Jul 03.  He was carrying a 
glass table out of his house when he fell and received acute 
lacerations to his right forearm and wrist.  He was seen in the 
emergency room at University Hospital, Cincinnati, OH where his 
lacerations were closed.  He was scheduled to be evaluated on 
14 Jul 13 for re-exploration of his wound.  He was coded as Duty 
Not Involving Flying (DNIF).    

Per AF Form 422, Physical Profile Serial Report, dated 24 Jul 03, 
the applicant was restricted from any duties involving the use of 
his right arm and was documented as not Worldwide Qualified (WWQ).  
The release date of the duty restriction was 1 Sep 03.  

According to the Hand Surgery Specialists note dated 24 Aug 03, he 
was cleared to return to work or school without restriction.  

Per AF Form 422, dated 15 Sep 03, he was returned to duty with no 
restrictions and was documented as WWQ.   

Payment for loss of ADL due to traumatic injury other than brain 
injury is paid as follows:  $25,000 at the 30th consecutive day, 
an additional $25,000 at the 90th consecutive day, and an 
additional $25,000 at the 120th consecutive day.  


AIR FORCE EVALUATION:

AFPC/DPFC recommends denial.  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 ADL (eating, bathing, 
dressing, toileting, transferring and continence). 

Based on the eligibility criteria outlined in CFR Title 
38 9.20 and the recommendation of the physician’s review of the 
original claim and appeal, the applicant’s TSGLI claim does not 
meet the TSGLI eligibility criteria for payment of ADL loss for 
60 consecutive days. 

On 17 Mar 13, the applicant submitted a TSGLI application claiming 
the inability to perform the ADL of bathing, dressing, eating and 
toileting beginning 10 Jul 03 (signed by the certifying medical 
professional on 21 Feb 13).  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.   

On 5 Sep 13, the applicant submitted an appeal for ADL loss 
through the 60 day threshold.  The medical review included the 
following statement, “he was paid for 30 days ADL loss with the 
original claim.  There is no indication whatsoever that the 
applicant could not perform all ADL using his non-dominant hand 
and arm.  While performing these ADLs would not have been as 
efficient with the non-dominant arm and hand, he was not rendered 
unable to perform them.”  On 31 Jan 14, the appeal authority 
signed the denial of his appeal.

The burden of proof is on the applicant to provide evidence that 
his ADL loss reached the 60 day threshold.  To the contrary, the 
evidence provided indicates the applicant’s medical provider 
released the patient to return to work without restrictions on 
24 Aug 03 (reference Hand Surgery Specialists, Incorporated, note 
dated 24 Aug 03).  It is reasonable to infer that the applicant 
was able to perform the cited ADLs at that time.  

A complete copy of the DPFC evaluation is at Exhibit C.


APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

A copy the Air Force evaluation was forwarded to the applicant on 
27 Jun 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 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 
failed to sustain his burden of proof that he has 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 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 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-2014-01344 in Executive Session on 26 Feb 15 under the 
provisions of AFI 36-2603:

	 , Panel Chair
	 , Member
	 , Member

The following documentary evidence was considered:

	Exhibit A.  DD Form 149, dated 1 Mar 14, w/atchs.
	Exhibit B.  Applicant's Master Personnel Records.
	Exhibit C.  Memorandum, AFPC/DPFC, dated 5 Jun 14.              
	Exhibit D.  Letter, SAF/MRBR, dated 27 Jun 14.