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 applicants 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, DPFCs 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.
DPFCs 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 applicants
complete submission, we are not persuaded the record warrants
the requested correction. The applicants 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 applicants 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.
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