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.


APPLICANT CONTENDS THAT:

His TSGLI claim for Activities of Daily Living (ADL), from 1 Mar 
through 6 May 13 was denied by the reviewing physician, due to 
incomplete evidence by the orthopedic specialist and personal 
opinion.  

His appeal, which included ADL specific documentation from two 
medical specialist and a sworn statement from his caregiver, was 
denied for completely different reasoning, including, “ADL 
capability is not provided by Occupational Therapy or Physical 
Therapy” which is not a requirement for TSGLI documentation.

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


STATEMENT OF FACTS:

According to AF IMT 348, Line of Duty Determination, the applicant 
was involved in a mid-air free fall collision with another jumper 
during a military free fall jump on 1 Mar 13 at Phillips Drop 
Zone, Yuma Proving Grounds, AZ.  His collision resulted in a 
fractured Left Knee (Left Tibial Plateau/Left Fibular Head).  He 
was immediately treated and transported to the Yuma Proving Ground 
Medical Clinic for initial evaluation and then to Yuma Regional 
Medical Center Emergency Room for Computerized Tomography (CT) 
scan.  One week later after a Magnetic Resonance Imaging (MRI), it 
was found that he also had involvement of his ligaments inside the 
knee Posterior Cruciate Ligament (PCL).  

On 28 Apr 14, the applicant was medically retired with a 
compensable disability rating of 60 percent and was credited with 
9 years, 4 months, and 14 days of active service for retirement.   


AIR FORCE EVALUATION:

AFPC/DPFC recommends denial indicating based on eligibility 
criteria outlined in CFR Title 38 9.20 and Emergency Supplemental 
Appropriations Act for Defense, the Global War on Terror, and 
Tsunami Relief, 2005 (Public Law 109-13), the applicant’s TSGLI 
claim does not meet the TSGLI eligibility criteria for payment of 
ADL loss for 60 consecutive days or lessor payment threshold.  

On 19 Jan 15, DPFC received the applicant's application requesting 
that his TSGLI claim be approved.  The burden of proof is on him 
to demonstrate that he suffered a scheduled loss (in this case, 
inability to perform two of six ADLs for at least 30 consecutive 
days).  After reviewing the original claim and appeal, their 
position remains firm that the applicant does not meet TSGLI 
criterion for ADL loss for any payable threshold. Neither the 
original claim nor the appeal was arbitrarily denied.  Two 
experienced physicians, trained by the Department of Veterans 
Affairs (DVA) on TSGLI loss criteria, reviewed the claim and 
medical records and determined the applicant did not meet TSGLI 
criterion for ADL loss.  As stated by the physician that perform 
the appeal package assessment, "while it is reasonable that the 
applicant’s completion of ADLs would certainly be easier, faster, 
and more confident with assistance; it does not follow that this 
injury would have rendered him incapable of performing ADLs."

It is also noted that the original claim's medical assessment 
indicated that the bathing ADL met TSGLI loss criteria; however, 
common sense dictates that ADLs of dressing and transferring could 
be performed without assistance by 25 Mar 13 when he was allowed 
to start working on range of motion exercises by taking the knee 
brace off (dressing could be done with the brace off). It is also 
logical to conclude that an able bodied (with the exception of the 
left lower extremity) person would be able to get in and out of a 
bed or chair using crutches alone (i.e., performing the 
transferring ADL).  In fact, his physician states that he only 
required assistance with the toileting ADL for the first seven 
days.  The toileting ADL includes aspects of the dressing and 
transferring ADLs.

The complete DPFC evaluation is at Exhibit C.


APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant refutes virtually every point made by the OPR and 
argues that based on the evaluation by his treating physician and 
his orthopedic specialist, his denial of TSGLI claim should be 
approved.  

He believes the reviewing physicians consistently ignore the 
stand-by assistance definition which states, “a patient requires 
someone to be within arm’s reach because the patient’s ability 
fluctuates and physical or verbal assistance may be needed.”  The 
two medical providers have described all of his ADL losses in 
detail.

He believes the advisory statement about the incident completely 
downplays the extreme nature of the accident by stating that he 
was “able to land.”

In para 3, the advisory, simply put, calls his flight surgeon a 
liar and says that his notes were “exaggerated or just not based 
in reality.”  His physician, is assigned to roughly 60 free fall 
instructors and understands the circumstances and the fact that 
the advisory attacks his integrity is offensive and has no place 
in this review.

The applicant goes on to express his disagreement with some of the 
statements in the advisory opinion and the training and experience 
it took to become an Air Force Combat Controller.  He has served 
his country and appeals to the Board to approve his claim.
 
The applicant’s complete response, with attachments, 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.  Sufficient relevant evidence has been presented to demonstrate 
the existence of error or injustice warranting corrective action.  
We note DPFC states that the medical consensus was he did not 
require the assistance of another person to perform the cited ADLs 
for 60 consecutive days or lessor payment threshold; however, we 
find a preponderance of the evidence supports a 30-day period.  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 employed human assistance to perform the various 
ADLs (bathing, dressing and transferring) for 30 consecutive days 
or more.  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 caregiver’s first-hand account 
of the assistance she provided sufficient to grant TSGLI for 
30 days.  Therefore, 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 the APPLICANT be corrected to show that his 
application for Traumatic Servicemembers’ Group Life Insurance 
(TSGLI) Protection 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-2014-02977 in Executive Session on 14 Apr 15 under the 
provisions of AFI 36-2603:

	, Panel Chair
	, Member
	, Member

All members voted to correct the records as recommended.  The 
following documentary evidence was considered:

	Exhibit A.  DD Form 149, dated 20 Jul 14, w/atchs.
	Exhibit B.  Pertinent Excerpts from Personnel Records.
	Exhibit C.  Letter, AFPC/DPFC, dated 9 Feb 15.
	Exhibit D.  Letter, SAF/MRBR, dated 27 Feb 15.
	Exhibit E.  Letter, Applicant, dated 14 Aug 13, w/atchs.