PROCEEDINGS


         IN THE CASE OF:
        

         BOARD DATE: 5 August 2003
         DOCKET NUMBER: AR2002081376

         I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual.

Mr. Carl W. S. Chun		Director
Mr. Joseph A. Adriance		Analyst

The following members, a quorum, were present:

Mr. Luther L. Santiful		Chairperson
Mr. Curtis L. Greenway		Member
Mr. Ronald J. Weaver		Member

         The applicant and counsel if any, did not appear before the Board.

         The Board considered the following evidence:

         Exhibit A - Application for correction of military
records
         Exhibit B - Military Personnel Records (including
         advisory opinion, if any)

FINDINGS :

1. The applicant has exhausted or the Board has waived the requirement for exhaustion of all administrative remedies afforded by existing law or regulations.

---

2. The applicant requests, in effect, that his records be corrected to show he was eligible for dental care prior to 1 July 2002.

3. The applicant states, in effect, that a mistake in the Defense Enrollment Eligibility Record System (DEERS) resulted in United Concordia Companies Incorporated (UCCI) not paying his dental bills during the year 2002. He claims that he has been a member of the Army National Guard (ARNG) in good standing since 1 May 1998, and he has continued to pay his dental premiums since that date. He claims there has been no gap in either his service or the dental coverage. He states that he has attempted to resolve this situation through the DEERS office, but they were unable to resolve the error. In support of his application, he provides a letter he submitted to the Washington State ARNG Inspector General, and a supporting memorandum from his unit administrator.

4. The applicant’s record shows that he served on active duty from 1994 through 1998, and on 1 May 1998, he enlisted in the ARNG. He has continued to serve in the ARNG since that time, and is currently still serving in this status.

5. The readiness noncommissioned officer (NCO) of the applicant’s unit provides a supporting memorandum that confirms that the applicant is a member of Company A, 341^st Military Intelligence (MI) Battalion, Washington ARNG. It further verifies that the applicant has been a member of the unit in good standing since 1 May 1998, and that he joined the UCCI dental program in May 2000 and has paid all program premiums due since that date.

6. The applicant has provided the following dental bills for the dates and services indicated: 2 January 2002/6 February 2002, Porcelain Crown Prep & Seat (Code 02740) for tooth 8, $797.00, and tooth 9, $797.00; 20 February 2002, Periodic Oral Examination (Code 00120), $29.00, Prophylaxis (Code 01110), $73.00, and Dura Flor Desentizer (09110), $30.00; and 15 October 2002, Resin-2 Surf-Post Perm (Code D2386), $158.00.

7. The UCCI, TRICARE Dental Program, National Fee for Service Schedule, provides the authorized allowable amounts of insurance claim payments for dental procedures. It shows that the following amounts would be paid by UCCI based on the procedure codes indicated: Code 02740 (Porcelain Crown Prep & Seat) $377.50; Code 00120 (Periodic Oral Examination) $25.00; Code 01110 (Prophylaxis) $53.00; Code 09110 (Dura Flor Desentizer) $30.00; and Code D2386 (Resin-2 Surf, Post Perm) $82.40.

---

CONCLUSIONS:

1. The Board notes the applicant’s contention that his record should be corrected to allow for the payment of his dental claims, and it finds this claim has merit.

2. The evidence of record confirms that the applicant has been a member of the ARNG in good standing since 1 May 1998, and that he has paid all TRICARE dental program premiums due since that date. Thus, the Board concludes that it would be appropriate to provide the applicant payment for the dental services he received while validly enrolled in the program.

3. Based on the UCCI, TRICARE Dental Program, National Fee for Service Schedule, the applicant is authorized to receive the following amounts for the dental procedures he received: Code 02740 (Porcelain Crown Prep & Seat) $377.50 times two; Code 00120 (Periodic Oral Examination) $25.00; Code 01110 (Prophylaxis) $53.00; Code 09110 (Dura Flor Desentizer) $30.00; and Code D2386 (Resin-2 Surf, Post Perm) $82.40. Thus, the Board concludes that given he was a member of the ARNG in good standing and paid all dental premiums, it would be appropriate to reimburse him a total of $945.40.

4. In view of the foregoing, the applicant’s records should be corrected as recommended below.

RECOMMENDATION:

That all of the Department of the Army records related to this case be corrected by reimbursing the individual concerned $945.40, the allowable payment due for all dental services he received during the year 2002 while a member of the ARNG in good standing and validly enrolled in the TRICARE Dental Program.

BOARD VOTE:

__LS__ _RJW___ __CLG___ GRANT AS STATED IN RECOMMENDATION

________ ________ ________ GRANT FORMAL HEARING

________ ________ ________ DENY APPLICATION




                  Luther L. Santiful
                  CHAIRPERSON     

---

INDEX

CASE ID	AR2002081376
SUFFIX
RECON
DATE BOARDED	2003/08/DD
TYPE OF DISCHARGE	N/A
DATE OF DISCHARGE	N/A
DISCHARGE AUTHORITY	N/A
DISCHARGE REASON	N/A
BOARD DECISION	GRANT
REVIEW AUTHORITY
ISSUES 1. 1021	100.0000
2.
3.
4.
5.
6.