RECORD OF PROCEEDINGS


	IN THE CASE OF:	  


	BOARD DATE:	  17 July 2007
	DOCKET NUMBER:  AR20070001209 


	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.  


Ms. Catherine C. Mitrano

Director

Mr. Michael L. Engle

Analyst


The following members, a quorum, were present:


Mr. Jonh N. Slone

Chairperson

Mr. David K. Haasenritter

Member

Ms. LaVerne M. Douglas

Member

	The Board considered the following evidence: 

	Exhibit A - Application for correction of military records.

	Exhibit B - Military Personnel Records (including advisory opinion, if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests, in effect, that his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim be reconsidered. 

2.  The applicant states, in effect, that he is entitled to a TSGLI payment because he was completely dependent on another person for completion of three activities of daily living (ADL), namely, dressing, bathing, and transferring.  He also states, in effect, that his TSGLI claim was denied for a third time, but that he disagrees with those decisions.   

3.  The applicant provides a copy of his documentation as submitted to TSGLI, 200 Stovall Street, Alexandria, Virginia 22332-0470.

CONSIDERATION OF EVIDENCE:

1.  On 9 March 1995, the applicant enlisted in the United States Army Reserve for 8 years, in the rank of private first class, pay grade E3.  He completed his initial training and was awarded military occupational specialty 11B1O (Infantryman).  He attained the rank of staff sergeant, pay grade E6 on 
24 September 2002.

2.  On 16 August 2004, the applicant was ordered to active duty in support of Operation Iraqi Freedom and served in Iraq from 1 February 2005 to 12 January 2006.

3.  The Chronological Record of Medical Care, dated 23 October 2006, shows that on 22 April 2005, the applicant fell to the ground while on a combat patrol in Iraq.  He injured his right shoulder and knee.  He was evaluated and treated in the medical clinic for continuing pain.  He refused to be medically evacuated and completed his deployment.  He was subsequently evaluated at Tripler Army Medical Center, Honolulu, Hawaii, and diagnosed with a torn rotator cuff.  The applicant underwent surgery on 1 March 2006 and again on 8 August 2006, with some improvement.  He has also suffered from back and neck pain since his fall.

4.  On 1 May 2006, the applicant submitted his first request for TSGLI benefits, claiming loss of ADLs for 30 days for dressing, bathing, and transferring, due to his injuries.  The medical documentation submitted did not substantiate complete dependence on another for performance of ADLs.  In addition, it was unclear if external force caused the applicant’s fall to make this a qualifying event.  On
12 June 2006, the administrator of the TSGLI program informed the applicant that his TSGLI claim was disapproved. 
5.  On 14 July 2006, the applicant submitted his TSGLI request for reconsideration, again claiming loss of ADLs for 30 days for dressing, bathing, and transferring.  On 5 August 2006, the administrator of the TSGLI program informed the applicant that his TSGLI claim was again disapproved because the medical documentation submitted did not substantiate complete dependence on another for performance of ADLs. 

6.  On 24 August 2006, the applicant submitted his TSGLI appeal, again claiming loss of ADLs for 30 days for dressing, bathing, and transferring.  On 18 October 2006, the administrator of the TSGLI program informed the applicant that his TSGLI appeal was denied because they were unable to find any documentary evidence to reverse the decision made on his claim.

7.  On 7 January 2007, the applicant was honorably discharged due to physical disability with severance pay.  He had completed a total of 3 years, 6 months, and 10 days of creditable active duty and 8 years, 3 months, and 19 days of inactive service.

8.  Public Law 109-13 (The Emergency Supplemental Appropriations Act, for Defense, the Global War on Terror, and Tsunami Relief, 2005), signed by the President on May 11, 2005, established the TSGLI program.  U.S. Army Combat-Related Special Compensation (CRSC) has been designated as the lead agent for implementing the Army TSGLI program.  The TSGLI program was established by Congress to provide relief to Soldiers and their families after suffering a traumatic injury.  TSGLI provides between $25,000 and $100,000 to severely injured Soldiers who meet the requisite qualifications set forth by the Department of Defense.  As of 1 December 2005, TSGLI is included as part of a Soldier's SGLI coverage.  Any Soldier who elected SGLI coverage automatically receives TSGLI coverage with an additional $1 taken out each month to cover the cost of the TSGLI policy.  Soldiers paying for SGLI coverage cannot decline TSGLI--it is a package.  In addition, there is a retroactive program, in which Soldiers who incurred a qualifying traumatic injury from 7 October 2001 through 30 November 2005, while supporting OIF and OEF or under orders in a Combat Zone Tax Exclusion (CZTE) area are covered regardless of whether they elected SGLI coverage or not.  Soldiers who elect SGLI coverage and incur a qualifying traumatic injury after 1 December 2005 (with the exception of some specific circumstances under which a traumatic injury will not be covered), regardless of their component (Active, Reserve, or National Guard) or the location in which they incurred the injury will be covered by TSGLI. 


9.  There are some specific circumstances under which a traumatic injury will not be covered by TSGLI.  A qualifying traumatic injury is an injury or loss caused by application of external force or violence (a traumatic event) or a condition whose cause can be directly linked to a traumatic event.  Traumatic injuries covered may include, but are not limited to the following types of losses:

	a.  total and permanent loss of sight in one or both eyes;

	b.  loss of hand or foot by severance at or above the wrist or ankle; 

	c.  total and permanent loss of hearing in one or both ears;

	d.  loss of speech;

	e.  loss of thumb and index finger of the same hand by severance at or above the metacarpophalandeal joints;

	f.  quadriplegia, paraplegia, or hemiplegia;

	g.  3rd degree or worse burns covering 30 percent of body or 30 percent of the face;

	h.  coma or traumatic brain injury; or

	i.  other traumatic injuries resulting in the inability to carry out two of the six ADLs, which are dressing, bathing, toileting, eating, continence, and transferring. 
TSGLI claims may be filed for loss of ADLs if the claimant is completely dependent on someone else to perform 2 of the 6 ADLs for 30 days or more 
(15 days or more in the case of traumatic brain injuries).  ADL loss must be certified by a healthcare provider in Part B of the claim form, and ADL loss must be substantiated by appropriate documentation such as Occupational/Physical Therapy Reports, Patient Discharge Summaries, or other pertinent medical documents demonstrating the injury type and duration of ADL loss.  While TSGLI claims won't be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.  

10.  Army Regulation 15-185 (Army Board for Correction of Military Records) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR.  This regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity.  The applicant has the burden of proving an error or injustice by a preponderance of the evidence.
DISCUSSION AND CONCLUSIONS:

1.  The evidence provided by the applicant was carefully considered.  

2.  There is no available evidence of record, and the applicant has not provided any evidence to show that his traumatic injury was caused by an external force or act of violence (a traumatic event) or a condition whose cause can be directly linked to a traumatic event.  Without such substantiation, his injuries cannot be considered as a qualifying event for coverage under the TSGLI.

3.  The applicant also has not provided sufficient documentation to support his contention that his TSGLI claims were improperly disallowed.  Neither the available records nor the medical documentation the applicant provided establish a basis to support his request. 

4.  In view of the above, the applicant’s request should not be granted.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

_LMD__  ___DKH _  __JNS ___  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.




______  John N. Slone______
          CHAIRPERSON




INDEX

CASE ID
AR20070001209
SUFFIX

RECON
 
DATE BOARDED
20070717 
TYPE OF DISCHARGE
 
DATE OF DISCHARGE
 
DISCHARGE AUTHORITY
 
DISCHARGE REASON

BOARD DECISION
DENY
REVIEW AUTHORITY

ISSUES         1.
124.0000
2.

3.

4.

5.

6.