RECORD OF PROCEEDINGS


	IN THE CASE OF:	  


	BOARD DATE:	  19 June 2007
	DOCKET NUMBER:  AR20070004765 


	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

Mrs. Antoinette Farley

Analyst


The following members, a quorum, were present:


Ms. Barbara J. Ellis

Chairperson

Mr. Frank C. Jones, II

Member

Mr. Qawly A. Sabree

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 essentially states that he is entitled to a TSGLI payment due to total left knee replacement and being completely dependent on his wife for completion of activities of daily living (ADL), namely: dressing, bathing, and incapacitation during the period 10 August 2005 through 7 September 2005.  

3.  The applicant continues that in August 2005, his doctor replaced his left knee. The applicant argues that his wife had to stop working to stay at home with him and it put the family in a financial bind which affected his savings and maxed out their credit cards.  The applicant continues that in the middle of his recuperation hurricane Katrina hit on the 29 August 2005 and they had to relocate to a hotel in Tennessee for 4 weeks.

4.  The applicant continues that he and his family returned home after the electricity was restored.  However, the applicant states that due to the lack of medical care he required a second surgery and his wife had to miss more time from work.  The applicant states that he is in need of financial help.

5.  The applicant provided copies of his service medical records, along with paperwork related to his TSGLI application, appeals and denials in support of this application.

CONSIDERATION OF EVIDENCE:

1.  The applicant is currently on Active duty in the Regular Army.

2.  On 7 July 2004, the applicant sustained an injury to his left knee after he fell off the back of a truck at Camp Shelby, Mississippi which required total knee replacement. 

3.  On 21 July 2004, the applicant was placed on light duty and returned to work. 

4.  On 10 August 2004, the applicant had left knee arthroscopy which showed he had definitive degenerative joint disease with a medial meniscus tear and anterior cruciate ligament injury.  The applicant's records shows he underwent one year of physical therapy and anti-inflammatory drug treatments.  

5.  On 2 August 2005, the applicant was admitted to Garden Park Medical Center, Tampa, Florida, for left knee surgery and was effectively discharge from the hospital upon on 5 August 2005.  The applicant's records show that he was deemed fit to return to full duty on 15 November 2005.

6.  On 12 September 2006, the applicant submitted a TSGLI claim for loss of ADLs for dressing, bathing, and incapacitation for 60 days, but on 26 September 2006, the United States Army Physical Disability Agency (USAPDA) returned his claim due to being incomplete.

7.  On 11 October 2006, the TSGLI Branch, USAPDA, informed the applicant that his TSGLI case was disallowed, as the medical documentation submitted did not substantiate his complete dependence on another for performance of ADLs.  Additionally, the applicant was informed that he did not qualify for TSGLI benefits because his injury was not sustained in a qualifying theater of operation.

8.  On 18 December 2006, the applicant filed an appeal of his TSGLI claim, for the loss of ADLs for 60 days for dressing, bathing, toileting, and transferring.  On 6 March 2007, the USAPDA disallowed his appeal because the medical documentation submitted did not substantiate his complete dependence on another for performance of ADLs.  He was again informed that he did not qualify for TSGLI benefits because he did not sustain the injury while serving in a qualified theater of operations.

9.  Part B (To be Completed by Attending Medical Professional) of the applicant’s Certification of Traumatic Injury Protection [TSGLI] form, dated 16 October 2006, shows that the applicant’s attending physician essentially stated that he incurred the injury on 7 July 2004, and needed a left total knee replacement due to degenerative joint disease.  The attending physician also states that the applicant's claim is for paralysis due to inflammation to the left knee which was not clinically stable or irreversible, and was unable to perform dressing, bathing, or transferring independently for over 60 days.

10.  The Doctor's comments also show that the applicant was approved for convalescent leave during the periods 5 August 2005 through 5 September 2005, and from 14 September 2005 through November 2005. 

11.  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. 

12.  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 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.  

13.  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.  The Board noted the applicant’s disagreement with responses to his TSGLI claims; however, evidence of record clearly shows that he was injured and treated for pain to his left knee after falling from the back of a truck while stationed at Camp Shelby, Mississippi which is not a qualifying theater of operation for award of TSGLI benefits. 

2.  The statement by the applicant’s attending physician in Part B of his TSGLI claim form shows that he could not perform dressing, bathing, or transferring independently for over 60 days is noted.  The Board does not dispute the fact that the applicant required medical care on 7 July 2004, the date of his initial injury.  However, the applicant's records show that he was placed on two periods of light duty and both times returned to work with lifting, walking, and running limitations.

3.  The applicant's medical records show that he was under the care of an Orthopedic Specialist for an anterior cruciate injury and underwent left knee surgery on 10 August 2005.  However, the evidence in his service medical records does not approach the level of required documentation to justify a TSGLI payment for loss of ADLs. 

4.  While it is unfortunate that the applicant suffered financial hardship based on the injury he sustained at Camp Shelby, Mississippi, and the evacuation due to Hurricane Katrina, there is no evidence in the available records and the applicant has not provided sufficient evidence showing that his injuries were sustained in a qualifying theater of operations or that he could not perform at least three ADLs for the required period.  Additionally, the applicant has not provided sufficient documentation supporting 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. 

5.  Based on the foregoing, there is no basis to grant the relief requested in this case.

6.  In order to justify correction of a military record the applicant must, or it must otherwise satisfactorily appear, that the record is in error or unjust.  The applicant has failed to submit evidence that would satisfy that requirement.  In view of the foregoing, there is no basis for granting relief to the applicant in this case.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

_BJE____  _QS____  __FCJ___  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.





__Barbara J. Ellis___
          CHAIRPERSON



INDEX

CASE ID
AR20070004765
SUFFIX

RECON
YYYYMMDD
DATE BOARDED
YYYYMMDD
TYPE OF DISCHARGE
(HD, GD, UOTHC, UD, BCD, DD, UNCHAR)
DATE OF DISCHARGE
YYYYMMDD
DISCHARGE AUTHORITY
AR . . . . .  
DISCHARGE REASON

BOARD DECISION
(NC, GRANT , DENY, GRANT PLUS)
REVIEW AUTHORITY

ISSUES         1.

2.

3.

4.

5.

6.