RECORD OF PROCEEDINGS


	IN THE CASE OF:	  


	BOARD DATE:	  17 January 2008
	DOCKET NUMBER:  AR20070006550 


	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

Ms. Antoinette Farley

Analyst


The following members, a quorum, were present:


Mr. Hubert O. Fry, Jr.

Chairperson

Mr. John T. Meixell

Member

Mr. Rowland C. Heflin

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 TSGLI payment due to arthritis and a torn meniscus received after falling from a vehicle [High Mobility Multipurpose Wheeled Vehicle].  The applicant also states that he suffered from spider bites and had anterior cruciate ligament (ACL) reconstructive surgery on his right knee.  

3.  The applicant continues that "on 6 March 2007 the doctor incorrectly filled out the ADL's."  He continues that the entry of 5 June 2006 should show that on 25 September 2006 he received multiple injuries to his right knee.  

4.  The applicant argues that he was not rejected because his injuries did not qualify, but because his paperwork was incorrectly filled out. 

5.  The applicant provided copies of his medical service records, and TSGLI application packet which included TSGLI reconsideration claim requests, TSGLI denial, and appeals letters in support of this application.

CONSIDERATION OF EVIDENCE:

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

2.  Department of Defense, State of Georgia, Military Division Office of The Adjutant General, Atlanta, Georgia Orders Number 358-457, dated 23 December 2004, show that the applicant was ordered to active duty in support of Operation Iraqi Freedom.

3.  A TSGLI Army Review Boards Agency (ARBA) Summary, shows on 15 April 2005, the applicant fell off a truck and hurt his back and knee, and that injury did not occur within the theatre of operations. 

4.  The Summary continues that on 21 December 2005, a Statement of Medical exam and duty status shows the applicant stepped out of a High Mobility Multipurpose Wheeled Vehicle (HUMVEE) and twisted his right knee in Iraq.  



5.  The summary continues that on 30 March 2006 the applicant was given a temporary profile with unlimited walking.  On 5 September 2006, the applicant had right knee ACL reconstruction surgery on 5 September 2006 at the United States Army Medical Center, Fort Stewart, Georgia.  The Summary continues that on 12 November 2006 the applicant was seen at the LRMC for a concussion and returned to duty.

6.  The Summary shows the applicant's first TSGLI claim was filed on 6 March 2006, for ADLs (dressing, bathing, eating, transferring and toileting) for 120 days, and partial hearing loss in both ears.  The Summary further shows that there were no medical documents to substantiate a level of hearing loss that would make him eligible for TSGLI and that the physician and the applicant claim that he fell off a truck at Fort Irwin, California.  The Summary continues that this claim alone made him ineligible under current guidelines because prior to 1 December 2005 the injury or loss must have occurred in a geographic location that qualified the applicant for the combat zone tax exclusion.  The Summary concluded that there was no medical documentation supporting complete dependence on another person for ADLs for 30 or more days, therefore, his claim was disallowed on 4 May 2006.  

7.  The summary adds the applicant filed several reconsideration claims which were disallowed due to duplication of previous claims and/or no medical documentation supporting complete dependence on another person for ADLs for 30 or more days. 

8.  Part B (To be completed by Attending Medical Professional) of the applicant’s Certification of Traumatic Injury Protection [TSGLI] form, undated, shows that the applicant was injured on 15 April 2005.  The form shows that the applicant stated that he fell off a truck and hurt his back and knee which initially happened in Fort Irwin, California.  The applicant also submitted a second Part B form, undated, which shows that he was injured on 15 April 2006, but also incurred a loss of hearing on 1 June 2005.  

9.  Part C (To be Completed by Branch of Service) of the applicant's Certification of Traumatic Injury Protection [TSGLI] form, dated 3 May 2006, shows the applicant was covered under SGLI, but does not qualify for TSGLI.  The TSGLI Program Manager states that the supporting medical documentation does not support the physician certification.  The Manager continues that there are insufficient supporting medical documents to support the loss 5 of 6 ADLs.  The Manager states that he could no verify event or geographic location although the physician stated on the certification that the event occurred at Fort Irwin on 15 April 2005, and two physicians reviews.
10.  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. 

11.  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.  

12.  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 initially injured on 15 April 2005 by falling off a truck and hurting his back and knee.  The applicant's records show that he was placed on light duty and returned to work with limitations.  Additionally these injuries did not occur in a qualified theater of operation.

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.   

3.  While it is unfortunate that the applicant suffered financial hardship based on the injury he sustained after falling off a truck and partial hearing loss in both ears.  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.  
4.  Further, the applicant has not provided sufficient documentation supporting his contention that his TSGLI claims were improperly disallowed by the TSGLI Program Management.  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

_HOF___  _RCH__ _  _JTM    ____  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.





___Hubert O. Fry, Jr.__
          CHAIRPERSON




INDEX

CASE ID
AR20070006550
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.