DOCKET NUMBER:  AR20080015556 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (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 has submitted the documents needed to determine his eligibility for TSGLI but he has been asked to submit them again.   

3.  The applicant provides the following evidence in support of this application:  a copy of his DD Form 214 (Certificate of Release or Discharge from Active Duty), copies of his DA Forms 2173 (Statement of Medical Examination and Duty Status), copies of his Standard Forms (SF) 500 (Chronological Record of Medical Care), and a copy of his Certification of Traumatic Injury Protection (TSGLI) claim form.      

CONSIDERATION OF EVIDENCE:

1.  The applicant was commissioned as a first lieutenant chaplain in the United States Army Reserve (USAR) on 26 June 2002 and ordered to active duty in support of Operation Iraqi Freedom (OIF) on 13 March 2003.  

2.  On 23 June 2004, the applicant sought treatment for hearing loss, ear pain, and ringing in his ears resulting from an Improvised Explosive Device (IED) explosion that occurred on 19 June 2004.  On 23 August 2005, the applicant sought treatment for injuries to his left shoulder, arm, and bilateral knee pain resulting from being thrown around inside a Humvee (High Mobility Multipurpose Wheeled Vehicle) during the IED explosion that occurred on 19 June 2004.  

3.  On 6 December 2007, the applicant submitted a TSGLI claim for traumatic brain injury, loss of hearing, and multiple knee surgeries due to an IED blast.  On 17 December 2007, the TSGLI Branch, United States Army Physical Disability Agency (USAPDA) informed the applicant that his TSGLI case was disallowed because his hearing average was 20db right ear and 17db left ear and did not meet the TSGLI standard of 80db or worse.  No activity of daily living (ADL) was certified and medical documents did not support ADL loss; therefore, he was not qualified under TGSLI. 

4.  On 5 March 2008, the applicant submitted a request for reconsideration of his TSGLI claim for loss of ADLs for 60 days for dressing, bathing, and transferring. On 2 April 2008, the USAPDA again disallowed his claim because the medical documentation submitted did not substantiate his complete dependence on another for performance of ADLs.  

5.  On 20 June 2008, the applicant filed an appeal of his TSGLI claim, again claiming loss of ADLs for 60 days for dressing, bathing, and transferring.  On 
21 July 2008, the USAPDA disallowed his appeal because the medical documentation submitted did not substantiate his complete dependence on another for performance of ADLs.  

6.  Part B (To be Completed by Attending Medical Professional) of the applicant’s Certification of Traumatic Injury Protection (TSGLI) claim form, dated 18 January 2008, shows that the applicant’s attending physician stated the applicant could not independently perform the functions of dressing, bathing, toileting, or transferring independently for 90 days, onset on 20 September 2007.  He also stated that the applicant had two knee surgeries in 2006 and shoulder surgery in May 2007.

7.  Although the applicant’s service medical records show that he underwent numerous operations to treat the injuries he sustained in June 2004, the applicant’s first surgery was 15 February 2006 and the applicant was ambulating and transferring independently thereafter.  

8.  On 30 June 2008, the applicant was honorably discharged from active duty in accordance with the provisions of Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), paragraph 4- 24b(2), for separation by reason of temporary physical disability.  Item 12c shows his net active service this period as 3 years, 3 months, and 18 days.

9.  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 Operation Enduring Freedom (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. 

10.  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 will not be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.

11.  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 applicant’s disagreement with responses to his TSGLI claims are noted; however, evidence of record clearly shows that although he suffered an injury while serving in Iraq, he was ambulatory and was transferring independently.  Therefore, it is reasonable to presume that if he was ambulatory only a couple of weeks after his surgery, he would not have been completely dependent on another for dressing and bathing at that time either.  There is also no evidence in his service medical records to support his complete dependence for ADLs for 60 days or the minimum 30 days for traumatic injuries other than traumatic brain injuries.

2.  The statement by the applicant’s attending physician in Part B of his TSGLI claim form that he could not perform dressing, bathing, or transferring independently for 90 days is inconsistent and not supported by information contained in his service medical records.  While the fact that the applicant required extensive medical care and support following his injury in June 2004 is not in question, the evidence in his service medical records does not approach the level of required documentation required to justify a TSGLI payment for loss of ADLs. 

3. The applicant 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 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 the applicant's requested relief.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

___ x    __  ___  x     _  ___ x    __  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.



      __________x______________
               CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.

ABCMR Record of Proceedings (cont)                                         AR20080015556



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20080015556



5


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1