IN THE CASE OF:	  

		BOARD DATE:	  10 August 2010

		DOCKET NUMBER:  AR20100001037 


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 her Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim for being completely dependent on another person for completion of three activities of daily living (ADL) (dressing, eating, and bathing) for 30 days be approved.  

2.  The applicant states some of her medical records were lost during redeployment.  However, she believes the physician's statement will verify her inability to perform any ADL for approximately 30 days.  Since her injury she has been medically retired from the Army, awarded Department of Veterans Affairs (VA) disability compensation, and Social Security disability.

3.  The applicant provides documents which she lists in her application.

CONSIDERATION OF EVIDENCE:

1.  The applicant, a Reservist serving on active duty in pay grade E-8, fell while exiting her quarters in Afghanistan when her unit was under mortar attack on 26 December 2005.

2.  The applicant provides four military medical documents:

   a.  The first is a Standard Form (SF) 600 (Chronological Record of Medical Care), dated 6 March 2006, which shows the applicant was seen for lower back pain.  No lower back pain radiating.  Lower back pain is worse in the morning, worsens with sitting in a car, and by lying down with leg straight, it is better with flexed leg.  The physician released the applicant without limitations;
   
   b.  The second is a memorandum, dated 5 June 2007, which shows the applicant was treated for migraine headaches.  The physician gave the applicant physical profile restrictions consisting of no running, timed walking, no lifting over 10 pounds, sit-ups, or jumping.
   
   c.  The third is a DA Form 3349 (Physical Profile), dated 21 December 2007, which shows the applicant was given permanent physical profile restrictions.
   
   d.  The fourth is a "Certification of Traumatic Injury Protection (TSGLI)," Part B, dated 7 May 2006, in which a military physician stated the applicant could not independently perform dressing, bathing, toileting, and transferring for 30 days.

3.  The TSGLI Branch, U.S. Army Human Resources Command denied the applicant's request for TSGLI on 13 June 2006, 6 October 2006, and 16 October 2007 because the applicant was on a 90-day profile that permitted walking, biking and swimming at her own pace.

4.  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 Operation Iraqi Freedom and Operation Enduring Freedom 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. 

5.  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.  

6.  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 Certification of Traumatic Injury Protection form provided by the applicant shows she could not independently perform dressing, bathing, toileting, and transferring for 30 days.

2.  The only medical record provided to the ABCMR preceding the date of that Certification is a SF 600, dated 6 March 2006, which shows the applicant was seen for lower back pain and was released without limitations.

3.  The TSGLI Branch indicates the applicant was on a 90-day profile that permitted walking, biking and swimming at her own pace during the time being claimed for TSGLI, however, the profile was not provided to the Board.

4.  Without a military medical record which imposes physical profile restrictions which would support the findings contained in the Certification, there is insufficient documentation in which to grant the applicant's request.

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)                                         AR20100001037



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ABCMR Record of Proceedings (cont)                                         AR20100001037



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