IN THE CASE OF:	  

		BOARD DATE:	  7 October 2010

		DOCKET NUMBER:  AR20100012533 


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 reconsideration of his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim.

2.  The applicant states he was unfamiliar with TSGLI procedures and exhausted his appeal rights with the Office of TSGLI.  He is now requesting that this Board review the new supporting documents.

3.  The applicant provides, in support of his application, copies of the TSGLI Activities of Daily Living (ADL) Worksheet, SGLI 8600 (Part A and B of TSGLI claim), appeal request and denial, motor vehicle accident report, Scott and White Hospital documents, and  medical records from Darnall Army Community Hospital, Fort Hood, TX.

CONSIDERATION OF EVIDENCE:

1.  At the time of his application, the applicant was serving on active duty in the Regular Army as a staff sergeant, pay grade E-6.

2.  On 12 May 2009, the applicant was operating a motorcycle when he swerved to avoid a collision with a pickup truck and crashed in a ditch.  He was transported by air to a civilian hospital emergency department.  He was examined and found to have sustained a left midshaft humeral fracture.  Subsequently, a splint was applied to the area of the broken bone.

3.  Following application of the splint, the applicant was still unable to perform wrist extension, thumb extension, and his finger abduction was weak.  The diagnosis was radial nerve neuropraxia.

4.  The applicant submitted his first request for TSGLI benefits, claiming loss of ADLs for 60 plus days due to left humerus bone fracture injury sustained in a motor vehicle accident.  Medical documentation did not support ADL loss for 
30 days or more.  The denial letter was sent on 9 September 2009.

5.  On 18 September 2009, the applicant submitted a request for reconsideration of his TSGLI claim.  He again claimed ADL loss due to left humerus fracture injury.  The medical documentation submitted did not support a finding that he could not perform the asserted ADL for 30 days or more.  Another denial letter was sent on 27 October 2009.

6.  Medical examination of the applicant's condition on 25 September 2009 revealed:

	a.  no gross motion in his upper left arm to manipulation.  He had significant left shoulder stiffness with only 80 degrees of left shoulder forward flexion.  He had full internal rotation, but external rotation was severely limited to about 
20 degrees.  Left elbow flexion was 140 to 145 degrees, which was within 
30 degrees of full extension; 

	b.  no active left wrist extension, no active left thumb extension, and no active left index, long, ring, or small extension;

	c.  x-rays indicated limited healing of the fracture.  There was some evidence of sparse callus formation; and

	d.  the plan was to review the x-rays with the traumatologist to ensure nothing further needed to be done for the fracture.  With respect to the radial nerve injury, he was to be seen again after another 2 months.

7.  On 26 October 2009, the applicant was given a pre-operation examination.  He was scheduled to undergo an operation on 30 October 2009 for left humeral shaft fracture delayed/nonunion repair, as well as left radial nerve palsy.  He was cleared for surgery.

8.  On 17 November 2009, the applicant filed his appeal claim.  He claimed ADL loss due to left humerus fracture.  All of his previous files and this appeal claim were reviewed by the in-house physician.  He recommended denial because the injury was an isolated, uncomplicated single limb injury in an otherwise uninjured Soldier.  Such an injury is generally insufficient justification for award of a payment for ADL loss for 30 days or more.  The denial letter was sent on 
4 December 2009.

9.  On 11 December 2009, the applicant underwent an operation for left radial nerve neurolysis and open reduction, internal fixation of left femoral shaft hypertrophic nonunion.

10.  The orthopeadic physician assistant stated the following on the TSGLI ADL Worksheet:

	a.  The applicant required physical assistance and stand-by assistance for bathing ADL's from 11 December 2009 to 15 January 2010 due to poor physical mobility/impairment in left arm.  He required assistance in washing lower extremities and was unable to reach opposite sides of his body.  He required stand-by assistance for reaching showering items such as soap and towels.  He had decreased digits motion and grip due to pain and range of motion.

	b.  The applicant required physical assistance for dressing ADL's from 
11 December 2009 to 15 January 2010 due to poor physical mobility/impairment in left arm.  He required assistance to reach and pull certain garments on/off such as underwear, socks, and shoes.  He required assistance with fastening devices such as zippers, buttons and shoe laces.

11.  On 17 December 2009, the occupational therapist evaluated the applicant's condition and set goals for his recovery:

	a.  His passive range of motion in flexion at the elbow was about 130 degrees;

	b.  His passive extension was about -40 from the neutral position.  Active was maybe 5 degrees less than passive;

	c.  His supination actively was only about 20 degrees.  Pronation actively was only about 20 degrees;

	d.  He had good opposition of his hand.  His pain level rating was level 5;

	e.  He was a good candidate for out-patient rehabilitation with clinic visits twice a week for 6 to 8 weeks;

	f.  He was completely unable to use his upper left extremity for ADL's; and

	g.  Goals were to improve range of motion of left elbow, to improve ability to perform light ADL's with upper left extremity, to improve overall ability to carry out a home program of active, active-assistive, and gentle passive range of motion; and to improve wrist extension and finger extension.

12.  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 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.

13.  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.

DISCUSSION AND CONCLUSIONS:

1. The applicant requests reconsideration of his TSGLI claim.  He contends he was unfamiliar with TSGLI procedures and he has exhausted his appeal rights with the Office of TSGLI.

2.  The evidence provided by the applicant was carefully considered and his disagreements with responses to his TSGLI claims were noted.  The available evidence clearly shows he suffered a traumatic injury to his left arm, wrist and hand causing him to lose the use of the extremity.  Such an injury is generally insufficient justification for award of a payment for ADL loss for 30 days or more.

3.  The statement by the applicant’s attending physician in the TSGLI claim form that he could not perform bathing and dressing ADL's independently for over 
30 days is not corroborated by information in the available medical records.

4.  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.

5.  In view of the above, the applicant's request should be denied.

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)                                         AR20100012533



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ABCMR Record of Proceedings (cont)                                         AR20100012533



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