IN THE CASE OF:	  

		BOARD DATE:	  27 January 2011

		DOCKET NUMBER:  AR20100015299 


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 for facial reconstruction be reconsidered.

2.  The applicant states the findings made on 21 September 2009 are in direct contradiction to the surgeon's certification dated 10 August 2009 wherein the surgeon provided the TSGLI officials with medical evidence that met the criteria set forth in category 6 (facial reconstruction).  The documentation and certification support his contention that he suffered a severe maxillofacial injury and surgery was required to correct traumatic avulsions of the face or jaw that cause discontinuity defects.

3.  The applicant provides:

* two letters from the U.S. Army Human Resources Command (HRC), Alexandria, VA
* photograph of the skull
* SGLV Form 8600 (Application for TSGLI Benefits)
* record of inpatient treatment
* History and Medical Examination
* Physical Medicine and Rehabilitation - Electrodiagnostic Laboratory, Walter Reed Army Medical Center (WRAMC)
* Medical Evaluation Board (MEB) Summary
* DA Form 3947 (MEB Proceedings)
* WRAMC narrative summary
* 
Standard Forms 600 (Chronological Record of Medical Care)
* Department of Veterans Affairs (VA) rating decision

COUNSEL'S REQUEST, STATEMENT AND EVIDENCE:

1.  Counsel requests the applicant's TSGLI claim for being completely dependent on another person for completion of activities of daily living (ADL) be reconsidered.

2.  Counsel states the applicant suffered a blast to his face, neck, and left jaw (mandible) that avulsed (tearing away of tissue, bones, and/or cartilage) the soft tissues and created a discontinuous (open wound with large separation or gaps in the major facial or jaw features), comminuted, fracture of his mandible.  This discontinuity was spanned by a mandibular reconstruction plate, across the missing segment of the ramus (portion of the bone) and body of the mandible.  The applicant has met the burden of proof set forth by category 6 (facial reconstruction) and should be awarded TSGLI benefits.  He did not suffer from a simple broken jaw.  The improvised explosive device (IED) blast caused severe facial trauma wherein the bones of his jaw were so severely broken they tore through the skin and his tongue had to be reattached.

CONSIDERATION OF EVIDENCE:

1.  The applicant's records show he enlisted in the Illinois Army National Guard on 16 March 2004 and held military occupational specialty 11B (Infantryman).  He was assigned to the 2nd Battalion, 130th Infantry.  His records also show he served in Kuwait/Iraq from 1 April 2005 to 15 October 2005.

2.  On 15 October 2005, he suffered an IED blast and sustained a traumatic right upper extremity (RUE) amputation, an open left mandibular fracture, several facial lacerations, and a tongue laceration.  In theater he underwent completion of the RUE amputation, a washout/hemorrhage control of facial injuries, and a fixation of his mandibular fracture with maxillary and mandibular arch bars.  He was transferred to Landstuhl Army Medical Center in Germany on 16 October 2005 where he underwent an incision and drainage procedure on 17 October 2005.

3.  He was transferred to WRAMC on 18 October 2005 with maxillary and mandibular arch bars and his jaw wired shut.  He underwent various surgeries, procedures, examinations, evaluations, and rehabilitation.  He underwent final closure on 26 October 2005.  He completed his course of antibiotics and remained afebrile without an elevated blood cell count.  He was followed by otology and neurotology for his mandibular fracture and facial trauma.  He adjusted well and was cleared of a traumatic brain injury (TBI) on 21 October 2005.

4.  He progressed well in therapy and at the time of his hospital discharge, he was modified independently with all ADL and was running without difficulty.  He was discharged to his spouse's room at Mologne House on 3 November 2005 for continued outpatient therapy, prosthetics, orthopeadics, and other follow-up.

5.  He was eligible for the $50,000.00 TSGLI benefit for the right arm amputation; however, he received the higher amount of $75,000.00 for the loss of ADL (bathing, dressing, and eating) and other traumatic injury (OTI) for 90 consecutive days of hospitalization.

6.  On 18 April 2006, an MEB convened at WRAMC and after consideration of clinical records, laboratory findings, and physical examinations, the MEB found the applicant was diagnosed as having the medically-unacceptable condition of right (dominant) forearm amputation with decreased right elbow range of motion, left mandibular fracture, and the medically-acceptable conditions of phantom pain and repaired ACL tear.  The MEB recommended he be referred to a physical evaluation board (PEB).  He agreed.

7.  On 15 May 2006, an informal PEB convened at WRAMC.  The PEB found the applicant's conditions prevented him from performing the duties required of his grade and specialty and determined he was physically unfit due to right forearm amputation, fracture of the mandible, and paralysis of the left marginal mandibular branch of his facial nerve.  He was rated under the VA Schedule for Rating Disabilities and granted an 80-percent combined disability rating.  The PEB recommended the applicant be permanently retired by reason of disability.  The applicant concurred with the PEB's finding and recommendation and waived his right to a formal hearing on the same date.

8.  He was honorably retired on 9 June 2006 under the provisions of paragraph 4-24e of Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) by reason of disability.  The DD Form 214 (Certificate of Release or Discharge from Active Duty) he was issued shows he completed 1 year, 5 months, and 5 days of active service.

9.  The applicant's original TSGLI application is not available for review with this case.  However, on 31 March 2009 HRC notified him by letter that based on the medical documentation he provided, HRC was unable to provide a favorable recommendation.  His documentation did not support his claim for additional payment under the TSGLI schedule of losses for facial reconstruction or speech. 
In order to qualify for facial reconstruction there must be surgery performed to correct traumatic avulsions of the face or jaw that cause discontinuity defects.  The medical documentation he provided described facial injuries that indicated fractures and lacerations but no avulsions or discontinuity defect.  Additionally, the documentation provided did not support that he suffered a total and permanent loss of speech.

10.  On 10 August 2009, the applicant completed and submitted his application for TSGLI benefits.  He claimed to having been hospitalized (at least 15 consecutive days) from 15 October 2005 to 3 November 2005 for TBI and OTI.  He claimed he suffered a qualifying loss for:

* a second-degree burn to the body including the face and head
* facial reconstruction of his lower jaw of 50 percent of the left mandibular on 15 October 2005; the form was certified by his surgeon on 10 August 2009
* amputation of his right hand on 15 October 2005

11.  The medical professional (Dr. A____ C____ C____, a plastic surgeon) stated the applicant suffered a blast to his face, neck, and left jaw (mandible) that avulsed the soft tissue and created a discontinuance, comminuted, fracture of his mandible.  This discontinuity was spanned by a mandibular reconstruction plate across the missing segment of the ramus and body of the mandible.

12.  On 21 September 2009, HRC notified him by letter that the TSGLI program office received his 14 August 2009 appeal.  That office reviewed his appeal as well as previous claims submitted to the SGLI program office and denied it.  Although he had suffered an injury to his left mandible and he was treated for facial lacerations, the medical documentation did not indicate a discontinuity defect.

13.  The applicant submitted the following documents:

	a.  A record of inpatient treatment, dated 19 November 2005, shows he was diagnosed with traumatic amputation of the right arm below the elbow, open fracture of unspecified site of mandible, open wound of tongue and floor of mouth, and post-inflammatory pulmonary fibrosis.  The form also shows he underwent various procedures.

	b.  Various medical records and documents relate to his injury and subsequent treatments.

14.  Public Law 109-13, signed by the President on 11 May 2005, established the 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 $25,000.00 and $100,000.00 to severely injured Soldiers who meet the requisite qualifications set forth by the Department of Defense.  A qualifying traumatic injury is an injury or loss caused by a traumatic event or a condition whose cause can be directly linked to a traumatic event.  The HRC official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II.  Each loss has a corresponding payment amount.

	a.  Part I loss includes sight, hearing, speech, quadriplegia, hemiplegia, uniplegia, burns, amputation of hand, amputation of four fingers on one hand or one thumb alone, amputation of foot, amputation of all toes including the big toe on one foot, amputation of big toe only, or other four toes on one foot, limb salvage of arm or leg, and facial reconstruction.  Injuries listed under facial reconstruction may be combined with each other, but the maximum benefit for facial reconstruction may not exceed $75,000.00.  Any injury or combination of injuries under facial reconstruction may also be combined with other injuries listed in Part I and treated as one loss, provided that all injuries are the result of a single traumatic event.  However, the total payment amount may not exceed $100,000.00.  Facial reconstruction is defined as reconstructive surgery to correct traumatic avulsions of the face or jaw that cause discontinuity defects as follows:

* jaw, surgery to correct discontinuity loss of the upper or lower jaw
* nose, surgery to correct discontinuity loss of 50 percent or more of the cartilaginous nose
* lips, surgery to correct discontinuity loss of 50 percent or more of the upper or lower lip
* eyes, surgery to correct discontinuity loss of 30 percent or more of the periorbita
* facial tissue surgery to correct discontinuity loss of the tissue in 50 percent or more of any of the following facial subunits:  forehead, temple, zygomatic, mandibular, infraorbital, or chin

	b.  Part II loss includes traumatic injuries resulting in the inability to perform at least two ADLs for 30 or more consecutive days and hospitalization due to a traumatic injury and OTI 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 two of the six ADLs for 30 days or more. 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.
15.  A member who is hospitalized for 15 consecutive days as the result of a traumatic injury is eligible for a $25,000.00 payment under TSGLI.  The count of consecutive hospitalization days begins when the injured member is transported to the hospital, includes the day of admission, continues through subsequent transfers from one hospital to another, and includes the day of discharge.  If a member is hospitalized for 15 consecutive days, the member's hospitalization takes the place of the first ADL milestone payment only.  The 15 days of hospitalization cannot be substituted for any other ADL milestone payment.  Payment will be made for the 15-day hospitalization or the first ADL milestone, whichever occurs first.  There are two situations covered by this replacement:  the member is hospitalized due to coma/TBI or the member is hospitalized due to OTI.

DISCUSSION AND CONCLUSIONS:

1.  The applicant contends he should be compensated an additional $25,000.00 in TSGLI benefits for facial reconstruction.

2.  The applicant suffered severe blast injuries as a result of an IED explosion.  He sustained a right arm amputation and facial trauma with left mandibular fractures, facial lacerations, and a tongue laceration.  

3.  The TSGLI guidance for Facial Reconstruction specifies that there must be "traumatic avulsions of the face or jaw that cause discontinuity defects."  An avulsion in this instance means missing tissue.  Additionally, as it pertains to the mandible, the discontinuity must be due to tissue loss of 50% or more.

3.  Facial reconstruction is defined as reconstructive surgery to correct traumatic avulsions of the face or jaw that causes discontinuity defects such as surgery to correct discontinuity loss of the upper or lower jaw or facial tissue surgery to correct discontinuity loss of the tissue in 50 percent or more of any of the facial subunits.

4.  In the applicant's case, his mandibular fracture was repaired primarily with maxillary and mandibular arch bars and mandibulomaxillary fixation.  The arch bars are standard internal fixation in the treatment of mandibular fractures and do not represent a structural replacement for lost bones.

5.  The medical documents provided by the applicant and his counsel show the applicant was treated for facial lacerations.  There was no discontinuity defect (certainly none of a 50 percent magnitude), only repair.  In order to qualify for facial reconstruction, there must be surgery performed to correct the traumatic avulsions of the face or jaw that cause the discontinuity defect.
6.  The available medical evidence describes facial injuries that indicate fractures and lacerations but no avulsion or discontinuity defect.  There is insufficient evidence that shows reconstruction occurred.  As such, there is insufficient evidence to support payment of TSGLI benefits for reconstructive surgery.

7.  Additionally, the applicant indicated on his TSGLI application that he suffered burns, but he did not provide any medical documents that might substantiate his eligibility for TSGLI compensation for burns.  If additional medical documentation verifying he met the TSGLI standards for a burn loss (second-degree burns over 20 percent of the face or body), the applicant is encouraged to resubmit his application to the TSGLI office as he may be eligible for an additional $25,000.00 compensation for this loss.

8.  It is noted that the maximum amount payable for any single traumatic event is $100,000.00.  He received $75,000.00 and regardless of any schedule loss he incurred, if eligible for the burn loss he may be eligible for a maximum of $25,000.00.

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 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)                                         AR20100015299



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ABCMR Record of Proceedings (cont)                                         AR20100015299



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