IN THE CASE OF:	  

		BOARD DATE:	  6 January 2011

		DOCKET NUMBER:  AR20100016824 


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 approval of his claim for payment of Traumatic Servicemember’s Group Life Insurance (TSGLI) benefits.

2.  The applicant states that he received a traumatic brain injury (TBI) when he was wounded on 27 March 2003 in Iraq.  He goes on to state that he has previously applied for TSGLI benefits and has been denied; however, the Department of Veterans Affairs (VA) as well as civilian doctors have all documented that he received a TBI and in fact did suffer immediate loss of cognitive and physical abilities.  He goes on to state that he has continued to have memory problems and is still unable to shower, put shoes on, and dress (due to extreme vertigo) without assistance.  He also states that he is under constant care and takes a lot of medicines every day in order to function.  He continues by stating that his wife is his primary care giver and does most of the daily tasks.

3.  The applicant provides:

* A two-page letter explaining his application
* Copies of his medical records
* Copies of his Medical Evaluation Board (MEB) proceedings
* Copies of his VA records
* Letters from two doctors
* Copies of his TSGLI denials


CONSIDERATION OF EVIDENCE:

1.  The applicant was born on 19 September 1975 and enlisted in the Regular Army on 3 June 1997 for a period of 3 years and training as an infantryman.  He completed his one-station unit training at Fort Benning, Georgia and remained on active duty through a series of continuous reenlistments.  

2.  His records show that he served in Iraq from 15 October 2003 to 20 October 2004 and that he was awarded the Purple Heart for a concussion he received from an improvised explosive device (IED) on 14 October 2004 while serving in the rank of sergeant.

3.  He was promoted to the pay grade of E-6 on 1 September 2005 and again deployed to Iraq from 31 May 2006 to 14 May 2007.

4.  On 7 November 2007, a medical evaluation board (MEB) convened at Madigan Army Medical Center in Tacoma, Washington and diagnosed the applicant with:

* Post-concussive syndrome with associated headaches, cognitive disorder, and balance difficulty
* Right ankle instability
* Low back pain
* Mild hearing loss and tinnitus, bilateral, meets retention standards

5.  The MEB recommended that the applicant be referred to a Physical Evaluation Board (PEB) and the applicant indicated that he did not desire to continue on active duty.

6.  On 11 December 2007, a PEB convened at Fort Lewis, Washington and confirmed his three unfitting disabilities.  The PEB recommended that he be placed on the Temporary Disability Retired List (TDRL) with a 40% disability rating.

7.  On 7 March 2008, he filed a claim for TSGLI benefits claiming paraplegia.  Paraplegia is defined as the inability to move lower body or, total inability to move both legs and usually the lower part of the trunk, often as a result of disease or injury of the spine.  The applicant’s documentation submitted did not support that the Soldier was involved in a traumatic event consisting of external force or violence and his request was denied on 18 March 2008. 

8.  On 21 March 2008, he was transferred to the TDRL in the pay grade of E-6.  He had served 10 years, 9 months, and 19 days of total active service and was awarded the Purple Heart, the Army Commendation Medal (3rd award), the Army Achievement Medal (3rd award), the Army Good Conduct Medal (3rd award), the National Defense Service Medal, the Global War on Terrorism Expeditionary Medal, the Global War on Terrorism Service Medal, the Kosovo Campaign Medal, the Iraq Campaign Medal, the Noncommissioned Officer Professional Development Ribbon, the Overseas Service Ribbon (3rd award), the NATO Medal, and the Combat Infantryman Badge.

9.  On 23 March 2010, he was removed from the TDRL and was permanently retired by reason of physical disability with a 40% disability rating.  

10.  He filed a request for reconsideration of TSGLI benefits on 14 April 2008 again claiming paraplegia and again his application was denied for the same reason.

11.  He again filed for reconsideration on 24 April 2008 for the same reason and his application was again denied on 22 May 2008.

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 11 May 2005, established the TSGLI program.  U.S. Army Combat-Related Special Compensation 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.  The 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 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 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 two of the six 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.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's contention that he is qualified for TSGLI benefits was carefully considered and unfortunately determined to be without merit.

2.  Records clearly show that he suffers from the residuals of TBI; however, these conditions are not medically qualifying for TSGLI benefits without a loss of ADLs and while he claims he is unable to shower, put his shoes on, and dress without assistance, he has provided no documented evidence to support his claim.
3.  Additionally, there is no evidence in the available records that serve as  sufficient evidence showing that he was unable to perform two of the activities of daily living for the required period.

4.  Absent evidence to show that the applicant's disabilities met the criteria for award of TSGLI benefits, there is no basis to grant the relief requested.

5.  It is unfortunate that the applicant's request could not be granted in this case; however, this by no means diminishes the applicant's dedicated service to and sacrifices for a grateful nation.

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)                                         AR20100016824





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ABCMR Record of Proceedings (cont)                                         AR20100016824



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