IN THE CASE OF:	  

		BOARD DATE:	  8 December 2011

		DOCKET NUMBER:  AR20110015703 


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 payment of a Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim. 

2.  He states he should have been granted TSGLI because he suffered a traumatic event which caused him to be dependent in his activities of daily living (ADL).   

3.  He provides:

* A request for appeal from the Department of Veterans Affairs (VA)
* An extract of his military medical records
* His DD Form 214 (Certificate of Release or Discharge from Active Duty)
* Pages 3 through 13 of a TSGLI application
* A letter of support

CONSIDERATION OF EVIDENCE:

1.  His records show he enlisted in the Regular Army on 22 August 2005.  After completion of training, he served in military occupational specialty (MOS) 11B (Infantryman) and served two tours of duty in Iraq.  

2.  The applicant’s medical record shows he was medically evacuated to Landstuhl Regional Medical Center (LRMC) and admitted on 9 January 2008.  He received treatment for open wounds of the neck, right leg, and foot and for a traumatic brain injury (TBI)/concussion, which were all a result of a blast from enemy action.   

3.  His medical record also shows he underwent surgery on his right leg and foot and was given 30 days convalescent leave and a temporary profile.  On 14 May 2008, he began physical therapy treatments for his right leg and foot.  

4.  On an unknown date in June 2008, he submitted his initial TSGLI claim.  While unavailable for review, its details were summarized by the Army Human Resources Command (AHRC) in its TSGLI Army Review Boards Agency (ARBA) Summary.  His claim was for loss of 3 of 6 ADLs for a 60-day period which were attributed to lower right leg and ankle injuries and TBI.  Following a physician's review, it was determined his incurred losses did not meet the TSGLI minimum standard to be compensated.  He sustained an open wound to the soft tissue of the web space on his right foot and an avulsion fracture of the right medial malleolus and his other injuries were minor.  His hospital course and recovery were unremarkable.  

5.  The TSGLI Summary also noted that after convalescent leave, on 
23 February 2008, the applicant was evaluated and he stated he was pain free and able to ambulate without crutches.  It was determined he did not meet reasonable standards that would indicate the inability to complete daily activities through adaptive measures.  Accordingly, his claim was denied.

6.  On an unknown date in August 2008, he requested reconsideration of his claim.  While unavailable for review, its details were summarized by AHRC in its TSGLI ARBA Summary.  He applied for the same losses again.  Following a physician's review, it was determined his incurred losses did not meet the TSGLI minimum standards for compensation under the TSGLI Schedule of Losses.  Accordingly, his request for reconsideration was denied.

7.  A medical report, dated 18 June 2009, also shows the applicant’s commander stated he could no longer perform in his current MOS and recommended that he be separated from active military service. 

8.  On 18 June 2009, the applicant’s primary care provider certified that over a 16-month period, he failed to make improvement as expected.  After receiving maximum care without restitution, a permanent profile of 113111 was approved.  He was also treated for TBI which was noted to be secondary to the explosion.  His overall prognosis for satisfactory recovery was poor. 

9.  On 22 July 2009, a Physical Evaluation Board (PEB) found the applicant unfit for service with a 10 percent disability rating based on his physical limitations due to lower right leg and ankle injuries.  He concurred with the decision.

10.  On an unknown date in July 2009 he submitted his appeal application for TSGLI benefits.  The physician noted his claim showed the injury pattern was an isolated, uncomplicated single limb injury.  An injury of this type in an otherwise uninjured Soldier would be generally insufficient justification for payment under item 19 (Traumatic injury resulting in inability to perform at least 2 ADLs).  His appeal was denied.  

11.  Accordingly, on 1 November 2009, he was discharged under the provisions of Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation), chapter 4 for a combat-related disability.  He was granted $28,018 in physical disability severance pay.  He had completed 4 years, 2 months, and 10 days of net active service.  

12.  He provided an SGLV Form 8600 (Application for TSGLI Benefits), dated 
11 April 2011.  This document shows he submitted a request to be paid TSGLI benefits as a result of injuries he sustained on 9 January 2008 while stationed in Iraq. 

13.  The applicant also submitted a document which shows an appeal for TSGLI benefits was submitted on his behalf by a case manager for the VA, Central Iowa Health Care System.  This form states the applicant was seriously injured in a blast on 9 January 2008, while stationed in Iraq.  He was medically evacuated to LRMC where he received treatment for his injuries.  He continued to receive outpatient medical treatment for a period of 7 months, which included 30 days of convalescent leave. 

14.  The case manager also states that due to the severity of the applicant’s ankle and leg injuries, he lost the ability to perform ADLs for several weeks.  He also suffered from TBI which was overshadowed by his physical injuries.  After his discharge from the U.S. Army, he began receiving medical treatment at the VA, Central Iowa Health Care System and his previous diagnosis of TBI was confirmed.  

15.  A letter of support from the applicant’s fiancée shows that during the period 23 January to 22 February 2008, while on convalescent leave, the applicant required medium help remembering different tasks and he required maximum help for the following functions:

* Getting in and out of bed or in any reclining position
* Standing up from a seated position
* Getting in and out of the shower
* Dressing himself
* Carrying any type of material
* Getting in and out of any mode of vehicular transportation

16.  The letter also shows that during the period 22 February to 16 March 2008 he required minimum help getting in and out of bed, medium help with his memory, dressing himself, and getting in and out of vehicles, and he still required maximum help getting in and out of the shower and carrying materials.  In addition, he required maximum assistance with house cleaning. 

17.  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 financial relief to Soldiers and their families after suffering a traumatic injury.  TSGLI payments are designed to help traumatically injured Service members and their families with financial burdens associated with recovering from a severe 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.  To be eligible for payment of TSGLI, service members must meet all of the following requirements: 

* must be insured by SGLI when you experience a traumatic event
* must incur a scheduled loss and that loss must be a direct result of a traumatic injury 
* must have suffered the traumatic injury prior to midnight of the day that you separate from the uniformed services
* must suffer a scheduled loss within 2 years (730 days) of the traumatic injury
* must survive for a period of not less than seven full days from the date of the traumatic injury 

18.  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.  

    b.  Part II loss includes traumatic injuries resulting in the inability to perform at least 2 ADLs for 30 or more consecutive days and hospitalization due to a traumatic injury and Other Traumatic Injury (OTI) resulting in the inability to carry out 2 of the 6 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. 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.

19.  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's request for payment of TSGLI was carefully considered.  However, there is insufficient evidence to support this claim.  

2.  His request for TSGLI was based on the inability to perform 2 of 6 ADLs for a 60-day period, occurring as a result of traumatic combat-related injuries to his lower right leg and ankle, and OTI resulting in TBI.  




3.  By law, for ADL loss from OTI to be covered, the loss must be for at least 30 days, the member must require assistance to perform 2 of 6 ADLs, the ADL loss must be certified by a healthcare provider and must be substantiated by appropriate documentation such as occupational therapy/physical therapy reports, discharge summaries and other medical documentation.  Medical documentation from the time of his injury until his initial claim submission in 2008 is insufficient to substantiate his claims of ADL loss, nor to attribute his losses to the injuries he sustained.

4.  The applicant has not provided sufficient documentation to support his implied 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.  TSGLI analysts strive to apply a "reasonable person" standard to each claim, with a bias in favor of the claimant, while still maintaining a high degree of internal consistency among similar claims.  The applicant's injury pattern, an isolated, single limb injury, is generally insufficient justification for payment of TSGLI benefits.  It is a reasonable expectation that a Soldier is capable of adopting, within 30 days of injury, adaptive behaviors to accomplish all ADLs in coping with injuries such as those he sustained. 

6.  In view of the foregoing, there is insufficient basis for granting relief in this case.

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)                                         AR20110015703



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ABCMR Record of Proceedings (cont)                                         AR20110015703



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