IN THE CASE OF:  

		BOARD DATE:  24 January 2012

		DOCKET NUMBER:  AR20110018610 


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 Traumatic Servicemember’s Group Life Insurance (TSGLI) injury request.

2.  The applicant states justification for his injury payment has been proven because his medical records and an internal investigation both conclude that he was injured while taking an annual Army Physical Fitness Test (APFT) when he fell on wet asphalt pavement.

3.  The applicant provides:

* the denial of his TSGLI claim
* his notice of disagreement to the denial of his claim
* his physical profile
* a letter from his unit administrative noncommissioned officer (NCO)
* civilian treatment records

CONSIDERATION OF EVIDENCE:

1.  The applicant was serving in the Missouri Army National Guard in the pay grade of E-4 on 16 May 2009 when he slipped on the asphalt pavement while taking an APFT and injuring his left knee.

2.  The applicant submitted his TSGLI claim to the Human Resources Command on three separate occasions.  During the first two reviews of his claim the analyst 


found that the applicant’s claim did not meet the minimum standards of the TSGLI Program.  During the third review of his claim a physician reviewed all of the applicant’s claims and supporting documents and determined that the applicant’s injury was not a traumatic event and recommended denial of the applicant’s claim.  The applicant’s claim was denied on 2 August 2011.

3.  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 $25,000.00 and $100,000.00 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 (OIF) and Operation Enduring Freedom (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.

4.  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 activities of daily living (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 (TBI)).  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 will not 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 he sustained an injury to his left knee while taking his APFT on 16 May 2009.  However, it does not appear that his injury qualifies as a traumatic event and is not medically qualified for TSGLI benefits without a loss of ADLs.

3.  Additionally, there is no evidence in the available records and the applicant has not provided sufficient evidence showing he was unable to perform two of the ADLs 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.  The applicant and all others should know that the sacrifices he made in service to the United States during the Global War on Terrorism are deeply appreciated.  The applicant and all Americans should be justifiably proud of his service in arms.

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)                                         AR20110018610



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ABCMR Record of Proceedings (cont)                                         AR20110018610



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