IN THE CASE OF:	  

		BOARD DATE:	  5 April 2012

		DOCKET NUMBER:  AR20110018995 


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 correction of his request for payment of Traumatic Servicemembers' Group Life Insurance (TSGLI) benefits to show he needed assistance with the activities of daily living (ADL) of bathing and dressing from 21 August to 23 November 2008.

2.  The applicant states he found an error in his TSGLI application where the doctor input some dates incorrectly.  The physician assistant who filled out the application made an error before the hospitalization but it was corrected.  The applicant found out the ADL [dates] were incorrect and he is trying to correct the error.  The physician assistant is no longer at Fort Bragg, NC and the applicant is sending documentation to support the medical records for August to December [2008].

3.  The applicant provides 180 pages of medical records/documentation.

CONSIDERATION OF EVIDENCE:

1.  Having had prior Reserve service, the applicant's records show he enlisted in the Regular Army on 8 August 2006 and he held military occupational specialty 94E (Radio and Communications Security Repairer).  On or about 8 July 2007, he deployed to Iraq in support of Operation Iraqi Freedom (OIF) while assigned to the 307th Brigade Support Battalion, 1st Brigade Combat Team, 82nd Airborne Division, Fort Bragg.

2.  In July 2007, he was injured in Iraq when a Light Medium Tactical Vehicle (LMTV) wheel fell on him causing a low back injury.  He was subsequently medically evacuated to Landstuhl Regional Medical Center, Germany on 13 May 2008 and further reassigned to Womack Army Medical Center (WAMC), Fort Bragg, NC on 27 June 2008.

3.  On 19 August 2008, he underwent surgery on his lower back at WAMC.  He was released from the hospital on 21 August 2008 and given 30 days of convalescent leave.

4.  On 9 June 2009, he submitted a claim for TSGLI to the U.S. Army Human Resources Command (USAHRC) for hospitalization from 13 May to 26 July 2008 and for ADL loss for 6 weeks post-operatively.  His claim was denied as "his medical records did not support a traumatic event."

5.  On 5 August 2009, he submitted an appeal to the denial of his request and it was again denied as "the documentation did not support ADL loss or 15 days of consecutive hospitalization."  The denial stated the injury and surgical treatment were not generally consistent with prolonged hospitalization or prolonged loss of ADLs in the post-operative period.  The supporting documents did not give any indication of inpatient evaluation or treatment in the period prior to surgery and there were no supporting documents for the period of claimed ADL loss.

6.  On 26 September 2009, the applicant appealed his second denial.  In the determination it was stated:

	a.  The applicant had been injured in theater by an LMTV wheel, causing a low back injury which was later diagnosed as a L4-L5 hemi-discectomy.  The certifying clinician stated the hospitalization dates on the previous submissions had changed because the applicant's records were incomplete at the time of submission.  The hospitalization dates were from 13 May to 26 July 2008 and the applicant was put on 30 days of convalescent leave post-operatively.  His surgeon noted the applicant's symptoms were significantly out of proportion to the clinical findings, the applicant did not show any motivation to move, and the surgeon expected a suboptimal outcome.

	b.  It was recommended that the applicant's claim for hospitalization be disapproved as the medical records provided clearly showed the applicant in an out-patient status during the 13 May to 26 July 2008 period.  It was determined the injury and surgical treatment were generally not consistent with ADL loss; however, it was recommended that his claim be approved for the loss of the ADL of bathing and transferring for 30 days.  The applicant was subsequently approved for a 30-day ADL loss.
	c.  On 17 March 2010, the applicant submitted a third appeal to USAHRC and requested approval for an additional 30 days of ADL loss.  A letter attached to the applicant's request from his primary care manager stated the review of records indicated the applicant required ADL assistance for 60 days post-operative.  However, it was determined that the applicant's medical documentation did not support that he could not perform the asserted ADL for 60 days or more and the appeal was denied.

7.  The applicant provides medical records which show that from 3 September to 4 November 2008 he received physical therapy as an out-patient at WAMC to aid him in his recovery.

8.  His medical records also show that he was seen as follows:

* On 23 September 2008, at the physical therapy clinic wherein it stated he was progressing toward his goals, did not tolerate treatment well that day, and complained of increased pain after [riding] the recumbent bike, which hindered him from doing other exercises
* On 24 September 2008, at the physical therapy clinic wherein it stated he tolerated some of the exercises, others he did not, and he continued to work toward his goals 
* On 30 September 2008, by his case manager for assistance in obtaining an appointment regarding pain management and pain in his left knee; he stated his neurosurgeon had told him his tests showed everything looked good 
* On 2 October 2008, by his case manager for a complaint of pain in his right knee and was referred to orthopedics for a consult
* On 6 October 2008, he called his case manager to complain his unit would not approve for him to go to his physical therapy appointment because he was on charge of quarters for 24 hours
* On 8 October 2008, the applicant's immediate commander called his case manager requesting clarification of the patient's rehabilitative status
* On 21 October 2008, by his case manager to follow-up on his profile and referrals; it was annotated that he had no new problems and appeared well
* On 4 November 2008, at the physical therapy clinic wherein it stated the applicant attended aquatic therapy at the pool
* On 24 November 2008, by his case manager to get a copy of his profile

9.  The applicant provided a 26 April 2011 statement from a physician for a WAMC medical review board.  The physician stated after the applicant had 


surgery in August 2008, he had continued to suffer from moderate to severe back pain from the bottom of his neck, along his spine, and to the lower extremities.  He underwent surgery in April 2010 for placement of a spinal cord stimulator and continues to participate in physical therapy.  In August 2010, his doctor determined his back pain was severe enough to prevent him from lifting and running and it was determined he failed to meet retention standards.

10.  Public Law 109-13 (The Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Tsunami Relief, 2005 was signed by the President on 11 May 2005) and 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 $1.00 deducted each month to cover the cost of the TSGLI policy.  Soldiers paying for SGLI coverage cannot decline TSGLI – it is a package.  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.

11.  There are basic eligibility requirements that must be met in order to be eligible for TSGLI.  All of the following must be met:

* The member must be an active duty or Reserve service member on the date a traumatic event occurs
* The member must suffer a loss that is a direct result of a traumatic event and no other cause
* The member must survive for a period of at least 7 full days from the date of the traumatic event
* The member must suffer a loss covered under the law within 2 years of the traumatic event

12.  Traumatic injuries covered under TSGLI include:

* Total and permanent loss of sight in one or both eyes, loss of hand or foot by severance at or above the wrist or ankle, quadriplegia, paraplegia, or hemiplegia, coma or traumatic brain injury
* Other traumatic injuries resulting in the inability to carry out two of the six ADL which are dressing, bathing, toileting, eating, continence, and transferring

13.  TSGLI claims may be filed for loss of ADL if the claimant is completely dependent on someone else to perform two of the six ADL for 30 days or more.  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 contends he should receive TSGLI for the period from 21 August to 23 November 2008 as he needed assistance with the ADLs of bathing and dressing during that time.

2.  The evidence of record shows he incurred a traumatic injury in Iraq in July 2007 that resulted in his requiring surgery on 19 August 2008.  He was released from the hospital on 21 August and given 30 days convalescent leave.  It was determined his injury and surgical treatment were generally not consistent with ADL loss; however, he was granted TSGLI for the 30 days of his convalescent leave from 22 August to 21 September 2008, for the ADL loss of bathing and transferring.

3.  Although his medical records show he continued to experience pain and that he received physical therapy and medical treatment during the additional period he is seeking TSGLI for, the evidence of record shows he returned to his unit albeit with work and duty limitations during the period 22 September to 23 November 2008.

4.  There is no evidence in the available records and the applicant has not provided sufficient medical evidence that shows he was completely dependent on someone else to perform two of the six ADL during the additional period he is seeking TSGLI for that would meet the qualifications for TSGLI as set forth by law.

5.  In view of the foregoing, there is an insufficient evidentiary basis to grant the requested relief.


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)                                         AR20110018995



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ABCMR Record of Proceedings (cont)                                         AR20110018995



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