BOARD DATE:  29 May 2012

		DOCKET NUMBER:  AR20110023048 


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, the spouse of a former service member (FSM), requests, in effect, that his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim be reconsidered.

2.  The applicant states:

	a.  the FSM was involved in improvised explosive device (IED) attacks on 
20 and 23 January 2006.  He has been diagnosed with traumatic brain injury (TBI) as a result of the attacks.  He has experienced health problems as a result of the explosions and he was admitted to Lincoln Trail Hospital, Radcliff, KY in February 2007.  He was also in the Wounded Warrior Program in Fort Knox, KY, until his medical discharge due to findings of injuries sustained while in active duty in Iraq.  He will require continuous care and help with his Activities of Daily Living (ADL) indefinitely.  This has been documented by the military medical board review and the Department of Veterans Affairs (VA).

	b.  The basis for the TSGLI denials are incorrect.  

		(1)  They claim there is insufficient medical information to support losses. The applicant states there is sufficient medical information to support the losses.

		(2)  They claim the loss occurred more than 730 days from the event.  The applicant states the FSM sustained multiple traumatic injuries while serving in a combat theater.  Due to the often occult nature of TBI, no significant injuries were diagnosed at the time of the trauma and remained undetected through no fault of the FSM.  However, he revealed obvious medical problems well within the 
730 days of the traumatic event, although he did not have a clear medical understanding of them. 

		(3)  They state the claim for hospitalization was not approved because the loss did not meet the TSGLI standard.  The applicant states that in February 2007, the FSM was admitted to Lincoln Trail Hospital for 28 days.  Not having a clear understanding of the origin of his cognitive and physical decline, yet knowing something was dangerously wrong with his health, he accepted the inpatient treatment.  This occurred well within 730 days of the traumatic event. 

	c.  It is well documented in medical literature that symptoms of TBI often do not present immediately or even soon, following the injury.  This is the case with the FSM.  He has suffered incredible cognitive and physical decline in the months and years following his injuries. 

	d.    According to one of his multiple medical reports, neuropsychological testing indicates cognitive dysfunction.  The FSM requires assistance with multiple ADL.  In fact, according to the Military Medical Review Board "He required near-constant supervision because of his forgetfulness, etc.  He has significant difficulties with activities of daily living.  Prognosis:  The Soldier's TBI related residual symptoms, Post Traumatic Stress Disorder (PTSD), and obviously orthopedic issues are stabilized and are unlikely to improve and are certainly unlikely to change within the next five years."

	e.  The FSM has aided in the protection of the United States and has been severely injured in the process.  He should be protected by the Government and the people he served, not denied coverage due to a deadline, whether arbitrary of not.

3.  The applicant provides:

* 10 November 2010 denial letter from the Office of Servicemember's Group Life Insurance (OSGLI)
* 14 March 2011 denial letter from OSGLI
* 8 December 2008 letter from Deaconess Home Care
* 18 May 2011 denial letter from the U.S. Army Human Resources Command, Fort Knox, KY 
* TSGLI application and allied medical records
* FSM's Combat Action Badge orders
* DA Form 638 (Recommendation for Award) showing FSM was recommended for the Army Commendation Medal for his service in Iraq 
* Denial letter from the Office of Servicemember's Group Life Insurance, Livingston, NJ, 4 May 2006
* VA rating decision and allied medical documents

CONSIDERATION OF EVIDENCE:

1.  Following prior service in the U.S. Marine Corps, the FSM enlisted in the Tennessee Army Nation Guard on 21 July 1989.  He completed training and was awarded military occupational specialty (MOS) 63H (Track Vehicle Repairman)

2.  On 13 January 2005, he was ordered to active duty in support of Operation Iraqi Freedom.   

3.  The available records show he was injured by two IED blasts in January 
2006 while he was deployed to Iraq.  The award recommendation shows that on 
20 and 23 January 2006 he was the driver in the last vehicle in a patrol when  IED's detonated less than 5 meters and 2 meters, respectively, from his vehicle.  He was awarded the Combat Action Badge effective 23 January 2006.

4.  The 23 July 2009 Chronological Record of Medical Treatment prepared at Ireland Army Community Hospital, Fort Knox, KY, shows:

	a.  he was exposed to multiple IED blasts while serving in Iraq.  Medical evaluation following the first IED diagnosed him with mild post-blast headache without obvious injury.  Evaluation following the second blast diagnosed him with post-blast headache and back pain without significant injuries.  In each case he was returned to duty.

	b.  His memory is impaired with the most difficulty in visual memory followed by verbal memory.  He has shown difficulty with verbal abstract thinking, acquired knowledge, common sense reasoning/judgment, attention to visual detail, and coding ability.  

5.  The extract from the Medical Board dated 13 April 2010 shows that subsequent to the exposure to the IED blasts, the FSM developed significant cognitive and emotional issues.   The FSM describes headaches, dizziness, poor coordination, clumsy, and unsteady gait.  Significant symptoms include vision problems, distorted or blurred vision, photophobia, constant tinnitus, and significant hearing deficit after the blasts.  He is significantly sensitive to sounds. He reports malaise, loss of energy, fatigue, easily annoyed, and poor coordination.  Cognitive symptoms include very forgetful difficulty in making decisions, significantly slowed thinking, difficulty with organization, sleep difficulties, and frequent disorientation.
6.  The FSM was retired due to permanent disability effective 3 October 2010, as a sergeant/E-5.  He had completed 10 years, 3 months, and 4 days of net active service.  His DD Form 214 shows in item 18 (Remarks) "Service in Iraq from 
28 January 2005 through 16 June 2006."  "Period from 20080311 to 20101003 Medical Retention Processing Service."

7.  On 18 August 2010, the FSM completed and submitted his application for TSGLI benefits.  He claimed he suffered a traumatic brain injury and the loss of ADL since 30 October 2008.  He needed assistance with bathing, getting out and putting on clothing, feeding himself, and moving in or out of the bath tub (transferring).  He further stated he had been hospitalized for other traumatic injury.

8.  On 10 November 2010, an official at OSGLI, Roseland, NJ, notified the applicant that his application was denied because there was not enough medical information to support his losses. The claim for hospitalization was not approved because the FSM's loss did not meet the TSGLI standard.  A claim for hearing loss in both ears was not approved because the loss did not meet the TSGLI standard.  

9.  On 14 March 2011, the OSGLI office notified the FSM his claim for hospitalization due to other traumatic injuries and the loss of ADL due to traumatic brain injuries for 90 days and other traumatic injuries for 120 days could not be approved because the loss did not occur within the prescribed time period.    To be eligible for a TSGLI payment, the FSM's loss must have occurred within 730 days of the traumatic event.  Because the evidence indicates the FSM's loss occurred on 30 October 2008, over 730 days from the event date of 23 January 2006. 

10.  On 18 May 2011, an official from the TSGLI Branch, U.S. Army Human Resources Command, Fort Knox, KY, notified the FSM that after reviewing his claim and the supporting documentation, they were unable to overturn the previous adjudication.  The appeal was denied because the losses were not within 730 days of the traumatic event.

11.  The applicant claims the FSM sustained the injuries in January 2006 and it is well documented in medical literature that symptoms of TBI often do not present immediately or even soon, following the injury.  This is the case with the FSM.  He has suffered incredible cognitive and physical decline in the months and years following his injuries. 

12.  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.  

	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 other traumatic injuries (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.

13.  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 was injured on 23 January 2006.  He applied for TSGLI benefits on 18 August 2010.  In his TSGLI application he stated he had suffered the loss of ADLs since 30 October 2008, more than 730 days after his January 2006 injuries.  His claim and appeal were reviewed and denied by OSGLI officials, and his appeal was denied by an official of the TSGLI office. 

2.  The applicant’s contention that symptoms of TBI often do not present immediately or even soon following the injury is acknowledged.  In the FSM’s case, it appears his symptoms that finally affected his ADL finally manifested themselves in October 2008.

3.  Unfortunately, by law, in order to be eligible for TSGLI benefits for a traumatic injury, the member must suffer a loss covered under the law within 730 days of the traumatic event.  The applicant has not provided sufficient documentation to show that the FSM suffered a covered loss within 730 days of his 23 January 2006 injury.  Neither the available records nor the medical documentation the applicant provided establish a basis to support his request.  

4.  Regrettably, there is insufficient evidence that would warrant granting the relief requested.

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)                                         AR20110012631



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ABCMR Record of Proceedings (cont)                                         AR20110023048



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