IN THE CASE OF:	  

		BOARD DATE:	  11 October 2012

		DOCKET NUMBER:  AR20120000794 


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 Traumatic Servicemembers' Group Life Insurance (TSGLI).

2.  The applicant states he has provided all the documentary evidence necessary to comply with active duty living (ADL) requirements to qualify for payment of TSGLI.

3.  The applicant provides:

* a letter to the TSGLI Branch, U.S. Army Human Resources Command (HRC), Fort Knox, KY, dated 17 June 2011
* pages 4-9 and 11-13 of a Servicemembers' Group Life Insurance (SGLV) 8600 (Application for TSGLI Benefits)
* Standard Form (SF) 600 (Health Record – Chronological Record of Medical Care), dated 6 April 2010
* DA Form 2173 (Statement of Medical Examination and Duty Status), dated 16 May 2010

CONSIDERATION OF EVIDENCE:

1.  The applicant's record shows that after serving in the Air National Guard from 
21 January 2000 to 1 October 2005, he enlisted in the U.S. Army Reserve (USAR) on 17 April 2007.


2.  On 23 September 2009, while serving in the USAR, the applicant was ordered to active duty in support of Operation Iraqi Freedom.  On 26 June 2011, he was honorably released from active duty at the completion of his required service and returned to his USAR unit.  He completed for 1 year, 9 months, and 4 days of net active service during this period.

3.  An SF 600 provided by the applicant, dated 6 April 2010, shows he was treated for hip pain.  The applicant indicated to treatment personnel that he had fallen 3 times in the past 5 months due to hip pain but he had no falls in several weeks.  This document indicates the condition the applicant was treated for was not deployment-related and the applicant was released without limitations.

4.  The record contains and the applicant provided a DA Form 2173, dated
16 May 2010, that indicates the applicant was seen at Winn Army Community Hospital, Fort Stewart, GA on 6 May 2010 for evaluation for the purpose of evacuation from theater.  It indicates the applicant reported low back and left hip pain from a fall that occurred in country on 6 April 2010 in Iraq.  It further indicates the applicant's injury was considered to have been incurred in the line of duty.

5.  On 25 March 2011, the applicant applied for payment of TSGLI based on requiring assistance with ADLs for 6 weeks.  On 4 May 2011, the TSGLI Branch, HRC denied his request based on the lack of supporting documentation.

6.  On 23 June 2011, the applicant's TSGI claim was reconsidered by the HRC and again denied based on not meeting TSGLI standards.

7.  On 28 July 2011, the applicant's appeal of the TSGLI decision was denied by the HRC based on there being no qualifying TSGLI injury.  The physician reviewing the appeal noted the applicant reported being injured in a fall in theater and he was later diagnosed with cervical disc disease treated with single level fusion surgery.  He further indicated the records submitted included a clinical visit on the day of the claimed injury documenting a fall due to hip pain with no mention of neck injury or neck pain.

8.  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 office 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.  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.

9.  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.

10.  In addition, there is a retroactive program in which Soldiers who incurred a qualifying traumatic injury between 7 October 2001 and 30 November 2005 while supporting Operation Iraqi Freedom and Operation Enduring Freedom 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.

11.  Other traumatic injuries resulting in the inability to carry out two of the six ADL, which are dressing, bathing, toileting, eating, continence, and transferring. TSGLI claims may be filed for loss of ADL 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 will not be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.

12.  Appendix B (Glossary of Terms) of the TSGLI Procedures Guide, dated September 2008, provides the following definitions:

	a.  Traumatic Event, the application of external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to a living body. Examples include:

* Military Motor Vehicle Accident
* Military Aircraft Accident
* Civilian Motorcycle Accident


* Rocket propelled grenade (RPG) Attack
* lED Attack
* Civilian Motor Vehicle Accident
* Civilian Aircraft Accident
* Small Arms Attack
* Training Accident

	b.  Traumatic Injury, the physical damage to a living body that results from a traumatic event.

	c.  External Force, as a force acting between the body and the environment, including a contact force, gravitational force, or environmental force, or one produced through accidental or violent means.

13.  A member who is hospitalized 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 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 other traumatic injury.

14.  Army Regulation 15-185 (Army Board for Correction of Military Records) prescribes the policies and procedures for correction of military records by the Secretary of the Army acting through the ABCMR.  This regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity.  The applicant has the burden of proving an error or injustice by a preponderance of the evidence.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's request for payment of TSGLI has been carefully considered.  However, by law and regulation, a traumatic event is the application of an external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to a living body.


2.  The evidence in this case shows the applicant suffered from and received surgery for cervical disc disease.  There is no indication this condition or his hip pain resulted from a qualifying traumatic event.

3.  In view of the foregoing, there is an insufficient evidentiary basis for granting the applicant's 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)                                         AR20120000794



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ABCMR Record of Proceedings (cont)                                         AR20120000794



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