IN THE CASE OF:	  

		BOARD DATE:  4 January 2013

		DOCKET NUMBER:  AR20120004344 


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 Traumatic Servicemembers’ Group Life Insurance (TSGLI) payment due the loss of activities of daily living (ADL) for a 120-day period.

2.  The applicant states his right hip was dislocated during a training exercise in February 2007 and he was placed on light duty until October 2007.  At this point he rapidly began to lose function in the hip accompanied by pain and spasms.  He lost the ability to use the toilet without assistance; to dress, bathe, make food for himself; or to transfer to and from his wheelchair by himself.  These problems continued from October until May 2008 when he had surgery.

3.  The applicant provides a copy of 101 pages of medical records and documents related to his application for additional benefits and the U.S. Army Human Resources Command (HRC) Traumatic Servicemembers' Group Life Insurance Branch denial of those benefits.

CONSIDERATION OF EVIDENCE:

1.  The applicant, an active duty medical specialist, injured his right hip on a physical fitness course on 18 February 2007.

2.  The records show that initially the problem appeared to be resolving; however, after six months it was reported as worsening.  The medical records show that after one year the problem continued to worsen with the applicant's mobility deteriorating and his pain level worsening.  
3.  The applicant's medical records report continued treatment for the hip. However, the available records do not include actual records of his prior treatments. 

4.  In February 2008, he was authorized a household assistant due to his wife's illness and her inability to provide needed assistance.  

5.  A bone scan (February 2008) showed minimal abnormalities.  A computerized tomography (CT) scan (February 2008) and a magnetic resonance imagining (MRI) arthrography (March 2008) were reported as normal. 

6.  His medical records show:

	a.  On 13 February 2008, he was referred to a private (civilian) hip specialist.  The doctor stated the applicant reported persistent hip pain, used a cane or crutches to walk, and had difficulty putting on his shoes and socks. 

	b.  On 13 March 2008, the applicant was issued a wheelchair due to the problems with his hip.

	c.  During a March 2008 case management appointment the applicant's wife was very agitated and complained about a number of situations with her husband's care including complaining that he had to drive himself to weekly appointments.  A second MRI was scheduled at this time.

	d.  the applicant did a self-referral to a private orthopedic specialist who recommended the applicant undergo arthroscopic surgery. 

	e.  a 19 June 2008 statement indicates the applicant had surgery on his hip on 22 April 2008.  It noted the applicant had an asymmetrical gait and walked with a cane. 

	f.  The record does not include any medical documentation of the hip surgery except by reference.

7.  In a 2 August 2009 statement, J___ S____, a Med-Aid and former active duty medical corpsman (medic), states that on 18 February 2007 he responded to a call of a fellow medic (the applicant) who had fallen and was unable to bear weight on his right side.  The diagnosis at that time was a dislocation of the right hip.  Following his release from active duty he was called upon to participate in the applicant's care, due to the applicant's wife's medical treatment.  He frequently assisted with household tasks and assisted the applicant with bathing, toileting, dressing, preparing food, and movement around the house to include getting in and out of bed.  He provided assistance from December 2007 through May 2008.

8.  In November 2009, Physical Therapy Clinic records stated that after the applicant's initial evaluation following surgery he was "blocked into a wheelchair" for several months.

9.  On 10 June 2010, the applicant submitted a TSGLI application.  On the form the applicant stated he needed assistance standing, transferring to and from his wheelchair or to the toilet, and in putting on his clothes.  In his statement he indicated that commencing in October 2007, as a result of a fall 6 months earlier, he experienced a deterioration of his hip function.  As a result of the significant problem with his hip, he was unable to transfer to or from his wheel chair without assistance, use the toilet without assistance, he could not make his own food, and needed assistance with activities of daily living.  His wife had acted as his care giver until it became too much for her and they requested and received medical assistance.  He eventually saw a private physician who recommended surgery.  Within 72 hours of the surgery he was able to walk again.  During his incapacitation he incurred massive debts from having his house adapted for wheelchair accessibility and the loss of his wife's income due to her having to provide his care.

10.  In a 10 June 2010 Command Assessment statement, he was praised for his performance of duty since assignment to the unit on 2 November 2009.

11.  A 20 June 2010 Supreme Headquarters, Allied Powers Europe memorandum states there was a lack of documentation of the applicant's conditions due to a loss of some the applicant's medical records for the period October 2007 to the date of his surgery, 22 May 2008.  However, during this period he had a daily loss of a minimum of 3 ADLs.  (The memorandum does not specify which ADLs the applicant was unable to perform.)  The statement was signed by Major M____ Pf____, Flight Surgeon.

12.  A 29 July 2010 Supreme Headquarters Allied Powers Europe memorandum states a review of the applicant's records shows a loss of almost complete ability to perform ADL functions from around the start of November 2007 until his surgery on 22 May 2008.  The memo was signed by Major J____ Ph____, Family Physician.

13.  On 19 August 2011, Prudential Insurance disapproved his claim stating the applicant did not meet the standards for TSGLI as he was not shown to be unable to perform at least two ADLs.

14.  On 9 November 2011, HRC TSGLI Branch denied the applicant's TSGLI claim stating there was no evidence of ADL loss beyond the initial 30 days milestone.

15.  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 official HRC 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 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.

	c.  A member who is hospitalized for 15 consecutive days as the result of a traumatic injury is eligible for a $25,000 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 requirement:  the member is hospitalized due to coma/TBI or the member is hospitalized due to (an) other traumatic injury (OTI).
DISCUSSION AND CONCLUSIONS:

1.  To receive payment under the TSGLI for ADL loss, the loss must be for at least 30 days in duration, the member must require assistance to perform two of six ADLs, the ADL loss must be certified by a healthcare provider and must be substantiated by appropriate occupational/physical therapy reports, discharge summaries, and other medical documentation.

2.  The applicant was injured on 18 February 2007.  Initially he appeared to be recovering well; however, in October 2007 his hip injury started to deteriorate rapidly and in either April or May 2008 the applicant underwent corrective surgery.  

3.  The available medical records covering the period from October 2007 through May 2008 do not contain any evidence that clarifies what if any ADLs the applicant was unable to perform.

4.  The 2010 memorandum that states the applicant had a loss of ADLs was prepared well after the applicant's surgery and does not specify what ADLs the applicant was unable to perform.  A review of the available medical records does not corroborate the assertions of either the flight surgeon or family physician.

5.  While there are clear indications the applicant had significant problems resulting from his hip injury, the available medical records fail to include documents, such as occupational/physical therapy reports, patient discharge summaries, or other pertinent documents, to support a finding of the inability to perform at least two ADLs or documenting the duration thereof.  The 2 August 2009 statement by the former medic fails to meet that requirement.

6.  The applicant has provided insufficient 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.  

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)                                         AR20120004344





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ABCMR Record of Proceedings (cont)                                         AR20120004344



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