IN THE CASE OF:	  

		BOARD DATE:	  18 October 2012

		DOCKET NUMBER:  AR20120014209 


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 records to show entitlement to the Traumatic Servicemen's Group Life Insurance (TSGLI). 

2.  The applicant states:

* he sustained injuries to his shoulder and knee in Afghanistan and received the Purple Heart
* he had a total loss of ligaments in his knee and was given a wheelchair to move about in his activities of daily living (ADL), but was unable to do so without the assistance of his wife
* he required assistance at all times moving in and out of the wheelchair
* he required direct physical assistance at least 90 consecutive days and was only able to perform 4 of the 6 activities listed for entitlement to TSGLI 
* he received $50,000 and submitted a new TSGI application due to the extension of his injuries and requiring assistance with bathing and dressing for more than 120 days
* he was told his request was denied because his shoulder and knee injuries did not occur from the same incident in Afghanistan and that there was no proof that his limitations in ADL extended beyond 60 days
* he still has restrictions in ADL and requires assistance from his wife to lift him to the bed, chair, and toilet
* he also requires assistance in dressing and bathing since he cannot raise his right shoulder

3.  The applicant provides:

* self-authored statements
* extracts of his medical records

CONSIDERATION OF EVIDENCE:

1.  After having had prior active service, the applicant reenlisted in the Regular Army on 21 March 2005.  He is presently serving in the rank/grade of staff sergeant/E-6.

2.  Orders Number PK-277-0062, Headquarters, Joint Readiness Training Center and Fort Polk, Fort Polk, LA, dated 4 October 2010, show the applicant was deployed to Afghanistan in support of Operation Enduring Freedom. 

3.  Permanent Orders Number 110-027, Headquarters, Combined Joint Task Force-101, Bagram Airfield, Afghanistan, dated 20 April 2011, awarded the applicant the Purple Heart for wounds sustained in action on 19 April 2011. 

4.  Permanent Orders Number 110-028, Headquarters, Combined Joint Task Force-101, Bagram Airfield, Afghanistan, dated 20 April 2011, awarded the applicant the Combat Action Badge.

5.  Orders Number A-04-108362, Landstuhl Regional Medical Center, dated 23 April 2011, show the applicant was medically evacuated for continued medical care.

6.  Records pertaining to the applicant's injuries received in Afghanistan are unavailable and the applicant does not provide copies.

7.  The complete application, rationale, and appeal of the applicant's submission to the TSGLI office are unavailable and the applicant does not provide copies.  A Summary Sheet from the TSGLI office shows:

* he was injured on 19 April 2011 by an improvised explosive device (IED)
* he received knee surgery on 23 June 2011
* he received payment for 60 days of OTI (other traumatic injury/ADL) loss related to his knee 
* the medical professional's statement did not indicate the applicant's loss met the minimum TSGLI standard
* no documents from the period of loss cited were submitted
* allowable use of right shoulder does not support a need for assistance due to being incapable and indicates only some difficulty in performing ADL

8.  Medical documentation provided by the applicant shows he underwent surgery for open rotator cuff repair (medium to large tear) on 20 October 2011.  The medical documentation provided does not show when or where his torn rotator cuff injury occurred.

9.  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.

10.  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. 

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 2 of the 6 ADLs for 30 days or more (15 days or more in the case of traumatic brain injuries).  Any 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.  Part 1 of the TSGLI Schedule of Losses show multiple injuries resulting from a single traumatic event may be combined with each other and treated as one loss for purposes of a single payment; however, the total payment amount may not exceed $100,000.  Part II shows payment amounts may not be combined with payment amounts in Part I.  Payment of an additional $25,000 is authorized when a traumatic injury resulting in the inability to perform at least 2 ADLs at the 60th consecutive day of ADL loss. 

13.  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
• IED 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.

14.  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, traumatic brain injury, or the member is hospitalized due to other traumatic injury.

15.  Army Regulation 15-185 (Army Board for Correction of Military Records (ABCMR)) 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 correction of his records to show entitlement to TSGI was carefully considered.

2.  A review of the medical evidence submitted by the applicant shows his injury did not approach the level required for documentation to justify a TSGLI payment for loss of ADL.  There is insufficient evidence to show how long his ADL limitations lasted.  Further, there was no evidence that the shoulder injury was the direct result of a 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)                                         AR20120014209



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ABCMR Record of Proceedings (cont)                                         AR20120014209



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