IN THE CASE OF:	  

		BOARD DATE:  3 December 2013

		DOCKET NUMBER:  AR20120021273 


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 reconsideration of his Traumatic Service Members’ Group Life Insurance (TSGLI) claim.

2.  The applicant states:

	a.  His first and second TSGLI claims were submitted without his permission and without documentation by the TSGLI office at Walter Reed Army Medical Center (WRAMC), resulting in denials.

	b.  He submitted a third request and his request was denied due to insufficient documentation.

	c.  He now has all the documentation needed to clearly show his entitlement to compensation under the TSGLI.

	d.  Due to the injury he received to his right shoulder, he was unable to lift, swing, bend his back, squat without assistance, and he was unable to grab, hold, push or pull.

	e.  He met the requirements because he needed physical assistance with bathing, dressing, and toileting which are three of the six activities of daily living (ADL).


	f.  His ADL loss began after the injury on 23 April 2009.  He was assigned a personal medical assistant from his unit to physically assist him with ADLs and to travel with him from Iraq to Landstuhl Regional Medical Center (LRMC) in Germany.

	g.  He was subsequently assigned to the U.S. Air Force Contingency Aeromedical Staging Facility (CASF) for transport to WRAMC and an Air Force Registered Nurse was appointed not only to provide him with medical care but to also physically assist him during the medical transport.

	h.  He spent most of the flight medicated and in pain and upon his arrival at WRAMC, he was immediately admitted.  He was hospitalized for 13 days from
23 April to 5 May 2009.  His spouse arrived at WRAMC on 29 April 2009.

	i.  The hospital administration began to process a request for orders for his spouse as a non-medical attendant in order to assist him with ADLs.  His spouse was placed on orders for 30 days from 6 May to 6 June 2009 but unfortunately, after the expiration of the orders, she could no longer assist him.

	j.  After his spouse's departure, he still required physical assistance but the hospital could not provide it.  Instead, they assigned another wounded warrior to assist him with ADLs for the remaining 30 days.  After his departure, he had nobody whom he trusted to continue to assist him so he did the best he could.

	k.  Without assistance, he suffered extreme difficulties with performing ADLs in order to get ready for the day or to attend any appointments and treatment.  It would take him two hours of painful preparation.

	l.  His medical records show the continued treatment he received for his injuries.  He was subsequently medically retired from the Army because of his injuries and other medical conditions.  His injuries and medical conditions were unacceptable for continuance in the military and his medical conditions continue to be a debilitating condition today.  He has been receiving social security disability since November 2009 and his claim for Department of Veterans Affairs (VA) compensation is pending.

3.  The applicant provides:

* five DD Forms 2173 (Statement of Medical Examination and Duty Status)
* several Standard Forms 600 (Chronological Record of Medical Care)
* DA Form 199 (Physical Evaluation Board (PEB) Proceedings) 
* excerpt from the TSGLI Procedures Guide
* DD Form 214 (Certificate of Release or Discharge from Active Duty)
CONSIDERATION OF EVIDENCE:

1.  Orders dated 20 May 2008 show he was ordered to active duty in support of Operation Iraqi Freedom as a member of the New Jersey Army National Guard.  He entered active duty on 20 June 2008.

2.  DA Forms 2173 show that he suffered a fractured forearm not otherwise specified (NOS), closed (fracture of an unspecified part of forearm); post-traumatic stress disorder; traumatic brain injury; insomnia; right shoulder injury; and lower back injury which resulted when in April 2009, while deployed to Iraq, he was helping an Army engineer unit when the bucket part of an Army Bobcat vehicle came down and struck him.

3.  His medical record shows he was medically evacuated to WRAMC and admitted on 27 April 2009.  His medical records also show he was hospitalized from 23 April to 5 May 2009 (13 days).

4.  On an unknown date, he submitted a TSGLI claim.  The TSGLI claim form indicates his claim was for loss of three of six ADLs (bathing, toileting, and dressing) for a 60-day period which were attributed to his right arm injury.

5.  On 21 July 2009, the Office of Servicemembers' Group Life Insurance (OSGLI), the administrator of the TSGLI program, sent the applicant a letter informing him that his TSGLI claim was not approved because there was not enough medical information to support his losses.  He was informed of his right to appeal the decision.

6.  He submitted two requests for reconsideration but his requests were denied on 21 September and 21 October 2009.  He was again informed that his claim was not approved because there was not enough medical information to support his losses.

7.  On 24 May 2011, a PEB convened and found his medical conditions prevented him from performing the duties required of his grade and military specialty and determined that he was physically unfit.  The PEB recommended placing him on the Temporary Disability Retired List (TDRL).  On 13 October 2011, he was placed on the TDRL.

8.  A review of the medical documentation provided does not show that he was unable to perform his ADLs for 30 or more days.  The medical documentation does show that he was having certain difficulties performing his ADLs.

9.  On 17 April 2012, he was informed by a representative of the TSGLI program that his TSGLI claim was reviewed at their highest appeal level but they were unable to approve his request.

10.  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 May 11, 2005, 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.  TSGLI provides between $25,000 and $100,000 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 taken out each month to cover the cost of the TSGLI policy.  Soldiers paying for SGLI coverage cannot decline TSGLI--it is a package.  In addition, there is a retroactive program, in which Soldiers who incurred a qualifying traumatic injury from 7 October 2001 through 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.  There are some specific circumstances under which a traumatic injury will not be covered by TSGLI.  A qualifying traumatic injury is an injury or loss caused by application of external force or violence (a traumatic event) or a condition whose cause can be directly linked to a traumatic event.  Traumatic injuries covered may include, but are not limited to the following types of losses:

   a.  total and permanent loss of sight in one or both eyes;
   
   b.  loss of hand or foot by severance at or above the wrist or ankle;
   
   c.  total and permanent loss of hearing in one or both ears;
   
   d.  loss of speech;

   e.  loss of thumb and index finger of the same hand by severance at or above the metacarpophalandeal joints;
   f.  quadriplegia, paraplegia or hemiplegia;
   
   g.  3rd degree or worse burns covering 30 percent of body or 30 percent of the face; 
   
   h.  coma or traumatic brain injury; or

	i.  other traumatic injuries 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 
(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 medical 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 evidence provided by the applicant was carefully considered.  The
applicant's disagreement with responses to his TSGLI claims as noted; however, the available evidence shows that although he suffered a traumatic injury while serving in Iraq the information provided does not show he was completely dependent on another person for completion of his ADLs.

2.  The statement in the TSGLI claim form indicates he could not perform bathing, toileting, and dressing for a 60-day period.  Unfortunately, the claim is not corroborated by information in the available medical records.  The fact that the applicant required medical care and support immediately following his injury in April 2009 as well as follow-up care is not disputed.  However, the available documentation (such as that noted in paragraph 11i, above) is not available to justify a TSGLI payment for loss of ADLs.

3.  The applicant has not provided sufficient documentation to support his contention that his TSGLI claims were improperly disallowed.  Neither the available records nor the medical documentation the applicant now provides establish a basis to support his request.

4.  In view of the foregoing, there is insufficient basis for granting relief in this case

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)                                         AR20120021273



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20120021273



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1