IN THE CASE OF:	   

		BOARD DATE:	  5 December 2013

		DOCKET NUMBER:  AR20130002850 


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 approval of Traumatic Servicemember’s Group Life Insurance (TSGLI) for his injury that he received surgery for on 19 June 2007.

2.  The applicant states that he is not trying to claim hospitalization; he is just giving a brief background of his injury and providing more documentation.

3.  The applicant provides copies of an operative report; orthopedic notes; chronological records of medical care; the denial of his TSGLI claim, dated
22 February 2012; his DD Form 214 (Certificate of Release or Discharge from Active Duty); and his permanent retirement orders. 

CONSIDERATION OF EVIDENCE:

1.  The applicant served in the Regular Army (RA) from 1 July 1994 until he was honorably released from active duty (REFRAD) on 30 June 1997 due to the expiration of term of service.  After a break in service, on 10 August 2005, he enlisted in the RA and remained on active duty through continuous reenlistments.  

2.  He deployed to Afghanistan on 2 April 2006 and sustained a gunshot wound to the left arm/elbow in 2007 that required multiple surgeries including resection of the radial head and neck.

3.  On 19 June 2007, he underwent surgical procedures that included left shoulder arthroscopic capsular release, debridement, extensive, open radial head excision, and removal of hardware from capitellum and radial head, deep.
4.  He was promoted to the pay grade of E-5 on 1 July 2007.

5.  The applicant made his original TSGLI claim on 12 May 2009 and he was paid $25,000 for an other-than-total injury for temporary activities of daily living (ADL) loss on 2 June 2009. 

6.  On 9 December 2009, he reenlisted for a period of 4 years and a selective service reenlistment bonus.

7.  On 1 November 2010, he was placed on the Temporary Disability Retired list (TDRL).   

8.  The applicant made a second TSGLI claim for benefits associated with his   19 June 2007 surgery and on 6 March 2011 his request was denied.  He filed for reconsideration on 2 June 2011 and that appeal was denied on 19 October 2011 based on his failure to provide evidence of the loss of ADLs.

9.  On 11 June 2012, he was removed from the TDRL and transferred to the Retired List by reason of permanent disability with a 70% disability rating.

10.  The documents submitted by the applicant with his application do not indicate any loss of ADL.

11.  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 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.  The 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.  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 (OIF) and Operation Enduring Freedom (OEF) 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.

12.  There are 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 (TBI); 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 TBI).  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.

13.  The TSGLI Schedule of Losses also provides for a TSGLI payment of $25,000 for a traumatic injury resulting in inability to perform at least two ADLs 


for 30 consecutive days.  An additional payment of $25,000 may be made for 
60 consecutive days of ADL loss, 90 consecutive days of ADL loss, and 
120 consecutive days of ADL loss. 

DISCUSSION AND CONCLUSIONS:

1.  The applicant's contention that he is qualified for additional TSGLI benefits was carefully considered and unfortunately determined to be without merit.

2.  The available evidence clearly shows he underwent a surgical procedure on 19 June 2007 that was associated with his injuries (gunshot wound) sustained in combat in Afghanistan; however, it does not appear that the surgery for his injury qualifies for additional TSGLI benefits without a loss of ADLs.  There is no evidence in the available records and the applicant has not provided sufficient evidence showing he was unable to perform two of the ADLs for the required period.

3.  Absent evidence to show the applicant's disabilities met the criteria for award of TSGLI benefits, there is no basis to grant the relief requested.

4.  The applicant and all others should know that the sacrifices he made in service to the United States during the Global War on Terrorism are deeply appreciated.  The applicant and all Americans should be justifiably proud of his service in arms.

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)                                         AR20130002850



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ABCMR Record of Proceedings (cont)                                         AR20130002850



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