BOARD DATE:	  16 April 2014

		DOCKET NUMBER:  AR20130012473 


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:

* documents completed by his neurosurgeon show he was disabled over 60 days
* his period of disability is as follows:

*	10 July 2009 to 10 September 2009 – unable to bathe independently
*	10 July 2009 to 10 September 2009 – unable to toilet independently
*	10 July 2009 to 11 September 2009 – unable to dress independently
*	10 July 2009 to 11 September 2009 – unable to eat independently

* he needed both physical and standby assistance to bathe, eat, and dress independently as well as standby and sometimes physical assistance to toilet independently
* his doctor's note shows his neuropathy caused him to be temporarily disabled 2 months after surgery and he continued to have short-term disability after the end dates
* evidence clearly shows that he was unable to provide or care for himself without his wife's assistance for over 2 months for a total of 62 to 63 days


3.  The applicant provides:

* SGLV 8600 (Application for TSGLI Benefits), dated 20 December 2010
* Progress Notes from St. Vincent's Spine and Brain Institute, Jacksonville, FL 

CONSIDERATION OF EVIDENCE:

1.  After having a prior period of honorable active duty service in the Regular Army, the applicant enlisted in the U.S. Army Reserve (USAR) on 26 June 2000.

2.  A DA Form 2173 (Statement of Medical Examination and Duty Status), dated 19 January 2009, shows that while assigned in Kuwait the applicant was treated as an outpatient on 14 January 2009 for cervical disc displacement.  The form also shows in:

* Item 15 (Details of Accident or History of Disease):

*	he was seen for a pinched nerve and stated that on 10 January 2008, while conducting maintenance of his vehicle, he struck his head on a tow pintle
*	he was evacuated to Landstuhl Regional Medical Center, Germany, and subsequently to Eisenhower Army Medical Center, Fort Gordon, GA

* Item 22 (Individual Was On) – active duty
* Item 30 (Details of Accident) – in July 2008, a vehicle door hit him in the back and shoulder

3.  Item 30 (Details of Accident – Remarks) of the applicant's DA Form 2173, dated 30 January 2009, shows that in September 2008, while on active duty in Iraq:

* the applicant was struck by an armored door causing his head to be thrown backwards
* since that time he developed neck pain and numbness in his right arm and fingers

4.  His SGLV Form 8600, dated 20 December 2010, shows:

   a.  his physician responded to the following:

* What is the predominant reason the patient is/was unable to independently perform ADL?  Response:  severe arm pain
* Patient is unable to bathe independently if…Describe assistance needed:  Response:  needs assistance bathing due to severe pain in arm and needed assistance to transfer in/out of tub/shower
* To your knowledge, were any of the losses indicated in Part B due to…:  Response:  No, but patient stated that immediately after surgery his symptoms were worse temporarily

b.  his physician only indicated the applicant was unable to bathe independently.

5.  On 6 April 2011, Prudential, Office of Servicemembers' Group Life Insurance, Roseland, NJ, notified the applicant that his claim for hospitalization and other traumatic injury was denied.  The notification also shows he received a $25,000 benefit for the inability to independently perform activities of daily living (ADLs) under other traumatic injury for 30 days.  His claim for inability to independently perform ADLs under other traumatic injury for an additional 30 days was not approved because his loss did not meet the TSGLI standard.

6.  His DA Form 199 (Physical Evaluation Board (PEB) Proceedings), dated 19 December 2011, shows he was rated as follows

* 20 percent – degenerative arthritis of the cervical spine
* 20 percent – right upper extremity radiculopathy
* 10 percent – limited motion right ankle
* he received a 40 percent total disability percentage 
* the PEB recommended permanent disability retirement

7.  On 30 December 2011, the applicant concurred with the findings and recommendations of the PEB.

8.  Orders Number 12-115-00035, issued by Headquarters, 81st Regional Support Command, Fort Jackson, SC, dated 24 April 2012, show the applicant was assigned to the Retired Reserve effective 24 May 2012.

9.  On 7 February 2013, the Department of Veterans Affairs (VA) granted the applicant the following:

* 50 percent disability rating for sleep apnea syndrome
* 30 percent disability rating for post-traumatic stress disorder
* 10 percent disability rating for painful motion of the knee
* 10 percent disability rating for cervical strain
10.  On 28 March 2013, the applicant was notified that his TSGLI appeal was denied.

11.  On 1 October 2013, the VA granted the applicant the following on appeal:

* 100 percent disability rating for traumatic brain injury to include hearing loss, right ear, and visual changes
* 20 percent disability rating for cervical radiculopathy, right upper extremity (major)
* 10 percent disability rating for osteoarthritis, right ankle
* 10 percent disability rating for tinnitus
* entitlement to special monthly compensation

12.  On 19 February 2014, the applicant was granted Combat-Related Special Compensation with a total combat-related disability rating of 100 percent.

13.  The applicant provides progress notes from the Spine and Brain Institute, St. Vincent's Healthcare which show:

* he was recommended for continued short-term disability
* he had been disabled for about 2 months after surgery
* he awoke after surgery with significantly increased right arm pain, numbness and swelling

14.  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.

15.  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. 

16.  Traumatic injuries resulting in the inability to independently carry out two of the six ADLs include 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.

17.  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. 

18.  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 attack
• improvised explosive device 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.

19.  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.

20.  The U.S. Army Human Resources Command official TSGLI website shows losses that are not covered include medical or surgical treatment of an illness or disease.

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.  His traumatic injury resulted in his inability to carry out one of the six ADLs.  Policy requires the inability to perform two out of the six ADLs.  Therefore, he is not entitled to the requested relief.

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)                                         AR20130012473



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ABCMR Record of Proceedings (cont)                                         AR20130012473



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