IN THE CASE OF:	  

		BOARD DATE:	  3 September 2013

		DOCKET NUMBER:  AR20130012742 


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 his Traumatic Servicemembers' Group Life Insurance (TSGLI) claim.

2.  The applicant states his TSGLI claim should be reconsidered for approval.  He claims that as a result of a fall on 9 September 2011, he required surgery that resulted in his inability to independently perform two Activities of Daily Living (ADL).  From 16 February to 26 March “2013,” he was unable to independently transfer onto or off the toilet nor onto or out of the bathtub.

3.  The applicant provides copies of his SGLV 8600 (Claim Information and Authorization), two ADL assessments, and three denial letters.

CONSIDERATION OF EVIDENCE:

1.  The applicant's records show that he is currently serving on active duty in the Regular Army in the rank of staff sergeant/pay grade E-6.

2.  A review of the applicant's Army Military Human Resource Record (AMHRR) revealed the following medical treatment records related to the injury in question.

   a.  An Occupational Therapy (OT) Evaluation, dated 16 February 2012, that shows the applicant sustained a left, grade 3 open ankle fracture on 13 June 2009 following a roll-over motor vehicle accident.  He was assessed with over 2 year's status-post left ankle fusion with distal fibula resection.  He stated that he had resumed all ADLs, to include working out and running, and he was doing well.
   
   b.  A Chronological Record of Medical Care that shows the applicant was seen at Brooke Army Medical Center, OT Outpatient Clinic, on 23 March 2012, for an ADL assessment for TSGLI.  The applicant stated he could do all his ADLs with relative ease.  The occupational therapist's assessment was that the applicant had no functional impairment to perform ADLs and that he was independent in performing ADLs.

3.  In support of his application the applicant provides the following documents:

   a.  An SGLV 8600 that shows the applicant filed a TSGLI claim on 15 June 2012 based on a traumatic injury (other than traumatic brain injury) that occurred on 9 September 2011 in Iraq when he fell off a vehicle, which caused his fused ankle to bend.  The injury required surgical intervention with fibular osteotomy for symptomatic distal fibula resection.  Part B (Medical Professional's Statement), dated 3 July 2012, shows that, due to the slick nature of bathrooms, to mitigate the risk of a fall, the applicant required physical assistance:
   
* getting into and out of bathtub (16 February to 26 March 2012)
* getting on and off toilet (15 February to 26 March 2012)
   
   b.  Prudential, Office of Servicemembers' Group Life Insurance, Roseland, NJ, letter, dated 29 November 2012, that shows the applicant's claim for the inability to perform ADLs due to traumatic injury could not be approved because his loss did not meet the standards for TSGLI.
   
    	(1)  He was informed that, in order to qualify, a claimant must have been unable to independently perform at least two ADLs for at least 30 consecutive days and any such circumstances must be certified by a medical professional.

    	(2)  The applicant's claim was disapproved and he was advised of his right to appeal.

   c.  U.S. Army Human Resources Command (HRC), Special Compensations Branch, Fort Knox, KY, memorandum, dated 26 February 2013, that shows the decision on the applicant's previous claim for the inability to perform ADLs due to traumatic injury was reconsidered.  The Chief, Special Compensations Branch, stated that he was unable to overturn the previous adjudication.  He explained 


that the medical documentation the applicant submitted did not indicate that his physical injuries rendered him incapable of performing the ADLs (that are covered by TSGLI standards) of bathing, dressing, or transferring for
30 consecutive days or greater.
   
   d.  HRC, Special Compensations Branch, Fort Knox, KY, memorandum, dated 31 May 2013, that shows the applicant's appeal on his claim for the inability to perform ADLs due to traumatic injury was considered.  The Chief, Special Compensations Branch, stated that after reviewing the claim and supporting documentation, he was unable to overturn the previous adjudication.  He explained that the medical documentation the applicant submitted did not indicate that his ankle injury rendered him incapable of performing the ADLs (that are covered by TSGLI) of bathing or toileting for
30 consecutive days or greater.
   
4.  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.  The HRC, Special Compensation Branch, 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.  As of 1 December 2005, TSGLI is included as part of a Soldier's SGLI coverage.  Any Soldier who elects SGLI coverage automatically receives TSGLI coverage with an additional $1.00 deducted from pay each month to cover the cost of the TSGLI policy.  The TSGLI law stipulates that 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 between 7 October 2001 and 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.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's request for reconsideration of his original TSGLI claim and appeal has been carefully considered.  However, there is insufficient evidence to support his claim.



2.  There are no serious incident reports or statements from members of the chain of command to confirm the applicant's injury in September 2011 that subsequently required surgery was a qualifying TSGLI event.

3.  On 3 July 2012, a medical professional indicated that, due to the slick nature of bathrooms, the applicant required physical assistance getting into and out of bath tub (during the period 16 February to 26 March 2012) and getting on and off toilet (during the period 15 February to 26 March 2012).  These statements were provided more than 3 months after the applicant's claimed period of inability to perform the ADLs.

4.  Conversely, the medical records prepared during the applicant's claimed period of inability to perform ADLs (i.e., on 16 February and 23 March 2012, respectively) do not support a conclusion that the applicant required assistance with ADLs for an extended period of time.  In fact, the two occupational therapists provided their assessments that show the applicant had no functional impairment to perform ADLs and that he was independent in performing ADLs at that time.  These two medical assessments (made during the claimed period of time) directly contradict the medical assessment provided in the applicant's TSGLI claim that was submitted more than 3 months later.

5.  Thus, the available medical evidence does not support the applicant's claim for TSGLI.

6.  Therefore, the evidence is insufficient to support a change to the previous decisions rendered by the appropriate TSGLI officials.

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)                                         AR20130012742



3


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1

ABCMR Record of Proceedings (cont)                                         AR20130012742



2


ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

 RECORD OF PROCEEDINGS


1