BOARD DATE:	  18 June 2014

		DOCKET NUMBER:  AR20130016202 


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:

The applicant defers to counsel.

COUNSEL'S REQUEST, STATEMENT AND EVIDENCE:

1.  Counsel requests, in effect, payment of a Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim.

2.  Counsel states, in effect, he disagrees with the denial of the applicant's TSGLI claim.

3.  Counsel provides:

* Colorado Statutory Power of Attorney
* letter from the Special Compensations Branch (TSGLI), U.S. Army Human Resources Command (HRC), Fort Knox, KY, dated 5 February 2013
* letter from a registered nurse, dated 15 May 2013
* SGLV Form 8600 (Application for TSGLI Benefits), pages 3 through 13
* letter from a neurosurgeon, dated 21 August 2012
* medical record extracts
* letter from Lawton Neurosurgery Services, dated 12 July 2010





CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 15 January 2008 for a 6-year period.

2.  His DA Form 199 (Physical Evaluation Board (PEB) Proceedings), dated 30 June 2011, shows he was diagnosed with the following after bouncing around in a high mobility multipurpose wheeled vehicle (HMMWV) at Fort Sill, OK, in March 2010:

*	left (non-dominant) C5 radiculopathy with ulnar neuropathy, rated 20 percent disabling
*	cervical intervertebral disc syndrome, status post C3-C4 laminectomy July 2010, rated 10 percent disabling

3.  On 30 June 2011, the PEB determined the applicant was physically unfit and recommended a permanent disability retirement with a combined disability rating of 30 percent.

4.  On 12 July 2011, the applicant concurred with the findings and recommendation and waived a formal hearing.

5.  On 21 September 2011, he was permanently retired with a 30 percent disability rating.

6.  On 5 February 2013, the Special Compensations Branch (TSGLI), HRC, Fort Knox, KY, notified the applicant that they were unable to overturn the previous denial adjudication of his claim for hospitalization and other traumatic injury.  The notification also shows his claim was denied because the documents that were submitted did not indicate:

* he was hospitalized for 15 consecutive days or more
* he was incapable of performing ADL skills of toileting, dressing, bathing, transferring, continence or eating for 30 days or more, per TSGLI guidelines

7.  The applicant provides a letter, dated 15 May 2013, from a registered nurse who states that:

   a.  On 9 April 2010, the applicant was riding in a military vehicle dressed in full combat gear when the vehicle crashed into a culvert slamming him and other passengers around inside the vehicle.  
   
   b.  He immediately began to experience severe pain in his left arm with numbness, loss of left arm strength, dizziness, episodes of seeing stars, blurred vision, and difficulty urinating.  After several weeks his symptoms began to worsen so he sought treatment from his primary care manager (PCM).
   
   c.  Following his cervical spine and left carpal tunnel surgeries, he was unable to perform 2 ADLs independently.  From 30 July 2010 through 30 September 2010, he required physical hands-on and stand-by assistance from his wife, to include bathing and dressing.
   
	d.  The applicant's ADL losses were annotated on his TSGLI application and certified by his neurosurgeon; however, his TSGLI claim was denied based on insufficient evidence showing he was incapable of performing ADLS for 30 days or more.

   e.  It is her professional opinion the applicant's loss of ADL days are consistent with his traumatic injury to include surgeries and rehabilitation.  It is reasonable to state that he would need assistance with ADLs such as bathing and dressing for at least 60 days during rehabilitation from his cervical spine surgery and subsequent left carpal tunnel surgery.

8.  The applicant provides pages 3 through 13 of his SGLV 8600.  His SGLV Form 8600, dated 31 May 2013, shows his physician responded to the following on 15 September 2010:

* What is the predominant reason the patient is/was unable to independently perform Activities of Daily Living (ADL)?  Response:  cervical herniated disc at C3-C4 with left C4 radiculopathy secondary to HMMWV accident
* Patient is unable to bathe independently if…Describe assistance needed:  Response:  patient is unable to bathe independently and required physical assistance from 30 July 2010 through 30 September 2010 with standby assistance from 30 September 2010 through 1 November 2010
* Patient is unable to dress independently if…Describe assistance needed:  Response:  …required assistance from 30 July 2010 through 30 September 2010 with standby assistance from 30 September 2010 through 1 November 2010
* Patient is unable to toilet independently if…Describe assistance needed:  …required assistance going to/from toilet, getting on/off the toilet, getting clothing off/on from 30 July 2010 through 30 September 2010 with standby assistance from 30 September 2010 through 1 November 2010
* Patient is unable to transfer independently if…Describe assistance needed:  …required assistance going to/from toilet, getting on/off the toilet, getting clothing off/on, and
* requires assistance from another person to move into or out of bed or chair from 30 July 2010 through 30 September 2010 with standby assistance from 30 September 2010 through 1 November 2010
* To your knowledge, were any of the losses indicated in Part B due to…:  Response:  blank

9.  The applicant provides a letter from his neurosurgeon who states the applicant underwent a left C3/4 foraminotomy and hemi-laminotomy for a cervical spondylotic myelo-radiculopathy on 30 July 2010.  He further states:

   a.  Post-operatively, he was advised to minimize his neck movements for 3 months to allow for healing of his cervical paraspinal muscles.  He suffered considerably from axial neck pain after the procedure and had significant limitations of both arms in elevation of his shoulders with the left shoulder being particularly severe.  This caused him to need assistance with activities including showering, feeding himself, dressing himself, and with transportation to and from his medical appointments.
   
   b.  The applicant underwent carpal tunnel release on 21 September 2010.  
   
   c.  When he was last seen prior to being cared for by another physician on 27 October 2010, he was improving with respect to his ADLs and was traveling to his medical appointments by himself.

	d.  He had significant physical limitations of his cervical spinal cord and the left C4 root for approximately 3 months post-operatively and as this was felt to be secondary to traumatic injuries suffered while overseas on active duty, a TSGLI benefit packet was completed on his behalf.

	e.  The applicant ceased to be his patient on 29 October 2010 and he had difficulty with follow-up treatment.

10.  The applicant also provides extracts of medical records and documents which show some of his treatment.

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.  The 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.

12.  A qualifying traumatic injury is an injury or loss caused by a traumatic event or a condition whose cause can be directly linked to a traumatic event.  The U.S. Army Human Resources Command's official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II.  Each loss has a corresponding payment amount.

13.  Part II losses include traumatic injuries resulting in the inability to perform at least 2 ADLs for 30 or more consecutive days and hospitalization due to a traumatic injury and other traumatic injury (OTI) resulting in the inability to carry out 2 of the 6 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 2 of the 6 ADLs for 30 days or more.  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.

14.  ADLs are routine self-care activities that a person normally performs every day without needing assistance.  There are six basic ADLs:  eating, bathing, dressing, toileting, transferring (moving in and out of bed or chair) and continence (managing or controlling bladder and bowel functions).  A member is considered to have an ADL loss if the member requires assistance to perform at least two of the six ADLs.  If the patient is able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.), the patient is considered to be modified independent.

15.  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.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's request for payment of a TSGLI claim was carefully considered.  However, there is insufficient evidence to support this claim.

2.  His request for payment of TSGLI was based on his inability to perform 3 of 6 ADLs for the period 30 July 2010 through 1 November 2010, occurring as a result of a HMMWV accident in which he incurred cervical spine injuries. 

3.  Medical documentation from the time of his injury until his initial claim submission is insufficient to substantiate his claims of ADL loss or to attribute his losses to the injuries he sustained.  While TSGLI claims will not be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.

4.  The applicant has not provided sufficient documentation to support his contention that his TSGLI claim was improperly disallowed.  Neither the available records nor the medical documentation the applicant provided establish a basis to support his request.  The documentation provided does not explain how the injuries he received made him completely dependent on someone else to perform 3 of the 6 ADLs for 3 months.

5.  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)                                         AR20130016202



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ABCMR Record of Proceedings (cont)                                         AR20130016202



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