IN THE CASE OF:	  

		BOARD DATE:	  19 June 2014

		DOCKET NUMBER:  AR20130017712 


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, in effect, that her Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim be reconsidered.

2.  The applicant states she underwent right shoulder and left foot surgery.  She was unable to take care of her Activities of Daily Living (ADL) due to both surgeries.  She is right handed. 

3.  The applicant provides a:

* Congressional correspondence
* denial letter from the U.S. Army Human Resources Command (HRC), dated 6 May 2013
* hand-written note
* Hospital discharge note, dated 17 February 2011 (left foot)
* Hospital discharge and special instruction note, dated 25 February 2011
* Operative report, dated 29 April 2011 (shoulder)

CONSIDERATION OF EVIDENCE:

1.  Having had prior service in the Army National Guard, the applicant enlisted in the U.S. Army Reserve (USAR) on 6 December 1984.  She held military occupational specialty 42A (Human Resources Specialist).  

2.  She served through multiple reenlistments in a variety of assignments including active duty mobilization from 16 November 2003 to 29 January 2005, and she attained the rank/grade of master sergeant (MSG)/E-8.  

3.  She entered active duty on 15 July 2005.  She served in Kuwait from 10 November 2009 to 30 August 2010.  

4.  Her records contain multiple DA Forms 2173 (Statement of Medical Examination and Duty Status), all dated (constructed) 21 January 2011, and all signed by the same line of duty clerk as well as unit commander, as follows: 

* On or about 13 November 2008, she complained of back pain; she was examined and underwent x-rays; she was diagnosed with herniated disc (L5-1) 
* On or about 22 December 2010, she complained of memory loss; she was examined and underwent a CAT scan; she was also screened for and diagnosed with traumatic brain injury (TBI) while at Fort Benning, GA 
* On or about 22 December 2010, she complained of headaches; she was examined and underwent a CAT scan; she was screened for and diagnosed with headaches syndrome while at Fort Benning, GA 
* On or about 26 March 2010, she complained of shoulder pain; she was examined and underwent x-rays and an MRI; she was diagnosed with tendonitis rotator cuff while stationed in Kuwait 
* On or about 12 March 2010, she complained of left hip pain and numbness; she was examined and underwent x-rays and an MRI; she was diagnosed with osteoarthritis while stationed in Kuwait 

5.  She provides: 

	a.  A multidisciplinary discharge note dated 17 February 2011 in relation to a treatment procedure related to chronic left foot pain.  On discharge, the physician diagnosed her with left hallux valgus, Tailor's bunion, and deviated 5th toe.  She was instructed to follow-up on 25 February 2011.   

	b.  Operative Report dated 29 April 2011 in relation to a treatment procedure for rotator cuff tear, right shoulder.  On discharge, the physician diagnosed her with large rotator cuff tear and biceps tendinosis, right shoulder.

6.  Her narrative summary is not available for review with this case.  However, it appears medical officials determined she had certain medically unacceptable conditions diagnosed by a medical examination related to a medical evaluation board (MEB).  It also appears the MEB referred her to a physical evaluation board (PEB).  Neither her MEB Proceedings nor her PEB Proceedings are available for review this case. 

7.  She retired on 3 June 2013 and she was placed on the Retired List in her retired rank/grade of MSG/E-8 on 4 June 2013 by reason of permanent disability. 

8.  Her TSGLI application with supporting documents and physician certification is not available for review with this case.  A summary of her available records yielded the following results: 

	a.  HRC initially received her application on 11 July 2011 and denied it on 26 July 2011.  Her request for reconsideration was received on 12 September 2011 and was denied on 26 September 2011.  Her appeal was received on 9 September 2012 and was denied on 2 May 2012.  

	b.  She claimed multiple injuries but without specific dates.  She also claimed hospitalization for 1 day (29 April 2011).  Her injuries consisted of a left shoulder rotator cuff tear sustained in Kuwait on 12 December 2009 when a duffel bag hit her shoulder and left bunionectomy on 17 February 2011.  Additionally, on 4 March 2010, a box fell and injured her shoulder, thus exacerbating her injury.  She underwent a bunionectomy on 17 February 2011 and left shoulder rotator cuff repair on 29 April 2011.  She recovered with no complications.  

	c.  denial letter, dated 6 May 2013.  The letter states the TSGLI program office received her appeal request.  After reviewing her claim and supporting documentation, that office was unable to overturn the previous adjudication.  The medical records submitted for the events that took place in Kuwait on 12 December 2009 did not indicate she met the TSGLI standard for hospitalization.  The documents she provided did not indicate she was hospitalized inpatient for 15 consecutive days or greater.  Also, the documents she submitted did not indicate her shoulder injury rendered her incapable of performing the ADLs of bathing, dressing, eating, or toileting that are covered by TSGLI standards for 30 consecutive days or greater. 

	d.  denial letter, dated 25 June 2013.  The letter states the TSGLI program office received her TSGLI appeal request.  However, the records indicate she had exhauster her appeal rights with the TSGLI office.  

9.  Public Law 109-13, signed by the President on May 11, 2005, established the 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 (DOD).  As of 1 December 2005, TSGLI is included as part of a Soldier's SGLI coverage. 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 or the location in which they incurred the injury will be covered by TSGLI.

10.  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 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 total and permanent loss of sight in one or both eyes, loss of hand or foot by severance at or above the wrist or ankle, total and permanent loss of hearing in one or both ears, loss of speech, loss of thumb and index finger of the same hand by severance at or above the metacarpo- phalandeal joints, quadriplegia, paraplegia or hemiplegic, third (3rd) degree or worse burns covering 30% of body or 30% of the face, and coma or TBI.

11.  Traumatic injuries (TI) resulting in the inability to carry out two of the six ADLs 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.  While TSGLI claims will not be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.

12.  Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR.  The ABCMR begins its consideration of each case with the presumption of administrative regularity.  The applicant has the burden of proving an error or injustice by a preponderance of the evidence.

DISCUSSION AND CONCLUSIONS:

1.  The applicant claims she underwent right shoulder and left foot surgery and she was unable to take care of her ADLs due to both surgeries.  She is right handed. 

2.  The complete facts and circumstances related to her TSGLI application, type of injury, physician/medical provider certification, and supporting medical conditions are not available for review with this case.  Nevertheless, the available evidence indicated she may have requested TSGLI based on hospitalization as well as ADLs:

	a.  The medical document she provides shows she was hospitalized for 1 day.  There is no evidence in her records and she provides none to show she was hospitalized for 15 consecutive days and as such, she does not qualify for any TSGLI benefits based on hospitalization.  

	b.  In order to support a claim for TSGLI ADL loss, the member must show and the healthcare provider must certify a loss of ADLs and complete dependence on someone else to perform 2 of the 6 ADLs for 30 days or more.  It is unclear what ADLs the applicant was unable to perform.  However, an otherwise healthy patient is not rendered ADL-incapable by a single limb trauma, dysfunction, or immobilization.  

3.  By law, for an ADL loss to be covered there must be a traumatic event that leads to a loss for a duration of at least 30 days; the member must require assistance to perform two of six ADLs; and the ADL loss must be certified by a healthcare provider and substantiated by appropriate documentation, such as occupational therapy/physical therapy reports, discharge summaries, and other medical documentation.  

4.  TSGLI analysts strive to apply a "reasonable person" standard to each claim with a bias in favor of the claimant while still maintaining a high degree of internal consistency among similar claims.  There is no medical documentation indicating a physical incapacity of performing ADLs without assistance.  The applicant provides medical documents related to shoulder surgery but not loss of ADLs for 30 days which clearly does not meet the criteria for TSGLI.

5.  In view of the foregoing, there is no 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)                                         AR20130017712



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ABCMR Record of Proceedings (cont)                                         AR20130017712



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