IN THE CASE OF:	

		BOARD DATE:	  19 December 2013

		DOCKET NUMBER:  AR20130018509 


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 to his left hip in March 2004.  He received this injury as a result of the heavy load he was carrying on a “Ruck” march, which subsequently resulted in a hip replacement and his medical retirement.

2.  The applicant states that his August 2009 TSGLI appeal was denied because the adjudicating officials incorrectly claimed that he did not suffer a loss of activities of daily living (ADL) and did not have a traumatic event.  He goes on to state that his records clearly show he had a traumatic event and suffered a loss of ADLs following his surgery in February 2009.  He goes on to state that it took  7 years after his injury was diagnosed to process him for medical retirement.  

3.  The applicant provides a four-page letter to the Wounded Warrior Project listing the enclosures he provides with his application.

CONSIDERATION OF EVIDENCE:

1.  The applicant was serving in the pay grade of E-6 as a U.S. Army Reserve (USAR) combat engineer when he was ordered to active duty on 7 December 2003 in support of Operation Iraqi Freedom.  

2.  He deployed to Iraq on 21 February 2004.  His records show that the applicant went on sick call on 20 May 2004 complaining of pain in his left hip that began in March 2004 following a ruck sack march and was diagnosed as groin pain.  He was given Ibuprofen for pain which provided no relief and he complained that the pain was worsening. 

3.  He departed Iraq on 25 February 2005 and was honorably released from active duty (REFRAD) on 28 March 2005.

4.  On 16 October 2006, the applicant applied for TSGLI and on 13 December 2006 he was notified that his claim was denied because he was not involved in a traumatic event.  On 16 January 2007, he submitted an appeal of the TSGLI denial decision and contended that gravity, combined with the load he was carrying at the time, was an application of external force and qualified as a traumatic event.  The applicant’s appeal was denied on 9 March 2007 and he was informed that his claim did not support the loss of performance of ADLs necessary to support a TSGLI claim. 

5.  On 24 October 2006, a DA Form 2173 (Statement of Medical Examination and Duty Status) was prepared to document the applicant’s condition (groin strain/pain in left hip).  It reflects that a formal line of duty investigation was not required and that his injury was incurred in the line of duty.

6.  The applicant underwent a total left hip replacement in February 2009.

7.  On 11 June 2009, he again appealed his denial of his TSGLI claim and on 
10 August 2009 his claim was again denied because he failed to show that his injury was the result of a traumatic event and he had failed to show the loss of at least two ADLs.  

8.  On 5 April 2013, the applicant was retired by reason of permanent disability with a 50% disability rating.  His retirement orders reflect that his disability was not the direct result of armed conflict or caused by an instrumentality of war. 

9.  On 22 May 2013, the applicant’s claim for Combat-Related Special Compensation (CRSC) was approved for a 60% disability rating based on an injury incurred while simulating war.

10.  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.  The scheduled loss must be suffered within 365 days of the traumatic event.

11.  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.  Additionally, the member must be on active duty, must suffer a loss that is a result of the traumatic event and no other cause, and the member must suffer a loss covered under the law within 365 days of the traumatic event.

12.  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 TSGLI benefits was carefully considered.

2.  The available evidence clearly shows he underwent a surgical procedure in February 2009 that was associated with his injury sustained in Iraq; however, it does not appear that his injury or the surgery for his injury qualifies for TSGLI benefits.  There is insufficient evidence in the available records and the applicant has not provided sufficient evidence showing that his injury qualifies as a traumatic event and that he was unable to perform two of the ADLs for the required period.

3.  It is also noted that his injury occurred in May 2004 and there is no evidence of a loss within 365 days of the event which is a requirement to qualify for TSGLI benefits.

4.  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.

5.  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)                                         AR20130018509





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ABCMR Record of Proceedings (cont)                                         AR20130018509



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