IN THE CASE OF:	  

		BOARD DATE:	 6 August 2014

		DOCKET NUMBER:  AR20130019597 


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, he be awarded Traumatic Servicemembers' Group Life Insurance (TSGLI) benefits. 

2.  The applicant states he submitted a corrected form and additional medical documents, but Prudential denied his appeal.

3.  The applicant provides:

* Application for TSGLI
* Medical documents

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 12 April 1994 and remained on active duty through continuous reenlistments.  He attained the rank of staff sergeant on 1 September 2001.

2.  He provides medical documentation, September 2010, which shows he was treated for right knee pain after a twisting injury.  Medical documentation, dated December 2010, shows:

* he reported he had right knee pain for 7 years and he related the pain to use and multiple airborne jumps
* he twisted his right knee in September 2010 while on a ruck march in Germany
* he was diagnosed with acute meniscal tear, osteoarthritis knee, and flat foot

3.  TSGLI records show:

	a.   in July 2011 he submitted a TSGLI claim and his application was denied in July 2011.

	b.  in August 2011, he submitted a request for reconsideration for TSGLI benefits.  The TSGLI office denied his request. 

4.  He provides an application for TSGLI benefits, dated 7 February 2012, wherein the attending physician stated the applicant could not perform dressing, bathing, toileting, or transferring independently during the period 9 September 2010 to 1 December 2010.

5.  Part B (Medical Professional's Statement) of this TSGLI application shows that his attending physician essentially stated:

* he was unable to bend his knee to get in and out of tub
* he required sponge bathing during this time
* he was unable to bend his knee to dress independently 
* he required hands on assistance putting on pants, socks and shoes
* he was unable to toilet independently and required hands on assistance with going to and from the toilet, getting on and off the toilet, getting clothing off and on
* he was unable to bend his knee to transfer independently and needed hands on assistance to move in and out of bed or chair or car
* he was not able to drive

6.  The attending physician also stated:

* the applicant injured his right knee during a ruck march on 9 September 2010 in Germany
* he sustained an acute menisal tear to the right knee and was recommended for orthopedic surgery
* he was placed on permanent profile pending medical retirement for this condition
* he wears a knee brace and uses a cane to walk and continues to have persistent pain that limits his ability to be independent
* he is also not able to drive
* he still requires assistance with Activities of Daily Living (ADLs) 
7.  In April/May 2012, the TSGLI office denied his appeal claim for TSGLI benefits for 30/60 days ADL loss.  The reviewing physician determined that:

	a.  the medical documentation verified chronic right knee pain worsened after sustaining a twisting injury during a ruck march.  

	b.  the applicant was referred to orthopedics for surgical evaluation.

	c.  walking/marching does not meet the TSGLI standard of a qualifying traumatic event and per the applicant he cites right knee injuries in September 2008 as a result of the Army Physical Fitness Test and in October 2009 as a result of a ruck march in Germany.  

	d.  this claim had previously been denied 2 times due to the absence of a qualifying TSGLI traumatic event.  The current appeal also contains no evidence of a qualifying TSGLI traumatic event.  Recommend disapproval.

8.  His records contain letters from the TSGLI Branch, U.S. Army Human Resources Command, Fort Knox, KY denying his appeal requests.  The letters state:

	a.  his claim for an injury to his knee during an airborne operation on 
24 September 2008 has been denied.  The documentation did not indicate his loss was the direct result of a traumatic event as defined by TSGLI guidance.  A traumatic event is the application of external force, violence, chemical, biological, or radiological weapons which causes injury to the body.  It also states "It would not include an injury that is induced by the stress or strain of the normal work effort that is employed by an individual."  This letter is dated 8 May 2012.

	b.  his claim indicates he aggravated his degenerative disc disease during a road march while stationed in Germany on 19 October 2009.  The documentation did not indicate his loss was the direct result of a traumatic event as defined by TSGLI guidance.  A traumatic event is the application of external force, violence, chemical, biological, or radiological weapons which causes injury to the body.  This letter is dated 8 May 2012.

	c.  his claim indicates he suffered a meniscal tear of his right knee on a road march while stationed in Germany on 9 September 2010.  The documentation did not indicate his loss was the direct result of a traumatic event as defined by TSGLI guidance.  A traumatic event is the application of external force, violence, chemical, biological, or radiological weapons which causes injury to the body.  This letter is dated 8 May 2012.

	d.  documentation submitted for the claimed event on 7 June 2006 during an airborne jump in North Carolina, did not indicate that his chronic right shin pain would make him incapable of performing the ADLs of bathing, dressing, toileting, or transferring that are covered by TSGLI standards.  This letter is dated 23 July 2012.

9.  On 29 August 2012, he was retired and placed on the Temporary Disability Retired List the following day. 

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 May 11, 2005, established the TSGLI program.  U.S. Army 
Combat-Related Special Compensation (CRSC) 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 elected SGLI coverage automatically receives TSGLI coverage with an additional $1.00 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 OIF and Operation Enduring Freedom (OEF) or under orders in a Combat Zone Tax Exclusion (CZTE) 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.

11.  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 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% of body or 30% of the face;

	h.  coma or TBI; or

	i.  other traumatic injuries 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
(15 days or more in the case of TBIs).  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.  

DISCUSSION AND CONCLUSIONS:

1.  Evidence shows the applicant injured his right knee during a ruck march on 
9 September 2010 in Germany.

2.  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.  

3.  The applicant claimed loss of four ADLs for 30/60 days in 2010.  However, the submitted documentation does not indicate that the injury was the result of a traumatic event, per TSGLI guidelines.

4.  Regrettably, based on the foregoing, there is an insufficient evidentiary basis for granting the 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)                                         AR20130019597





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ABCMR Record of Proceedings (cont)                                         AR20130019597



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