BOARD DATE:	 2 September 2014 

		DOCKET NUMBER:  AR20130020701 


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 award of Traumatic Servicemembers' Group Life Insurance (TSGLI) benefits.

2.  The applicant states:

* she would like a review of her TSGLI claim
* she believes she is eligible and her claim should be approved
* she had substantial head trauma and other injuries that she still suffers from today

3.  The applicant provides:

* medical records
* accident photographs
* TSGLI denial letter

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the U.S. Army Reserve on 19 July 2000.

2.  Medical records show the applicant was involved in a motor vehicle accident on 26 June 2006 in Texas.  She was treated for complex abrasions and lacerations to her forehead and left forearm.



3.  She provided:

	a.  a certificate to return to work or school, dated 10 July 2006, which states she would be able to return to work on 10 August 2006;

	b.  a Work Status Report, dated 22 August 2006, which states she was unable to perform active duty due to injuries sustained in a motor vehicle accident; and

	c.  a letter from a physician, dated 22 August 2006, who states she was hospitalized for 1 day following her accident.

4.  She provided a DA Form 3349 (Physical Profile), dated 18 October 2006, which shows she was issued a temporary physical profile for multiple skeletal fractures and lacerations from a motor vehicle accident.

5.  She provided a DA Form 3349, dated 8 February 2007, which shows she was issued a permanent physical profile for multiple skeletal fractures and lacerations from a motor vehicle accident.

6.  She was ordered to active duty in an Active Guard Reserve status on 19 November 2008 for a period of 6 years.

7.  She was promoted to sergeant first class on 1 April 2012.

8.  She provided a DA Form 3349, dated 4 June 2012, which shows she was issued a permanent physical profile for post-traumatic stress disorder, depression, and left forearm injury.

9.  She provided a TSGLI application, dated 16 October 2012, wherein she reports:

* she was involved in a motor vehicle accident in Texas on 26 June 2006
* her vehicle rolled over several times
* she was hospitalized in Texas
* she received extensive deep lacerations to her left forearm and head
* she also had extensive swelling to her head
* there was a questionable mass on her spine that was noted from her 
x-rays and she lost the feeling sensation in her forehead
* she received hundreds of stitches to both areas
* due to the severity of her injuries, she was only able to utilize one arm
* she needed assistance completing daily functions such as bathing, getting dressed, and cooking
* she was prescribed muscle relaxers, rendering her unable to operate a motor vehicle temporarily
* she remained unable to perform any of her daily activities independently for a month
* she had to undergo physical therapy and pain management rehabilitation

10.  Part B (Medical Professional's Statement) of her TSGLI application shows the attending physician stated the applicant could not perform bathing, dressing, or eating during the period 26 June 2006 to 7 August 2006.  The attending physician also stated the applicant could not perform toileting or transferring independently, but did not provide starting or ending dates.

11.  On an unknown date, the applicant's initial TSGLI claim was denied.  However, in a letter, dated 15 November 2012, the applicant contends her claim was denied due to the lack of medical documentation supporting her inability to carry out activities of daily living (ADL) for at least 30 days.

12.  On 4 March 2013, the U.S. Army Human Resources Command Special Compensations Branch (TSGLI) denied her appeal request for TSGLI.  The letter stated her claim was not approved because the medical documents submitted for her motor vehicle accident which occurred on 26 June 2006 did not indicate she was hospitalized for 15 consecutive days or more.  Also, the submitted documents did not indicate she was incapable of performing the ADL skills of toileting, dressing, bathing, transferring, continence or eating for 30 days or more, per TSGLI guidelines.

13.  She reenlisted in the U.S. Army Reserve on 9 June 2014 for a period of 3 years.

14.  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 (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 deducted 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 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.  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.

15.  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.  third-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 ADL, which are dressing, bathing, toileting, eating, continence, and transferring. TSGLI claims may be filed for loss of ADL if the claimant is completely dependent on someone else to perform two of the six ADL 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.

DISCUSSION AND CONCLUSIONS:

1.  The evidence shows the applicant was injured in a motor vehicle accident in June 2006 and she suffered deep lacerations to her forearm and head.  She was hospitalized for only 1 day.

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 three ADL for approximately 45 days.  However, the submitted documentation does not indicate that the injury rendered the applicant incapable of performing any ADL for 30 days or more per TSGLI guidelines.  In addition, it appears she first applied for TSGLI about 6 years after the accident.

4.  Otherwise healthy patients are not rendered ADL-incapable by a single limb trauma/immobilization.

5.  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 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)                                         AR20130020701



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ABCMR Record of Proceedings (cont)                                         AR20130020701



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