BOARD DATE:	  11 December 2014

		DOCKET NUMBER:  AR20140004656 


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, in effect:

	a.  He was denied TSGLI for his lower back, even though the Army had or has rated his lower back pain as combat-related and he was injured on the job.

	b.  He was injured on the job and required lower back surgery.

	c.  He was cared for at home by his wife who had to assist him in his everyday tasks, such as bathing, dressing, and getting out of bed.

3.  The applicant provides no additional evidence.

CONSIDERATION OF EVIDENCE:

1.  Having prior active enlisted service, the applicant enlisted in the Regular Army on 10 December 2009.

2.  His medical records show:

	a.  On 25 October 2010, he was seen at the emergency room for lower-back pain associated with a fall while training the day before.

	b.  He was evaluated on 2 November 2010 for lower-back pain from a fall while wearing a 70-pound rucksack at Sapper School 7 days prior.  A magnetic resonance imaging (MRI) examination was ordered.

	c.  An MRI examination was conducted on 30 November 2010.  He was diagnosed with spondylolisthesis, lumbar disc degeneration L4-L5, and congenital spinal anomaly lumbosacral spondylolysis.  A lumbar fusion to alleviate the back pain was recommended.

	d.  He underwent back surgery on 31 January 2011.

3.  A medical record, dated 4 February 2011, shows his activities of daily living (ADL) were accessed as follows:

	a.  For dressing (upper body), he was able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance.  For dressing (lower body), someone must help him put on undergarments, slacks, socks, and shoes.

	b.  For bathing, he was able to bathe in a shower or tub with the intermittent assistance of another person.

	c.  For toilet transferring, he was able to get to and from the toilet and transfer independently with or without a device.

	d.  For transferring, he was able to independently transfer.

4.  The applicant's initial TSGLI application is not available.  However, records show his TSGLI claims were denied on:

* 7 March 2011
* 28 April 2011
* 6 July 2011

5.  On 1 August 2011, the U.S. Army Human Resources Command TSGLI Branch denied his appeal.  The letter states there was insufficient medical documentation supplied to support his claim for loss of ADL.  He was referred to the Army Review Boards Agency (ARBA) if he disagreed with the decision.

6.  He served in Iraq from 12 September 2011 to 23 July 2012.

7.  In December 2012, the U.S. Army Human Resources Command Special Compensations Branch (TSGLI) responded to an inquiry from a Member of Congress regarding the applicant's claim to TSGLI.  The letter stated:

	a.  The applicant's claim was denied because the medical documentation provided to support his claim did not indicate he met the standards of the TSGLI Program.  The documentation did not indicate his surgery rendered him incapable of performing two or more of the six basic ADL (that TSGLI covers) for greater than 30 consecutive days.

	b.  The Army TSGLI Program Office is unable to overturn the previous adjudication.

	c.  At this time the applicant has exhausted his appeal rights with the Army TSGLI Program Office and in the most recent decision letter, dated 1 August 2011, he was referred to ARBA.

8.  His records do contain a TSGLI application, dated October 2013, which shows he reported he fell with his 70-pound rucksack and injured his back at Sapper School during military training on 25 October 2010.  He was removed from the course and sent back to Fort Bliss, Texas.  He then received an MRI examination and found that a disc in his lower back was slipped and out of place and surgery was the only recourse.

9.  Part B (Medical Professional's Statement) of the TSGLI application shows the attending physician stated the applicant could not perform bathing, dressing, toileting, or transferring independently during the period 31 January 2011 to 3 March 2011.

10.  Part B of this TSGLI application also shows his attending physician essentially stated:

	a.  The applicant required medical back surgery on 31 January 2011 to correct a slipped disc in his lower back from an injury incurred during training.

	b.  He required hands-on and standby assistance from his spouse to do all of the following ADL:  bathing, dressing, toileting, and transferring.

	c.  He was having refractory back and lower extremity pain and did not improve with conservative treatment.

11.  In November 2013 and December 2013, the U.S. Army Human Resources Command Special Compensations Branch (TSGLI) acknowledged his TSGLI appeals and informed him that he had exhausted his appeal rights with that office.

12.  On 19 January 2014, he retired by reason of temporary disability and was placed on the Temporary Disability Retired List the following day.

13.  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) was 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.

14.  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; 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 traumatic brain injuries).  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 injured his back at Sapper School in October 2010 and he underwent back surgery on 31 January 2011.

2.  He contends he was unable to bathe, dress, toilet and transfer independently from 31 January 2011 to 3 March 2011.  However, he provided medical documentation, dated 4 February 2011, that states:

	a.  For dressing (upper body), he was able to get clothes out of closets and drawers, put them on and remove them from the upper body without assistance.  For dressing (lower body), someone must help him put on undergarments, slacks, socks, and shoes.

	b.  For bathing, he was able to bathe in shower or tub with the intermittent assistance of another person.

	c.  For toilet transferring, he was able to get to and from the toilet and transfer independently with or without a device.

	d.  For transferring, he was able to independently transfer.

3.  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.

4.  The applicant's TSGLI application shows his attending physician stated he was unable to perform four ADL during the period 31 January 2011 to 3 March 2011.  However, no substantiating documentation was attached.

5.  The submitted documentation does not indicate the injury rendered the applicant incapable of performing any ADL for 30 days or more under TSGLI guidelines.

6.  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)                                         AR20140004656



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ABCMR Record of Proceedings (cont)                                         AR20140004656



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