IN THE CASE OF:  	  

		BOARD DATE:  25 November 2014	  

		DOCKET NUMBER:  AR20140006684 


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 reconsideration of his earlier request for correction of his military records to show he is entitled to payment under the Traumatic Servicemembers' Group Life Insurance (TSGLI).

2.  The applicant states he is entitled to a TSGLI payment beyond the first 15 consecutive days of approved loss of activities of daily living (ADL) through the 30th and 60th consecutive day, but his claim was denied due to substantive errors in his medical diagnosis and the lack of consideration of all the evidence.  He contends:

* he was misdiagnosed with a renal cell carcinoma (RCC) pseudoaneurysm and traumatic encephalopathy by the TSGLI medical consultant
* he provided medical documentation that substantiates his inability to perform the ADL beyond the 15-day threshold

3.  The applicant provides:

* 10-page self-authored statement
* SGLV Form 8600 (Application for TSGLI Benefits), dated 10 March 2014
* Army Board for Correction of Military Records (ABCMR) denial letter, dated 10 March 2014 
* ABCMR Docket Number AR20130020944, dated 6 March 2014
* University of Colorado Hospital Rehabilitation/Physical Medicine Consult Follow-Up, dated 10 January 2012
* University of Colorado Hospital Neurosurgery Discharge Summary, dated 10 January 2012
* University of Colorado Hospital Neurology Department Progress Notes, dated 19 January and 11 May 2012
* University of Colorado Hospital Ophthalmology Department Progress Note, dated 31 January 2012
* Evans Army Community Hospital, Fort Carson, Colorado, Chronological Record of Medical Care, dated 10 February 2012
* University of Colorado Hospital Spine and Rehabilitative Medicine Progress Notes, dated 13 and 15 February 2012
* University of Colorado Hospital Speech Therapy Department Progress Notes, dated 7 March 2012
* University of Colorado Hospital Occupational Therapy Progress Notes, dated 22 March 2012
* University of Colorado Hospital Department of Neurology doctor's letters, dated 17 and 22 August 2012
* Headquarters, 10th Special Forces Group, Battalion Surgeon's letter, dated 6 March 2013

CONSIDERATION OF EVIDENCE:

1.  Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the ABCMR in Docket Number AR20130020944 on 6 March 2014.

2.  The applicant provided more than twice the amount of documentary evidence as listed in the original Record of Proceedings.  Additionally, he advanced the argument that he was misdiagnosed and all the evidence was not considered.

3.  The original ABCMR Record of Proceedings inadvertently introduced erroneous information in falsely quoting the TSGLI medical consultant in paragraph 3b.  The Record of Proceedings as written states, "Both summaries [by neurosurgery and neurology (Dr. S____)] diagnosed an R MCA [right middle cerebral artery] right cerebrovascular accident (CVA) secondary to a renal cell carcinoma pseudoaneurysm [a hematoma that forms as the result of a leaking hole in an artery].  Dr. S____ advised against driving and returning to work, implying that the applicant was fairly capable, certainly of ADLs.  Neither summary mentioned the claimed TBI [traumatic brain injury] traumatic encephalopathy (TE), or posited trauma as contributory or causative."

4.  The TSGLI medical consultant case summary actually states, "Both DC [discharge summaries] (by neurosurgery and neurology (Dr. S____)) diagnosed R MCA CVA secondary to [an] RCC pseudoaneurysm….Neither DC summary mentioned the claimed TE, or posited trauma as contributory or causative."  The RCC pseudoaneurysm referred to by the TSGLI physician is "right common carotid pseudoaneurysm" with which the applicant was diagnosed by neurologists at the University of Colorado Hospital as seen on the applicant-provided Neurosurgery Discharge Summary updated on 11 January 2012.  The "TE" referred to by the TSGLI physician is "traumatic event" as seen in the definition section of the SGLV Form 8600.  The TSGLI physician does not use the terms "renal cell carcinoma pseudoaneurysm" or "traumatic encephalopathy" in his case summary and they were inadvertently included in the ABCMR Record of Proceedings, dated 6 March 2014.

5.  On 3 July 2013, the applicant's claim under the provisions of TSGLI was approved for $25,000.00 for the first 15 days of the loss of ADL due to a TBI.  However, the remaining 30th and 60th-consecutive day payments were denied.

6.  The applicant provided medical documents, dated 13 February through 22 March 2012, which he specifically highlights in his statement as documenting his ADL capabilities beyond the 15-day juncture and corroborate his entitlement to additional claimed days.

7.  The University of Colorado Hospital Spine and Rehabilitative Medicine Progress Notes, dated 13 February 2012, state, "His persistent deficits included a left visual field cut, mild left sided hemiparesis, and swallowing difficulties.  He has been doing PT [physical therapy], OT [occupational therapy] and SLP [speech and language pathology].  For his mobility, he walks independently.  He denies falls.  He does have some ADL deficits, mostly with dressing (putting clothes on backwards).  He has also had some difficult[y] with eating, including occasionally coughing while eating food."

8.  The University of Colorado Hospital Spine and Rehabilitative Medicine Progress Notes, dated 15 February 2012, state, "He feels as though he is doing quite well at this time and has no specific complaint, though he does have persistent problems with word finding that are subjective.  He feels as though his left hand coordination is still not back at baseline and while subjectively he feels his vision is okay, he does report still bumping into things on the left side with his shoulder, sometimes such as when he is walking around [a] wall with a corner.  He has tried reading comprehension of complex topics and feels as though his ability to logically process information is still hampered.  This concerns him because he feels he has to be able to perform these tasks for his employment.  He understands that he will no longer be able to jump from airplanes….On examination, the patient's cranial nerves II through XII are grossly intact.  He has a mild left inferior greater than superior visual field cut but is able to count fingers approximately 30-40 degrees off the midline to the left side.  The patient has no pronator drift and intact finger-to-nose testing.  He has mildly impaired rapid alternating movements and fine motor skills on the left side.  He has intact light touch sensation and no obvious sensory neglect or extinguishing.  He has a normal narrow based gait.  I reviewed the patient's imaging from his hospitalization with him.  Both his arteriogram which demonstrates the small aneurismal outpouching near the origin of the right internal carotid artery, the right middle cerebral artery occlusion, and the post embolectomy images which reveal recanalization of the vessel.  My impression is that [Applicant] is doing quite well at this time following his right middle cerebral artery occlusion and stroke."

9.  University of Colorado Hospital Speech Therapy Department Progress Notes, dated 7 March 2012, state, "Pt [Patient] is making excellent progress towards goals.  His immediate memory skills are improving during therapy with use of verbalizing out loud.  He is also able to maintain attention with minimal difficulty.  He is inconsistent in the use of strategies in ADLs at this time."

10.  University of Colorado Hospital Occupational Therapy Department Progress Notes, dated 22 March 2012, note:

	a.  Activity 1 – tying shoes – goal met;

	b.  Activity 2 – upper extremities dressing;

	c.  Activity 3  – zip and tie pants;

	d.  Activity 4 – remembering to flush toilet/lid down; and

	e.  Assessment – "[Patient demonstrated] increased speed and accuracy with timed 'blink' activity; expresses increased strength/fine motor with left hand.  Anticipate [patient] ready for d/c [discharge] from OT services, will see [patient] 1 more session to review HEP [home exercise program] and complete assessments."

11.  The medical documents he submitted do not indicate the injury rendered him incapable of performing the claimed ADL (dress, bath, eat) without assistance for 15-plus days per TSGLI guidelines.  The impairments did not rise to the requirements for scheduled loss per TSGLI standards.  The TSGLI medical consultant recommended disapproval for any TBI ADL at 15-plus days.

12.  Public Law 109-13 established the TSGLI Program 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.

13.  A member is considered to have loss of ADL if the member requires assistance to perform at least two of the six ADL (dressing, bathing, toileting, eating, continence, and transferring).  Required assistance is defined as without the assistance, the patient would be incapable of performing the task.

14.  TSGLI claims may be filed for the loss of ADL if the claimant is dependent on someone else to perform two of the six ADL for 30 days or more and is incapable of performing the tasks without the required assistance.  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 certificate from a healthcare provider, additional documents must be provided to substantiate the certificate.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's contentions and the documentation he provided were carefully considered.

2.  Discharge summaries do not describe the applicant's ADL capabilities at day 15 or day 30, but implied that he was ADL-capable by the second day following the CVA using his left unaffected side.  Documents reviewed by the TSGLI medical consultant did not indicate that his injury rendered him incapable of performing ADL for 15-plus days per TSGLI guidelines and standards.

3.  Although the applicant provided multiple medical documents, he did not provide sufficient evidence supporting his claim for the 30 and 60-day TSGLI payments.  The documents do not support a loss of a minimum two of his three claimed ADL (dress, bathe, eat) at day 30 or day 60 or that he was incapable of performing those tasks without the required assistance at the 30 and 60-day junctures.  By law, for an ADL loss to be covered, the loss must be certified by a healthcare provider and substantiated by appropriate documentation (i.e., occupational/physical therapy reports, discharge summaries, and other medical documents).

4.  His records do not show and he did not provide evidence that his 30 and 
60-day TSGLI payments were improperly disallowed.  Therefore, there is an insufficiently evidentiary basis for granting him 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 to amend the decision of the ABCMR set forth in Docket Number AR20130020944, dated 6 March 2014.



      _______ _   _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)                                         AR20140006684



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ABCMR Record of Proceedings (cont)                                         AR20140006684



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