IN THE CASE OF:  	  

		BOARD DATE:  2 December 2014	  

		DOCKET NUMBER:  AR20140007259 


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) claim for $100,000 for his injury on 29 October 2010 that occurred in his backyard.

2.  The applicant states, in effect, on 29 October 2010 he was cutting trees in his backyard.  He started to burn the yard debris, which went on into the night.  He collapsed inside of his house and his wife called 9-1-1.  He was taken to the hospital and was diagnosed with bilateral upper extremity compartment syndrome.  He required multiple complex surgeries and was hospitalized from  30 October to 24 November 2010.  He required assistance with activities of daily living (ADL) for over 120 days due to the inability to use his hands.  It was unjust to deny him compensation under the TSGLI as he believes he was qualified under TSGLI standards.

3.  The applicant provides copies of his TSGLI denial, a letter from a registered nurse, his TSGLI claim with medical records and a power of attorney granting his counsel power to act on his behalf.

CONSIDERATION OF EVIDENCE:

1.  The applicant was serving in the rank of captain at Fort Bragg, North Carolina when he suffered a heat stroke at his off-post residence on 29 October 2010 and developed unfitting conditions.

2.  On 18 November 2011, a physical evaluation board (PEB) convened at the National Capitol Region PEB in Arlington, Virginia and determined that he had unfitting conditions of cognitive disorder and anxiety with panic attacks, right upper extremity compartment syndrome, dominant and left upper extremity compartment syndrome, non-dominant.  The PEB recommended that he be permanently retired with a 70% disability rating.  He concurred with the PEB’s findings and the PEB was approved on 1 December 2011.

3.  On 28 February 2012, he was retired under the provisions of Army Regulation 635-40, chapter 4, due to permanent disability (enhanced).  He had served       13 years, 1 month and 1 day of active service. 

4.  A review of the medical records he provided failed to show specific or sufficient evidence that he was unable to perform two of the activities of daily living for the required period.

5.  He applied to the U.S. Army Human Resources Command (HRC) for TSGLI benefits on multiple occasions.  On 1 October 2013, HRC advised him that his appeal did not meet the requirements of the TSGLI program in that his situation did not meet the definition of a traumatic event.  He was advised that the TSGLI Procedures Guide defines a traumatic event as “the application of external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to the body."  He was also advised to apply to this Board.

6.  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.

7.  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.

8.  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.  After reviewing the available evidence it appears he had a heat stroke.

3.  In any event, his injuries were not caused by an external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to the body as defined by the guidelines governing TSGLI.  

4.  Therefore, absent sufficient evidence to show the applicant's disabilities met the criteria for award of TSGLI benefits, there is no basis to grant the relief requested.

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)                                         AR20140007259





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ABCMR Record of Proceedings (cont)                                         AR20140007259



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