IN THE CASE OF:  

		BOARD DATE: 10 February 2015

		DOCKET NUMBER:  AR20140008883


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 payment of his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim.

2.  The applicant states that it is an injustice that his TSGLI claims have been denied.

3.  The applicant provides copies of:

* letter from his counsel, dated 7 May 2014, with power of attorney
* his statement, dated 3 May 2014
* his spouse's statement, dated 3 May 2014
* letter of support, Terri B----, RN, BSN, dated 6 May 2014 
* SGLV Form 8600, TSGLI Claim dated 8 May 2014
* previous TSGLI claims and supporting medical documents
* U.S. Army Human Resources Command (HRC) denial memoranda dated 11 June 2012 and 23 August 2013

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 21 December 1997.

2.  In his statement the applicant indicated that on 23 December 2010 he slipped and fell on the ice suffering a complex fracture to his lower left leg.  He was transported to the hospital and had surgery the next day to repair the fracture with screws and plates.  He was discharged with strict instructions from his surgeon to stay in bed.  The surgeon stated, "If you get up make sure someone is with you."  The applicant's wife helped him with bathing, dressing, toileting, and transferring from 23 December 2010 to 16 March 2011, when the hardware was removed and he could put weight on his left leg.  The cast had been taken off in February 2011 but he could not put any weight on his left leg.  Because of his condition his wife bathed, dressed him, and cleaned him after he used the bathroom.

3.  In his wife's statement, she indicated that she provided her husband with physical and stand-by care assistance after he suffered a complex fracture to his left leg after slipping and falling on the ice on 23 December 2010.  She stated that for months he could not get up and down the stairs and was pretty much immobile and helpless.  Between 23 December 2010 and 16 March 2011 she helped him with bathing, dressing, toileting, and transferring.

4.  In a 6 May 2014 letter appealing the previous TSGLI denials, Terri B---- provided a description of the applicant's medical condition.  

	a.  Surgery was performed on 24 December 2010 and the applicant was casted and given strict instructions to elevate his leg and remain non-weight bearing for 6-8 weeks.  A second surgery was performed on 16 March 2011 to remove screws and then he was allowed to bear weight.  

	b.  The applicant was given strict orders from his orthopedic surgeon to keep his left leg elevated and refrain from bearing weight.  Although crutches were dispensed, the applicant was unable to use them to get in and out of the bathtub, get himself up/off the toilet and go up/down the stairs due to environmental factors in his home.  There is very small space to maneuver in his bathroom and stairs.  Additionally, he was unable to bend his left leg to pull his pants on/off, put on socks and shoes and tie his shoes because of the lower leg immobilizer splint and cast that he wore for 8 weeks. 

	c.  The applicant previously submitted evidence showing he qualified for TSGLI benefits under the TSGLI Procedures Guide Version 2.25, 2 April 2014
because of his inability to independently perform bathing, dressing, toileting and transferring without assistance.

5.  In a 16 April 2012 letter, Doctor George C. B----recommended reconsideration of the applicant's claim for TSGLI and describes the treatment rendered to the applicant after his left ankle fracture and surgery.  He indicated the applicant was unable to bear weight on his left lower extremity from the date of the injury through 16 March 2011.  During that time, he was unable to perform several of the activities of daily living without assistance or adaptive measure in each case.  He required assistance getting in and out of the tub or shower because he could only bear weight on his right leg.  He also required stand-by assistance because he could not bear weight on his left leg and he was unable to bathe independently and dress or undress independently without assistance.  He also required assistance getting up and down from the toilet, transferring out of bed and chair without assistance or adaptive measures.  

6.  The applicant provides HRC memoranda showing his initial application for TSGLI was reconsidered and denied on 11 June 2012, and an appeal was denied on 6 August 2013.  His requests were denied because the evidence did not indicate his injury rendered him incapable of performing the ADLs of bathing, dressing, toileting, or transferring for 30 days or greater. 

7.  On 19 January 2015, the applicant was placed on the Temporary Disability Retirement List (TDRL) as a master sergeant/E-8 with a disability rating of 100%.  

8.  Public Law 109-13, signed by the President on 11 May 2005, established the 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.  A qualifying traumatic injury is an injury or loss caused by a traumatic event or a condition whose cause can be directly linked to a traumatic event.  The HRC official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II.  Each loss has a corresponding payment amount.

	a.  Part I loss includes sight, hearing, speech, quadriplegia, hemiplegia, uniplegia, burns, amputation of hand, amputation of four fingers on one hand or one thumb alone, amputation of foot, amputation of all toes including the big toe on one foot, amputation of big toe only, or other four toes on one foot, limb salvage of arm or leg, and facial reconstruction.  

	b.  Part II loss includes traumatic injuries resulting in the inability to perform at least two Activities of daily living (ADLs) for 30 or more consecutive days and hospitalization due to a traumatic injury and other traumatic injuries (OTI) 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.  Emphasis added).  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.
DISCUSSION AND CONCLUSIONS:

1.  The evidence clearly shows the applicant suffered a traumatic injury.

2.  There is evidence showing that his initial application for TSGLI was reconsidered and denied on 11 June 2012.  An appeal was denied on 6 August 2013.  His requests were denied because the evidence did not indicate his injury rendered him incapable of performing the ADLs of bathing, dressing, toileting, or transferring for 30 days or greater. 

3.  The evidence shows the applicant's wife assisted him with his ADLs during his recovery period.  It does not show he was completely dependent on someone else to perform ADLS.  (Emphasis added).

4.  The guidance governing the TSGLI program states that 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.  

5.  The applicant has not provided sufficient documentation to support his contention that his TSGLI claims were improperly disallowed.  Neither the available records nor the medical documentation the applicant provided establish a basis to support his request.

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)                                         AR20120022988



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ABCMR Record of Proceedings (cont)                                         AR20140008883



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