IN THE CASE OF:	  

		BOARD DATE:	  17 March 2014

		DOCKET NUMBER:  AR20140012406 


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 correction of his records to show his previous request for payment of Traumatic Servicemembers' Group Life Insurance (TSGLI) benefits was approved.

2.  The applicant states he believes the record is unjust because he qualified for compensation under TSGLI standards.

3.  The applicant provides:

* two letters to himself from the TSGLI Branch, U.S. Army Human Resources Command (HRC), dated 27 June 2013 and 25 April 2014
* two letters to the TSGLI Branch, HRC, dated 24 February 2014 and 31 March 2014
* two affidavits to the TSGLI Branch, HRC, dated 21 February 2014
* pages 3 to 15 of SGLV 8600 (Application for TSLGI Benefits), dated 23 January 2013
* two DD Forms 689 (Individual Sick Slip)
* three DA Forms 3349 (Physical Profile), dated between 5 January 2007 and 23 July 2007
* DA Form 3947 (Medical Evaluation Board (MEB) Proceedings) with attachments
* 70 pages of various medical records, dated between 31 January 2004 and 8 January 2008


CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 3 January 2003 in the rank/grade of specialist/E-4 and he held military occupational specialty 91W (Health Care Specialist).  He served in Iraq in support of Operation Iraqi Freedom (OIF) in 2004.  The specific dates of his service in Iraq are not known.  He was promoted to the rank/grade of sergeant/E-5 on 1 August 2004.

2.  The applicant provides:

	a.  A DD Form 689, dated 15 January 2006 and annotated that it ended 19 February 2006 (36 days), wherein it shows a medical officer signed the form and annotated in the medical officer's Remarks block of the form that the applicant was "confined to quarters; no running, jumping, or marching due to broken back received in an U.S. Army Iraqi tank rollover in February 2004."  This sick slip shows his unit as Headquarters and Headquarters Troop (HHT), 1st Battalion, 14th Cavalry, Fort Lewis, WA.  It also shows his commander signed the form and annotated in the unit commander's Remarks block the entry "tank rollover, after bomb attack on vehicle; 28 days quarters, no lifting, quarters bed confinement" (emphasis added).

	b.  An automated Standard Form (SF) 600 (Chronological Record of Medical Care), dated 2 February 2006, wherein it shows he was seen at the Occupational Health Clinic, Madigan Army Medical Center (MAMC), Fort Lewis, on that date for Occupational Health in-processing and was counseled on reporting work-related injuries.

	c.  An Operative Summary, dated 8 February 2006, wherein it shows he had photorefractive keratectomy (PRK) Lasik surgery on that date at the Refractive Surgery Center, MAMC.

	d.  Two SF Forms 600, dated 13 and 21 February 2006, wherein they show he was seen for follow-up to his Lasik surgery on those dates at the Refractive Surgery Center. 

3.  He was subsequently assigned to Company A, MAMC, as the assistant noncommissioned officer in charge (NCOIC) of the Optometry Services, MAMC.

4.  The applicant provides and his record contains:

	a.  DA Form 3947, dated 5 July 2007, wherein it shows an MEB convened on that date and confirmed his unfitting diagnosis of post L5-S1 laminectomy syndrome with radiculopathy.  The MEB recommended he be referred to a physical evaluation board (PEB).  The MEB found his conditions of depressive disorder not otherwise specified, post OIF deployment stress syndrome, and headaches did meet retention standards.

	b.  An MEB Narrative Summary (NARSUM), dated 19 June 2007, wherein it stated, in part, the applicant was a passenger in a Stryker vehicle in February 2004 while deployed in OIF.  The vehicle rolled over while avoiding a civilian Iraqi vehicle that cut into the convoy.  His health record review showed the initial entry dated 20 February 2004 on an SF 600 from the battalion aid station noting lower back pain status post being inside a flipped Stryker vehicle.  He was treated with naproxen and Flexural.  The next entry was dated November 2006 by the MAMC Orthopaedic Clinic indicating disk herniation with L5-S1 compressing the S1 nerve root and radiculopathy.  There were several sick slips for quarters due to acute low back pain flare-up in December 2006, January 2007, and April 2007.

5.  On 16 August 2007, an informal PEB convened and confirmed his one unfitting disability of intervertebral disk syndrome.  The PEB found the applicant's condition prevented him from performing the duties required of his grade and specialty and determined that he was physically unfit due to his disability.  The PEB recommended he be separated with severance pay.

6.  The PEB rated him under the Department of Veterans Affair Schedule for Rating Disabilities (VASRD) code 5243 for intervertebral disk syndrome and rated it as 10 percent disabling.  On 27 November 2007, he was discharged from active duty with entitlement to disability severance pay. 

7.  In 2010, he submitted a claim for TSGLI to HRC.  In a letter, dated 1 February 2011, HRC stated his claim was denied as "there was not enough medical information to support his losses."  To be eligible for the TSGLI benefit, his medical providers must present information that demonstrated the extent of his losses.  The information must address the specific injury/injuries he sustained and illustrate a timeline of treatment.  The timeline would consist of notations from licensed medical providers.

8.  He submitted an appeal to the denial of his request and on 25 April 2011, it was again denied as "his claim for hospitalization and loss of activities of daily living (ADL) was not approved because his loss was the result of a physical or mental illness.  Losses that result from a physical or mental illness are not covered under TSGLI."

9.  On 23 January 2013, the applicant submitted another claim for TSGLI for the period 15 January to 19 February 2006.  On the form, the medical professional, Ms. TB, a registered nurse in Colorado Springs, CO, stated "Due to exacerbation of severe lumbar spine symptoms, the applicant was placed on bed confinement quarters by Captain MB from 15 January through 19 February 2006.  He suffered lower back pain with radiation into the buttocks down into both feet with numbness and tingling.  He was unable to lift anything and any kind of motion caused him severe pain.  His wife helped him to dress/undress, bathe/groom, get up/out of bed, and going up/down stairs during this time."

10.  In a statement to HRC, dated 23 January 2013, Ms. TB stated, in part:

	a.  She reviewed medical records and conducted a personal interview regarding the applicant's traumatic injuries.  On 24 February 2004, while serving in Iraq, he was involved in a Stryker vehicle rollover accident during a bomb attack.  He was seen and treated in a remote, outpost field hospital, was diagnosed with a fractured lumbar spine, numerous abrasions, minor lacerations, and an anaphylactic reaction to an unknown chemical during a search for weapons of mass destruction.  He was placed on 7 days bed rest and continued to have tolerable symptoms of low back pain until late December 2005 when his symptoms progressed.

	b.  Due to the exacerbation of severe lumbar spine symptoms, he was placed on confine bed rest quarters from 15 January to 19 February 2006.  He was unable to independently perform three of the six ADLs; he was unable to dress independently, unable to bathe independently, and unable to transfer independently.  Due to the nature of his traumatic lumbar spine injury, severe pain, and limited mobility, it is reasonable to state that he would need some assistance with ADLs such as bathing, dressing, and transferring during the time specified. 

11.  In a letter, dated 27 June 2013, HRC denied his appeal request .  The letter stated, in part, after receiving his appeal request and reviewing the supporting documentation they were unable to overturn the previous adjudication.  The medical documents he provided did not indicate he was incapable of performing the ADLs of bathing, dressing, or transferring.  Also, the documents he provided for his hospitalization indicated he was not hospitalized as an inpatient for 15 consecutive days or greater.  If he disagreed with the decision, he had the right to apply to the Department of the Army Review Boards Agency (ARBA).

12.  In a letter, dated 25 April 2014, HRC stated his appeal request was received. However, he had exhausted his appeal rights with their office and he had been directed to submit any further appeals to ARBA.

13.  Public Law 109-13 (The Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Tsunami Relief, 2005 was signed by the President on 11 May 2005) and established the 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 $1.00 deducted each month to cover the cost of the TSGLI policy.  Soldiers paying for SGLI coverage cannot decline TSGLI - it is a package.  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.

14.  There are basic eligibility requirements that must be met in order to be eligible for TSGLI.  All of the following must be met:

* The member must be an active duty or Reserve service member on the date a traumatic event occurs
* The member must suffer a loss that is a direct result of a traumatic event and no other cause
* The member must survive for a period of at least 7 full days from the date of the traumatic event
* The member must suffer a loss covered under the law within 2 years of the traumatic event

15.  Traumatic injuries covered under TSGLI include:

* Total and permanent loss of sight in one or both eyes, loss of hand or foot by severance at or above the wrist or ankle, quadriplegia, paraplegia, or hemiplegia, coma or traumatic brain injury
* Other traumatic injuries resulting in the inability to carry out two of the six ADL which are dressing, bathing, toileting, eating, continence, and transferring

16.  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.  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 won't be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification.
17.  Army Regulation 40-66 (Medical Record Administration and Healthcare Documentation), chapter 13 prescribes policy and procedures for the preparation, use, and disposition of DD Form 689.  It states, in part, the form would be issued to a patient who either requests or receives medical or dental treatment or evaluation at an Army medical treatment facility.  When the patient is returned to his/her unit for medically directed self-treatment [Quarters] and is not to perform military duty until a medical officer indicates that he/she may perform such duties, the medical officer will indicate in the remarks section the duration of the quarters status in the number of hours and indicate the inclusive period (for example Quarters 24 hours, 0730, 17 May until 0730, 18 May 1995).  Quarters status will normally not exceed 72 hours (3 days).  

DISCUSSION AND CONCLUSIONS:

1.  The applicant contends he should receive TSGLI for the period from 15 January to 19 February 2006 as he needed assistance with the ADLs of bathing, dressing, transferring during that time.

2.  The evidence of record shows he incurred an injury to his back while deployed in February 2004.  He provided a DD Form 689 that appears to show he was given 36 days quarters from 15 January to 19 February 2006 by a medical officer for his back injuries while his commander annotated he was placed on 28 days quarters.  Notwithstanding the discrepancies, it is unclear why a sick slip would have been issued for quarters lasting more than 3 days.  In addition, he provided medical records that show he was seen in the Occupational Health Clinic on 2 February 2006, had Lasik surgery on 8 February 2006, and was seen for follow-up to his surgery on 13 and 21 February 2006.  It is doubtful he would have been healthy enough to undergo Lasik surgery if he had been confined to bed rest during that period.

4.  Regardless, the applicant provided evidence that shows he required some assistance with the ADLs of bathing, dressing, and transferring during the period 15 January to 19 February 2006.  The evidence of record does not show and he has not provided medical evidence that shows he was completely dependent on someone else to perform two of the six ADLs during the period he is seeking TSGLI for that would meet the qualifications for TSGLI as set forth by law.

5.  In view of the foregoing, there is an insufficient evidentiary basis to grant the applicant 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 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)                                         AR20140012406





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ABCMR Record of Proceedings (cont)                                         AR20140012406



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