IN THE CASE OF:	  

		BOARD DATE:	  18 December 2014

		DOCKET NUMBER:  AR20140019774 


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 military records to show he is entitled to payment for a Traumatic Servicemembers' Group Life Insurance (TSGLI) claim.

2.  The applicant states:

* his TSGLI application and subsequent appeal were both denied
* the physical therapists he saw did not meticulously record his medical information in the records
* all the physical therapy he participated in was passive
* he contacted the physical therapists and they refused to amend the records to reflect that his therapy was passive
* he has sworn statements from his wife and others supporting his request
* he was on convalescent leave for 30 days at home following his surgery, during which time his wife helped him with his activities of daily living (ADL)

3.  The applicant provides:

* U.S. Army Human Resources Command Special Compensations Branch denial of reconsideration letter, dated 24 July 2014
* Office of Servicemembers' Group Life Insurance denial of TSGLI claim, dated 12 December 2013
* SGLV Form 8600 (Application for TSGLI Benefits)
* recommendation for convalescent leave
* three sworn statements
* Headquarters, 4th Infantry Division and Fort Carson, deployment orders
* photographic images
* four radiologic examination reports
* operative report
* Standard Form 600 (Chronological Record of Medical Care)

CONSIDERATION OF EVIDENCE:

1.  The applicant enlisted in the Regular Army on 27 January 1995 and is currently serving on active duty in military occupational specialty 19K (M1 Armor Crewman) in the rank of sergeant first class.

2.  On 31 October 2011, the applicant was involved in a firefight in Kandahar City, Afghanistan, during which he was propelled from a 14-foot wall after an insurgent detonated himself on the other side of the wall.  The applicant provided two sworn statements attesting to the incident.  The fall resulted in a re-injury of his right shoulder, in which four screws were already surgically placed as a result of a prior injury to the shoulder in July 2009.

3.  On 7 June 2013, the applicant underwent surgery to repair the injuries to his shoulder and removal of two of four previously-placed screws.  The applicant was given 30 days post-surgery convalescent leave.

4.  On 11 September 2013, the applicant submitted a claim for TSGLI payment based on his inability to perform five of the six ADLs for the period 7 June through 11 July 2013 due to other traumatic injury.  On 12 December 2013, his claim was disapproved because the medical documentation did not support his inability to perform ADLs for 30 days.

5.  The applicant provided a sworn statement written by his wife on 6 February 2014.  She attests to the fact that she took care of him for over 1 month.  She specifically states she had to assist him with getting dressed and undressed, toileting, showering, shaving, and eating due to his inability to use his dominant right arm following the surgery.

6.  The Army TSGLI Program Office reconsidered the decision of his previously-denied claim and informed him via letter, dated 24 July 2014, that they were unable to overturn the previous adjudication.  The medical documentation he submitted did not indicate that his shoulder surgery rendered him incapable of performing the ADLs of bathing, dressing, eating, toileting, or transferring that are covered by TSGLI standards for 30 consecutive days or greater.

7.  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.  The U.S. Army Combat-Related Special Compensation Office 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.  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.

8.  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 U.S. Army Human Resources Command's official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II.  Each loss has a corresponding payment amount.

9.  Part II losses include traumatic injuries resulting in the inability to perform at least two ADLs for 30 or more consecutive days and hospitalization due to a traumatic injury and other traumatic injury 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 ADL if the claimant is completely dependent on someone else to perform two of the six ADLs for 30 days or more.  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.

10.  ADL are routine self-care activities that a person normally performs every day without needing assistance.  There are six basic ADLs:  eating, bathing, dressing, toileting, transferring (moving in and out of bed or chair), and continence (managing or controlling bladder and bowel functions).  A member is considered to have ADL loss if the member requires assistance to perform at least two of the six ADLs.  If the patient is able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.), the patient is considered to be modified independent.

11.  Appendix B (Glossary of Terms) of the TSGLI Procedures Guide, dated September 2008, provides the following definitions:

	a.  Traumatic Event:  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 a living body. Examples include:

* military motor vehicle accident
* military aircraft accident
* civilian motorcycle accident
* rocket propelled grenade attack
* improvised explosive device attack
* civilian motor vehicle accident
* civilian aircraft accident
* small arms attack
* training accident

	b.  Traumatic Injury:  The physical damage to a living body that results from a traumatic event.

	c.  External Force:  A force acting between the body and the environment, including a contact force, gravitational force, or environmental force, or one produced through accidental or violent means.

DISCUSSION AND CONCLUSIONS:

1.  The applicant's request for payment of a TSGLI claim was carefully considered.  However, there is insufficient evidence to support this claim.

2.  The applicant's request is based on his inability to perform five of six ADLs for the period 7 June through 11 July 2013 resulting from a firefight in Afghanistan and follow-on shoulder surgery.

3.  The medical documentation submitted with his claim is insufficient to substantiate his claim of ADL loss.

4.  The applicant has not provided sufficient documentation to support his contention that his TSGLI claim was improperly disallowed.  Neither the available records nor the medical documentation the applicant provided establish a basis to support his request.  The documentation provided does not substantiate how the injuries he received made him completely dependent on someone else to perform at minimum two of the six ADLs for over 30 days.

5.  In view of the foregoing, there is insufficient basis for granting relief in this case.



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)                                         AR20140019774



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ABCMR Record of Proceedings (cont)                                         AR20140019774



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