RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 15 November 2007 DOCKET NUMBER: AR20070009945 I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual. Ms. Catherine C. Mitrano Director Mr. Michael L. Engle Analyst The following members, a quorum, were present: Ms. Margaret K. Patterson Chairperson Mr. Larry C. Bergquist Member Mr. Dale E. DeBruler Member The Board considered the following evidence: Exhibit A - Application for correction of military records. Exhibit B - Military Personnel Records (including advisory opinion, if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests, in effect, that his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim be reconsidered. 2. The applicant essentially states that he is entitled to a TSGLI payment because his activities of daily living (ADL) still are not normal. The first 120 days of his injury he needed help bathing, dressing and preparing meals. He needed to be driven everywhere. He has a ruptured disk in his neck and back, a shattered left shoulder, and a traumatic brain injury. 3. The applicant provides a binder containing what appears to be his entire medical treatment history, including a copy of his medical evaluation board and Certificate of Release or Discharge from Active Duty (DD Form 214). CONSIDERATION OF EVIDENCE: 1. The applicant was retired from the Regular Army on 27 December 2006 due to a permanent physical disability. He had completed 5 years and 3 months of creditable active duty and had attained the rank of sergeant, pay grade E-5. 2. On 20 May 2005, the applicant was wounded in action, and received superficial shrapnel wounds to his left shoulder and neck and a broken left humerus from an exploding improvised explosive device in Iraq. On 21 May 2005, he was medically evacuated, first to the regional hospital in the Federal Republic of Germany, and then to Eisenhower Army Medical Center on 25 May 2005. On 31 May 2005, he was released without limitations. 3. On 24 March 2006, the applicant submitted his first request for TSGLI benefits, claiming loss of ADLs for 120 days due to a fractured left arm, shrapnel to the left arm, and a hearing loss to his left ear. His hearing loss was not within guidelines and medical documentation submitted did not support physicians certification of ADL's. On 7 June 2006, the Office of Servicemembers’ Group Life Insurance, the administrator of the TSGLI Program, informed the applicant that his TSGLI case was not approved, as the medical documentation submitted essentially did not substantiate his complete dependence on another for performance of ADLs. 4. On 20 June 2006, the applicant submitted his TSGLI reconsideration request, again claiming loss of all ADLs, except for eating, for 120 days. He essentially based his reconsideration request on the same documentation that he submitted with his initial claim. On 5 August 2006, the Office of TSGLI, Department of the Army disallowed his claim because the medical documentation submitted did not support the physician’s certification. 5. On 18 August 2006, the applicant submitted his TSGLI appeal request, again claiming loss of all ADLs except for eating for 120 days. He essentially based his appeal on the same documentation as submitted with his previous claim requests. On 18 October 2006, his TSGLI appeal request was disallowed for the same reasons his TSGLI reconsideration request was disallowed. 6. Part B (To be Completed by Attending Medical Professional) of the applicant’s Certification of Traumatic Injury Protection [TSGLI] form, dated 22 March 2006, shows that the applicant’s attending physician essentially stated that he could not perform dressing, bathing, toileting, continence, or transferring independently for over 120 days. He also stated that he had limited movement of his left arm. 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 May 11, 2005, established the TSGLI program. U.S. Army Combat-Related Special Compensation (CRSC) 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 and $100,000 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 and Operation Enduring Freedom or under orders in a Combat Zone Tax Exclusion (CZTE) 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. 8. There are some 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; 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 2 of the 6 ADLs for 30 days or more (15 days or more in the case of traumatic brain injuries). 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 medical 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. 9. Army Regulation 15-185 (Army Board for Correction of Military Records) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. This regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. DISCUSSION AND CONCLUSIONS: 1. The evidence provided by the applicant was carefully considered. While this evidence clearly shows he suffered multiple fragmentation wounds while serving in Iraq, the documentation does not substantiate his loss of ADL or the duration of such loss. 2. The statement by the applicant’s attending physician in Part B of his TSGLI claim form that he could not perform dressing, bathing, toileting, continence, or transferring independently for over 120 days is not corroborated by information in the available medical records. While the Board does not dispute the fact that the applicant required medical care and support immediately following his wounding on 20 May 2005, and extensive follow-up care for months afterwards, documentation required to justify a TSGLI payment for loss of ADLs has not been submitted. 3. 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. 4. In order to justify correction of a military record the applicant must, or it must otherwise satisfactorily appear, that the record is in error or unjust. The applicant has failed to submit evidence that would satisfy that requirement. 5. In view of the foregoing, there is no basis for granting relief to the applicant in this case. BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING __ DED __ __MKP__ __LCB _ 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. __ M. K. Patterson ____ CHAIRPERSON INDEX CASE ID AR20070009945 SUFFIX RECON DATE BOARDED 20071115 TYPE OF DISCHARGE DATE OF DISCHARGE DISCHARGE AUTHORITY . . . . . DISCHARGE REASON BOARD DECISION DENY REVIEW AUTHORITY ISSUES 1. 124.05 2. 3. 4. 5. 6.