IN THE CASE OF: BOARD DATE: 28 June 2016 DOCKET NUMBER: AR20150001260 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ____X____ ____X____ ___X_____ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 28 June 2016 DOCKET NUMBER: AR20150001260 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. IN THE CASE OF: BOARD DATE: 28 June 2016 DOCKET NUMBER: AR20150001260 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: The applicant defers to counsel. COUNSEL'S REQUEST, STATEMENT, AND EVIDENCE: 1. Counsel requests award of Traumatic Servicemembers' Group Life Insurance (TSGLI) benefits to the applicant. 2. Counsel states the Army TSGLI Program Office denied the applicant's TSGLI claim appeal on 25 November 2013. The applicant's claim fits the legal requirements for award of TSGLI. 3. Counsel provides TSGLI Appeal Summary, dated 18 November 2013, and denial, dated 25 November 2013. CONSIDERATION OF EVIDENCE: 1. The applicant enlisted in the Regular Army on 23 August 1988. 2. On 18 June 2009, he was involved in a single-vehicle motorcycle accident. He lost control of his motorcycle and veered off the roadway into a ditch. He was transported to the Columbus Medical Center. He suffered a subarachnoid hemorrhage (bleeding inside the brain); facial abrasions; and bilateral hip, neck, back, and shoulder injuries. 3. A formal line-of-duty investigation determined he was injured in the line of duty. 4. On 8 August 2012, a physical evaluation board found him physically unfit for the conditions of lumbar degenerative disc disease following implantation of spinal cord stimulator (20 percent), cervical fusion (20 percent), and right knee osteoarthritis (10 percent). The board recommended a disability rating of 40 percent and his permanent disability retirement. 5. On 13 August 2012, he concurred with the PEB findings and recommendation and indicated he did not request reconsideration of his Department of Veterans Affairs ratings. 6. He retired by reason of permanent physical disability on 13 December 2012 and was placed on the Retired List on 14 December 2012. 7. On 30 October 2012, he submitted a claim for TSGLI based on the injuries he sustained on 18 June 2009. His medical provider indicated he was unable to bathe independently and dress independently. His medical provider stated he had not observed the applicant's loss; he had reviewed the applicant's medical records. His claim was denied on 20 December 2012. 8. On 25 April 2013, he requested reconsideration of his TSGLI claim. 9. U.S. Army Human Resources Command letter, dated 12 July 2013, notified the applicant that the TSGLI Program Office reconsidered the decision of his previous claim and was unable to overturn the previous adjudication. The documentation provided for his motorcycle accident did not indicate he met the TSGLI standards for loss of activities of daily living (ADL). The medical documentation he submitted did not indicate his injuries rendered him incapable of performing the ADL of bathing and dressing for 30 consecutive days or more. He was advised of his right to submit a TSGLI appeal claim. 10. On 13 September 2013, he appealed denial of his claim for TSGLI. 11. U.S. Army Human Resources Command letter, dated 24 November 2013, notified the applicant that the TSGLI Program Office considered his appeal and was unable to overturn the previous adjudication. The documentation provided for his motorcycle accident did not indicate he met the TSGLI standards for ADL loss. The medical documentation he submitted did not indicate his injuries rendered him incapable of performing the ADL of bathing, continence, dressing, eating, toileting, or transferring for 30 consecutive days or more. He was advised that if a Soldier is able to perform activity by the use of accommodating equipment/adaptive measures (e.g., cane, crutches, wheelchair, etc.), the then Soldier is considered able to independently perform the activity. He was further advised of his right to apply to the Army Board for Correction of Military Records to contest the adverse TSGLI decision. 12. Neither he nor his counsel provided further medical documentation to support his claim for TSGLI. REFERENCES: 1. 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 (CRSC) was 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. As of 1 December 2005, TSGLI is included as part of a Soldier's SGLI coverage. 2. 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 (i.e., 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. third-degree or worse burns covering 30 percent of the 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 ADL, 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 ADL 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 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. 3. 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. a. Paragraph 2-2 provides that the ABCMR considers individual applications that are properly brought before it. The ABCMR will decide cases on the evidence of record. It is not an investigative body. b. Paragraph 2-9 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. c. Paragraph 2-15 provides that an applicant may request the reconsideration of an ABCMR decision under the following circumstances: (1) If the ABCMR receives the request for reconsideration within 1 year of the ABCMR's original decision and if the ABCMR has not previously reconsidered the matter, the ABCMR staff will review the request to determine if it contains evidence (including, but not limited to, any facts or arguments as to why relief should be granted) that was not in the record at the time of the ABCMR's prior consideration. If new evidence has been submitted, the request will be submitted to the ABCMR for its determination of whether the new evidence is sufficient to demonstrate material error or injustice. If no new evidence is found, the ABCMR staff will return the application to the applicant without action. (2) If the ABCMR receives a request for reconsideration more than 1 year after the ABCMR's original decision or after the ABCMR has already considered one request for reconsideration, then the case will be returned without action and the applicant will be advised the next remedy is appeal to a court of appropriate jurisdiction. DISCUSSION: 1. The applicant was involved in a single-vehicle motorcycle accident on 18 June 2009. He suffered a subarachnoid hemorrhage (bleeding inside the brain); facial abrasions; and bilateral hip, neck, back, and shoulder injuries. 2. He retired by reason of permanent physical disability on 13 December 2012. 3. He submitted a claim for TSGLI on 30 October 2012; however, his claim was denied on 20 December 2012. 4. He requested reconsideration of his TSGLI claim on 25 April 2013. The TSGLI Program Office reconsidered the decision of his previous claim and was unable to overturn the previous adjudication. The medical documentation he submitted did not indicate his injuries rendered him incapable of performing the ADL of bathing and dressing for 30 consecutive days or more. 5. He appealed denial of his claim for TSGLI on 13 September 2013. The TSGLI Program Office considered his appeal and was unable to overturn the previous adjudication. The medical documentation he submitted did not indicate his injuries rendered him incapable of performing the ADL of bathing, continence, dressing, eating, toileting, or transferring for 30 consecutive days or more. 6. He provided no further medical documentation to support his request. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150001260 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150001260 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2