IN THE CASE OF: BOARD DATE: 29 May 2008 DOCKET NUMBER: AR20070014973 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, in effect, that his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim to the U.S. Army Physical Disability Agency be reconsidered. 2. The applicant states that he has provided supporting medical documentation and photographs with his three denied claims that are within the guidelines for approval in accordance with page 8 of the TSGLI Procedures Guide (Version Aug 2007). 3. The applicant provides a letter, dated 13 September 2007, from his orthopedic surgeon; a letter, dated 9 April 2007, from the U.S. Army Physical Disability Agency; a page from the TSGLI Procedural Guide; his DD Form 214 (Certificate of Release or Discharge from Active Duty) for the period ending 10 June 2006; two DA Forms 2173 (Statement of Medical Examination and Duty Status), both dated 5 October 2005; and a memorandum, Subject: Informal Line of Duty Determination, dated 6 December 2005. CONSIDERATION OF EVIDENCE: 1. After having had prior service in the Regular Army, the applicant enlisted in the Army National Guard on 29 April 1998. He was promoted to staff sergeant on 2 May 2003. The applicant was ordered to Full-Time National Guard Duty in the Active Guard Reserve (AGR) in a Title 10 status on 15 February 2004 in support of Operation Iraqi Freedom. His DA Form 2-1 (Personnel Qualification Record) shows he served in Iraq from 10 August 2004 through 22 December 2005. 2. The applicant was ordered to Full-Time National Guard duty in the AGR on 23 December 2005 in a Title 32 status. He was released from active duty on 10 June 2006. 3. The applicant’s service records are incomplete; however, his records show that the U.S. Army Physical Disability Agency, TSGLI Branch provided a chronological summary of the applicant’s appeals. The TSGLI summary chronological listing shows that: a. On 25 August 2006, the applicant filed his first TSGLI claim for loss of the ability to perform activities of daily living (ADLs) for dressing, bathing, and toileting for 60 days. There was insufficient medical documentation to substantiate that the applicant could not independently perform ADLs. The claim was disallowed and a disapproval letter was sent on 14 September 2006; b. On 1 November 2006, the applicant’s reconsideration claim was filed for loss of ADLs for dressing, bathing, and toileting for 60 days. There was insufficient medical documentation to substantiate that the applicant could not independently perform ADLs. The claim was disallowed and a disapproval letter was sent on 20 November 2006; and c. On 17 January 2007, the applicant filed an appeal of his TSGLI claim, for the loss of dressing, bathing, transferring, and toileting for 60 days. There was insufficient medical documentation to substantiate that the applicant could not independently perform ADLs. The claim was disallowed and a disapproval letter was sent on 9 April 2007. 4. The applicant provided a letter from an orthopedic surgeon. The surgeon stated the applicant was in his office on three occasions in regards to an injury that he incurred while in Iraq. The surgeon also stated that apparently an Improvised Explosive Device (IED) blew up and the applicant sustained severe shrapnel wounds to his right leg which involved a femoral artery laceration. The surgeon stated the applicant was initially seen on 9 February 2006 with three wounds in his leg, all of which were opened and initially treated by the Army. The applicant returned state-side and he was treated by a general surgeon. The surgeon further stated the applicant was very limited in his ability to bathe and to dress during his recovery. The surgeon stated that the weakness in the applicant’s right leg and the care of the three separate wounds made it very difficult for him to shower, bathe, and dress. The surgeon stated the time frame the applicant required assistance was around 24 September 2005 to 27 November 2005. 5. 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. 6. 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 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. DISCUSSION AND CONCLUSIONS: 1. The evidence provided by the applicant was carefully considered. The applicant’s disagreement with responses to his TSGLI claims were noted. Evidence of record shows that he sustained shrapnel wounds to his right leg by the explosion of an IED. 2. The statement by the applicant’s orthopedic surgeon that he had very limited ability to bathe and to dress for 60 days is not corroborated by other evidence. While the fact that the applicant required medical care following his injury is not disputed, the evidence in his service records does not approach the level of documentation required to justify a TSGLI payment for loss of ADLs. The surgeon stated it was very difficult for the applicant to shower, bathe, and dress, but there is no evidence to show he was completely dependent on someone else to perform those functions. 3. The applicant has not provided sufficient documentation supporting 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 xx______ xx______ xx______ 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. ____xxxx____________ 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) AR20070014973 3 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1 ABCMR Record of Proceedings (cont) AR20070014973 5 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1