AR20160000511

IN THE CASE OF:

BOARD DATE: 26 April 2016

DOCKET NUMBER: AR20160000511

BOARD VOTE:

_________ _______ ________ GRANT FULL RELIEF

________ ________ ________ GRANT PARTIAL RELIEF

________ ________ ________ GRANT FORMAL HEARING

____X___ ____X___ ____X___ DENY APPLICATION

2Enclosures
1. Board Determination/Recommendation
2. Evidence and Consideration

IN THE CASE OF:

BOARD DATE: 26 April 2016

DOCKET NUMBER: AR20160000511

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: 26 April 2016

DOCKET NUMBER: AR20160000511

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, correction of his record to show his claim for Traumatic Servicemembers’ Group Life Insurance (TSGLI) benefits was approved.

2. The applicant states he was hit by an improvised explosive device (IED) in 2003. Doctors advised him not to undergo any medical surgeries until years later and to wait as long as possible before having a full right hip replacement. When he submitted his TSGLI paperwork, completed by his physician assistant, it was denied because he did not meet the time requirement from the date of injury and surgery. He thinks this is an error because he was advised to wait as long as possible before having the surgery. He should be awarded some sort of TSGLI despite the time gap. The instruction received from his military doctors to wait for the surgery should not prevent him from receiving a portion or all of the TSGLI.

3. The applicant provides copies of:

* DA Form 1156 (Casualty Feeder Report)
* DA Form 1155 (Witness Statement on Individual)
* DD Form 1380 (Medical Field Card)
* DA Form 4187 (Personnel Action)
* two DA Forms 2823 (Sworn Statement)
* letter from Arthritis Associates Center
* U.S. Air Force Academy (USAFA) Form O-515 (USAFA Hospital Patient Discharge Instructions)
* Standard Forms (SF) 600 (Health Record Chronological Record of Medical Care)
* Radiologic Examination Report
* TSGLI Application
* Memorandum for Record (MFR)
* letter from Prudential

CONSIDERATION OF EVIDENCE:

1. The applicant enlisted in the Regular Army (RA) on 29 January 2002.

2. He provides copies of:

* DA Form 1156 showing he was lightly wounded in action in Iraq on 7September 2003
* DA Form 1155 in which a member of the applicant’s unit confirmed the applicant’s injury on 7September 2003 was the result of an IED explosion
* DD Form 1380, dated 7 September 2003, showing the applicant lost consciousness and hearing and had vision loss as a result of an IED explosion; he received medical treatment and was placed on observation for 36hours for post-concussion syndrome
* Undated DD Form 4187 in which the applicant’s company commander recommended the applicant for award of the Purple Heart for wounds received in action on 7September 2003
* Two DA Forms 2838, dated 21July 2005, in which the applicant and a member of his unit reiterated the events of 7September 2003
* Letter, dated 31 July 2006, in which the Arthritis Associates Center stated the applicant was referred for an evaluation of right hip arthritis
* USAFA Form O-515 showing he was discharged from the hospital on 15August 2006

3. He reenlisted in the RA on 17 July 2012 for an indefinite period.

4. He also provides copies of:

a. SFs 600 showing he received medical treatment between 7July 2011 and 13August 2013 for right hip pain and arthritis.

b. A Radiologic Examination Report, dated 1 July 2013, for his right hip.

c. An SF 600 showing he underwent an evaluation for a TSGLI benefit application on 23September 2013. The form shows:
* he sustained an injury while serving in Iraq on 7September 2003 and was transported to a local hospital where he was evaluated and treated
* he subsequently suffered from right hip pain and difficulty with ambulation and underwent a complete right hip replacement on 19February 2013
* during his time in rehabilitation he required daily help from his wife for activities of daily living (ADL), including, but not limited to ambulation of going to the bathroom, bathing, eating, and transferring in and out of bed, for at least 2months
* currently he ambulated with a slight limp and continued to perform daily exercise to improve his pain and movement

d. A TSGLI Application, dated 23 September 2013, and attached MFR, dated 26September 2013, in which he reiterated the events of his injury and subsequent issues with his right hip.

5. In a letter, dated 8 November 2013, the Program Manager, TSGLI, U.S. Army Human Resources Command, advised the applicant that his TSGLI claim did not meet the eligibility requirements as he did not suffer a scheduled loss within 2years of his traumatic event.

6. He further provides a copy of a letter, dated 17 April 2014, in which Prudential advised him of the denial of his TSGLI claim because his ADL losses did not occur within the prescribed time period defined by regulation. The medical evidence indicated his loss occurred 9years after the traumatic event and did not meet the TSGLI minimum standard.

REFERENCES:

Public Law 109-13 establishes the TSGLI Program to provide relief to Soldiers who are severely injured and incurred a loss as a result of a traumatic event. The law states:

a. For the purposes of TSGLI, a traumatic event is defined as the application of external force, violence, chemical, biological, or radiological weapons, or accidental ingestion of a contaminated substance causing damage to a living being. A service member must meet all of the following requirements to be eligible for payment of TSGLI:

* have been insured by SGLI at the time of the traumatic event
* have incurred a scheduled loss and that loss must be a direct result of a traumatic injury
* have suffered the traumatic injury prior to midnight of the day of separation from the Uniformed Services
* have suffered a scheduled loss within 2years (730days) of the traumatic injury

b. The TSGLI Schedule of Losses is comprised of two parts. PartII addresses the inability to carry out ADLs due to a loss directly resulting from a traumatic injury other than a brain injury. A member is considered to have loss of ADL due to a traumatic injury if the member requires assistance to perform at least two of the six ADLs (dressing, bathing, toileting, eating, continence, and transferring). Required assistance is defined as without the assistance, the patient would be incapable of performing the task.

DISCUSSION:

1. The applicant sustained a traumatic injury in Iraq on 7September 2003. He received medical treatment and was evaluated with post-concussion syndrome. He received medical treatment for right hip pain and arthritis in 2006 and from 2011 to 2013. He underwent complete right hip replacement surgery on 19February 2013 and required assistance with several ADLs.

2. His TSGLI claim for loss of ADLs was denied because the medical evidence indicated his loss occurred 9years after the traumatic event and did not meet the TSGLI minimum standard.

3. There is no evidence and he did not provide sufficient evidence supporting his claim that his ADL losses occurred less than 2years from claimed traumatic event. By law, a member must have suffered a scheduled loss within 2years of the traumatic injury. There is no evidence showing he was improperly disallowed TSGLI benefits.

//NOTHING FOLLOWS//

ABCMR Record of Proceedings AR20150000953

Enclosure 1

ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

RECORD OF PROCEEDINGS

ABCMR Record of Proceedings (cont) AR20160000511

2

ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

RECORD OF PROCEEDINGS

Enclosure 1

ABCMR Record of Proceedings (cont) AR20160000511

4

ARMY BOARD FOR CORRECTION OF MILITARY RECORDS

RECORD OF PROCEEDINGS

Enclosure 2