CVMA544 - retirement has no effect on eligibility for TGSLI, but the date and severity of the event does. PM me with you service component, date and extent of injury and I will get you the right determination.
From the facts you gave, you will not be denied coverage based on your accident: https://www.hrc.army.mil/site/crsc/tsgli/documents/TSGLIProceduresGuide.pdf , page 6:
The following injuries are excluded from TSGLI payment:
1) Injuries caused by one of the following:
a) A mental disorder
b) A mental or physical illness or disease, (not including illness or disease caused by a pyogenic
infection, biological, chemical, or radiological weapon, or accidental ingestion of a contaminated
c) Attempted suicide
d) Self-inflicted wounds
e) Diagnostic procedures, preventive medical procedures such as inoculations, medical or surgical
treatment for an illness or disease, or any complications arising from such procedures or treatment.
f) The members’ willful use of an illegal or controlled substance, unless administered or consumed on
the advice of a medical professional.
2) Injuries sustained while committing, or attempting to commit, a felony.
Well, I'm new here. But I've been spending the past 2 days trying to figure out if I was eligable for TSGLI for my TBI but I'm just as confused now as when I started. Can I tell someone the specifics of my DES claim to help me figure out if I should put an application together? Can I PM someone? I don't want to do something like that if it's against the rules of this fourm. Would I put it in after I get out or now while I'm still in?
i'm just working my claim and my friend just put in a claim for TBI, so it can't hurt to try IMO. shoot me an e-mail or PM w/any questions. i'm no expert but i can fill you in on my take on it. i know there are a few people well versed w/the whole TSGLI thing, so maybe someone will chime in. good luck!
Getting paid TSGLI for TBI was a lot easier than you may think, if you have a legit claim. I was issued a PDA by the Army because of my TBI. Before I was issued it I had to be reminded to eat and bathe (among other things) My doctors filled out the form and verifying that information, it was sent forward and I was paid in 3 weeks.
I never thought I would get it because I never spent a day in the hospital but I was encouraged to turn it in, am I ever glad I did!
How funny that serving three tours in Iraq, 2x in Balad with the whole burn pit thing and the last in Mosul and then coming home with Leukemia (terminal disease), that I don't qualify for any TSGLI coverage. I would glady take TBI or trade an appendage to rid my body of this terminal disease. So many Soldiers all of sudden coming back with Cancer and NOBODY seems to care!
I submitted a claim in October for "activities of daily living." Of the six categories, you only have to be deficient in two. My doctor documented deficiencies in 4. The problem I had is that for the first 3 months following my injury, I was awaiting a line of duty determination and orders placing me on active duty. Without orders, I had no pay or benefits which includes healthcare. I was left to fend for myself at home and my spouse quit her job to care for me full time while we awaited pay and benefits to catch up. To make a long story short, the TSGLI claim was denied due to "lack of medical documentation."
I was at home recovering for 3 months and there was no medical documentation showing that at that time I needed help transferring, dressing, toileting, etc. My lower leg and ankle was an extra 6 inches in diameter and the incision bled for 4 months (see photos). The first photo shows how my leg was for one month following surgery. The second shows how my leg looked the next two months. I had a signed statement from a neighbor who helped get me to appointments and personally observed my disabilities. My medical profile has stated for the last year "no standing, walking, or sitting > 10 mins." I provided the names and phone numbers of other doctors and witnesses yet NO ONE was ever contacted. I included a series of photos of my leg which documented the severity of the injuries. Yet, they denied the claim.
I have since appealed the decision which included a letter from my primary doctor which stated I still am still deficient in the activities of daily living after 14 months. Program may be good for the other services, but for the Air Force the decision was in the hands of ONE doctor at AFPC who stated I SHOULD have been able to take care of myself without assistance.
I've been waiting now for an answer to my claim for 15 months, and have been sending additional documentation as I find it. This has got to be some sort of record. Has anyone else waited this long for a claim decision???