The Adjutant General Directorate “People Always... Mission First” [PRESENTER] CRSC/TSGLI Division (Date) [EVENT NAME] TSGLI and Introduction to CIP and CRSC

The Adjutant General Directorate “People Always... Mission First” 2 TSGLI is a Department of Veterans Affairs insurance program created by congress and bundled with Servicemembers Group Life Insurance coverage As of 31 May 2007 the Army’s TSGLI program has approved more than 2,000 claims The TSGLI program has given out almost $126 million of the total $203 million paid out across all branches of service TSGLI helps injured Soldiers and their Families –Designed to help with expenses and get a head start on life after recovery –Provides a one-time payment for eligible Soldiers and their Families –Offers free financial counseling from FinancialPoint to recipients Traumatic Servicemembers’ Group Life Insurance (TSGLI)

The Adjutant General Directorate “People Always... Mission First” 3 Qualifying Traumatic Injuries or Losses Qualifying injuries (losses)As a result of (event examples) Amputation Loss of Sight, Speech or Hearing Paralysis Brain Injury or Coma Burns Other traumatic injuries resulting in loss of Activities of Daily Living (ADL’s) Improvised Explosive Device Rocket Propelled Grenade Training Accident Motorcycle Accident Civilian Aircraft Accident Vehicle Borne Improvised Explosive Device Small Arms Civilian Car Accident Definition of Qualifying Event: Injury or loss caused by external force or violence (a traumatic event) Losses #1-43 Loss #44

The Adjutant General Directorate “People Always... Mission First” 4 Activities of Daily Living (ADLs) Loss Descriptions Eating Bathing Dressing Toileting Transferring Continence …on another person or a feeding tube to receive nourishment …on another person (can’t bathe independently) …on another person to help put on shoes and socks (for example) …or unable to relieve bladder/bowel or perform associated hygiene …on another person to get in and out of bed or chair …or unable to manage and control bowel and bladder function Completely Dependent…

The Adjutant General Directorate “People Always... Mission First” 5 “TNT” —Time and Type of ADL Loss There must be no break in the period of ADL loss—otherwise the clock re- starts. Currently, the ADL standards are being reevaluated Other Traumatic Injuries (OTI): The Soldier must have ADL loss in increments of… $100,000 $75,000 $50,000 $25,000 To receive a one- time TSGLI payment of… Traumatic Brain Injury (TBI): The Soldier must have ADL loss in increments of …

The Adjutant General Directorate “People Always... Mission First” 6 Time Constraints You may apply for TSGLI at any time after a qualifying loss occurs Qualifying loss must have happened within 730 days of the traumatic event to be eligible for TSGLI Traumatic events that happen less than seven days apart are considered one traumatic event Traumatic events more than seven days apart are considered more than one traumatic event A deceased Soldier must have survived at least seven days after a traumatic event to be eligible for TSGLI—otherwise only SGLI (life insurance) coverage applies

The Adjutant General Directorate “People Always... Mission First” 7 TSGLI Eligibility—Circumstances RETROACTIVE Related to combat zones PROSPECTIVE Any time, anywhere 7 October 2001 – 30 November December 2005 – forward Qualifying traumatic injury must occur while on orders in a Combat Zone Tax Exclusion (CZTE) area Soldier does not have to be currently serving in Army SGLI coverage not necessary Qualifying traumatic injury can occur under any circumstances—doesn’t have to be combat-related Traumatic injury does NOT have to occur while on orders Soldier must have SGLI coverage Two Programs: Pending legislation: Senate Bill 225 would do away with the retroactive CZTE requirement, offering “anytime, anywhere” coverage for all Soldiers with qualifying injuries from 7 October 2001 to now.

The Adjutant General Directorate “People Always... Mission First” 8 Claim Form Part A - Servicemember PART A – Member’s Identifying Information Section 1 – Servicemember Information Section 2 – Guardian and Attorney-in-fact Information Section 3 – Payment Information Section 4 – Signature Section 5 – Authorization to Speak to Third Party Section 6 – Authorization to Release Information Filled out by Servicemember or advocate

The Adjutant General Directorate “People Always... Mission First” 9 Claim Form Part B – Licensed Medical Provider PART B – Licensed Medical Provider’s Statement Section 1 – Patient and Injury Information Sections 2 – 10 Losses Suffered by Patient Section 11 – Medical Professional’s Comments Section 12 – Contact Information Section 13 – Medical Professional’s Signature Two-page ADL Questionnaire MUST be completed by a licensed Medical Provider— does not necessarily have to be a physician

The Adjutant General Directorate “People Always... Mission First” 10 Supporting Documentation Submit only documents pertinent to loss(es): Provides duration of ADL loss and type of injury Provides basis for certification of loss Balances out healthcare-provider subjectivity Provides a scale/standard for reviewer Allows for quicker claim processing (If all of the proper medical documentation is submitted with a TSGLI claim, typical resolution takes about 30 days from date of receipt)

The Adjutant General Directorate “People Always... Mission First” 11 Qualified licensed healthcare providers give primary certifying statements: –Physicians –Physician Assistants –Nurse Practitioners –Registered Nurses Other healthcare providers give supporting documentation statements within their lane of expertise: –Registered Dieticians –Optometrists –Audiologists –Speech/Language Pathologists –Occupational/Physical Therapists –Dentists –Other licensed medical providers within his/her scope of practice Licensed Medical Providers

The Adjutant General Directorate “People Always... Mission First” 12 Documents commonly used to support TSGLI claims Occupational/Physical Therapy Report (ADL Documentation) Neurological Reports (TBI/ADL Documentation) Nurses Notes (ADL Documentation) OR Report (amputation) Hearing Test Results (for hearing loss) Eye Test Results (for sight loss) Speech Test Results (for speech loss) Patient Discharge Summaries Medical Summary and/or History Patient Movement Request Radiographic Reports (X-Ray, MRI, Ultrasound, etc.) Accident Report Line of Duty (LOD) Medical/Physical Evaluation Board (MEB/PEB) Other diagnostic test results (e.g., lab reports, etc.) Other pertinent documents demonstrating time duration of ADL loss and type of injury

The Adjutant General Directorate “People Always... Mission First” 13 Claim Form Part C – Human Resources Command Office of Servicemember’s Group Life Insurance (OSGLI) receives Certified Claim. Branch of Service Validates Info in Parts A&B and Completing Part C to Certify Claim Do NOT complete this form— TSGLI will complete it Branch of Service Validates Info in Parts A&B and Completing Part C to Certify Claim Do NOT complete this form— TSGLI will complete it

The Adjutant General Directorate “People Always... Mission First” 14 Servicemember Sends Claim Form E-Fax Address: 200 Stovall Street Alexandria, VA ONLY send claims through the secure channels below:

The Adjutant General Directorate “People Always... Mission First” 15 Multiple Claims Reconsiderations and Appeals Multiple Claim Submissions are possible for: –Consecutive periods of ADL loss –Additional traumatic event(s) –Multiple injuries DO NOT require multiple claim forms Reconsideration –If a Servicemember feels that his/her claim has been wrongly denied, there are three levels of appeal. Each of them will require gathering additional information and documentation to prove the case. The process is as follows: First: Reconsideration - The Servicemember may gather additional supporting documentation and apply for a reconsideration Second: Army Appeals Board - If the claim is still denied, the Servicemember can supply additional medical documents and appeal the claim to the U.S. Army TSGLI Appeals Board Third: ARBA Appeals Board - The third level of the appeal process is to apply to the U.S. Army Review Board Agency (ARBA).

The Adjutant General Directorate “People Always... Mission First” 16 Where we are today— and how you can help The program is maturing and there are still significant improvements that need to be made through the VA The Army can only run the program by the rules created by Congress and the VA—the Army can not change program guidance We CAN AND DO influence Congress and the VA to make changes that will improve TSGLI and better serve the Soldier Your feedback helps us influence Congress—we have already made improvements to claim forms and processes based on feedback from people who care for Soldiers We have given our feedback on program issues to the VA and expect certain improvements to be made to the program by Fall of Thank you for your help in telling us your experience

The Adjutant General Directorate “People Always... Mission First” 17 TSGLI—Takeaways 1.Traumatic Injury definition: –Caused by external force or violence 2.Medical documentation must substantiate duration of each ADL impacted 3.Every case is different –Each case stands on its own; every injury is different –Circumstances, injury specifics and documentation vary

The Adjutant General Directorate “People Always... Mission First” 18 Combat-Related Injury Rehabilitation Pay (CIP) Combat-Related Special Compensation (CRSC) Benefit Programs Related to TSGLI

The Adjutant General Directorate “People Always... Mission First” 19 Combat-Related Injury Rehabilitation Pay (CIP) Congressionally mandated Special pay program effective 23 March 06 No claim process – awarded automatically Criteria for Eligibility  Must have been MEDEVACED from Combat Zone  Inpatient in a medical treatment facility (MTF)  Outpatient of an MTF  Payment continues as long as a Soldier remains under MTF control CIP Termination  TSGLI payment or notification of payment  Released to Unit or Demobilization Site  REFRAD  Assigned to Community Based Healthcare Organization*  Convalescent Leave*  Transferred to VA Poly Trauma*  No Restarts once terminated, unless return to Theater  Reconsiderations and appeals are possible * NOTE: under policy revision

The Adjutant General Directorate “People Always... Mission First” 20 CIP – A Decision CIP Compensation Breakdown Hardship Duty Pay – Location (HDP-L) $100 Hostile Fire /Imminent Danger Pay (HF/IDP) $225 Per Diem for meals & incidentals $3.50 x 30 $105 Total CIP monthly payment: $430 MosCIP Benefit 12$5,160 24$10,320 36$15,480 Because TSGLI and CIP are mutually exclusive programs, each Soldier must decide with their Family to determine if and when TSGLI and CIP are right for their particular situation. Below is an outline of CIP pay and how it stacks up over time.

The Adjutant General Directorate “People Always... Mission First” 21 Combat-Related Special Compenstion (CRSC) What is CRSC?  CRSC restores military retired pay to eligible retired veterans  CRSC is a monetary award paid monthly  Retired veterans must have a % disability rating, draw military retired pay and VA disability payments How does CRSC help retired veterans?  CRSC replaces VA disability compensation subtracted from retired pay  CRSC recognizes veterans for their sacrifice to our country How do we execute CRSC?  Shape perceptions of Soldiers, healthcare providers, counselors, and advocates (SRTV, events, VSO’s, direct mail, electronic media)  Adjudicate claims: new, reconsiderations, and appeals  Validate approval payments to DFAS  Digitize case files to iPERMS  Serve veterans through Call Center, IVR, and dynamic website

The Adjutant General Directorate “People Always... Mission First” 22 Who is Eligible for CRSC? Must Have ALL Four At Least One AND 1. AC, RC, NG or medically retired with 20 years 2. 10% or greater VA rated injury 3. Receiving military retired pay 4. Military retired pay is reduced by VA disability payments (VA Waiver) 1. Simulating War (SW) 2. Hazardous Service (HS) 3. Instrumentality of War (IN) 4. Armed Conflict (AC)

The Adjutant General Directorate “People Always... Mission First” 23 CRSC: Website: TSGLI: CIP: CRSC: TSGLI: CRSC: Call: TSGLI: CIP: (M-F hrs EST) Questions Become an Official Ambassador - Contact us above! We recognize that all injuries impact a Soldier’s life, and we appreciate the sacrifice of every Soldier.