| TSGLI Qualifiying Conditions
TSGLI EXCLUDED Conditions
- Loss of sight, hearing, or speech
- Amputation(s) and Limb Salvage
- Paralysis (paraplegia, quadriplegia, hemiplegia, uniplegia)
- Genitourinary injuries - retroactive to 7 October 2001
- Facial Reconstruction
- 15-day Hospitalization
- Loss of Activities of Daily Living due to a Traumatic Brain Injury or other injuries
- Due to a mental disorder or mental or physical illness or disease
- Due to routine medical or surgical treatment for an illness or disease, medical or surgical treatment for an illness or disease, medical errors or complications
- Injuries sustained while committing or attempting to commit a felony
- Injuries sustained during attempted suicide
- Injuries that were intentionally self-inflicted
- Injuries sustained while using illegal or a controlled substance not prescribed by a medical professional
How to Submit a Claim
Assistance for Navy members seeking TSGLI Benefits (Updated April 9, 2018)
We recommend that you visit the Veterans Affairs website for TSFLI for some basic infomation regarding submitting an SGLV-8600. https://www.benefits.va.gov/insurance/tsgli.asp. Please be mindful of the conditions under which the program operates.
Traumatic Event - A traumatic event is the application of external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to the body. The event must involve a physical impact upon an individual.
Some examples: an airplane crash, RPGs, IED, or as in some certain communities: Static line/freefall with impacts of ground/tree or teammate, or brick/build parts/teammates that fall and cause a sudden blow to the head.
Traumatic external event that causes injuries must have occurred on or after 07 October 2001 per 38 CFR Part 9, Dept. of Veterans Affairs.
If you are able to perform an activity by using accommodating equipment (such as a wheelchair, crutches, walker, commode, extended sock stick, extending gripper to reach items) or use of ADAPTIVE BEHAVIOR (like using opposite hand to dress or bathe) you are able to independently perform the activity.
Part A is your part to fill out; the member starts on page 3.
- Required information includes name, SSN, home address where you currently get mail, telephone number and email for correspondence.
- Rank/Grade is for the level you WERE when injured such as E4/STS3 or O3/LT
NAME of the COMMAND & UIC you WERE attached to WHEN the injury OCCURRED
On page 4, use the Navy method of writing: Keep It Simple S!!!!
* When - month/day/year, TIME
* Where - city /state/ship/country
[WHERE WERE THE SHIPS...underway...pier side, port of call?]
* What - type of injury, but keep it simple.
(Example: Motor vehicle accident on Hwy 222 in Somewhere, ST)
**DO NOT List injuries: that is part of the medical documentation and what the DOCTOR writes in Part B!
Page 5 is banking information.... CHOOSE ONLY ONE OPTION...
If you get paid via EFT, then it should be simply enough to select Option 2!!
Pages 6 and 7: each must be dated and signed before submission
Part B MUST BE COMPLETED BY A MEDICAL PROFESSIONAL who is a LICENSED practitioner of the healing arts acting within the scope of his/her LICENSE - either directly involved in the care or has access to the medical records.
Page 8: Your name and the date of injury is filled in? Was injury the result of a Traumatic Brain Injury (TBI) or Other Than a Traumatic Brain Injury (OTI)?
- INPATIENT only hospitalization/rehabilitation: MUST BE 15 CONSECUTIVE DAYS or more (this does include any transportation time to/from hospitals and inpatient rehabilitation facilities.)
SUBSTANTIATING DOCUMENTS This comprises a list of documents that may or may not apply to your specific type of injury but are necessary to support your application for benefits:
1. Portions of your medical record that pertains to the injury STARTING immediately after the injury occurred
2. Need copies of admission/discharge for all hospitals, rehabilitation facilities, emergency room visits, etc.
3. ALL surgeon summaries and follow up visits
4. Radiologist reports need ONLY THE RADIOLOGIST LISTS THEIR FINDINGS and IMPRESSION - DO NOT send x-rays
5. Occupational/Physical therapy notes- NOT DAILY NOTES but ONLY 1 every 2-3 WEEKS, preferably evaluations/reevaluation notes;
shows goals, progress, setbacks, changes order by primary doctor, etc.
6. IF applicable (not everyone will need to have these)
Full legal POLICE REPORT 3-5 pages, Ambulance and/or Emergency Department Admission / Line of Duty / Full copy of Physical Evaluation Board (PEB) / Full copy of Medical Evaluation Board (MEB) / NCIS
7. PHOTOS are for BURN victims only, to show the body area suffering the burns.
LES-The requirement for an LES for the MONTH of INJURY is required and if your injury is more than 11 months past you will need to contact DFAS: The DFAS Customer Care Center at 1-888-332-7411 or 1-800-321-1080 and follow the automated menu choices for "General Pay Information" and are connected with a representative within a couple of minutes. Once they verify your identity, they will forward the LES that is requested that same day, on or about...
When requesting information from DFAS you can email based on the last 3 of each persons' SSN.
You also need to provide your most recent copy of your Servicemembers Group Life Insurance ONLINE Enrollment. Per NAVADMIN 085/17, Navy members were to validate/change your SGLI or Family (FSGLI) coverage NLT APRIL 2018. This replaced your SGLV 8286.
Sailors access SOES by navigating to My Navy Portal at https://my.navy.mil and selecting the milConnect tab, and once logged into milConnect, selecting the "SOES" option under the "Benefits" tab. Access requires a Common Access Card, DFAS (my Pay) account, or DS LOGON account.
You can seek assistance from your local Navy Wounded Warrior/Safe Harbor (NWW/SH) staff as they are a great asset in completing this and submitting all the documentation via AMRDEC to protect your PII and HIPPA. NWW staffs are associated with all of the major military hospitals and fleet concentration centers.
If you were inpatient at a military hospital/clinic, you were assigned a REGISTERED NURSE CASE MANAGER – they can assist as well; they ARE licensed TO SIGN and can fill out the majority of this WITH you.
OTHER Specific Guidance
* All FACIAL RECONSTRUCTION claims must have page 9 signed by a facial specialist/ maxillofacial/ oral surgeon, that clearly shows an AVULSION (a wound caused by the tearing away of tissues, bone, and/or cartilage.) but the rest of the claim can still be completed by any other licensed provider, such as your PCM. What does NOT qualify: broken nose, fractured eye sockets, fractured jaw unless there is missing bone/skin/muscle…
* LIMB SALVAGE - must have clear evidence of multiple surgeries related to saving limb rather than amputation; include all the surgeon's summaries that demonstrates or shows without medical intervention, such as removing NECROSIS (death) of muscle, bone, tissue for maintaining healthy regrowth, skin grafts, allographs, tissue/bone/vein grafting, etc.
* HEARING LOSS: provide audiogram demonstrating loss of hearing is not expected to improve (with reasonable certainty) throughout your life, or a total and permanent loss, of 80 decibels or more.
- Loss caused by IED blast that ruptures tympanic membrane (ear drum) can be permanent
- Hearing Acuity must be measured at 500 Hz, 1000 Hz, and 2000 Hz to calculate the average hearing threshold.
- Loss of hearing must be clinically stable and unlikely to improve at 80 decibels or higher.
* LOSS OF SIGHT is when loss of sight that has lasted at least 120 days or is not expected to improve (with reasonable certainty) throughout your life; requires copies of field acuity tests [unless physical loss of eye is being claimed]
* AMPUTATION of any limb is self-explanatory; however, fingers/toes:
- Amputation of four fingers (or a thumb) on the same hand (not including the thumb) at or above* the metacarpophalangeal joint (in the standard refers to the loss being closer to the body)
- Amputation of four toes (or a big toe) on one foot (not including the big toe) at or above* the metatarsophalangeal joint (in the standard refers to the loss being closer to the body)
- Losing tip of a finger(s) or to the 2nd knuckle does not qualify
* BURNS: When a member suffers burns, the member is eligible for a TSGLI benefit for burns if the member meets one of the following two standards:
- 2nd degree (partial thickness) or worse burns to 20% of the body including the face and head OR
- 2nd degree (partial thickness) or worse burns to 20% of the face only
Note: COLOR PHOTOS ARE REQUIRED!
Note: Correctly completed claims and paperwork can take between 45 and 90 days. Incomplete claims where further paperwork is needed can take longer.
Should you have any questions regarding the above guidance, please send an email, and we will provide further guidance.
Navy Personnel Command
Navy Casualty Office, PERS-00C (TSGLI)
5720 Integrity Dr.
Millington, TN 38055-6200
Toll Free: 1-800-368-3202 and ask for TSGLI Admin
Email: MILL_TSGLI.FCT(AT)NAVY. MIL