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38 U.S.C. § 1980A — Traumatic injury protection

Federal law — U.S. Code and appendices · legal_authorities

38 U.S.C. § 1980A — Traumatic injury protection

**(a)** (1) A member of the uniformed services who is insured under Servicemembers’ Group Life Insurance shall automatically be insured for traumatic injury in accordance with this section. Insurance benefits under this section shall be payable if the member, while so insured, sustains a traumatic injury on or after December 1, 2005, that results in a qualifying loss specified pursuant to subsection (b)(1). (2) If a member suffers more than one such qualifying loss as a result of traumatic injury from the same traumatic event, payment shall be made under this section in accordance with the schedule prescribed pursuant to subsection (d) for the single loss providing the highest payment. **(b)** (1) A member who is insured against traumatic injury under this section is insured against such losses due to traumatic injury (in this section referred to as “qualifying losses”) as are prescribed by the Secretary by regulation. Qualifying losses so prescribed shall include the following: (A) Total and permanent loss of sight. (B) Loss of a hand or foot by severance at or above the wrist or ankle. (C) Total and permanent loss of speech. (D) Total and permanent loss of hearing in both ears. (E) Loss of thumb and index finger of the same hand by severance at or above the metacarpophalangeal joints. (F) Quadriplegia, paraplegia, or hemiplegia. (G) Burns greater than second degree, covering 30 percent of the body or 30 percent of the face. (H) Coma or the inability to carry out the activities of daily living resulting from traumatic injury to the brain. (2) For purposes of this subsection: (A) The term “quadriplegia” means the complete and irreversible paralysis of all four limbs. (B) The term “paraplegia” means the complete and irreversible paralys

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Source location: Title 38, Chapter 19, § 1980A; chapter-019-insurance.md

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**(a)** (1) A member of the uniformed services who is insured under Servicemembers’ Group Life Insurance shall automatically be insured for traumatic injury in accordance with this section. Insurance benefits under this section shall be payable if the member, while so insured, sustains a traumatic injury on or after December 1, 2005, that results in a qualifying loss specified pursuant to subsection (b)(1). (2) If a member suffers more than one such qualifying loss as a result of traumatic injury from the same traumatic event, payment shall be made under this section in accordance with the schedule prescribed pursuant to subsection (d) for the single loss providing the highest payment. **(b)** (1) A member who is insured against traumatic injury under this section is insured against such losses due to traumatic injury (in this section referred to as “qualifying losses”) as are prescribed by the Secretary by regulation. Qualifying losses so prescribed shall include the following: (A) Total and permanent loss of sight. (B) Loss of a hand or foot by severance at or above the wrist or ankle. (C) Total and permanent loss of speech. (D) Total and permanent loss of hearing in both ears. (E) Loss of thumb and index finger of the same hand by severance at or above the metacarpophalangeal joints. (F) Quadriplegia, paraplegia, or hemiplegia. (G) Burns greater than second degree, covering 30 percent of the body or 30 percent of the face. (H) Coma or the inability to carry out the activities of daily living resulting from traumatic injury to the brain. (2) For purposes of this subsection: (A) The term “quadriplegia” means the complete and irreversible paralysis of all four limbs. (B) The term “paraplegia” means the complete and irreversible paralysis of both lower limbs. (C) The term “hemiplegia” means the complete and irreversible paralysis of the upper and lower limbs on one side of the body. (D) The term “inability to carry out the activities of daily living” means the inability to independently perform two or more of the following six functions: (i) Bathing. (ii) Continence. (iii) Dressing. (iv) Eating. (v) Toileting. (vi) Transferring. (3) The Secretary may prescribe, by regulation, conditions under which coverage otherwise provided under this section is excluded. (4) A member shall not be considered for the purposes of this section to be a member insured under Servicemembers’ Group Life Insurance if the member is insured under Servicemembers’ Group Life Insurance only as an insurable dependent of another member pursuant to subparagraph (A)(ii) or (C)(ii) of [section 1967(a)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1967/a/1&num=0&edition=prelim). **(c)** (1) A payment may be made to a member under this section only for a qualifying loss that results directly from a traumatic injury sustained while the member is covered against loss under this section and from no other cause. (2) (A) A payment may be made to a member under this section for a qualifying loss resulting from a traumatic injury only for a loss that is incurred during the applicable period of time specified pursuant to subparagraph (B). (B) For each qualifying loss, the Secretary shall prescribe, by regulation, a period of time to be the period of time within which a loss of that type must be incurred, determined from the date on which the member sustains the traumatic injury resulting in that loss, in order for that loss to be covered under this section. **(d)** (1) Payments under this section for qualifying losses shall be made in accordance with a schedule prescribed by the Secretary, by regulation, specifying the amount of payment to be made for each type of qualifying loss, to be based on the severity of the qualifying loss. The minimum payment that may be prescribed for a qualifying loss is $25,000, and the maximum payment that may be prescribed for a qualifying loss is $100,000. (2) As the Secretary considers appropriate, the schedule required by paragraph (1) may distinguish in specifying payments for qualifying losses between the severity of a qualifying loss of a dominant hand and of a qualifying loss of a nondominant hand. **(e)** (1) During any period in which a member is insured under this section and the member is on active duty, there shall be deducted each month from the member’s basic or other pay until separation or release from active duty an amount determined by the Secretary (which shall be the same for all such members) as the share of the cost attributable to provided coverage under this section, less any costs traceable to the extra hazards of such duty in the uniformed services. (2) During any month in which a member is assigned to the Ready Reserve of a uniformed service under conditions which meet the qualifications set forth in [section 1965(5)(B) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1965/5/B&num=0&edition=prelim) and is insured under a policy of insurance purchased by the Secretary under [section 1966 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1966&num=0&edition=prelim), there shall be contributed from the appropriation made for active duty pay of the uniformed service concerned an amount determined by the Secretary (which shall be the same for all such members) as the share of the cost attributable to provided coverage under this section, less any costs traceable to the extra hazards of such duty in the uniformed services. Any amounts so contributed on behalf of any member shall be collected by the Secretary concerned from such member (by deduction from pay or otherwise) and shall be credited to the appropriation from which such contribution was made in advance on a monthly basis. (3) The Secretary shall determine the premium amounts to be charged for traumatic injury protection coverage provided under this section. (4) The premium amounts shall be determined on the basis of sound actuarial principles and shall include an amount necessary to cover the administrative costs to the insurer or insurers providing such insurance. (5) Each premium rate for the first policy year shall be continued for subsequent policy years, except that the rate may be adjusted for any such subsequent policy year on the basis of the experience under the policy, as determined by the Secretary in advance of that policy year. (6) The cost attributable to insuring members under this section for any month or other period specified by the Secretary, less the premiums paid by the members, shall be paid by the Secretary concerned to the Secretary. The Secretary shall allocate the amount payable among the uniformed services using such methods and data as the Secretary determines to be reasonable and practicable. Payments under this paragraph shall be made on a monthly basis or at such other intervals as may be specified by the Secretary and shall be made within 10 days of the date on which the Secretary provides notice to the Secretary concerned of the amount required. (7) For each period for which a payment by a Secretary concerned is required under paragraph (6), the Secretary concerned shall contribute such amount from appropriations available for active duty pay of the uniformed service concerned. (8) The sums withheld from the basic or other pay of members, or collected from them by the Secretary concerned, under this subsection, and the sums contributed from appropriations under this subsection, together with the income derived from any dividends or premium rate adjustments received from insurers shall be deposited to the credit of the revolving fund established in the Treasury of the United States under [section 1869(d)(1) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1869/d/1&num=0&edition=prelim). **(f)** When a claim for benefits is submitted under this section, the Secretary of Defense or, in the case of a member not under the jurisdiction of the Secretary of Defense, the Secretary concerned, shall certify to the Secretary whether the member with respect to whom the claim is submitted— (1) was at the time of the injury giving rise to the claim insured under Servicemembers’ Group Life Insurance for the purposes of this section; and (2) has sustained a qualifying loss. **(g)** (1) Payment for a loss resulting from traumatic injury may not be made under the insurance coverage under this section if the member dies before the end of a period prescribed by the Secretary, by regulation, for such purpose that begins on the date on which the member sustains the injury. (2) If a member eligible for a payment under this section dies before payment to the member can be made, the payment shall be made to the beneficiary or beneficiaries to whom the payment would be made if the payment were life insurance under [section 1967(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1967/a&num=0&edition=prelim). **(h)** Coverage for loss resulting from traumatic injury provided under this section shall cease at midnight on the date of the termination of the member’s duty status in the uniformed services that established eligibility for Servicemembers’ Group Life Insurance. The termination of coverage under this section is effective in accordance with the preceding sentence, notwithstanding any continuation after the date specified in that sentence of Servicemembers’ Group Life Insurance coverage pursuant to [section 1968(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section1968/a&num=0&edition=prelim) for a period specified in that section. **(i)** Insurance coverage provided under this section is not convertible to Veterans’ Group Life Insurance. **(j)** Regulations under this section shall be prescribed in consultation with the Secretary of Defense. **(k) Designation of Fiduciary or Trustee.—** (1) The Secretary concerned, in consultation with the Secretary, shall develop a process for the designation of a fiduciary or trustee of a member of the uniformed services who is insured against traumatic injury under this section. The fiduciary or trustee so designated would receive a payment for a qualifying loss under this section if the member is medically incapacitated (as determined pursuant to regulations prescribed by the Secretary concerned in consultation with the Secretary) or experiencing an extended loss of consciousness. (2) The process under paragraph (1) may require each member of the uniformed services who is insured under this section to— (A) designate an individual as the member’s fiduciary or trustee for purposes of subsection (a); or (B) elect that a court of proper jurisdiction designate an individual as the member’s fiduciary or trustee for purposes of subsection (a) in the event that the member becomes medically incapacitated or experiences an extended loss of consciousness. **(l)** (1) If a claim for benefits under this section is denied, the Secretary concerned shall provide to the member at the same time as the member is informed of such denial a description of the following: (A) Each reason for that denial, including a description of all the information upon which the denial is based and a description of the applicable laws, regulations, or policies, with appropriate citations, and an explanation of how such laws, regulations, or policies affected the denial. (B) Each finding that is favorable to the member. (2) Any finding favorable to the member as described in paragraph (1)(B) shall be binding on all subsequent reviews or appeals of the denial of the claim, unless clear and convincing evidence is shown to the contrary to rebut such favorable finding.

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Federal law — U.S. Code and appendices · legal_authorities

38 U.S.C. § 1966 — Eligible insurance companies

**(a)** The Secretary is authorized, without regard to section 6101(b) to (d) of title 41, to purchase from one or more life insurance companies a policy or policies of group life insurance to provide the benefits specified in this subchapter. Each such life insurance company must (1) be licensed to issue life insurance in each of the fifty States of the United States and in the District of Columbia, and (2) as of the most recent December 31 for which information is available to the Secretary, have in effect at least 1 percent of the total amount of group life insurance which all life insurance companies have in effect in the United States. **(b)** The life insurance company or companies issuing such policy or policies shall establish an administrative office at a place and under a name designated by the Secretary. **(c)** The Secretary shall arrange with the life insurance company or companies issuing any policy or policies under this subchapter to reinsure, under conditions approved by the Secretary, portions of the total amount of insurance under such policy or policies with such other life insurance companies (which meet qualifying criteria set forth by the Secretary) as may elect to participate in such reinsurance. **(d)** The Secretary may at any time discontinue any policy or policies which the Secretary has purchased from any insurance company under this subchapter.

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Federal law — U.S. Code and appendices · legal_authorities

38 U.S.C. § 101 — Definitions

For the purposes of this title— (1) The terms “Secretary” and “Department” mean the Secretary of Veterans Affairs and the Department of Veterans Affairs, respectively. (2) The term “veteran” means a person who served in the active military, naval, air, or space service, and who was discharged or released therefrom under conditions other than dishonorable. (3) The term “surviving spouse” means (except for purposes of chapter 19 of this title) a person who was the spouse of a veteran at the time of the veteran’s death, and who lived with the veteran continuously from the date of marriage to the date of the veteran’s death (except where there was a separation which was due to the misconduct of, or procured by, the veteran without the fault of the spouse) and who has not remarried. (4) (A) The term “child” means (except for purposes of chapter 19 of this title (other than with respect to a child who is an insurable dependent under subparagraph (B) or (C) of section 1965(10) of such chapter) and [section 8502(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section8502/b&num=0&edition=prelim)) a person who is unmarried and— (i) who is under the age of eighteen years; (ii) who, before attaining the age of eighteen years, became permanently incapable of self-support; or (iii) who, after attaining the age of eighteen years and until completion of education or training (but not after attaining the age of twenty-three years), is pursuing a course of instruction at an approved educational institution; and who is a legitimate child, a legally adopted child, a stepchild who is a member of a veteran’s household or was a member at the time of the veteran’s death, or an illegitimate child but, as to the alleged father, onl

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Federal law — U.S. Code and appendices · legal_authorities

38 U.S.C. § 1965 — Definitions

For the purpose of this subchapter— (1) The term “active duty” means— (A) full-time duty in the Armed Forces, other than active duty for training; (B) full-time duty (other than for training purposes) as a commissioned officer of the Regular or Reserve Corps 11 See Change of Name note below. of the Public Health Service; (C) full-time duty as a commissioned officer of the National Oceanic and Atmospheric Administration; and (D) full-time duty as a cadet or midshipman at the United States Military Academy, United States Naval Academy, United States Air Force Academy, or the United States Coast Guard Academy. (2) The term “active duty for training” means— (A) full-time duty in the Armed Forces performed by Reserves, or by members of the Space Force in a space force active status (as defined in [section 101(e)(1) of title 10](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section101/e/1&num=0&edition=prelim)) but not on sustained duty under [section 20105 of title 10](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title10-section20105&num=0&edition=prelim), for training purposes; (B) full-time duty for training purposes performed as a commissioned officer of the Reserve Corps 1 of the Public Health Service; (C) full-time duty as a member, cadet, or midshipman of the Reserve Officers Training Corps while attending field training or practice cruises; and (D) in the case of members of the National Guard or Air National Guard of any State, full-time duty under sections 316, 502, 503, 504, or 505 of title 32, United States Code. (3) The term “inactive duty training” means— (A) duty (other than full-time duty) prescribed or authorized for Reserves (including commissioned officers of the Reserve Corps 1 of the Publ

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Federal law — U.S. Code and appendices · legal_authorities

38 U.S.C. § 1980A — Traumatic injury protection

Page 551 TITLE 38—VETERANS’ BENEFITS § 1980A (2) the procedures under which any such ap- plication shall be considered. (f)(1) An election to receive a benefit under this section shall be irrevocable. (2) A person may not make more than one election under this section, even if the election of the person is to receive less than the max- imum amount of the benefit available to the person under this section. (g) If a person insured under Servicemembers’ Group Life Insurance elects to receive a benefit under this section and the person’s Servicemembers’ Group Life Insurance is there- after converted to Veterans’ Group Life Insur- ance as provided in section 1968(b) of this title, the amount of the benefit paid under this sec- tion shall reduce the amount of Veterans’ Group Life Insurance available to the person under sec- tion 1977(a) of this title. (h) Notwithstanding any other provision of law, the amount of the accelerated death benefit received by a person under this section shall not be considered income or resources for purposes of determining eligibility for or the amount of benefits under any Federal or federally-assisted program or for any other purpose. (Added Pub. L. 105–368, title III, § 302(a)(1), Nov. 11, 1998, 112 Stat. 3332; amended Pub. L. 111–275, title IV, § 405(a), Oct. 13, 2010, 124 Stat. 2880.) Editorial Notes AMENDMENTS 2010—Subsec. (b)(1). Pub. L. 111–275 struck out ‘‘re- duced by an amount necessary to assure that there is no increase in the actuarial value of the benefit paid, as determined by the Secretary’’ after ‘‘death benefit’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2010 AMENDMENT Pub. L. 111–275, title IV, § 405(b), Oct. 13, 2010, 124 Stat. 2880, provided that: ‘‘The amendment made by sub

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