SGLV Form 8284
Traumatic Injury Protection Claim (TSGLI)
You sustained a qualifying traumatic loss while covered by SGLI (on active duty or within 2 years of traumatic injury).
- Who fills it
- service-member-active
- Journey phase
- Filing Your Claim
- Estimated time
- 30-45 minutes plus medical documentation gathering.
- When to file
- As soon as possible after the qualifying traumatic loss is documented.
Official VA form page: https://www.benefits.va.gov/insurance/tsgli.asp
Gather before you start
- ▸Medical records documenting the traumatic injury and resulting losses
- ▸DoD records confirming SGLI coverage at time of injury
- ▸Physician certification of qualifying losses
- ▸Statement of activities of daily living (if claiming ADL loss)
Attach with the form
- ▸Medical records
- ▸Physician certification (SGLV 8284a)
- ▸Proof of SGLI coverage at time of injury
Section I - Service Member Identification
Blocks 1-5Name, SSN, rank, branch, unitPII
Your identifying information at the time of the traumatic injury.
(legal name, SSN, branch, rank at time of injury)
Common mistakes
- ×Not knowing TSGLI applies to traumatic injuries regardless of whether they are service-connected for VA disability purposes - TSGLI is insurance, not compensation.
Section II - Traumatic Injury Details
Blocks 6-12Date and description of traumatic event and resulting losses
Describe the traumatic event and the specific qualifying losses: (1) Total/partial loss of sight, (2) Total/partial loss of hearing, (3) Loss of limb(s) at or above ankle/wrist, (4) Loss of speech, (5) Severe burns (covering 20%+ BSA), (6) Inability to perform ADLs for 15+ consecutive days (bathing, dressing, eating, toileting, transferring). Include medical documentation for each claimed loss.
e.g., IED blast on 03/15/2021; traumatic amputation of right hand above wrist; hearing loss in both ears; unable to perform bathing/dressing/toileting independently for 45 consecutive days.
Common mistakes
- ×Not claiming ADL losses - inability to perform basic self-care for 15+ consecutive days is a qualifying loss even without limb amputation or vision loss.
- ×Not submitting SGLV 8284a (physician certification) with the claim - required documentation.
- ×Missing the 2-year filing deadline from the date of the traumatic injury.
Authority
- 38 USC 1980A - Lump-sum TSGLI for qualifying losses (vision, limb, paralysis, ADLs).
Section III - Certification
Blocks 13-14Claimant signature and datePII
Sign and date. File through your branch TSGLI program manager.
(signature/date)
Common mistakes
- ×Not working with your branch TSGLI office - they coordinate the claim with medical reviewers.
Statutory and regulatory authority
- 38 USC 1980A - Lump-sum TSGLI for qualifying losses (vision, limb, paralysis, ADLs).