IN THE CASE OF: BOARD DATE: 21 April 2016 DOCKET NUMBER: AR20150003612 BOARD VOTE: _________ _______ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING ____X____ ____X__ ____X___ DENY APPLICATION 2 Enclosures 1. Board Determination/Recommendation 2. Evidence and Consideration IN THE CASE OF: BOARD DATE: 21 April 2016 DOCKET NUMBER: AR20150003612 BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. _____________X___________ CHAIRPERSON I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case. IN THE CASE OF: BOARD DATE: 21 April 2016 DOCKET NUMBER: AR20150003612 THE BOARD CONSIDERED THE FOLLOWING EVIDENCE: 1. Application for correction of military records (with supporting documents provided, if any). 2. Military Personnel Records and advisory opinions (if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests, in effect, approval of his Traumatic Servicemembers' Group Life Insurance (TSGLI) claim for an additional $75,000.00 (a total award of $100,000.00). 2. The applicant states: a. His medical discharge resulted in a subsequent eligibility to file a retroactive TSGLI claim. b. His initial claim was approved for $25,000.00. The remaining $75,000 to which he was entitled is payable for his inability to perform activities of daily living (ADLs). c. His condition began on the date of the accident and is a direct result of the accident itself. The inability to perform ADLs has continued from the date of the accident to the present day. d. TSGLI is payable for his conditions in increments of $25,000.00 for every consecutive 30-day period. He meets the requirements for full payment of $100,000 and his record should be corrected to reflect this amount. e. The time lapse between his eligibility to legally file a claim and the date of his injury created a nearly insurmountable and unreasonable burden to obtain documentation of his injuries and their lasting effects on his daily life. 3. The applicant provides: * TSGLI Appeal addressed to the Army Review Boards Agency (ARBA) * Letter, addressed to the Army Board for Correction of Military Records (ABCMR), undated and unsigned * Narrative regarding Public Law 111-275 * TSGLI Loss Standards * TSGLI ADL definitions * Memorandum For Record, Subject: Medical Care of [applicant], dated 4 May 2006 * Memorandum, Subject: Physical Disability Board of Review (PDBR) Recommendation on [applicant] Case Number PD-2009-00027, dated 25 February 2010 * Letter, from the Deputy Assistant Secretary (Army Review Boards), dated 3 March 2010 * Letter, from the Department of Veteran Affairs (DVA), Des Moines, IA, dated 4 August 2010 * Four TSGLI ADL Worksheets, dated 11 August 2011 * SGLV 8600 (Application for TSGLI Benefits), 11 August 2011 * Prudential Electronic Payment Notification, dated 4 October 2011 * Letter from Prudential, dated 16 February 2012 * Letter, from Chief, Special Compensations Branch (TSGLI), U.S. Human Resources Command (HRC), Fort Knox, KY, dated 24 September 2012 * Letter of appeal addressed to HRC, undated * Letter, from Chief, Special Compensations Branch, HRC, dated 19 February 2014 CONSIDERATION OF EVIDENCE: 1. Title 10, U.S. Code, section 1552(b), provides that applications for correction of military records must be filed within 3 years after discovery of the alleged error or injustice. This provision of law also allows the ABCMR to excuse an applicant's failure to timely file within the 3-year statute of limitations if the ABCMR determines it would be in the interest of justice to do so. While it appears the applicant did not file within the time frame provided in the statute of limitations, the ABCMR has elected to conduct a substantive review of this case and, only to the extent relief, if any, is granted, has determined it is in the interest of justice to excuse the applicant's failure to timely file. In all other respects, there are insufficient bases to waive the statute of limitations for timely filing. 2. The applicant enlisted in Regular Army on 20 January 1999. 3. He served in Kuwait and Iraq from 10 March 2003 to 17 June 2003. 4. His record shows he was injured in a motorcycle accident on 25 August 2005. He sustained a severely comminuted fracture of the right patella that required surgical removal of the right knee cap. His Enlisted Record Brief shows he was assigned to Fort Carson, CO at the time of his accident. 5. He provided a Memorandum for Record, issued by Dr. JRP, an Orthopedic Services, Staff Orthopedic Surgeon, from the Fort Carson Medical Department Activity, Fort Carson CO, on 4 May 2006. Dr. JRP stated the applicant suffered a massively comminuted open fracture of his patella on 25 August 2005; underwent a patellectomy and a chondroplasty of the distal femur; had not regained the ability to walk comfortably; relied upon a cane and a brace to allay instability of his knee; and had been faithful in his Physical Therapy rehabilitation process. The surgeon stated the applicant's injury had produced a significant and permanent change in his life. The applicant was unable to exercise in an accustomed manner, couldn't walk without external aids, couldn't climb stairs, couldn't kneel or squat, and couldn't perform his military duty. The surgeon also stated the applicant was in the process of obtaining a medical discharge, he had no current civilian job prospects, and his future occupational pursuits had been altered drastically and permanently. The surgeon further stated there was a very real possibility of future reconstructive surgery for his knee. 6. His record contains a voided DD Form 214 (Certificate of Release or Discharge) showing he was honorably discharged by reason of disability, with severance pay on 4 October 2006. 7. His record contains a VA rating decision, dated 14 July 2007, showing the VA awarded him combined rating of 70 percent (%) for the following service-connected disabilities: * right knee instability status post-surgical removal of patella - 30% * irritable bowel syndrome associated with fibromyalgia - 30% * fibromyalgia - 10% * left knee patellofemoral syndrome - 10% * right knee patellofemoral syndrome - 10% * tinnitus - 10% * right ear hearing loss - 0% * residuals of kidney stones - 0% * surgical scar on right knee - 0% 8. He provided a memorandum, dated 25 February 2010, from the Deputy Director, PDBR informing the ARBA that the applicant's separation was recharacterized to reflect permanent disability retirement with combined disability rating of 30%. 9. He provided a letter, from the Deputy Assistant Secretary (Army Review Boards), dated 3 March 2010 notifying him of acceptance of the recommendation of the Department of Defense (DoD) PDBR to recharacterize his separation as a disability retirement with the combined disability rating of 30% effective the date of his medical separation for disability with severance pay. The official informed him that the accepted DoD PDBR recommendation was forwarded to respective Army agencies for required correction of records and to the U.S. Defense Finance and Accounting Service to make the necessary adjustment to his pay and allowances. 10. Orders Number 076-0022, issued by the Installation Management Command, Fort Carson, CO on 17 March 2010 directed his retirement from active duty by reason of a permanent physical disability on 4 October 2006 placed him on the retired list on 5 October 2006. 11. He was issued a new DD Form 214 showing he was honorably retired by reason of disability, permanent, on 4 October 2006. 12. He provided a VA rating decision, dated 4 August 2010, informing him that the service-connected ratings for conditions of non-obstructive coronary artery disease with premature ventricular contractions (60%) and Post Traumatic Stress Disorder with major depressive disorder (50%) had not changed. The letter indicates he was given an overall or combined rating of 100%. 13. He provided four TSGLI ADL worksheets, signed by Dr. TV (a doctor of osteopathic medicine (D.O.)), on 11 August 2011. These worksheets contain a field marked "Date Examined." Dr. TV did not make an entry in this field. a. The narrative summary states, while serving on active duty, the applicant was involved in a motor-vehicle accident at Fort Carson, CO on 25 August 2005. He injured his right knee as a result of the accident and required surgery and removal of the patella, which resulted in permanent right knee instability. b. This form also shows the applicant was unable to perform the ADLs of: (1) Bathing - he required physical assistance and stand by assistance from 25 August 2005 to 25 October 2005 (ongoing). He "uses bars and has [a] brace to prevent falling. He is not able to wear [the] brace into [the] shower/bath tub. [He] requires hands on assistance getting into and out of [the] shower/bath tub to prevent falling... and [He] needs physical assistance with bathing." (2) Dressing - he required physical assistance and stand by assistance from 25 August 2005 to 25 October 2005 (ongoing). Putting on his "Pants and shoes require physical assistance. [He] has a leg brace on [his] right leg." (3) Toileting - he required physical assistance and stand by assistance from 25 August 2005 to 25 October 2005. He "has [a] leg brace, [and] requires hands on assistance getting on and off [the] commode." (4) Transferring - he required physical assistance and stand by assistance from 25 August 2005 to 25 October 2005. He "Has [a] leg brace, [and] requires hands on assistance to prevent falling." 14. His record contains an SGLV Form 8600, dated 11 August 2011. This form shows: a. Part A (Member's Claim Information and Authorization), was completed by the applicant. The applicant stated in Part A, item 3 (Traumatic Injury Information), that he was injured on 25 August 2005, in a motor-vehicle accident. He left his office at Fort Carson, CO on his motorcycle at approximately 5:30 P.M. on 25 August 2005. He was traveling east on a two way road when his motorcycle was struck by another vehicle. When the vehicle struck he was thrown off his motorcycle onto the street. He suffered a massively comminuted fracture (fracture in which the bone is splintered or crushed) of the right patella. The fracture to his patella required a total patellectomy of his right leg. Additionally, a small portion of his femur had to be debrided. He also suffered from "road rash" and numerous cuts and bruises. He was on convalescent leave for 30 days following the accident. He was also on restricted duty for the remainder of his time on active duty. He was medically retired from the Army due to the lasting effects of the injuries he sustained in the accident. He suffered from an inability to perform ADLs. He continued to suffer from his physical disabilities. He was/is unable to work and continued to require assistance with simple tasks. This was evidenced by the fact that his wife had been approved for the VA caregiver program. b. Part B (Medical Professional's Statement) was completed by Dr. TV (D.O.). (1) In Part B, item 2 (Reason for Inpatient Hospitalization), Dr. TV indicated/stated the predominant reason the applicant was hospitalized was for "other traumatic injury." Dr. TV also indicated the applicant was transported/admitted to the first hospital [Evans Army Community Hospital, Fort Carson, CO] on 25 August 2005 and discharged from the last hospital on 27 August 2005. (2) In Part B, item 3 (Qualifying Losses Suffered by Patient) Dr. TV states the predominant reason the applicant was unable to independently perform ADLs was due to "Limb Salvage... Salvage of right leg… Limb Salvage is defined as: A series of operations designed to avoid amputation of an arm or leg while at the same time maximizing the limb's functionality. The surgeries typically involve bone and skin grafts, bone resection, reconstructive and plastic surgeries and occur over a period of months or years." Dr. TV also stated the applicant had surgery on 25 August 2005, and indicated the surgical notes were not available. Dr. TV listed his name and placed his signature in the blocks marked "Name of Surgeon" and "Signature of Surgeon" on 24 August 2011. However, he lined through both block titles to indicate he was not the surgeon. Dr. TV further states/indicated: (a) The predominant reason the applicant is/was unable to independently perform the ADLs was due to "Other Traumatic Injury." On 25 August 2005, the applicant was in a motor-vehicle accident at Fort Carson, CO. The applicant's right knee was injured. He required surgery and the removal of his patella, which resulted in a permanent instability of the right knee. (b) The applicant had been unable to perform the ADL of bathing independently, since 25 August 2005 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). Dr. TV made the following entry in the item/block marked "describe the assistance needed": "uses bars and has brace to prevent falling." This form states a patient is UNABLE to bathe independently if he or she requires assistance from another person to bathe (including sponge bath) more than one part of the body or get in or out of the tub or shower. (c) The applicant was unable to perform the ADL of dressing, since 25 August 2005 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). Dr. TV made the following entry in the item/block marked "describe the assistance needed": "pants and shoes require assistance." This form states a patient is UNABLE dress independently if he/she requires assistance from another person to get and put on clothing, socks, or shoes. (d) The applicant was unable to perform the ADL of toileting independently, from 25 August 2005 to 25 September 2005 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). Dr. TV made the following entry in the item/block marked "describe the assistance needed": "while hospitalized and 45 days after." This form states a patient is UNABLE toilet independently if he/she requires assistance from another person for any of the following: going to and from the toilet, getting on and off the toilet, cleaning self after toileting, getting clothing of and on. (e) The applicant was unable to perform the ADL of transferring independently, from 25 August 2005 to 25 September 2005 because he needed physical assistance (hands-on). Dr. TV made the following entry in the item/block marked "describe the assistance needed": "while hospitalized and 45 days after." This form states a patient is UNABLE transfer independently if he/she requires assistance from another person to move into or out of a bed or chair. c. In Part B, item 5 (Medical Professional's Comments), Dr. TV stated the applicant "requires [a] complex, mechanical/electrical brace for walking and ADLs. This assistance will be lifelong. After injury [applicant] was incapacitated for 45 days." d. In Part B, item 7 (Medical Professional's Signature) Dr. TV indicated his specialty was in family practice. Dr. TV checked a box stating, "I have observed the patient's loss" and a box "I have not observed the patient's loss but I have reviewed the patient's medical records." Dr. TV further acknowledged by affixing his signature to this document that, "This Medical Professional's Statement is based upon my examination of the patient and/or, a review of pertinent medical evidence. I understand the patient and/or I may be asked to provide supporting documentation to validate eligibility under law." Dr. TV dated his portion of the form on 24 August 2005. 15. On 15 September 2011, Prudential insurance company paid him $25,000.00 as a result of his TSGLI claim for inability to perform two or more ADLs due to "other traumatic injury" for 30 days. 16. The evidence of record shows his second TSGLI application was received by HRC on or about 6 December 2011 and was denied on 25 January 2012. 17. On 16 February 2012, the Prudential Office of TSGLI advised the applicant that his branch of service had evaluated his claim for Traumatic Injury Protection under TSGLI benefits. His claim for the inability to perform ADLs could not be approved. The agency further stated: a. He was previously awarded $25,000 for the loss of ADLs for 30 days due to traumatic injury. b. His claim for limb salvage of the right leg was not approved by his branch of service because his loss did not meet the TSGLI standard. Under TSGLI, limb salvage is defined as a series of operations designed to avoid amputation of an arm or a leg while at the same time maximizing the limb's functionality. The surgeries typically involve bone and skin grafts, bone resection, reconstructive and plastic surgeries and often occur over a period of months or years. A surgeon must certify surgeries defined as limb salvage. c. His claim for hospitalization was not approved because his loss did not meet the TSGLI standard. Under TSGLI, hospitalization is defined as an inpatient hospital stay, which lasts for 15 or more consecutive days in a hospital or series of hospitals accredited as a hospital under the Hospital Accreditation Program of the Joint Commission on Accreditation of Healthcare Organizations. This includes Combat Support Hospitals, Air Force Theater Hospitals, and Navy Hospital Ships. d. His claim for other traumatic injury for an inability to perform ADLs for 60 days due to traumatic injury was not approved because his loss did not meet the standards for TSGLI. To qualify, a claimant must have been unable to independently perform at least two ADLs for at least 60 days. The claimant is considered unable to perform an activity independently only if he or she requires at least at least one of the following, without which they would be incapable of performing the task: * physical assistance (hands-on) * stand-by assistance (within arm's reach) * verbal assistance (must be instructed) e. The inability to perform two or more ADLs for at least 60 days must also have been certified by a medical professional. f. The maximum amount payable for all losses covered resulting from a single traumatic event is limited, under the law, to $100,000. g. He was informed he had the right to submit an appeal within one year of the date of the memorandum to the HRC Special Compensation Branch (TSGLI). 18. The evidence of record shows the HRC Special Compensations Branch (TSGLI) reconsidered his TSGLI application on or about 29 June 2012. 19. The HRC Special Compensations Branch (TSGLI) denied the applicant's request for reconsideration in a memorandum, dated 24 September 2012. The memorandums states, HRC was unable to overturn the previous adjudication. The medical documentation submitted did not indicate his loss met the TSGLI minimum standard. The medical records he submitted did not contain any evidence to show his right leg was in significant jeopardy or that amputation was contemplated or offered in lieu of other more conservative treatment. Additionally, the medical documents he submitted did not indicate that his injury caused additional ADL losses beyond the 30-day milestone, for which he was previously paid. HRC informed the applicant that he could submit an appeal to the Special Compensation Branch (TSGLI). 20. The applicant submitted an undated, unsigned memorandum appealing the 24 September 2012 TSGLI decision, wherein he stated: a. He had submitted his appeal on many occasions via fax and mail. Eventually a staff member he spoke to admitted he had been given incorrect information on how to file his appeal and his appeal had been either lost or misplaced. As a result, the process took longer than it should. b. The ability to file a TSGLI claim for his injuries was not granted until 1 October 2010, when the Veterans' Benefits Improvement Act of 2010 allowed retroactive filings for injuries not incurred in Operations Iraqi Freedom or Enduring Freedom. This delay of six years placed him at a significant disadvantage because it was so difficult to obtain the appropriate medical documentation after the fact. c. He also stated he acquired all the documents he needed and conducted all the pertinent research that applied to him, specifically. He is entitled to the additional TSGLI monies. He is extremely frustrated his claim continues to be denied, but not surprised. The Services seem to rubber stamp a denial on most veteran's requests pertaining to benefits in the hopes the veteran will become frustrated and give up. He has had to fight for every benefit and accommodation he received since the accident. 21. The evidence of record shows his TSGLI application was reconsidered on or about 4 December 2013. 22. An appeal summary revealed the Appeals Review Panel recommended denial of the applicant's appeal on 10 February 2014. The summary stated the panel voted 4 out of 4 to recommend denial of the appeal for limb salvage because the medical records did not indicate the limb was in jeopardy of amputation and amputation was not offered as a treatment option. The appeal recommended denial for ADL loss because the documents provided suggested the applicant was able to perform ADLs with modified independence prior to day 60. 23. The HRC Special Compensations Branch (TSGLI) denied the applicant's request for reconsideration in a memorandum, dated 19 February 2014. The memorandums states, HRC was unable to overturn the previous adjudication. The agency stated: a. The applicant had been previously awarded $25,000 for loss of ADLs for 30 days for his event, which took place on 25 August 2005 in "Afghanistan." The medical documents submitted did not indicate he was incapable of performing the ADLs of toileting, dressing, bathing, or transferring for greater than 60 consecutive days, which was the next milestone required for further payment, per TSGLI guidelines. b. The applicant's medical documents submitted did not indicate he met the TSGLI standard for limb salvage in place of amputation. The documentation provided did not indicate that a series of operations were performed that were designed to avoid amputation while simultaneously maximizing the limb's functionality, per the TSGLI guidelines. c. The applicant has the right to apply to the Army Review Boards Agency in addition to having the right to file suit in federal court to contest an adverse TSGLI decision. 24. He provided a letter, undated, appealing the denial of his previous appeal for TSGLI benefits. He stated in previous appeals that there was a significant delay in his application for benefits. This delay was a direct result of Public Law 111-275 that removed the requirements for TSGLI related injuries to have occurred in Operation Iraqi Freedom/Operation Enduring Freedom. He also stated HRC did not thoroughly review the evidence he provided and as a result, his previous appeals were incorrectly adjudicated and denied. He further stated: a. His injuries were sustained on 25 August 2005. Public Law 111-275 was not enacted until 1 October 2011. b. The doctor in the Emergency Room at the Evans Army Hospital told him that he would probably lose his military career and there was a possibility he might lose his leg at or above the knee. His life changed the day of the accident. He immediately began transitioning out of the military although he had planned on a career as a Soldier. c. He was paid at the first tier of $25,000 when his original claim was submitted, but his subsequent claims were denied. HRC disregarded all the evidence he provided. He submitted notes from the surgeon, records from the PDBR (disability rating increased from 0% to 30%), and treatment records from his physical therapists and orthotics providers showing his initial medical board was improperly administered. d. He provided a Department of Veterans Affairs (VA) Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) that was approved by the VA for the VA Caregiver Program's highest tier. The VA has completed a clinical review of his case and maintained his third tier rating. The VA Caregiver Program ratings system is based on the inability to independently complete ADLs. His rating is severe enough to require attendance from his wife for numerous ADLs and the VA compensates her at the highest possible level. e. It is apparent that the main issue preventing full compensation for TSGLI is a lack of documentation. The changes in legislation have hampered his ability to present an effective case. The significant lapse in time, from the date of his injury to the date of eligibility to file a claim (over six years), meant he would have been expected to document and maintain records to justify a claim he was not eligible to file. He also stated that it places an unreasonable burden on the claimant to produce records from six years after a career ending injury. However, he has provided significant documentation of the medical board proceedings, an VA Form 21-2680, documentation from the PDBR, a letter from his surgeon, treatment records, case law, and various other records that substantiate his claim. The documentation he has provided demonstrates an undeniable preponderance of evidence. f. His injuries resulted from military service. He has been unable to perform ADLs independently since the accident and he continues to demonstrate the same or significantly worse problems. According to the TSGLI Procedural Guide, to qualify for compensation at the highest level (specifically for inability to perform ADLs) requires a consecutive period of inability to perform two or more ADLs for a period of 90 days. He has had 3,371 consecutive days of inability to perform no less than three ADLs. He was never able to return to full duty following his accident. He went back to work but was on restricted duty until his discharge a year later. g. He outlined the inaccuracies in the correspondence, dated 19 February 2014, from the Special Compensations Branch (TSGLI). (1) He cites the second paragraph of the correspondence, which states, "You have been previously awarded $25,000 for loss of ADLs for 30 days for your event which took place on 25 August 2005 in Afghanistan." He states he wasn't deployed to Afghanistan, but he was deployed to Iraq in 2003, two years prior to motorcycle accident. He didn't sustain the injuries while deployed. He was stationed at Fort Carson, CO and was injured while he was on the installation. It is clear that his claim was improperly reviewed and the only thing that's correct is the date of the accident and that he was paid for the first 30 days. (2) The correspondence also states, "The medical documents submitted did not indicate you were incapable of performing the ADLs of toileting, dressing, bathing, or transferring for greater than 60 consecutive days, which is the next milestone required for further payment per TSGLI Guidelines." He references the TSGLI Guidelines, dated 26 February 2014 regarding eligibility for TSGLI benefit for ADL, definitions for physical, stand-by, and verbal assistance, member's rights to file suit in federal court. h. The medical documentation provided actually states that not only did he require assistance with his ADLs for more than 120 days; he continues to require assistance with his ADLs. His spouse was the first VA Caregiver in the nation to be certified. He requires daily assistance with bathing, dressing, and preparing meals. These requirements are clearly documented on the SGLV Form 8600 submitted with the original claim which was completed and certified by his treating physician. i. The only possible determination is an affirmative claim resulting in full payment of the remaining $75,000.00 of benefits to which he is entitled. Failure to properly adjudicate his claim again will leave him no alternative but to proceed with a legal filing in federal court. REFERENCES: 1. Public Law 109-13, signed by the President on 11 May 2005, established the TSGLI program. The TSGLI program was established by Congress to provide relief to Soldiers and their families after suffering a traumatic injury. TSGLI provides between $25,000.00 and $100,000.00 to severely injured Soldiers who meet the requisite qualifications set forth by DOD. As of December 2005, TSGLI is included as part of a Soldier's SGLI coverage. Any Soldier who elected SGLI coverage automatically receives TSGLI coverage with an additional $1.00 taken out each month to cover the cost of the TSGLI policy. Soldiers paying for SGLI coverage cannot decline TSGLI -- it is a package. In addition, there is a retroactive program in which Soldiers who incurred a qualifying traumatic injury from 7 October 2001 through 30 November 2005 while supporting Operation Iraqi Freedom and Operation Enduring Freedom or under orders in a Combat Zone Tax Exclusion area are covered regardless of whether they elected SGLI coverage or not. Soldiers who elect SGLI coverage and incur a qualifying traumatic injury after 1 December 2005 (with the exception of some specific circumstances under which a traumatic injury will not be covered), regardless of their component or the location in which they incurred the injury will be covered by TSGLI. 2. There are some specific circumstances under which a traumatic injury will not be covered by TSGLI. A qualifying traumatic injury is an injury or loss caused by a traumatic event or a condition whose cause can be directly linked to a traumatic event. Traumatic injuries covered may include, but are not limited to the following types of losses: total and permanent loss of sight in one or both eyes, loss of hand or foot by severance at or above the wrist or ankle, total and permanent loss of hearing in one or both ears, loss of speech, loss of thumb and index finger of the same hand by severance at or above the metacarpophalangeal joints, quadriplegia, paraplegia or hemiplegic, third (3rd) degree or worse burns covering 30% of body or 30% of the face, and coma or TBI. 3. The six ADLs are dressing, bathing, toileting, eating, continence, and transferring. TSGLI claims may be filed for loss of ADLs if the claimant is completely dependent on someone else to perform two of the six ADLs for 30 days or more. ADL loss must be certified by a healthcare provider in Part B of the claim form, and ADL loss must be substantiated by appropriate documentation, such as Occupational/Physical Therapy Reports, Patient Discharge Summaries, or other pertinent documents demonstrating the injury type and duration of ADL loss. While TSGLI claims will not be approved without a certification from a healthcare provider, additional documentation must be provided to substantiate the certification. 4. TSGLI - Procedural Guidelines provides the following definitions: a. Limb Savage - A series of operations designed to avoid amputation of an arm or a leg while at the same time maximizing the limb’s functionality. The surgeries typically involve bone and skin grafts, bone resection, reconstructive, and plastic surgeries and often occur over a period of months or years. b. Inpatient Hospitalization - A member who is hospitalized as an inpatient for 15 consecutive days as the result of a traumatic injury is eligible for a $25,000 payment under TSGLI. The following general rules apply to the inpatient hospitalization benefit. (1) Inpatient hospitalization days include transportation time from the site of the injury to the hospital, transfers from one hospital to another, the day of admission and the day of release. (2) Payment for a 15-day inpatient hospital stay replaces the first ADL milestone payment only and can only be issued once per qualifying traumatic event. Subsequent periods of 15-day inpatient hospitalization due to the same traumatic injury do not qualify for an additional benefit. (3) Combinations of inpatient hospitalization and ADL loss must be continuous (occur on consecutive days) to qualify for the second ADL milestone payment. (4) Inpatient hospitalization for fewer than 15 days and inpatient hospitalization for non-consecutive days is not eligible for the TSGLI benefit. (5) Inpatient hospitalization for coma/TBI may be combined with other injuries provided the inpatient hospitalization is primarily due to TBI or coma. (6) Inpatient hospitalization for traumatic injuries other than coma/TBI may not be combined with other injuries. (7) Inpatient hospitalization for illnesses and diseases is not covered under TSGLI (except for disease caused by a pyogenic infection, biological, chemical, or radiological weapon, or accidental ingestion of a contaminated substance). c. Member is hospitalized due to OTI - When a member is hospitalized as an inpatient for 15 consecutive days and the hospitalization is due to a traumatic injury other than Coma/TBI, payment for inpatient hospitalization replaces the 30-day other traumatic injury ADL milestone. DISCUSSION: 1. The evidence of record shows the applicant was involved in a motorcycle accident and sustained a severely comminuted fracture of his right patella on 25 August 2005 while stationed in Fort Carson, CO. He subsequently underwent surgery for removal of the knee cap for the salvage of his right leg. 2. He initially filed a TSGLI claim and received a payment of $25,000.00 based on his inability to perform two ADLs for 30 consecutive days due to other traumatic injury. 3. The evidence of record shows the applicant applied for additional TSGLI benefits on or about December 2011 for limb salvage of the right leg, hospitalization, and inability to perform ADLs for 60 days or more due to other traumatic injury. HRC denied his request. a. Based on the TSGLI guidelines, a member is eligible for TSGLI benefit for limb salvage if he or she had a series of operations designed to avoid amputation of an arm or a leg while at the same time maximizing the limb’s functionality. The surgeries typically involve bone and skin grafts, bone resection, reconstructive, and plastic surgeries and often occur over a period of months or years. The applicant did not meet this TSGLI standard. b. The applicant's TSGLI application shows he was hospitalized for less than 15 consecutive days. Based on the TSGLI guidelines, inpatient hospitalization for fewer than 15 days and inpatient hospitalization for non-consecutive days is not eligible for the TSGLI benefit. 3. In order to qualify for increased TSGLI benefits, the applicant must have been unable to perform at least 2 ADLs independently for more than 60 consecutive days. A member is considered unable to perform an activity independently if he or she requires at least one of the following without which they would be incapable of performing the task: physical assistance (hands on); stand by assistance (within arm's reach), or verbal assistance (must be instructed). In addition, the ADL loss must have been certified by a healthcare provider and substantiated by appropriate documentation, such as occupational therapy/physical therapy reports, discharge summaries, and other medical documentation. The applicant did not provided the Board with any such medical documentation to substantiate his claim. 4. There is no evidence in the available records that serves as sufficient evidence. Additionally, the applicant has not provided sufficient evidence to meet the qualifications for TSGLI as set forth by law, such as documentation to show he required assistance and was dependent on someone else for performance of ADLs for the required period as the result of a traumatic event/injury or that he was hospitalized for 15 consecutive days. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20150003612 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20150003612 16 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2