IN THE CASE OF: BOARD DATE: 19 January 2017 DOCKET NUMBER: AR20160014601 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: 19 January 2017 DOCKET NUMBER: AR20160014601 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 to amend the decision of the Army Board for Correction of Military Records (ABCMR) set forth in Docket Number AR20140009491, dated 14 January 2015. ______________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: 19 January 2017 DOCKET NUMBER: AR20160014601 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 case comes before the Army Board for Correction of Military Records (ABCMR) on a remand from the U.S. District Court, Western District of Kentucky, Louisville Division. The defendant, the U.S. Government, moved for a voluntary remand of this case so that the Board may reconsider the Plaintiff's (hereinafter referred to as the "applicant") claim for benefits under the Servicemembers' Group Life Insurance Traumatic Injury Protection Program (TSGLI). 2. There was no additional evidence provided in this case. CONSIDERATION OF EVIDENCE: 1. Incorporated herein by reference are military records that were summarized in the previous consideration of the applicant's case by the ABCMR in Docket Number AR20140009491 on 14 January 2015. 2. The United States District Court, Western District of Kentucky, Louisville Division, directed the ABCMR to reconsider the applicant's TSGLI claim. On voluntary remand, the U.S. Government asserted the Board could explain its application of the TSGLI Procedural Guide and address the applicant's claim of procedural error concerning medical opinions. The applicant opposes the reconsideration, arguing the remand would unnecessarily delay resolution of his claim. Based on the aforementioned and at the direction of the Court, the case will be considered by this Board. 3. The applicant enlisted in the U.S. Army Reserve (USAR) on 25 January 2006. He completed one station unit training and was awarded military occupational specialty 31B (Military Police). 4. The applicant was involved in a high-speed, head-on motor vehicle accident on 10 May 2008. He was found to have acute alcohol intoxication on presentation and sustained numerous injuries, including assorted abrasions and contusions, atelectasis (collapsed lung), right eye debris, sinusitis (sinus infection), closed head injury with retrograde amnesia for the car accident (later determined to be benign), and a severely fractured right ankle. He was airlifted to Flagstaff Medical Center (hereinafter referred to as "FMC") in Flagstaff, Arizona. He had surgery the same day to repair the fractured right ankle and was released the following day. 5. During the processing of his original case, the U.S. Army Human Resources Command (HRC) Special Compensation/TSGLI medical consultant provided a summary of the applicant's case submissions, wherein he stated: * the applicant's initial application for TSGLI was received on or about 20 December 2011 and was denied on 23 February 2012 * the applicant's application for reconsideration was received on or about 29 January 2013 and was denied on 8 March 2013 * the applicant's appeal application was received on or about 9 August 2013 and was denied on 7 November 2013 6. The applicant's record contains an SGLV Form 8600 (Application for TSGLI Benefits) dated 22 November 2011. This form shows: a. Part A (Member's Claim Information and Authorization) was completed by the applicant's authorized third party. The party stated in Part A, Item 3 (Traumatic Injury Information), that the applicant had suffered a very serious injury on 10 May 2008, specifically, a traumatic shattered right ankle as a result of a high speed motor vehicle collision in Heber, Arizona. b. Part B (Medical Professional's Statement) was completed and signed by Doctor H., assumed to be the applicant's family practice physician, on 25 November 2011. Doctor H. further initialed the statement: "I have not observed the patient's loss, but I have reviewed the patient's medical records." (1) Part B, Item 3, indicates the predominant reason the applicant was unable to independently perform activities of daily living (ADL) was due to other traumatic injury incurred when he was in a motor vehicle accident that resulted in a closed head injury, multiple contusions, and comminuted closed fractures in his right ankle. He received surgery to repair the fractured ankle and he failed post-operative treatment with braces and a fracture boot, requiring further surgery on 4 September 2009. (a) The applicant was unable to perform the ADL "bath independently" from 10 May 2008 to 10 August 2008 (a period of 93 days) because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). The medical professional made the following entry in the block marked "describe the assistance needed": "Physical and stand-by assistance to bathe and get to tub transfer bench and in and out of clothes, etc." 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 into or out of the tub or shower. (b) The applicant was unable to perform the ADL "dress independently" from 10 May 2008 to 10 August 2008 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). The medical professional made the following entry in the block marked "describe the assistance needed": "Physical and stand-by assistance especially for pants because of poor balance, braces and bandages and medication increased risk of fall." This form states a patient is UNABLE to dress independently if he/she requires assistance from another person to get and put on clothing, socks, or shoes. (c) The applicant was unable to perform the ADL "toilet independently" from 10 May 2008 to 10 August 2008 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). The medical professional made the following entry in the block marked "describe assistance needed": "Physical and stand-by assistance to sit or stand or balance with non-weight bearing on right leg." This form states a patient is UNABLE to toilet independently if he/she must use a bedpan or urinal to toilet or 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 off and on. (d) The applicant was unable to perform the ADL "transfer independently" from 10 May 2008 to 10 August 2008 because he needed physical assistance (hands-on) and stand-by assistance (within arm's reach). The medical professional made the following entry in the block marked "describe the assistance needed": "Physical and stand-by assistance to transfer to and from bed, chair, or car. Patient with decreased gait, balance and strength." This form states a patient is UNABLE to transfer independently if he/she requires assistance from another person to move into or out of a bed or chair. (2) Part B, Item 5 (Medical Professional's Comments) was completed providing additional information. He stated: "When he was taken back to surgery 4 September 2009 they found abscess formation of the right ankle, foreign body in the right ankle and synovectomy of the right ankle. He had continued pain and decreased range of motion and was taken back to surgery on 29-30 December 2009 for right ankle resurfacing utilizing graft and external fixator placed and was non-weight bearing till fix at or was removed on 22 February 2010. He continued with ADL limitations and medical disqualification paperwork was started on 8 June 2010 and finalized 19 April 2011." 7. The applicant received a letter on 5 March 2012 from the TSGLI Program Office, the Office of Servicemembers' Group Life Insurance, Prudential Insurance Corporation. The letter stated the following: a. The applicant's claim for the inability to perform ADLs due to traumatic injury (other than traumatic brain injury) could not be approved. b. The applicant's claim for the inability to perform ADLs 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 30 consecutive days. The claimant is considered unable to perform an activity independently only if he or she required 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) c. The applicant's inability to perform two or more ADLs for at least 30 days must also have been certified by a medical professional. 8. The applicant submitted another SGLV Form 8600 for reconsideration of his case on or about 29 January 2013 (per the date stamp on the form). This form, accompanied by his counsel's letter, shows the exact reasoning and is dated and signed by the applicant's authorized third party and the medical professional, as was the case in the initial SGLV Form 8600. 9. The TSGLI Branch Chief informed the applicant on 13 March 2013 that the TSGLI Program Office reconsidered its decision in his previous claim and was unable to overturn the previous adjudication. The medical documents provided for his motor vehicle accident on 10 May 2008 did not indicate he was incapable of performing at least two of his ADLs for 30 consecutive days. 10. The applicant submitted another SGLV Form 8600 on or about 9 August 2013, appealing the previously denied claims, utilizing the same supporting documentation as previous submitted with his other claims. 11. The Chief, U.S. Army Personnel Records Division, informed the applicant on 18 October 2013 that the Army TSGLI Program Office received his appeal request and was unable to overturn the previous adjudication. In addition, the applicant was informed he could appeal the decision to the Army Review Boards Agency (ARBA). The following rationale was provided in support of the denial of his appeal: The medical documents submitted for your event which took place on 10 May 2008 in Arizona did not indicate you met the TSGLI Standard for Loss of [ADLs]. The medical documentation you submitted did not indicate that your ankle injury rendered you incapable of performing the ADLs of bathing, dressing, toileting, or transferring that are covered by TSGLI standards for 30 consecutive days or greater. 12. A review of the applicant's evidence, provided in the original case, included medical documents and a letter of support from the applicant's stepmother, which describes the applicant's condition. a. On the day of his discharge from FMC (11 May 2008), he was provided physical therapy/rehabilitative services with a condition of being able to pass the exercises prior to his release from the hospital. He received crutch training, was instructed in icing, elevation, how to promote circulation, activity progression, use of stairs, and a list of exercises with respect to non-weight bearing on his right lower extremity. The following was noted by the attending physical therapist (PT): (1) The areas of balance and stairs were addressed. It stated he met all goals with assist of father and was provided a list of exercises that he could do at home and how to progress activity. The PT provided him a script for a tub transfer bench and determined no ongoing intervention was needed. (2) The area of bed mobility was determined to be completed with his status as independent. (3) The area of transfer was determined to be completed with his status as independent. (4) The area of ambulation was determined to be completed with minimal assistance as provide by an assistance device - crutches. b. At the time of his discharge, he was provided instructions that included keeping the right leg elevated, placing ice on his right leg/ankle, and not putting any weight on his right ankle. He was also provided crutches (accommodating equipment) to help in his ambulation and performed stairs. He was further instructed to meet with the doctor in two weeks for a follow-up. c. On 21 May 2008 (11 days after surgery), the doctor who performed the surgery removed the sutures, X-rays showed the ankle was healing properly, and he recommended continue non-weight bearing. The doctor also put him in a fracture boot for the next 3 to 4 weeks. d. On 18 June 2008 (39 days after surgery), the nurse practitioner for the applicant's surgeon stated, while he recommended for him to be non-weight bearing, the applicant said he had been applying full weight while standing, though he had mostly been walking without applying full weight on his ankle. The doctor cautioned the applicant not to put weight on the ankle for three more weeks as he ran the risk of breaking the screws holding the bone in place. e. On 16 July 2008 (67 days after surgery), the applicant's surgeon stated the applicant had progressed to 30 percent weight-bearing on his right ankle. The doctor recommended he begin to bear weight on his right ankle while wearing a fracture boot. f. On 15 August 2008 (97 days after surgery), the nurse practitioner for the applicant's surgeon stated, the applicant was fully weight-bearing on his right ankle without the assistance of the fracture boot. The applicant had full range of motion with his right ankle. He recommended the applicant increase his activities and employ use of a lace-up brace. He should avoid any impact activities. g. On 31 July 2013, the applicant's stepmother provides a letter of support and describes his condition and states she was his primary caregiver. It states, in effect, that: * she provided care for him for a period of over four months, beginning in May 2008 and lasting until mid-to-late September 2008 * he was bedridden for the first month, but required her assistance with daily tasks for about 130 days * in the first month, he needed her help to dress, use the bathroom, and shower; the applicant was completely dependent on her and could not be left alone * he needed help when transferring from bed to a chair and when he ate his meals * he had strict instructions from his doctor to keep his leg elevated and not put any weight on his right ankle; this continued until October 2008 * when he sat on the toilet, they had to keep his leg elevated; and he could not reach to wipe himself following a bowel movement * he needed physical assistance to bathe by being moved in and out of the shower utilizing a shower chair (accommodating equipment) 13. The available record, to include the medical documentation provided in the original case, is void of any record of physical therapy treatments the applicant may have received for the time period between his discharge date and 10 August 2008 (the requested relief for TSGLI benefits). REFERENCES: 1. Public Law 109-13 (The Emergency Supplemental Appropriations Act for Defense, the Global War on Terror, and Tsunami Relief 2005) signed by the President on 11 May 2005 established the TSGLI program. U.S. Army Combat-Related Special Compensation has been designated as the lead agent for implementing the Army 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 the Department of Defense. 2. As of 1 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 deducted 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 between 7 October 2001 and 30 November 2005 while supporting OIF and OEF 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 (Active, Reserve, or National Guard) or the location in which they incurred the injury, will be covered by TSGLI. 3. A qualifying traumatic injury is an injury or loss caused by application of external force or violence (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: a. total and permanent loss of sight in one or both eyes; b. loss of hand or foot by severance at or above the wrist or ankle; c. total and permanent loss of hearing in one or both ears; d. loss of speech; 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. third degree or worse burns covering 30 percent of the body or 30 percent of the face; h. coma or traumatic brain injury; or i. other traumatic injuries resulting in the inability to carry out two of the six ADL, which are dressing, bathing, toileting, eating, continence, and transferring. TSGLI claims may be filed for loss of ADL if the claimant is completely dependent on someone else to perform two of the six ADL for 30 days or more (15 days or more in the case of traumatic brain injuries). 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. The TSGLI Procedural Guide, version 2.25, dated 2 April 2014, provides the definition and criteria of ADL. ADLs are routine self-care activities that a person normally performs every day without needing assistance. There are six basic ADL: eating, bathing, dressing, toileting, transferring (moving in and out of bed or chair) and continence (managing or controlling bladder and bowel functions). When determining if a member has a loss of ADL, he/she is considered to have a loss of ADL if the member requires assistance to perform at least two of the six activities of daily living. If the patient is able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.) or adaptive behavior, the patient is considered able to independently perform the activity. a. The table below should be used to help to determine whether a member has lost the ability to perform a particular ADL. Patient is… if he/she requires physical, stand-by, or verbal assistance from another person… UNABLE to bathe independently to bathe more than one part of the body (via tub bath or sponge bath) or get in or out of the tub or shower UNABLE to maintain continence independently to manage catheter or colostomy bag. The patient is also unable to maintain continence independently if he/she is partially or totally unable to control bowel and bladder function. UNABLE to dress independently to get and put on appropriate clothing (i.e. dress for the correct season), socks or shoes (may have help tying shoes). UNABLE to eat independently to get food from plate to mouth, or take liquid nourishment from a straw or cup. The patient is also unable to eat independently if he/she is fed intravenously or by a feeding tube. UNABLE to toilet independently to go to and from the toilet, get on and off the toilet, clean self after toileting, or get clothing off and on before and after toileting. The patient is also unable to toilet independently if he/she must use a bedpan or urinal. UNABLE to transfer independently to move into or out of a bed or chair. b. When a member is unable to perform two of the six ADLs due to a traumatic injury other than traumatic brain injury, the TSGLI benefit will be paid based on the number of consecutive days the member is unable to perform ADL. The duration of the loss of ADL includes the date the member began to be unable to perform ADL and the date the member was again able to perform ADL. c. Payments for loss of ADLs due to traumatic injury other than brain injury will be made as follows: $25,000 at the 30th consecutive day; an additional $25,000 at the 60th consecutive day; an additional $25,000 at the 90th consecutive day; and an additional $25,000 at the 120th consecutive day. 5. In accordance with an on-line medical dictionary the definition of adaptive behavior is any behavior that enables a person to adjust to a particular situation or environment. It reflects an individual's social and practical competence of daily skills to independently meet the demands of everyday living. 6. Army Regulation 15-185 (Army Board for Correction of Military Records) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. This regulation provides that the ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. DISCUSSION: 1. The applicant contends that his TSGLI claim should be reconsidered because he experienced the loss of ADLs (bathe, dress, toilet, and transfer) for the period 10 May 2008 to 10 August 2008; thereby, qualifying for a TSGLI benefit of $75,000. 2. The available evidence clearly shows the applicant suffered a broken right ankle in a motor vehicle accident that required surgery to repair. Medical records indicate his blood alcohol content at the time was more than 0.20. The TSGLI procedural guide indicates that a TSGLI claim should be denied if the applicant was injured while committing, or attempting to commit, a felony. Given that the TSGLI officials did not deny, or even analyze, the claim in that basis, it must be presumed that applicant’s conduct in this regard did not rise to the level of felony misconduct. Therefore, this traumatic event would qualify for consideration of benefits under the TSGLI program. Accordingly, the applicant, with counsel, applied for those benefits. After several appeals and a final denial by the Army, the applicant sued the United States. 3. The United States District Court, Western District of Kentucky, Louisville Division, through the voluntary remand at the government's request, moved the Board to reconsider the applicant's claim for benefits. The applicant did oppose the reconsideration of his case, arguing it would unnecessarily delay the resolution of his claim. 4. A review of the previous Board action shows the lack of a complete and detailed explanation in support of the Board’s decision. In this case, a comprehensive description of the applicable sections from the TSGLI Procedural Guide is provided. a. TSGLI standards are required knowledge to understand this case. ADLs are routine self-care activities that a person normally performs every day without needing assistance. There are six basic ADL: eating, bathing, dressing, toileting, transferring (moving in and out of bed or chair) and continence (managing or controlling bladder and bowel functions). b. When determining if a member has a loss of ADL, he/she is considered to have a loss of ADL if the member requires assistance to perform at least two of the six activities of daily living. If the patient is able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.) or adaptive behavior, the patient is considered able to independently perform the activity. c. "Requires assistance" is defined as: physical assistance (when a patient requires hands-on assistance from another person), stand-by assistance (when a patient requires someone to be within arm's reach because the patient's ability fluctuates and physical or verbal assistance may be needed), and verbal assistance (when a patient requires verbal instruction in order to compete the ADL due to cognitive impairment; without these verbal reminders, the patient would not remember to perform the ADL). d. The patient is unable to bathe independently if he/she requires physical, stand-by, or verbal assistance to bathe more than one part of the body (via tub bath or sponge bath) or get in or out of the tub or shower. e. The patient is unable to dress independently if he/she requires physical, stand-by, or verbal assistance from another person to get and put on appropriate clothing (i.e. dress for the correct season), socks or shoes (may have help tying shoes). f. The patient is unable to toilet independently if he/she requires physical, stand-by, or verbal assistance from another person to go to and from the toilet, get on and off the toilet, clean self after toileting, or get clothing off and on before and after toileting. The patient is also unable to toilet independently if he/she must use a bedpan or urinal. g. The patient is unable to transfer independently if he/she requires physical or stand-by assistance to move into or out of a bed or chair. 5. A review of his medical documentation fails to show he was unable to perform at least two of his ADLs for 30 consecutive days or more as a result of his broken right ankle. a. He was required to pass his rehabilitative service/physical therapy examination prior to his discharge from the hospital. He was given exercises with respect to non-weight bearing, icing, elevation, and circulation instructions and successfully passed this exercise with the PT stating: * he was ambulatory with minimal assistance as provided by the use of crutches (accommodating equipment) and performed stairs * he met all the goals with assist from his father (at the time) in the areas of balance and stairs * he was provided a script for a tub transfer bench (accommodating equipment) and determined no ongoing intervention was needed * the area of bed mobility was determined to be complete with his status as independent * the area of transfer was determined to be complete with his status as independent b. On a 21 May 2008 follow-up doctor's visit (11 days after surgery), his doctor put him in a fracture boot for the next 3 to 4 weeks. c. On a 18 June 2008 follow-up doctor's visit (39 days after surgery), by his own admission stated he had been applying full weight while standing though he had mostly been walking without applying full weight while standing. This could be construed to lead one to assume he could perform the ADLs of transfer, toilet, and bathe (and possibly dress) with the utilization of his accommodating equipment (crutches and tub transfer bench/shower chair) and adapting his behavior, since he still had three fully functioning extremities (left leg and upper extremities); thereby, being considered able to independently perform those activities in accordance with the TSGLI procedure guide. It is also reasonable to assume that this was accomplished within the first 30 days before the doctor's visit since he would have been performing his prescribed list of exercises at home. d. On a 16 July 2008 follow-up doctor's visit (67 days after surgery), he had progressed to 30 percent weight-being on his right ankle and the doctor recommended he begin to bear weight on his right ankle while wearing a fracture boot. e. On a 15 August 2008 follow-up doctor's visit (97 days after surgery), he was fully weight-being on his right ankle without the assistance of the fracture boot and had full range of motion with his right ankle. He also was instructed to increase his activities, employ the use of a lace-up brace, and avoid impact activities. 6. In the case of a medical professional signing the SGLV 8600, the signature represents a certification to the medical information provided per the TSGLI procedural guide. His family practice doctor indicated he did not observe the applicant's loss, but that his findings were based on a review of the applicant's medical records. However, the doctor's assessment does not appear to account for the applicant's fully functional left lower extremity, his upper extremities or the accommodating equipment (crutches and tub transfer bench/shower chair) he was provided. 7. TSGLI officials in 2012 and 2013 determined that applicant’s ankle fracture did not meet the two-ADL loss standard necessary to collect TSGLI benefits. In making their determination, the TSGLI officials noted that "an isolated uncomplicated single limb injury in an otherwise uninjured Soldier is generally insufficient justification for a traumatic loss." Although the applicant’s ankle suffered a significant fracture, the TSGLI officials reviewing the case did not view the injury as a complicated one. Thus, these same officials went on to state that, based on their experience and knowledge about how injured individuals recover from lower-leg fractures, that "[i]t is a reasonable expectation that a Soldier capable of adopting, within 30 days of injury, adaptive behaviors to accomplish all activities of daily living in a modified independent manner in coping with a single limb injury." 8. After assessing the applicant’s case, the TSGLI officials noted that only 2 days after his accident, the applicant was using crutches to ambulate. They also noted that within 11 days of surgery, he progressed to using a fracture boot. Despite being advised to not bear weight with his right ankle, it appears applicant was feeling strong enough to place some weight on his right foot as early as 40 days from the surgery, and in fact had been "applying full weight when standing onto the ankle" within that same timeframe. Within 68 days of his surgery, the applicant was advised he could bear weight on his right foot "as tolerated" and remove his fracture boot when not walking. By mid-August 2008, the applicant "was fully weight-bearing without assistance in a fracture boot" and enjoyed "full range of motion in his ankle." He was advised at that time to "increase his activities to weight-bearing as tolerated without the boot." These descriptions of applicant’s progress are notably dissimilar to applicant’s step-mother’s assertion that applicant was to be "non-weight bearing … during the month immediately after his accident and the 4-5 months following, until October when he was allowed to bear only some weight on his ankle." 9. The statement offered by applicant’s stepmother is noted. However, much of what is contained in her statement is inconsistent with applicant’s medical history. For instance, the stepmother states that applicant was "bedridden for the first month" following the accident. But applicant’s physical therapy notes indicate he was ambulating fairly well with the assistance of crutches and was otherwise progressing normally. Applicant’s step-mother also claims she had to provide extensive assistance for toileting activities because "when he sat on the toilet, we had to keep make sure [applicant’s] leg stayed elevated." But this statement is at odds with the medical documentation inasmuch as nothing in applicant’s records indicate he was required to keep his leg elevated (as opposed to merely non-weight bearing) during the short time required to use the toilet. It is therefore unclear why applicant would exert such an effort to keep his leg elevated during toileting activities. 10. Dr. H.'s narrative statement is also noted. But his statements are somewhat perfunctory and are often incongruent with applicant’s physical therapy record. The records from Northern Arizona Healthcare/Orthopedics indicate a steady progression of function in applicant’s injured ankle. These records confirm that the applicant was sent home the day following the accident; that he achieved all of his physical therapy goals on that same day; and that applicant’s treating physician noted that the injured ankle was "in excellent alignment" only 11 days after the accident. By June 2008, applicant was applying full weight to the ankle; by July 2008, applicant’s physical therapy practitioner noted that the applicant stated he was "feeling well" and was permitted to bear weight "as tolerated." By August 2008, he was fully weight-bearing and had full range of motion in the ankle. By September 2008, applicant was feeling so well that he skipped a scheduled appointment at the Northern Arizona facility. 11. The physical therapy notations and applicant’s overall medical history indicate a patient making steady recovery from an ankle fracture. This evidence is more persuasive than the step-mother’s statement and Dr. H.’s assessment because the notations and the medical history were created contemporaneously with the events they describe. Although helpful in providing a generalized portrayal of applicant’s physical challenges, the step-mother’s statement and Dr. H.'s assessment were authored years after the events and are therefore more retrospective. 12. TSGLI staff physicians provide medical opinions on individuals who apply for benefits. Of necessity, they must base their opinions on a review of medical records. However, their opinions are tempered by a knowledge of the treatment histories of numerous applicants with the same set of medical circumstances. Given the applicant's set of circumstances, TSGLI staff physicians opined that given an uncomplicated single limb injury in an otherwise uninjured Soldier, it is a reasonable expectation that he was capable of adapting, within 30 days of injury, to accomplish all activities of daily living in a modified independent manner. 13. The evidence does not appear to substantiate dependence on another for performance of ADL functions for 30 consecutive days or that his TSGLI claims were improperly disallowed. //NOTHING FOLLOWS// ABCMR Record of Proceedings AR20150000953 Enclosure 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS ABCMR Record of Proceedings (cont) AR20160014601 2 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 1 ABCMR Record of Proceedings (cont) AR20160014601 15 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS Enclosure 2