ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS BOARD DATE: 3 May 2019 DOCKET NUMBER: AR20160014990 COUNSEL REQUESTS: on behalf of the applicant, reversal of the decision to deny his Traumatic Servicemembers’ Group Life Insurance (TSGLI) claim for loss of Activities of Daily Living (ADL) for the 60 day milestone and then the 90 day milestone. He further requests to appear before the board. COUNSEL'S SUPPORTING DOCUMENTS CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * Power of Attorney * Independent Nurse Review with Course of Treatment Timeline * U.S. District Court, Chad Carver v. USA Memorandum Opinion and Order * U.S. District Court, Deval Blackwood v. USA Memorandum Opinion and Order * TGGLI, A Procedural Guide * Code of Federal Regulations, Title 38 * Application for TSGLI Benefits, dated 25 March 2014 * Prudential, OSGLI office letter, dated 13 May 2014 FACTS: 1. Counsel states the TSGLI office has denied the applicant’s claim and subsequent appeals for the applicant’s loss of ADLs for the 60 day milestone and the 90 day milestone. The finding is not consistent with the hospitalization, submitted statements and medical reports. Ignoring the statements and medical records is an error and injustice. The evidence demonstrates the applicant required assistance to perform at least two of his ADLs for over 90 days. In this case, only 15 days for inpatient hospitalization has been paid. The statements and medical records have been ignored or unjustifiably discounted, which makes the finding an injustice and error, especially under the low burden of proof for the preponderance of the evidence standard. Also, in further review of this appeal, Counsel would like binding court decisions on the TSGLI administrative process to be considered. 2. The applicant retained Counsel and signed a document authorizing him to represent him in his TSGLI claim on 11 January 2014. On 1 April 2014, on behalf of the applicant, counsel completed an Application for TSGLI Benefits. The application states: a. During physical training (PT) the applicant was mistakenly shot by another Soldier on or about November 2011, (taken to mean 2001). The fellow Soldier had a live round in his weapon and accidently shot the applicant right below the knee. b. On 3 November 2001, he was admitted to Samaritan Hospital. He was discharged on 22 November 2001. c. The reason he was unable to independently perform ADLs was he suffered a serious gunshot wound to his left leg. X-rays showed "severe shattering of the upper one half or more of the tibia." He was hospitalized for 20 days, being discharged from the hospital into the care of his wife on 22 November 2001. His leg was casted for 3 months. Impaired mobility, immobilization, non-weight bearing status, weakness, loss of range of motion, and pain in the left leg impeded the applicant's ability to bathe, dress, toilet, and transfer on his own without the physical assistance of his wife. d. He had an inability to independently perform the following ADLs from hospital discharge through 3 February 2002 and required physical and stand-by assistance from his wife with these ADLs: * bathe * dress * toilet * transfer e. The document was signed by a medical professional on 26 March 2014, attesting he did not observe the patient’s loss, but reviewed his medical records. f. A letter from the applicant’s wife, dated 1 April 2014, states she had to: * give the applicant sponge baths and wash his hair because he could not get into the bathtub * help the applicant get his pants on and off * bring the applicant a bedside urinal because he had difficulty standing * help the applicant get up and down stairs, in / out of the car, and bring him food and drinks g. A letter from the applicant corroborates his wife's assertion of the assistance she provided to him. 3. On 25 September 2014, the applicant’s TSGLI claim was disapproved to the extent he claimed ADL loss for 60 days or more because he did not meet the standards for TSGLI. The 25 September 2014 notification noted that the applicant had previously been awarded $25,000 in TSGLI benefits based on his inability to perform ADLs for 30 days or more due to traumatic injury. a. Under TSGLI, a claimant must have been unable to independently perform at least two ADLs for at least 60 days consecutive days. The claimant is considered unable to perform an activity independently only 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) * verbal assistance (must be instructed) b. Inability to perform two or more ADLs for at least 60 days must also be certified by a medical professional. His claim for the inability to perform ADLs due to traumatic injury (other than traumatic brain injury (TBI)) was not approved by his branch of service because medical documentation did not support his inability to perform ADLs for 60 days. c. He was advised of his right to appeal the decision within 1 year of the date of his denial letter. 4. A 6 October 2014 TSGLI appeal, prepared and signed by Counsel states: a. He has been retained to file an appeal of his denied TSGLI claim. The denial letter indicated the approval was for 30 days loss of ADLs due to a non-TBI. However, the Request for Reconsideration and original claim made it clear the applicant was hospitalized inpatient for a total of 22 days. Consequently, the appropriate first payment should have been for Inpatient Hospitalization for 15 days, while the remaining requested benefits were for ADL loss. He included the prior claims with all related records. b. The injury date was 18 November 2001. 30 days of ADL loss were approved (November 18, 2001 -December 17, 2001), but the payment should have been for 15 days inpatient hospitalization (November 18, 2001 -December 2, 2001). Therefore, only 30 days need to be shown after the 15 days of inpatient hospitalization to qualify for the first ADL milestone (December 2, 2001 -January 1, 2002). He asked that the claim be reconsidered in light of this error with the correct time calculation. Further, he and his client specifically disagreed in regards to the finding the applicant's limitations did not reach over 60 days after the 15 days of inpatient hospitalization. c. After interviews and reviewing medical records, it is apparent the applicant depended on his wife's assistance until 3 February 2002 to transfer throughout the home, dress, bathe, and use the toilet. The applicant and his wife lived in a two story apartment. His wife had to give him sponge baths, help him dress, and help him with a bed side urinal. This help was demonstrated through declarations and showed ADL assistance was required and the applicant could not independently perform at least two ADLs without assistance. If assistance was not provided, the applicant could not dress, use the restroom, bathe, or transfer throughout the house. Therefore, the assistance of his wife was required and although only two ADL requirements are needed to qualify, the applicant could not perform four ADLs -bathing, transferring, toileting, and dressing. In addition to the mistaken calculation, in light of these statements, he asked the entire claim be reconsidered and the award to be properly increased. d. In review of this appeal, Counsel desired binding court decisions on the TSGLI administrative process in which the court found claims to have been denied in an arbitrary and capricious manner, to be considered. As in those cases, the applicant’s medical records do not conclusively deny the ability of ADL assistance. 5. On 20 May 2015, the HRC TSGLI office denied the applicant’s appeal after reconsidering his request. a. His request was denied because he had been previously awarded $25,000.00 for loss of ADLs for 30 days for the event which took place on 3 November 2001, in New York. His wife's statement was reviewed and considered. Treatment notes from North County Orthopedic Group skip from 18 December 2001 to 6 February 2002; however, he was fitted for a Bledsoe knee brace in 11 January 2002, indicating he was being seen during this period. He was asked to provide these records to corroborate his wife's statement of ADL support. The records provided show that he was provided a walker and a wheelchair upon discharge. TSGLI guidance states if a Soldier is able to perform the activities by the use of accommodating equipment/adaptive measures (such as a PDA, cane, crutches, wheelchair, etc.) then the Soldier is considered to be independently perform the activity. b. Medical documentation does not indicate the member's loss met the TSGLI minimum standard. He had the right to submit an appeal. c. Any appeal of his claim should include additional medical documentation to support his claim, and must cover the entire period of ADL loss claimed (3 November 2001 through 3 February 2002). 6. A TSGLI-appeal was signed by Counsel on 7 July 2015 stating: a. He and the applicant request TSGLI evaluate all of the evidence submitted herein to support the applicant's TSGLI claim. Servicemembers pay in to the TSGLI insurance program each month with the expectation if they are severely injured, there will be financial assistance to help them and their families. Many years after suffering a traumatic injury, the applicant finds himself fighting for TSGLI benefits. The onus is on the TSGLI branch of service to recognize severely injured servicemembers and issue the benefit due. It is the responsibility of the TSGLI branch of service to consider all evidence, medical records, caregiver statements, professional statements and other supporting evidence, especially in cases where the servicemember has undoubtedly been severely injured to ensure servicemembers receive proper compensation. b. To reiterate and correct any inaccuracies in the last letter, the injury date was 3 November 2001. Either 15 days inpatient hospitalization or 30 days of ADL loss were approved, it is unclear which exactly was approved, but either way, the $25,000.00 payment covers 3 November 2001 through 2 December 2001 as this is an OTI ADL and inpatient claim. Being such, the decision to deny the 60 day period and 90 day period of ADL losses are the point of specific disagreement and basis of this appeal. c. The original certified date of inpatient hospitalization and ADL losses in the TSGLI application was from 3 November 2001 until 3 February 2002, which is in excess of 90 consecutive days, but less than 120 consecutive days of ADL losses with required assistance. He and his client are now seeking the remaining $50,000.00 in TSGLI benefits for 90 consecutive days of required assistance to complete at least two ADLs from 3 December 2001 through 1 February 2002. Only $25,000.00 has been paid. d. In the 20 May 2015 letter, it states, "Treatment notes from the North County Orthopedic Group skip from 18 December 2001 to 6 February 2002, however, you were fitted for a Bledsoe knee brace on January 11, 2002 indicating you were being seen during this period. Please provide these records so that we may corroborate your wife's statement of ADL support." While he and his client hold the severity of the injury, the previously provided medical records, and statements from the applicant and his wife are sufficient to provide the fully requested benefits, we have ordered and received all records from North County Orthopedic Group and they are attached. The statements from the applicant and his wife are again provided. e. The statements are consistent with the newly provided records since the applicant was not partially weight-bearing until 6 February 2002. When the applicant left the hospital, he was given a cane, crutches, a walker, and a wheelchair. However, these devices obviously do not help with stairs, preparing food, getting dressed, and taking a bath, among other issues best detailed in the statements. The listed ADLs could only be performed with the assistance of the applicant's wife. Further, as new and material evidence in support of this claim, is proof of convalescent leave for the request period of TSGLI benefits and beyond. f. In light of the foregoing, the applicant had a loss of ADLs and required assistance from 3 November 2001 until 3 February 2002, which is a period of over 90 days, but less than 120 days, and therefore, the applicant is entitled to an additional $50,000.00 under the TSGLI Procedures Guide and Schedule of Loss Number 20. In light of such, he respectfully requests an award of $50,000.00 to be issued in care of his counsel of record. 7. On 18 July 2016, his TSGLI appeal was disapproved. The denial letter states: a. After reviewing the claim and supporting documentation the previous adjudication concerning losses associated with ADL from the traumatic event that occurred on 3 November 2001, at Fort Drum. b. The applicant was previously paid $25,000.00 for 15 days or greater of hospitalization related to a traumatic injury (other than TBI). According to the program guidelines, this hospitalization payment replaces the 30 day milestone for ADL, therefore, the next milestone for payment is 60 days or greater of activities of ADL loss. c. According to program guidelines, a member is considered to have a loss of ADL if the member requires assistance to perform at least two of the six ADLs. If the patient is able to perform the activity by using accommodating equipment (such as cane, walker, commode, etc.) or adaptive behavior, the patient is considered able to independently perform the activity. d. The discharge summary from 25 November 2001, showed the applicant was given a walker and a wheelchair at that time. The office noted dated 25 March 2002, stated he was using crutches with weight-bearing as tolerated for the prior three months, which would mean he begun using them well before the 60 day milestone. With the use of accommodating equipment and his fully functioning bilateral his, waist, right leg, and bilateral upper extremities, he should be able to transfer, toilet, and dress in a modified independent manner. Therefore, this claim does not qualify for payment for the 60 day milestone or beyond of loss of ADL. e. The sworn statements from the applicant and his wife were reviewed and considered for this adjudication. f. The applicant has the right to apply to the Army Review Boards Agency if he disagrees with the decision. In addition to the administrative appeals process, he had the right to appeal this decision in federal court. 8. Counsel provides a statement from an independent nurse reviewer, who states she reviewed the applicant’s records, statement, and the applicant’s wife’s statement: a. A review of his record confirms the applicant was shot in the anterior aspect of the left leg during a training exercise at Fort Drum, NY on 3 November 2001. He was transported to the Samaritan Medical Center in Watertown, NY and given emergency care. Imagining studies showed a severe open comminuted fracture of the proximal left tibia. He was taken to surgery for irrigation and debridement of the wound with application of a long leg cast, which was windowed for dressing changes. On 21 November 2001, he underwent surgical closure of the bullet wound by a plastic surgeon. He was discharged on 25 November 2001, to the care of his wife. His mobility instruction was to be non-weight bearing on the left leg, and was given a prescription for a walker and wheelchair. His non weight bearing restriction was again confirmed at his follow-up visit on 30 November 2001, with Dr. P. b. On 4 January 2002, Dr. P approved the applicant to transition to a long leg Bledsoe brace. The purpose of the brace would have been to provide stability to the leg as he began weight-bearing, until this point, it is undisputable he would have needed physical assistance with his ADLs, as he was on non-weight-bearing status. The statements of the applicant and his wife detail how long the applicant’s wife provided care. It is not until 6 February 2002, that it noted the applicant was partial weight- bearing. He would have been unsteady with his transfers and at high risk for a fall and further injury, as his muscles would have atrophied from lack of use. c. In the most recent denial letter to the applicant’s appeal, there is a statement about an office visit on 25 March 2002, which claims the applicant was using crutches with weight-bearing as tolerated for the prior three months, which would mean he began using them well before the 60 day milestone. She has attached a timeline for review. In fact, it states he was using a cane at that time and he could get rid of his equalizer brace. It then describes how careful he must be as far as slipping, turning, twisting, or anything of that sort, indicating his mobility status was quite precarious. The note apparently being referenced in the denial letter is actually from March 2002, and was written by a physician’s assistant who was assessing him for right knee pain in light of the effects of the strain placed on his right leg by the partial weight bearing status of the leg. He does not address the effect on his ADLs. He does initiate the physical therapy consultation with a referral from the orthopedic physician. Physical therapy began on 13 March 2002. d. Orthopedic physicians do not currently address specific ADL needs. That is why the statements of the patient and his wife contribute so much to the full story. Judgement in another TSGLI case was made in favor of the servicemember when it was noted an orthopedic physician’s documentation regarding ADL is not typically part of standard care. Based on the nature of the applicant’s injury and the restriction of his recovery, as well, as the accompanying strain to the other leg, and risk to fall, it is more than reasonable to conclude he required physical and standby assistance with bathing, dressing, toileting, and transferring until at least 3 February 2002. The statements of the applicant and his wife are creditable and she supports the opinion of registered nurse T.B. 9. On 31 January 2019, the Army Review Boards Agency (ARBA) senior medical advisor provided an advisory opinion which states, in part, the applicant was appropriately awarded TSGLI benefits for Inpatient Hospitalization ($25,000) based on the clinical history and medical record. The Advisor did not recommend the award of any additional benefits (i.e. ADLs at 60, 90, and/or 120 days) as the evidence clearly does not support the request. A copy of the complete medical advisory was provided to the Board for their review and consideration 10. In response to the medical advisory, counsel would like binding court decisions on the TSGLI administrative process to be considered and he states in part: a. In the Advisory Opinion assumptions are made about records not in existence or at issue. It should be noted a thorough search for all medical records available for this traumatic event which occurred nearly seventeen and a half years ago has been made and all records available have been provided. The overall tone of the Advisory Opinion is dismissive. It discusses irrelevant material, such as medical records not at issue, and misses the actual TSGLI ADL loss standards. The reviewer does not carefully weigh evidence in support of the claim. A bias against the claimant and a presumption for denial are apparent throughout the Advisory Opinion. b. The reviewer also ignores and dismisses the applicant’s long period of hospitalization and the severity and complications of his shattered tibia. The reviewer also does not properly consider that for the period at issue, the applicant was non- weight bearing, in a wheelchair, and had documented issues with mobilization, weakness, loss of range of motion, and pain. Additionally, the Advisory Opinion does not adequately consider the first-hand witness statements regarding the requirement of assistance for bathing, dressing, toileting, and transferring. Selective portions of the statements are copied and pasted into the Advisory Opinion, but overall, the statements are provided unjust consideration outside of the correct TSGLI standards on ADL losses. Instead of the proper consideration of the statements, the reviewer mentions the applicability of adaptive devices that were not issued. Ultimately, against the statements, records, and other evidence, the reviewer finds that the ADL assistance was not required for the time claimed. c. In this case, the reviewer has an eye for denial. The reviewer's conclusion was set before the case was reviewed. This, unfortunately, has been the problem from the start. Like the reviewer, the TSGLI office simply saw a single limb injury, then issued a denial based on that alone, the other facts were disregarded. He agrees most single limb injuries do not qualify for TSGLI benefits due to a lack of required ADL assistance. However, this case is the exception due to the "severe shattering of the upper one half or more of the tibia" as well as the non-weight bearing status and wheelchair requirement for the period of ADL losses claimed. Being such, a correction of the applicant’s military record to allow an approval of all four claimed ADLs for up to 90 days should be issued. The applicant has claimed both physical assistance and standby assistance for bathing, dressing, toileting and transferring. In the applicant’s case, only two of the eight types of ADL assistance needs to be shown. Only a small portion of each ADL requires assistance to meet the guidelines. Being such, the rigid assessment in the Advisory Opinion is not in accordance of the law, in error, unjust, and should be corrected. d. The minimal requirements for physical, standby, or verbal assistance are missed by the reviewer in his/her analysis. For example, in assessing the bathing ADL, the examiner states, in part, "The applicant clearly had the means and ability to sponge bath himself. Sitting in the bathtub is not a required ADL. The applicant had 2 hands and a chair/wheelchair with the ability to wash his own hair (in the sink or elsewhere)." This analysis clearly misses the correct definition for the ADL standard of bathing. Second, there is no rationale or facts to support the finding that a non-weight bearing injured servicemember with a shattered tibia could sponge bathe himself in his wheelchair. This is nonsensical against the correct ADL loss standards and discredits the statements of the applicant and his wife. e. Similar problems exist in the analysis of other ADLs. For example, how can an injured non-weight bearing person with a shattered tibia in a wheelchair get up and put on clothing, socks, and shoes without any assistance? How can they go to and from the toilet, get on and off the toilet, clean after toileting, and get clothing off and on without assistance? How about moving into or out of a bed or chair without assistance? If the examiner answered these questions, the conclusion would have been favorable to the applicant. The examiner creates a new standard of ADL losses while the severity of the injuries is ignored. The statements are disregarded and only selective evidence is considered. It should be noted TSGLI program benefits are administered by the Secretary of the Veterans Administration and is fully applicable to TSGLI benefit determinations. Therefore, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. f. In the applicant’s claim, the medical records demonstrate he suffered traumatic injuries that would require assistance with his ADLs for at least 90 days after the traumatic event. The requirement for ADL assistance was provided in his declaration as well as several declarations of his caregivers. For this appeal, per judicial order, these statements must be given proper consideration. Considering a proper weighing of the evidence under the correct application of the law, he and his client respectfully request he be found entitled to a correction of his military record to allow an additional recovery of $50,000.00 under TSGLI Schedule of Losses for inability to perform at least two ADLs for over 90 days, but less than 120 days. A copy of the complete rebuttal was provided to the Board for their review and consideration. 11. Army Regulation 15-185 (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. The ABCMR will decide cases on the evidence of record. It is not an investigative body. Applicants do not have a right to a hearing before the ABCMR. The Director or the ABCMR may grant a formal hearing whenever justice requires. Additionally, applicants may be represented by counsel at their own expense. ? BOARD DISCUSSION: 1. After reviewing the application and all evidence, the Board determined partial relief is warranted. The applicant’s and his counsel contentions, medical concerns, letters of support, and the medical advisory opinion were carefully considered. The applicant requests TSGLI qualifying under the inability to carry out four of the following six ADL without being completely dependent on someone else for 90 days: dressing, bathing, toileting, eating, continence, and transferring. If regulatory guidance is met, TSGLI is paid based on the number of consecutive days the member was unable to perform ADLs; starting when he was unable to perform the ADL, and ending when he was again able to perform the ADL. 2. The applicant received severe injuries to his lower body and was hospitalized on 3 November 2001. His supporting documents show he remained hospitalized through 22 November 2001 (20 days). The 15 days or more of consecutive days of hospitalization automatically qualified him for the 30 day milestone. He left the hospital prescribed a walker and a wheelchair. 3. The applicant and his spouse contend the spouse helped him perform four ADLs through the 90 day milestone. He was injured on 3 November 2001, so the 90 day milestone would have been reached on 3 February 2002. The record shows he was issued a full leg cast and crutches on 4 January 2001 (62 days after the injury). Regulatory guidance provides that a patient is considered able to independently perform the activity when able to perform the activity by using accommodating equipment (such as a cane, walker, commode, etc.) or adaptive behavior. 4. The ARBA advisory official recommended disapproval of his request stating his clinical history and medical evidence clearly does not support the request. Clear evidence of a medical disability or condition that would medically support loss of two, or more ADLs for 30, 60, 90, 120 or more days was not found. 5. Notwithstanding the medical advisory, and based upon the preponderance of evidence, the Board agreed that it was most likely that the applicant could not perform the ADLs of bathing, dressing, transferring, and using the toilet without the assistance of another person for approximately 62 consecutive days due to his lower body injury: as he was issued accommodating equipment at that juncture. Reaching the 60-day milestone would authorize one more $25,000 insurance payment. The Board determined there is insufficient evidence to grant any further relief. ? BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF :X :X :X GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING : : : DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: 1. The Board determined the evidence presented is sufficient to warrant a recommendation for partial relief. As a result, the Board recommends that all Department of the Army records of the individual concerned be corrected by showing he was approved for a 60-day TSGLI payment for the inability to perform at least two ADLs during the period 3 November 2001 – 4 January 2002, and providing him with the insurance payment authorized for that time period. 2. The Board further determined the evidence presented is insufficient to warrant a portion of the requested relief. As a result, the Board recommends denial of so much of the application that pertains to approving additional TSGLI payments for reaching 90 or more days. 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. ADMINISTRATIVE NOTE(S): Not Applicable ? 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. The U.S. Army Combat-Related Special Compensation Office 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. A servicemember must meet all of the following requirements to be eligible for payment of TSGLI. The servicemember must have: * been insured by SGLI at the time of the traumatic event * incurred a scheduled loss and that loss must be a direct result of a traumatic injury * suffered the traumatic injury prior to midnight of the day of separation from the Uniformed Services * suffered a scheduled loss within 2 years (730 days) of the traumatic injury * survived for a period of not less than 7 full days from the date of the traumatic injury (in a death-related case) 2. 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. The HRC official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II. Each loss has a corresponding payment amount. 3. Part I losses includes sight, hearing, speech, quadriplegia, hemiplegia, uniplegia, burns, amputation of hand, amputation of four fingers on one hand or one thumb alone, amputation of foot, amputation of all toes including the big toe on one foot, amputation of big toe only, or other four toes on one foot, limb salvage of arm or leg, and facial reconstruction. 4. Part II losses include traumatic injuries resulting in the inability to perform at least two ADL for 30 or more consecutive days and hospitalization due to a traumatic injury and other traumatic injury 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 requires assistance from another person to perform two of the six ADL 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. 5. Payments for loss of ADL due to traumatic injury other than brain injury (OTI) 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 ? an additional $25,000 at the 120th consecutive day 6. A member who is hospitalized as an inpatient for 15 consecutive days as the result fo the traumatic injury is eligible for a $25,000 payment under TSGLI. 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. Payment will be made for the 15- day inpatient hospitalization OR the first ADL milestone, whichever occurs first. 7. Appendix B (Glossary of Terms) of the TSGLI Procedures Guide, dated September 2008, provides the following definitions: a. Traumatic Event: The application of external force, violence, chemical, biological, or radiological weapons, accidental ingestion of a contaminated substance, or exposure to the elements that causes damage to a living body. Examples include: * military motor vehicle accident * military aircraft accident * civilian motorcycle accident * rocket propelled grenade attack * improvised explosive device attack * civilian motor vehicle accident * civilian aircraft accident * small arms attack * training accident b. Traumatic Injury: The physical damage to a living body that results from a traumatic event. c. External Force: A force acting between the body and the environment, including a contact force, gravitational force, or environmental force, or one produced through accidental or violent means. 8. Army Regulation 15-185 (ABCMR) states ABCMR members will review all applications that are properly before them to determine the existence of an error or injustice; direct or recommend changes in military records to correct the error or injustice, if persuaded that material error or injustice exists and that sufficient evidence exists on the record. The ABCMR will decide cases on the evidence of record. The ABCMR begins its consideration of each case with the presumption of administrative regularity. The applicant has the burden of proving an error injustice by a preponderance of the evidence. It is not an investigative body. The Director or the ABCMR may grant a formal hearing whenever justice requires. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20160014990 2 1