IN THE CASE OF: BOARD DATE: 31 January 2023 DOCKET NUMBER: AR20220003809 APPLICANT REQUESTS, through Counsel: reconsideration of his previous request to reverse the decision by the U.S. Army Human Resources Command, Special Compensation Branch that denied him payment of additional $50,000 Traumatic Servicemembers’ Group Life Insurance (TSGLI) for TBI-related Activities of Daily Living (ADL) loss, for his 14 January 2006 incident in. He also requests an appearance before the Board. APPLICANT'S SUPPORTING DOCUMENT(S) CONSIDERED BY THE BOARD: * DD Form 149 (Application for Correction of Military Record) * January and February 2006 Leave and Earnings Statements * Letter from counsel, 1 November 2021 * Extract of 38 CFR 9.20 – Traumatic injury protection * Attorney Letter, dated 20 October 2017 * Narrative Summary, dated 25 January 2006 * Physical Therapy referral, dated 26 January 2006 * Health Record, dated 2 February 2006 * Discharge Summary, dated 13 February 2006 * Health Record, dated 28 February 2006 * Discharge Summary, dated 14 March 2006 * Proof of Legal Representation, dated 14 October 2014, FACTS: 1. Incorporated herein by reference are military records which were summarized in the previous consideration of the applicant's case by the Army Board for Correction of Military Records (ABCMR) in Docket Number on 15 December 2020. 2. The applicant was involved in a motor vehicle accident on 14 January 2006 in. He was hit by a car while crossing the street. He was transported to a hospital in , where he was unconscious for 3-5 days. He remained in the hospital until evacuated to and admitted at Tripler Army Medical Center, HI, won 25 January 2006. He suffered brain injuries and right sided hearing loss. He was transferred to TBI Rehabilitation Hospital for inpatient TBI care. He was ultimately discharged from hospital on 30 March 2006, he was discharged. 3. Counsel states the Army TSGLI Certifying Office evaluated the applicant’s claim for Traumatic Injury Protection benefits under TSGLI. His claim for his event in on January 14, 2006, was approved for $25,000 for hospitalization due to traumatic brain injury. Other losses claimed were not approved. a. The TSGLI office denied additional payments for the claim and subsequent appeals for the applicant’s ADL losses due to TBI for 30 days and right ear hearing loss. Benefits for 15 days of ADL loss due to TBI have been provided. the final denial decision by HRC, dated 17 September 2017, does not mention the most reliable hearing test where insert earphones were used to block out contralateral routing, which is the most relevant test for right ear hearing loss. Instead, the decision erroneously refers to air conduction tests that are unreliable in this case as they involved the assistance of the left ear, which made the hearing ability in the right ear inaccurately higher. For ADLs, the nature of the injuries, treatment. and medical records show the requirement of ADL assistance until 30 days. b. The applicant claimed three ADLs, needing verbal assistance for dressing, bathing, and transferring while two ADLs are required. The reliance on the idea that basic ADLs must have been met since only instrumental ADLs were mentioned as not being met is an unreliable and unfair assumption against the applicant’s entitlement to benefits. A lack of assessment of basic ADLs does not equate to a lack of basic ADL ability. The medical records support the claimed losses. As such, benefits for 30 days of ADL losses due to TBI must be provided. c. It should also be noted that the TSGLI Application and Procedures Guide have minimal requirements for the ADL tasks that require assistance: "He/ 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."; "He/she requires assistance from another person to get and put on clothing, socks Or shoes."; He/she requires assistance from another person to move into or out of a bed or chair" . There only needs to a small part of each ADL that requires assistance, and verbal assistance is permitted. The reading of the decision is strict and looks to require assistance with the complete ADL in all aspects. This rigid assessment is not in accordance with the law, and is in error, and unjust. and should be corrected as the applicant arguably met three ADL losses at 30 days, and especially met the criteria for bathing and dressing, which are the ADLs that he asks to be focused on in the next decision. 4. Review of the applicant’s service records shows: a. He enlisted in the Regular Army (RA) on 13 October 2004. He served in from February 2005 to January 2006. He reenlisted on 6 December 2006. b. On 14 January 2006, he was involved in a motor vehicle accident in. He was hit by a car while crossing the street. c. DA Form 2173 (Medical Examination and Duty Status), dated 29 March 2006, shows in section I (Patient Administrator) the applicant was admitted to a hospital. Item 15 (Details) on 14 January 2006, the applicant was hit by a car while crossing the street. d. A Line of Duty (LOD) memorandum, dated 29 March 2006, shows the applicant line of duty was reviewed for completeness. His accident was “In Line of Duty.” e. He also served in Iraq for nearly 10 months from on or about 11 May 2007 to on or about 17 March 2008. On return to Fort Lewis, He was transferred to Madigan Army Medical Center, and assigned on 3 July 2008 to the Wounded Warriors Transition Company. f. On 2 December 2008, an informal physical evaluation board (PEB) convened and found the applicant medically unfit for residuals of TBI, resulting from a 2006 motor vehicle accident. Ongoing signs and symptoms are difficulties in problem solving and impulsivity as evaluated and documented in the 2008 Neuropsychological Testing Report. The PEB assigned a 70% disability rating with his disposition as permanent disability retirement. g. A Physical Disability Report, dated 7 January 2009, shows the applicant was placed on the permanent disability retired list (PDRL) with a date of separation date of 27 February 2009. i. He was honorably retired from active duty on 27 February 2009 due to disability. His DD Form 214 (Certificate of Release or Discharge from Active Duty) shows he completed 4 years, 4 months, and 15 days of active duty service. 5. The applicant filed a TSGLI on 28 January 2015, he stated he stated in January 2006, in Korea, he was hit by a drunk taxi driver. He was in a coma for 3-4 days. He also suffers from traumatic brain injuries, loss of hearing in his right ear and completely dislocated his left knee. He claimed inpatient hospitalization (121st general Hospital, Korea 14 to 25 January 2006), Tripler Army Medical Center (25 January to 12 February 2006), and Tampa Poly TBI Rehab Unit (12 February to 30 March 2006). He also claimed loss of hearing in his right ear, 6. On 21 July 2015, the TSGLI Office responded to his claim and stated that the U.S Army TSGLI Certifying Office has evaluated his claim for Traumatic Injury Protection benefits under TSGLI. His claim for his accdent on 14 January 2006 in as previously approved for $25,000 for hospitalization due to Traumatic Brain Injury (TBI). Other losses claimed were not approved. This letter explains why these losses were not approved, your rights to appeal this decision, and the general requirements for TSGLI benefits. Evaluated Losses with regard to this decision: Activities of Daily Living (ADL) due to Traumatic Brain Injury (OTI) up to 30 days and Hearing Loss, Right Ear a. TBI-ADL Loss at 15 Days: His claim for hospitalization was previously approved; however, under current law, an additional payment for loss of Activities of Daily Living (AOL) for 15 consecutive days could not be made. His claim met the TSGLI standards for Hospitalization and for the inability to perform ADL for 15 consecutive days due to TBI. According to the regulations that govern the TSGLI Program, 15 consecutive days of hospitalization replaces the first increment of AOL loss. Since his claim was approved for the loss of ADL for a period of 15 days, he cannot be paid for 15 consecutive days of hospitalization for the same time period during which he was paid for loss of ADL. Denial Code: Payment for this loss cannot be made in combination with other losses paid. b. TBI-ADL Loss at 30 Days: His claim for Traumatic Brain Injury was not approved because his loss did not meet the TSGLI criteria. Documentation provided with his claim indicates that as of January 28, 2006, he was able to perform all ADLs independently, except for bathing, which was not tested. Under the regulations that govern the TSGLI Program, traumatic brain injury is covered if it causes the inability to independently perform at least two activities of daily living (ADLs) for at least 15 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) or, Stand-by assistance (within arm's reach) or, Verbal assistance (must be instructed). TSGLI regulations also state if the Soldier is able to perform the activity by the use of accommodating equipment/adaptive measures (such as a PDA, cane, crutches, wheelchair, etc.) then the Soldier is considered able to independently perform the activity. Denial Code: Medical documentation provided does not indicate the member's loss met the TSGLI minimum standard. c. Hearing Loss, Right Ear: His claim for loss of hearing in his right ear was not approved because his loss did not meet the TSGLI criteria. Documentation provided with his claim dated February 10, 2006 indicates that the hearing acuity measurement for his right ear was 63.3 decibels. Under the regulations that govern the TSGLI Program, total and permanent loss of hearing is defined as an average hearing threshold sensitivity for air conduction of at least 80 decibels measured via pure tone audiometry by air conduction, without amplification device. Loss of hearing must also be clinically stable and unlikely to improve. Denial Code: Medical documentation provided does not indicate the member's loss met the TSGLI minimum standard. 7. On 7 May 2016, the U.S Army TSGLI Certifying Office evaluated his claim for Traumatic Injury Protection benefits under Servicemembers' Group Life Insurance (TSGLI). His claim for his event in on January 14, 2006 was previously approved for $25,000 for hospitalization due to traumatic brain injury. Other losses claimed were not approved. This letter explains why these losses were not approved, his rights to appeal this decision, and the general requirements for TSGLI benefits. The following losses were evaluated with regard to this decision: * Hospitalization * Activities of Daily Living (AOL) due to Traumatic Brain Injury (TBI) up to 90 days * Hearing; Right Ear a. His TBI-ADL Loss: His claim for the inability to perform ADLs due to traumatic brain injury was not approved because his loss did not meet the TSGLI medical standard. His Functional Independence Measure (FIM) assessment, dated January 28, 2006, 15 days after his initial date of injury, indicates he was able to perform all ADLs in an independent or modified independent manner. Under the regulations that govern the TSGLI Program, traumatic brain injury is covered if it causes the inability to independently perform at least two activities of daily living (ADLs) for at least 15 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) or, Stand-by assistance (within arm's reach) or,Verbal assistance (must be instructed). TSGLI regulations also state if the Soldier is able to perform the activity by the use of accommodating equipment/adaptive measures (such as a PDA, cane, crutches, wheelchair, etc.) then pthe Soldier is considered able to independently perform the activity. Denial Code: Medical documentation provided does not indicate the member's loss met the TSGLI minimum standard. b. Hearing (Right Ear): His claim for loss of hearing in the right ear was not approved because his loss did not meet the TSGLI criteria. Documentation provided with his claim indicates his hearing loss was at 75 decibels as of February 10, 2006, whereas it had improved to 68 decibels as of May 2008. Under the regulations that govern the TSGLI Program, total and permanent loss of hearing is defined as an average hearing threshold sensitivity for air conduction of at least 80 decibels measured via pure tone audiometry by air conduction, without amplification device. Furthermore, loss of hearing must also be clinically stable and unlikely to improve (with reasonable certainty) throughout the member's life. Denial Code: Medical documentation provided does not indicate the member's loss met the TSGLI minimum standard. 8. On 24 May 2016, counsel wrote to HRC indicating he and the applicant did not agree. He stated that the attached exhibits, medical records, and other supporting evidence demonstrate the applicant is entitled to recovery of $75,000.00 under the Traumatic Service Member's Life Insurance coverage. $25,000.00 has already been issued for inpatient hospitalization. Therefore, in light of the foregoing, and on behalf of the applicant, he requests $50,000.00 to be issued under the Traumatic Service Members Group Life Insurance Schedule of Losses #17 for suffering a Traumatic Brain Injury Resulting in Inability to Perform at Least Two Activities of Daily Living (ADL) for over 30 days, but less than 60 days consecutive days of ADL loss which under Schedule of Losses# 17, which qualifies for $50,000.00, and Schedule of Losses #2 Hearing: Total and permanent loss of hearing; for one ear, which does not run concurrent with TBI/ADL claims, unlike Non­ TBI/ADL claims (see Exhibit C for Page 22 of TSGLI Procedures Guide), and therefore, qualifies for an additional $25,000.00 for a total remaining due award of $50,000.00, which is to be issued to [Counsel]. 9. On 25 September 2017, HRC issued its final decision. the denial letter states the TSGLI program office has received his appeal request for the applicant. After reviewing the claim and supporting documentation, they are unable to overturn the previous adjudication concerning claimed losses associated with activities of daily living (ADL) and hearing loss of the right ear from the traumatic event on January 14, 2006 in Korea. a. The applicant was previously paid $25,000 for Traumatic Brain Injury (TBI) related hospitalization of 15 days or greater. Since hospitalization payment replaces the first milestone of AOL loss, the next eligible milestone for payment is TBl­ related AOL loss of 30 days or greater. b. Why The Claim Was Not Approved: In determining ADL loss, the TSGLI Procedural Guide states "the member 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. Concerning TBl-related ADL loss, the January 27, 2009 (Day 14 after the traumatic event) Physical Medicine Consultation Note documents the applicant reported he was ambulating independently and feeding and grooming himself without assistance. The Physical Therapy Inpatient Consultation Note from that same date shows he was independent with transfers and ambulating with good balance. It also records functional range of motion and normal strength in all extremities along with the ability to pick up an object from the floor without losing balance. The January 28, 2006 (Day 15 after the traumatic event) Occupational Therapy Clinic Note documents [Applicant] was modified independent to independent with all basic ADLs (bed mobility, transfers, dressing, hygiene, and eating), except bathing. Although bathing was not tested, the good endurance and balance discussed in this note along with the independent ambulation of 400 feet and picking up an object from the floor discussed in the January 27, 2009 Physical Therapy Note demonstrate a functional capacity that should allow bathing performance. The February 2, 2006 (Day 20 after the traumatic event) Occupational Therapy Note states physically he was able to perform all ADLs, however his cognitive deficits limited him to carry out tasks purposefully and holistically. However, it states he will be provided Instrumental ADL training with a focus on his cognitive deficits. This would indicate his cognitive deficits were limiting his independent performance of Instrumental ADLs. Instrumental ADLs (managing finances, handling transportation (driving or navigating public transit}, shopping, preparing meals, using the telephone and other communication devices, managing medications, housework and basic home maintenance, etc.) are not the standard for payment for TSGLI TBI-related ADL loss. Basic ADLs (bathing, dressing, maintaining continence, eating, toileting, and transfers) are the standard for TSGLI payment. By focusing only on Instrument ADL training, this note indicates that basic ADLs did not require training, and therefore could be performed in at least a modified independent manner. This assessment of basic ADL performance is supported by the preponderance of evidence in the remaining medical record. Furthermore, the Clinical Neuropsychology Clinic Note from February 2, 2006 indicates he had moderate to severe cognitive deficits that required 24 hour supervision for safety reasons. However, the listed tasks that were adversely affected by his cognitive deficits were Instrumental ADLs (managing medications, managing finances, and responding to novel situations), which are not the TSGLI standard for payment as discussed above. Independent basic ADL performance would only require a basic cognitive functioning level, and this note indicates basic attention and concentration ability was one of his relative strengths at that time. Therefore, although he had moderate to severe cognitive deficits, these deficits were not of a severity to prevent at least modified independent basic ADL performance per TSGLI guidelines. Thus, his TBI-related ADL loss claim does not qualify for payment at the 30 day milestone or beyond. d. Concerning hearing loss, the TSGLI Procedural Guide states "If the member's average hearing threshold sensitivity for air conduction in at least one ear is 80 decibels or more and the loss of hearing will not improve (with reasonable certainty) throughout the member's life. Hearing acuity must be measured at 500 Hz, 1000 Hz and 2000 Hz to calculate the average hearing threshold. Loss of hearing must be clinically stable and unlikely to improve." The February 10, 2006 (Day 28 after the traumatic event) Audiology Clinic Note records [Applicant’s] right ear air conduction hearing acuity for the TSGLI-pertinent frequencies as follows: 65 dB at 500 Hz, 85 dB at 1000 Hz, and 75 dB at 2000 Hz. With these readings, the average hearing threshold for TSGLI purposes was 75 dB. Furthermore, the May 29, 2008 (Day 867 after the traumatic event) Audiology Clinic Note documents an audiogram with the following air conduction readings in the right ear at TSGLl-pertinent frequencies: 40 dB at 500 Hz, 65 dB at 1000 Hz, and 75 dB at 2000 Hz. It also records the masked air conduction readings for the right ear at TSGLl-pertinent frequencies as follows: 45 dB at 500 Hz, 75 dB at 1000 Hz, and 85 dB at 2000 Hz. This shows the right ear's average hearing threshold with air conduction was 60 dB for TSGLI purposes, and the right ear's average hearing threshold for masked air conduction was 68.3 dB. These do not meet the standard of 80 dB or greater required for TSGLI payment of hearing loss. e. Appeal Rights: [Applicant] has the right to apply to the Army Review Boards Agency, if he disagrees with this decision. Army Regulation 15-185 (Army Board for Correction of Military Records) provides direction on the purpose of the board, and the information needed to apply for relief. 10. On 15 December 2020, the Board considere dthe applicant’s/counsel’s petition for payment of Traumatic Injury Protection (TSGLI) to the applicant for injuries that resulted in loss of Activity of Daily Living (ADL). Prior to rendering a decision, the Board requested a medical review of the case. The Army Review Board Agency (ARBA) Medical Advisor reviewed the supporting documents provided and the VA's Joint Legacy Viewer (JLV). a. The applicant is requesting TSGLI benefits be awarded for injuries he sustained on 14 January 2016. He was injured when he was struck by a car while crossing the street. The injuries were determined to have been sustained in the line of duty. The records indicate that the applicant updated his SGLI documents on 19 September 2008 which was well after the date of injury. According to the TSGLI procedural guide, a Soldier must be eligible for SGLI benefits at the time of a line of duty injury in order to qualify for the award of TSGLI benefits. SGLI benefits are not automatic, and must be elected by the Soldier. Without SGLI benefits in place the Soldier is not authorized to receive TSGLI benefits. The applicant’s submitted record is void of any documentation indicating that the he had SGLI benefits in effect at the time he sustained the injuries reported. If the applicant did not, in fact, have SGLI benefits available at the time of his injuries then he would not be eligible to receive TSGLI benefits. b. Effective 1 December 2005 all members were determined to be covered under SGLI benefits who experience a traumatic event that results in a traumatic injury causing a scheduled loss as defined under the program are eligible for TSGLI benefits. However, due to the applicant’s period of service the record is void of any documents indicating that the applicant was covered under the SGLI program as there are no documents contained in the applicant’s iPERMS record. Therefore, based on the available information, it is the opinion of the Agency Medical Advisor that there is insufficient evidence to support that the applicant was eligible for benefits under the TSGLI program at the time of his reported injuries. 11. After reviewing the medical provider’s review, and after reviewing the application and all supporting documents, the Board determined relief was not warranted. Based upon the available documentation and the findings and recommendation of the medical advisor, the Board concluded there was insufficient evidence of an error or injustice which would warrant a change to the previous TSGLI decision for the applicant. 12. MEDICAL REVIEW: a. The Army Review Boards Agency (ARBA) Medical Advisor was asked to review this case. Documentation reviewed included the applicant’s ABCMR application and accompanying documentation, the military electronic medical record (AHLTA), the VA electronic medical record (JLV), the electronic Physical Evaluation Board (ePEB), Healthcare Artifact and Image Management Solution system (HAIMS), and the Interactive Personnel Electronic Records Management System (iPERMS). b. The applicant is applying to the ABCMR requesting reversal of the denials of his application for benefits from the Traumatic Servicemember’s Group Life Insurance (TSGLI) program. Through counsel, he is seeking the $25,000 TSLGI benefit for total and permanent hearing loss in his right ear; and $25,000 for having been unable to independently perform the three activities of daily living (ADLs) of dressing, transferring from bed to/from a chair, and bathing, with or without modification and/or assistive devices, for more than 30 but less than 60 consecutive days due to a traumatic brain injury (TBI) sustained on 14 January 2006. c. The Record of Proceedings (ROP) details the circumstances of the case and the prior denials. The applicant has previously received a payment of $25,000 from the TSLGI program for the inability to perform two or more ADLs for more than 15 but less than 30 consecutive days due to a TBI. Under the laws and regulations that govern the TSGLI Program, “When a member is unable to perform two of the six activities of daily living (ADL) due to TBI in combination with another injury, the member’s TSGLI benefit will include the benefit for the number of consecutive days the member has loss of ADL due to the brain injury plus the benefit for the other injury up to a combined maximum payment of $100,000.” (See 38 U.S.C. 1980A(d)(1) and 38 CFR 9.20(f)(18, 21)). The next milestone for the inability to perform 2 or more ADLS is at 30 days (12 February 2006). d. The applicant was injured in Korea on 14 January 2006 when the vehicle he was sitting in was struck by a sanitation truck. He was initially admitted to a Korean hospital where evaluation revealed he had sustained both subarachnoid and subdural hematomas in the right frontoparietal area with a fracture of the parietal bone. He was stabilized, transferred to the 121st Field Hospital, and medically evacuated to Tripler Army Medica Center on 25 January 2006. e. He is noted to have had a Glasgow Coma Score (GCS) of 15 (15 is normal) upon admission but had some short-term memory loss and confusion. f. When evaluated by physical therapy on 27 January 2006, the therapist noted: “The patient demonstrates a willingness to learn by actively participating in the evaluation. The patient also demonstrates an ability to respond to questions and follow commands. He has no pain.” The physical therapist documented normal upper and lower extremity strength; that he was “independent with bed mobility, supine to sit, and sit to stand and he ambulated 400 ft without AD {assistive device} with normal gait pattern and no loss of balance with general supervision. He went on to state: “He has good balance, he is able to stand with feet together with eyes closed, he was able to stand in tandem with eyes closed, no loss of balance with balance testing. He was able to pick object up from the floor without losing balance. g. He was evaluated by occupational therapy on 28 January 2006. The occupational therapist assessed the applicant as fully independent with bed mobility and transfers as well as dressing both upper and lower extremities. Bathing was not tested but he was noted to be fully independent with “hygiene.” Given this and his balance evaluation by physical therapy, the applicant would have had little if any difficulties bathing. h. He was evaluated by otolaryngology for asymmetric sensorineural hearing loss affecting the right side. He was started on a ten-day steroid taper with prednisone. i. Records from this admission show that he had several cognitive difficulties but there is no evidence they prevented the applicant from performing his basic ADLs. From his 10 February occupational therapy note: “Patient stated that he still has a hard time remembering things. Patient performed mapping activities using the internet to retrieve directions. Patient was able to perform this task with minimal assistance as patient stated that he did not know the keyboard had the DELETE button when he attempted to correct his mistake. Patient was able to retrieve 3/3 driving directions through the internet using "Mapquest". Patient tolerated treatment session well. Continue to require assistance to complete his task at times secondary to patient highly distractable. Patient continues to provide incorrect response secondary to decrease memory and decrease general knowledge.” j. Physical therapy notes from his inpatient stay show he continued to have no mobility issues and was apparently independent in getting to clinics with the facility. From his 11 February 2006 physical therapy note: “Patient awake and agreeable to treatment. Pain scale @ 0/10. Patient standing at the side of the bed getting ready to go down to audiology. Gait training without AD 1000 feet @ independent. Precautions: none Assessment: S/P TBI, patient tolerated the treatment well and is pleasant and cooperative with therapist. Patient continues to be distracted and require cues to stay on task.” k. He was discharged on 13 February 2006, taking an accompanied flight to Tampa, Florida where he was admitted to a Veterans Hospital Administration Facility for inpatient TBI rehabilitation. l. A claimant for TSLGI is considered unable to perform an activity independently only if he or she, with or without activity modification and/or assistive devices, requires at least one of the following without which they would be incapable of performing the task: (1) Physical assistance (hands-on) or, (2) Stand-by assistance (within arm's reach) or, (3) Verbal assistance (must be instructed) m. For determining if a member has a loss of TSGLI program specific ADLs, Title 38 of the Code of Federal Regulation, section 9.20 states "the term inability to carry out activities of daily living means the inability to independently perform at least two of the six following functions: (A) Bathing, (B) Continence, (C) Dressing, (D) Eating, (E) Toileting, (F) Transferring in or out of a bed or chair with or without equipment." The TSGLI Procedural Guide further clarifies "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." n. Under the laws and regulations governing the TSGLI Program (38 U.S.C. 1980A(b)(1)(H), (b)(2)(D), and 38 CFR 9.20(d), (e)(6)(vi), (f)(17) and (f)(20)), documentation must demonstrate the inability to independently perform at least two of the six ADLs (Eating, Bathing, Dressing, Toileting, Transferring, and Continence). Documentation addressing the specific injury/injuries sustained as a result of the traumatic event, and providing a timeline of treatment and recovery during the period of claimed inability to ADLs is required in order to approve a claim. The timeline of treatment would consist of notations from licensed medical providers such as physicians, physician assistants, nurse practitioners, registered nurses, etc. Supporting documentation can also be submitted by other medical providers acting within the scope of their practice pertinent to the sustained injury/injuries, to include occupational/physical therapists, audiologists, or speech/language pathologists. o. Though the applicant had sustained significant head injuries which affected his cognition, there were no significant injuries noted to the then healthy 21-year-old Soldier’s spine or four extremities. Given the occupational and physical therapy documentation noted above and no probative medical documentation to the contrary, it must be assumed he was able to perform his basic ADLs in at least a modified independent manner per TSGLI guidelines before 12 February 2006. p. The TSLGI guidelines state a claimant is eligible for the benefit for hearing loss when their average hearing threshold sensitivity at 500, 1000, and 2000 hertz measured via air conduction is 80 decibels or more and unlikely to improve throughout their life. Using insert earphones, the applicants sensitivity thresholds measured on 10 February 2006 were 65, 85, and 75 for an average of 75 decibels. This is below the 80-decibel threshold required to be eligible for the hearing loss benefit. q. It is the opinion of the Agency Medical Advisor that there is insufficient probative evidence the applicant was unable to perform two or more ADLS after the 29th day following his accident and that his hearing loss is not eligible for the TSLGI benefit. Hence, it is recommended the request for an additional TSGLI payments should be denied. BOARD DISCUSSION: 1. The applicant's request for a personal appearance hearing was carefully considered. In this case, the evidence of record was sufficient to render a fair and equitable decision. As a result, a personal appearance hearing is not necessary to serve the interest of equity and justice in this case. 2. After reviewing the application, all supporting documents, and the evidence found within the military record, the Board found that relief was not warranted. The applicant’s contentions, the military record, and regulatory guidance were carefully considered. a. The Board noted that the applicant is requesting this Board reverse the denials of his application for benefits from the TSGLI program. Through counsel, he is seeking the $25,000 TSLGI benefit for total and permanent hearing loss in his right ear; and $25,000 for having been unable to independently perform the three activities of daily living (ADLs) of dressing, transferring from bed to/from a chair, and bathing, with or without modification and/or assistive devices, for more than 30 but less than 60 consecutive days due to a traumatic brain injury (TBI) sustained on 14 January 2006. b. The Board thoroughly reviewed the applicant’s original application, together with his reconsideration request, as well as the denial letters by the TSGLI Program Office. The Board also reviewed and agreed with the medical advisor’s finding insufficient probative evidence the applicant was unable to perform two or more ADLS after the 29th day following his accident and that his hearing loss is not eligible for the TSLGI benefit. ? BOARD VOTE: Mbr 1 Mbr 2 Mbr 3 : : : GRANT FULL RELIEF : : : GRANT PARTIAL RELIEF : : : GRANT FORMAL HEARING :X :X :X DENY APPLICATION 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 to amend the decision of the ABCMR set forth in Docket Number, on 15 December 2020. 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. REFERENCES: 1. Public Law 109-13 (Making Emergency Supplemental Appropriations for Defense, the Global War on Terror, and Tsunami Relief 2005) signed by the President on 11 May 2005 established the Traumatic Servicemembers’ Group Life Insurance (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 service member must meet all the following requirements to be eligible for payment of TSGLI. The service member 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 U.S. Army Human Resources Command’s official TSGLI website lists two types of TSGLI losses, categorized as Part I and Part II. Each loss has a corresponding payment amount. a. 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, facial reconstruction, and coma from traumatic injury and/or traumatic brain injury resulting in the inability to perform two activities of daily living (ADL). b. Part II losses include traumatic injuries resulting in the inability to perform at least two ADLs 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 ADLs, which are dressing, bathing, toileting, eating, continence, and transferring. TSGLI claims may be filed for loss of ADL if the claimant requires assistance from another person 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. 3. Army Regulation 15-185 (Army Board for Correction of Military Records (ABCMR) prescribes the policies and procedures for correction of military records by the Secretary of the Army, acting through the ABCMR. Paragraph 2-9 of the regulation states: a. The ABCMR begins its consideration of each case with the presumption of administrative regularity, which is that what the Army did was correct. The ABCMR is not an investigative body and decides cases based on the evidence that is presented in the military records provided and the independent evidence submitted with the application. The applicant has the burden of proving an error or injustice by a preponderance of the evidence. b. The ABCMR may, in its discretion, hold a hearing or request additional evidence or opinions. Additionally, it states 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. //NOTHING FOLLOWS// ABCMR Record of Proceedings (cont) AR20220003809 1 ARMY BOARD FOR CORRECTION OF MILITARY RECORDS RECORD OF PROCEEDINGS 1