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TSGLI Program Changes

Why Are We Making Changes to the TSGLI Program?

VA conducted a review of TSGLI as part of its ongoing oversight of the program. The objectives of the review were to:

  • assess proposals for program improvements,
  • clarify complex eligibility standards to promote consistency in adjudication and improve the claims experience for Servicemembers,
  • identify administrative or operational enhancements, and
  • determine if the program is meeting its congressional intent.

Based on this review, VA has made a range of changes to the TSGLI Program to improve the program.

How has the Schedule of Losses Changed?

Based on the review, VA made changes to the following areas of the Schedule of Losses, effective date of regulation publication.

Loss Change

Explanation

Loss of Activities of Daily Living (ADL)
  • Defined each of the ADL to clarify what qualifies as loss of that ADL
  • Defined adaptive behavior and accommodating equipment to clarify that they impact determinations on when a member can perform an ADL
  • Defined the types of assistance needed (physical, stand-by, and verbal) that qualify as being unable to perform an ADL

Facial Reconstruction
  • Defined the terms “avulsion” and “discontinuity defect”, both key criteria to qualify for payment
  • Clarified where tissue and/or bone must be lost to qualify for payment

Hospitalization
  • Clarified the types of inpatient treatment settings that qualify as inpatient hospitalization
  • Clarified when hospitalization for assessments involving TBI/PTSD are payable
  • Clarified how hospital passes impact consecutive hospitalization days

Limb Salvage
  • Changed name of loss to Limb Reconstruction to better reflect the type of loss the program covers
  • Changed the eligibility criteria to provide a more objective standard

You can find more information on these changes on the TSGLI Schedule of Losses and in the TSGLI Procedures Guide.

How has the TSGLI Application Changed?

The TSGLI Application now clearly requires claimants to submit supporting evidence along with their claim form.  Part A of the TSGLI Application now includes a specific section (Section 6) requesting supporting evidence and asks the claimant to list the evidence being provided with the application.   The requirement for supporting evidence is in addition to a medical professional completing Part B of the application.

Supporting evidence is needed to document not only that the claimant meets the medical standard for the TSGLI loss they are claiming, but that they meet other eligibility criteria or program exclusions do not apply.

You can access the TSGLI Application Form (SGLV 8600) TSGLI Schedule of Losses on the VA Insurance Forms page.  For detailed information on completing the TSGLI Application, take our online training titled “Completing the TSGLI Application (SGLV 8600) – A Guide for TSGLI Claimants and Medical Professionals”.  

What Other Changes Should I Be Aware Of?

The review also made changes to the following areas:

Change

 Explanation

Defined External Force
  • Clarified the definition of traumatic event, one of the key criteria for TSGLI payment, by explaining what is and is not considered external force

Heat Stroke and Frostbite
  • Clarified that heat stroke and frost bite are traumatic events

Anaphylactic Shock from Bite/Sting
  • Clarified that a bite or a sting is a traumatic event and that losses due to anaphylactic shock from the bite or sting are not excluded by the illness/disease exclusion

Non-Penetrating Blast Waves
  • Clarified that non-penetrating blast waves are a traumatic event
  • Clarified that the two-year period for incurring a loss begins on the date the last verified non-penetrating blast wave occurred

Complications from Surgery Due to A Traumatic Event
  • Clarified that surgical complications alone do not qualify for TSGLI payment, but if the surgery was necessitated due to a traumatic event and complications caused a loss, TSGLI benefits can be paid.

Preexisting Conditions
  • Clarify that claimants will be entitled to payment for a TSGLI loss as long as any preexisting condition did not substantially contribute to that loss.

Clarify Standard of Evidence
  • Clarify application of 38 USC 5107(b) to the TSGLI program

Clarify TSGLI Appeal Process
  • Explain the three‐tiered uniform service appeals process
  • Explain that the existing one‐year limit on TSGLI appeals does not apply when the claimant submits new and material evidence
  • Explain that claimants must utilize the full three‐tiered uniformed service appeals process prior to litigating in federal district courts (38 USC 1975)

You can find more detailed information on each of these areas in the TSGLI Procedures Guide.

Is There Additional Training Available on Any of the Changes?

Yes, training is available.   VA has developed new online training modules on “Completing the TSGLI Application (SGLV 8600) – A Guide for TSGLI Claimants and Medical Professionals” and the “TSGLI Activities of Daily Living”.   Other online trainings that provide an overview of TSGLI, information on TSGLI coverage, and genitourinary losses were already available prior to the review.   All TSGLI Online trainings can be found on the VA Insurance Training page.

 

Where Can I Find Detailed Information on the TSGLI Program?

You can find comprehensive and detailed information on the TSGLI Program in the TSGLI Procedures Guide.  The Procedures Guide provide now includes all of the changes from VA’s review and is updated regularly should any additional changes occur.

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