APPLICANT REQUESTS:  That the finding that his hospitalization for deep vein thrombosis (the collection of blood frequently causing vascular obstruction at the point of its formation), be considered the result of a service related aggravation to his pre-existing condition caused by a trauma to his right leg while he was on active duty.

APPLICANT STATES:  That his condition was misdiagnosed when he was hospitalized.

In support of his application he submits a brief from a medical consultant.  The medical consultant states that the applicant’s hospitalization was due to a trauma and, therefore, an aggravation to his pre-existing medical condition, deep venous thrombosis.  He argues that the diagnoses, the medical treatment regimen, the test findings, and the conclusions made by the physicians treating the applicant before and after his hospitalization were flawed, as is the conclusions made by the Office of The Surgeon General (OTSG) in the review of the applicant’s case.

EVIDENCE OF RECORD:  The applicant's military personnel and medical records show:

On 17 May 1991 the applicant entered on 58 days of Active Duty for Special Work (ADSW) as a lieutenant colonel assigned to the USAR Control Group.  On a physical examination taken by the applicant prior to his ADSW tour, it was noted that that he had a T3 sitting edema of his right lower leg, and that he had a history of deep vein thrombosis dating back to 1971.

On 24 May 1991, 2 weeks after he entered on active duty, he was seen at Walter Reed Army Medical Center (WRAMC), which gave him referrals to internal medicine for an evaluation for chronic fatigue, and a referral to the vascular clinic for evaluation for right lower extremity numbness, tingling and for foot drag.  Based on those referrals, he was seen at DeWitt Army Hospital on 30 May 1991 where he was diagnosed as suffering from chronic fatigue, given a profile restriction of no physical training for 2 months, and was told to return to the clinic in 1 month for reassessment.  

Thereafter, the applicant reported that he had been injured by being kicked in his right leg while playing volleyball on 19 June 1991.  There is no clinical record of the applicant being treated for that injury.  

On 25 June 1991 the applicant was evaluated at the WRAMC Internal Medicine Clinic where he was diagnosed as suffering from chronic fatigue, not easily identifiable, and questionable anemia (a reduction below normal in the number of erythrocytes [one of the elements found in peripheral blood] per cubic millimeter in the quantity of hemoglobin).  He was also diagnosed as having chronic edema of his right lower leg.  He was instructed to apply warm compresses to his leg and to return to the clinic if he did not experience any improvement in 5 to 7 days.

On 27 June 1991 the applicant was seen at DeWitt Army Hospital Internal Medicine Clinic for chronic fatigue and was given a temporary physical profile for a viral infection.

On 9 July 1991 he was evaluated at the WRAMC Vascular Clinic where he was diagnosed as having right peroneal (pertaining to the fibula or to the outer side of the leg) nerve injury and chronic venous (pertaining to the veins) stasis (a stoppage or diminution of the flow of blood or other body fluid) changes.  He was given a permanent profile precluding him from running.  On that date he was also seen at the WRAMC Internal Medicine Clinic which found no obvious medical reason for his fatigue.  He was also found to suffer from anemia, but the examination also found significant improvement in his leg.  He was instructed to continue to apply soaks to the affected area.

On 14 July 1991, the day he completed his tour of active duty, the applicant departed his duty station by commercial air to return home to Colorado.  He then drove an automobile to Canada, a 3-day trip.  On 19 July 1991 he was admitted to Ottawa General Hospital complaining of right calf discomfort, progressive malaise and chest tightness.  He was diagnosed as suffering from deep venous thrombosis.  The treating physicians ruled out pulmonary embolism and stated that there was no definite evidence of acute deep vein thrombosis.

On 17 December 1992 a formal line of duty (LOD) investigation was completed which found that the applicant’s hospitalization for right leg deep vein thrombosis was not incurred in line of duty, that it existed prior to service.  The investigating officer based that finding on the fact that the applicant’s medical records showed that the acute medical conditions he suffered from while on active duty had been resolved prior to his release from active duty, that the applicant was not on active duty when he was admitted to Ottawa General Hospital, and that the applicant was found to suffer from chronic, not acute, deep venous thrombosis during that admission.

The applicant submitted a rebuttal to the formal LOD investigation.  That rebuttal was reviewed by the OTSG on 27 September 1993.  The OTSG stated that the applicant’s deep vein thrombosis was not caused or aggravated by the alleged volleyball injury, and that the condition for which the applicant was hospitalized was not a result of a natural progression of the alleged volleyball injury.  The OTSG opined that the deep vein thrombosis condition that the applicant was hospitalized for was probably the result of an aggravation of his deep vein thrombosis condition brought on by his long automobile trip.  The OTSG has responded to two other inquiries pertaining to the service connection of the applicant’s hospitalization, and consistently concluded that the condition for which the applicant was hospitalized was most likely due to his lengthy automobile trip, not due to a progression of an alleged volleyball injury.

Army Regulation 600-8-1, paragraph 41-8 states, in pertinent part, that if a condition which existed prior to a reservist’s entry on active duty was aggravated by military service, the finding will be in line of duty.  If a 
pre-existing condition is not aggravated by military service, the finding will be not in line of duty, existed prior to service.  Specific findings of natural progress of the pre-existing injury or disease based on well established medical principles alone are enough to overcome the presumption of service aggravation.

The Court of Claims and the Comptroller General of the United States have held that short periods of active duty do not give rise to the presumption of the cause of an illness or disease.

DISCUSSION:  Considering all the evidence, allegations, and information presented by the applicant, together with the evidence of record and applicable law and regulations, it is concluded:

1.  The applicant and his counsel have based their contentions on the argument that all of the physicians who treated the applicant misdiagnosed the nature of his condition, and that the three reviews of the case made by the OTSG were fatally flawed.  However, neither the applicant nor his counsel have provided any objective evidence which would substantiate their contentions.

2.  Without objective evidence to show that the diagnoses from both an Army hospital and an Army medical center were flawed, the Board must presume regularity in this case.  Such a presumption is supported by the three reviews of the case by the OTSG.

3.  The fact remains that the applicant had a long-standing medical condition which is not service connected.  Although the applicant alleges that he was injured while playing volleyball while on active duty, there is no clinical report to substantiate that fact.  Even if there was, there is no indication that the applicant’s hospitalization was due to a natural progression of a trauma.  

4.  The OTSG’s conclusion that the applicant’s hospitalization was a result of the long hours he spent sitting in his automobile while traveling appears reasonable to the Board.

5.  In view of the foregoing there is no basis for granting the applicant’s request.

DETERMINATION:  The applicant has failed to submit sufficient relevant evidence to demonstrate the existence of probable error or injustice.

BOARD VOTE:

                       GRANT          

                       GRANT FORMAL HEARING

                       DENY APPLICATION




						Karl F. Schneider
						Acting Director