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Greenwood v. United States

United States District Court, S.D. California

June 6, 2017

CHRISTOPHER GREENWOOD, an individual, Plaintiff,


          Hon. Dana M. Sabraw United States District Judge

         This matter comes before the Court on Plaintiff's motion for summary judgment and Defendant's cross-motion for summary judgment. The motions are fully briefed. For the reasons set out below, the Court denies Plaintiff's motion and grants Defendant's motion.


         On February 27, 2012, Plaintiff Christopher Greenwood was a member of the United States Navy. On the night of February 27, 2012, Plaintiff fell from his apartment and was found lying on the sidewalk.[1] He was transported via ambulance to UCSD Medical Center where he was diagnosed with a fractured skull. (Id. at ADM000029.) Plaintiff was admitted to the Intensive Care Unit, and remained in the hospital until March 3, 2012. Plaintiff returned to the hospital on March 4, 2012, where he was readmitted and discharged the next day.

         Plaintiff had an otolaryngology consult at the Naval Medical Center (“NMC”) on March 9, 2012, at which time he was complaining primarily of facial nerve weakness. (Id. at ADM000285.) Four days later, Plaintiff had an audiology assessment at the NMC. (Id. at ADM000280-82.) Two days after that, Plaintiff returned to the NMC for follow-up, and was seen by P.M. Kearney, PA-C. (Id. at ADM000277-79.) At that visit, Plaintiff reported feeling sore and having upper back pain. (Id. at ADM000277.) PA Kearney's notes indicate “No dizziness, no vertigo, no decrease in consciousness, no decrease in concentrating ability, no confusion, no memory lapses or loss, no taste disturbances, no speech difficulties, no arm weakness, and no leg weakness. No gait abnormality. Good coordination and no sensory disturbances.” (Id. at ADM000278.) PA Kearney placed Plaintiff on Sick in Quarters status for thirty days. (Id. at ADM000304.)

         Five days later, Plaintiff returned for follow-up with the otolaryngology department. (Id. at ADM000274-75.) At that visit, Plaintiff denied any dizziness or vertigo and reported “no difficulty with balance.” (Id. at ADM000274.)

         A little more than two weeks later, on April 5, 2012, Plaintiff presented to the Physical Medicine and Rehab Clinic at the NMC. (Id. at ADM000271-73.) During that visit, Plaintiff reported no balance problems. (Id. at ADM000272.)

         At his next visit to the Otolaryngology Department on April 17, 2012, Plaintiff reported he had returned to work and was exercising without any problems. (Id. at ADM000269.) He also denied any episodes of dizziness or vertigo, or difficulty with balance. (Id.)

         On August 29, 2013, Plaintiff filed a claim for $50, 000 in benefits under the Traumatic Servicemembers' Group Life Insurance Policy (“TSGLI”) based on the February 27, 2012 accident. (Id. at ADM00003.) Plaintiff's claim was based on his suffering a traumatic brain injury and his resulting inability to independently perform three activities of daily living (“ADLs”) for over thirty days. (Id.) In support of his claim, Plaintiff submitted his medical records from USCD and the NMC, and included a statement from Bassam Zakhour, M.D. (Id.) Dr. Zakhour did not treat Plaintiff, but reviewed his medical records. (Id.) Plaintiff also submitted a statement on his own behalf and a statement from his friend Starr Altsmannsberger. (Id.) That claim was denied on March 11, 2014. (Id. at ADM000329.) The basis for the denial was Plaintiff's failure to provide “enough medical information to support that you could not perform ADLs independently.” (Id.)[2]

         On April 7, 2014, Plaintiff filed an appeal of that decision. (Id. at ADM000331.) That appeal was denied on June 27, 2014. (Id. at SADM000410AG.) The denial letter states, “The medical evidence you provided was evaluated by a Medical Officer assigned to the Navy Personnel Command. It was determined that your claimed injuries and the available medical documentation were inconsistent with the program definition for 15 consecutive days of hospitalization or the loss of two or more ADLs for 120 or more days.” (Id.)

         On August 11, 2014, Plaintiff appealed that decision to the TSGLI Appeals Board. (Id. at AMD000407-09.) That appeal was denied on January 22, 2015. (Id. at AMD000411.)

         Plaintiff filed a request for reconsideration of that denial on February 3, 2015. (Id. at AMD000415-16.) That request was denied on March 9, 2015. (Id. at AMD000451.) Plaintiff filed a follow up request to that denial, (id. at ADM000452), to which he attached a medical analysis from Nancy Olson, MSN, RN, but that request was also denied. (Id. at ADM000471.)

         On July 7, 2016, Plaintiff filed the present case challenging the denial of his claim for benefits. The present motions followed.

         II. ...

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