In re Angela Snyder

OPINION

SPRAGUE, J. Claimant, Angela Snyder, wife of SSG Scott Snyder of the U.S. Army, U.S. Army Reserve, and National Guard, brings this claim pursuant to the Illinois Line of Duty Compensation Act, 820 ILCS 315/1 et seq. In its Report filed on September 12, 2012, the Attorney General (AG) recommended a hearing, concluding that it was unable to determine whether SSG Snyder was "killed in the line of duty" under the Illinois Act. This Court then referred this matter to a Commissioner, who conducted a hearing on May 28, 2014.

FACTUAL BACKGROUND

Army protocol requires all soldiers to undergo an extensive post-deployment health assessment to identify any changes in their overall health that may have occurred during deployment and that may manifest in the months after deployment. The avowed goal is to [*163] ensure the soldiers receive adequate medical care. Pursuant to the Army's Warrior Transition Unit (WTU) program, soldiers who incur an illness, injury or disease, or aggravate a pre-existing medical condition during their current mobilization are retained on Active Duty status so they can be offered further medical care and evaluation. If the military medical staff fails to diagnose an injury or illness during the post deployment screening, the affected soldier is eligible to return to Active Duty status through the Medical Retention Processing 2 Program (MRP2).

SSG Snyder honorably served over 14 years in the U.S. Army, U.S. Army Reserve, and the National Guard. His service included two deployments with the Illinois National Guard to the Middle East: his first one was in Kuwait/Iraq in support of Operation Iraqi Freedom (OIF), and his second one was in Egypt in support of Operation Enduring Freedom (OEF).

On March 3, 2011, during his deployment in Egypt, SSG Snyder fell off a Segway he crashed while on leave in Sharm Sheikh, Egypt. Claimant, SSG Snyder's wife, testified that she communicated with SSG Snyder almost every day while he was in Egypt and that after the fall he experienced pain in the tailbone area and eventually rectal bleeding.

Despite the pain and bleeding, SSG Snyder did not seek immediate medical attention. Claimant explained that at the time of the fall, SSG Snyder was serving his last rotation as Outpost Commander. He was afraid if he went on sick call, the Army would remove him from that position until his deployment ended on April 28, 2011.

According to Claimant, SSG Snyder enjoyed this position, which required him to command eight to ten soldiers. After SSG Snyder finished his rotation as Outpost Commander, since his deployment was ending soon, he began worrying about sitting during the 24-hour flight back to the United States.

Eventually, on April 26, 2011-two days before his deployment in Egypt ended-SSG Snyder went to a military treatment facility, complaining that he had severe pain in his right thigh and buttocks area and blood in his stool after falling off a Segway on March 3, 2011. The doctors at the facility attributed his symptoms to a fractured coccyx from the Segway crash. SSG Snyder then returned to the United States on April 28, 2011, arriving at Fort McCoy, Wisconsin to begin demobilizing.

Two days after arriving at Fort McCoy, Wisconsin, SSG Snyder went on sick call on May 1, 2011. Military records indicate that the examining physician noted a possible coccyx fracture and referred SSG Snyder to the Troop Medical Clinic for an MRI.

On May 2, SSG Snyder was seen at Ft. McCoy primary care for an MRI referral.

SSG Snyder still felt pain in his tail bone and stated that he had been experiencing rectal bleeding since he crashed the Segway. The next day, May 3, SSG Snyder returned to Fort McCoy primary care and reported severe pain for which he was given medication. On May 6, MRIs and X-rays of his coccyx were taken at Tomah Memorial Hospital. The doctors noted that the MRI results indicated a non-displaced coccygeal fracture. On May 9, 2011 Headquarters, U.S. Army Garrison, Fort McCoy, WI, published Orders releasing SSG Snyder from active duty, not by reason of physical disability, effective June 2, 2011. On May 10, SSG Snyder visited primary care at Fort McCoy to discuss the MRI results. The doctor expected continued gradual improvement of SSG Snyder's coccyx and cleared SSG Snyder to demobilize. The Anny honorably discharged SSG Snyder from active duty status to the Illinois National Guard on June 2, 2011.

[*164] SSG Snyder eventually went to a private practitioner in late June 2011. A biopsy was immediately performed. On June 28, 2011 Dr. Stewart Garneau diagnosed him with Stage IV metastatic cancer - which had spread from his anus to his liver, lungs, bones, and right inguinal lymph node.

Based on this diagnosis, it became apparent to the Illinois National Guard that he had been misdiagnosed by Army doctors. The Illinois National Guard tried to connect the Army's error by getting SSG Snyder placed back on Active Duty through the MRP2 program.

However, SSG Snyder died on August 3, 2011 before the paperwork could be completed.

Subsequently, the Illinois National Guard JAG conducted a line of duty investigation pursuant to the relevant Federal line of duty laws. LTC Robert C. Roth, Staff Judge Advocate for the Illinois National Guard JAG declared that, "the preponderance of the evidence clearly shows that SSG Snyder's cancer began developing while he was on active duty, and there being no basis to conclude otherwise, the only finding supported by the preponderance of the evidence is that this matter is In the Line of Duty [sic]."

On April 15, 2014 the Army Board for Correction of Military Records (ABCMR) issued a decision. It ordered the Illinois National Guard to void the orders releasing SSG Snyder from active duty in support of OEF and ordered that he receive all benefits and compensation entitled to him under Federal law. It based its decision on finding that the Army doctors should have further evaluated SSG Snyder and discovered his cancer. It noted that had the Army doctors done so, he would have been retained on WTU and/or explored other administrative options regarding his medical condition that would have suspended his demobilization and likely rendered him on active duty status when he died.

ANALYSIS

This claim is governed by the Illinois Line of Duty Compensation Act, 820 ILCS 315/1 et seq. For this Court to grant compensation under this Act the decedent must have been "killed in the line of duty." See 820 ILCS 315/3. Killed in the line of duty with respect to Armed Forces members means, "losing ones life while on active duty in connection with the September 11, 2001 terrorist attacks on the United States, Operation Enduring Freedom, or

Operation Iraqi Freedom."

Claimant argues that the requirements of 820 ILCS 315/2(e) are satisfied because Decedent was on active duty status in support of OEF when he died. Claimant states that this Court has previously held that, under the Illinois Act, a claimant need only establish the following two elements for us to find that an armed forces member was "killed in the line of duty": 1. the decedent died while he/she was on active duty; and 2. his/her active duty was in connection with either the September 11, 2001 terrorist attacks on the United States, Operation Enduring Freedom, or Operation Iraqi Freedom.

We required these elements when the decedent died while on active duty that was not in support of one of the three designated military operations, and the claimant argued the Act still applied because the decedent's active duty at the time of his/her death was "in connection with" one of these military operations. In In re Application of Linda Crislip 08- CC-0516 (Apr. 3, 2009), a case Claimant cites in her brief, the decedent died while he was on active duty in Fort Lewis with the 5th Stryker Brigade Combat team. The claimant argued [*165] that the decedent's active duty was in connection with OIF because he was in the first year of a three-year cycle typically ending in deployment to Iraq. We rejected this argument and held that the possibility of deployment to Iraq did not constitute active duty "in connection" with OIF.2 However, when the decedent died while on active duty that was not in support of one of the three designated military operations, but the claimant instead argued the Act applied because the underlying fatal injury occurred while decedent was on active duty in one of them, we required the following elements to find that a decedent was killed in the line of duty: 1. Decedent was on active duty in connection with one of the three designated military operations; and 2. Decedent died in connection with that active duty. See In re Application of Lori Tuttle (Nov. 24, 2008), 07-CC-3163 (claimant argued that decedent's suicide in the United States was in connection with OIF because his suicide was the result of PTSD associated with his deployment to Iraq two years before).

Having died while on "active duty in connection with" one of the three designated military operations implies that a decedent's death was related to his/her active duty in them. This does not mean that the death must have occurred in the performance of decedent's job-related duties. Claimant cites In re Application of Linda Calhoun and Laurie Harris (Feb. 9, 2006), 05-CC-2310, for this proposition in her brief.

In Calhoun we agreed with the AG's recommendation and found that the decedent's death was in connection with OIF where decedent committed suicide while in the theater of war for OIF. Although the decedent's death did not occur in the performance of decedent's job-related duties in OIF, we granted compensation because when decedents have committed suicide in a theater of war for one of the specified operations, we have found a link between their death and active duty. Suicide, unfortunately, has become closely associated with deployment in OIF or OEF.

Here, like the decedent's PTSD in Tuttle, SSG Snyder's Stage IV metastatic cancer is argued to be an underlying fatal injury that occurred while he was on active duty in one of the specified operations. In Tuttle, we found that if the decedent had PTSD due to his service in OIF two years prior, the claimant failed to establish that this was the underlying injury that caused the decedent's unfortunate suicide. See Tuttle (holding that "[b]ased on the evidence Claimant has presented all this Court can conclude is that, even if posttraumatic stress from Iraq existed, it could have played a role in Decedent's suicide - in much the same way that his suicide could have been the result of the psychological stress associated with his Army discharge, sexual assault allegations, his divorce, or other stressful situations in his life.").

Here, SSG Snyder died from Stage IV metastatic cancer. Thus, unlike Tuttle, there is no question that SSG Snyder's death was caused by an underlying injury most Regardless, even in such cases, we noted that the link between a decedent’s death and her active duty in one these military operations also needed to be considered when applicable. In In re Application of Renaldo Ariza, 07-CC-2886 the decedent died of adrenocortical carcinoma while on active duty at Fort Sam Houston. After finding that her active duty at Fort Sam Houston was not "in connection" with one of the three designated military operations, we stated "[f]urther, because we find that Decedent's active duty at the time of death was not related to one of the three specified operations, we need not discuss the significance under the Act of her death being caused by carcinoma."

[*166] likely to have arisen during his active duty. But there is no direct link that SSG Snyder's underlying injury was related to his service in OEF. Claimant tries linking the metastatic cancer to SSG Snyder's active duty in OEF by arguing that had he been properly diagnosed by the Army prior to demobilization clearance on May 10, 2011, he would have had a more favorable prognosis.

We find no legal support for Claimant's argument that SSG Snyder being deprived of "a more favorable prognosis" rises to the level of SSG Snyder having been "killed in the line of duty" under the Act. Further, SSG Snyder's symptoms began sometime after March 3, 2011, but the first and only time he consulted Army medical staff about his pain and rectal bleeding during his deployment in Egypt was on April 26, 2011, two days before his deployment in Egypt ended. But his MRI's and every other medical visit he had with Army physicians regarding his condition were conducted in the United States. Thus, SSG Snyder's deployment in Egypt did not play a role in the Army medical staffs failure to diagnose him with cancer during his multiple medical visits.

In Claimant's Brief on the Issue of Medical Prognosis, she supports her argument by directing our attention to the findings by the Surgeon General's Medical Evaluation Board Consultant/Oncology Consultant quoted in the April 15, 2014 ABCMR decision. Claimant argues that the findings indicate that had SSG Snyder been diagnosed properly on April 26, 2011, he would have had available treatment options. The following is the relevant quote from the ABCMR decision of the findings by Surgeon General's Medical Evaluation Board Consultant/Oncology Consultant: [SSG Snyder] had a medical history of metastatic melanoma. It is the advisory official's opinion that further evaluation of the [SSG Snyder's] rectal bleeding would have been appropriate and would have increased his disposition options to include possible WTU treatment [Warrior Transition Unit retention], an MEB [Medical Evaluation Board evaluation], and probable medical retirement. Whether he would have or would not have died on active duty cannot be determined retrospectively.

The "options" mentioned in the findings, however, are not treatment options.

These "disposition options," are administrative options related to SSG Snyder's medical condition that could have prolonged his active duty status. SSG Snyder could have explored one or all of these options had he been apprised of his cancer on April 26, 2011.3 The following passage from the ABCMR decision shows that this is exactly how the ABCMR used this information: It cannot be determined with certainty, from the available evidence, whether his Stage IV melanoma occurred while on active duty. However further evaluation of the [SSG Snyder's] rectal bleeding would have been an appropriate course of action at the time of his demobilization. This would have increased his disposition options to include WTU, an MEB, and possible Under WTU, he would have been retained under active duty status while he received treatment. If not treatment could be offered, SSG Snyder would have been referred to the Medical Evaluation Board (MEB) to determine if his condition rendered him unable to meet retention standards. If it did, then MEB would refer him to the PEB (Physical Evaluation Board), who would formally determine if SSG Snyder was fit for continued military service and subsequent eligibility for disability compensation. If the PEB determined that SSG Snyder's medical condition met certain criteria, he would have been eligible for permanent medical retirement.

[*167] a medical retirement, all of which would have taken time conduct/conclude, and almost certainly would have meant he would have been on active duty at the time of his death.

(emphasis supplied).

Cancer can be caused by a myriad of factors. There is no evidence that leads this Court to conclude that it is more likely than not that SSG Snyder's fatal cancer was related to his active duty in Egypt in support of OEF. Even if the Army medical staff was negligent in not diagnosing SSG Snyder's cancer during one of his medical visits, only one of those visits-his first one-occurred during deployment in OEF-two days before his deployment ended. His remaining visits, some of which were more in depth than his April 26 visit, took place in the United States of America. There is no link between the Army's failure to diagnose SSG Snyder's cancer and his active duty in Egypt in support of OEF.

The legislative intent is clear: compensation must be limited to the extent the death was connected with one of the three designated military operations. Bound to honor that intent, we do not find by a preponderance of the evidence that SSG Snyder's fatal cancer was directly linked with his Active Duty in OEF and accordingly do not find that SSG Snyder's tragic death from cancer, constitutes SSG Snyder having died while on active duty in connection with OEF under the Illinois Line of Duty Compensation Act. Therefore, it is hereby ordered that this claim is denied.