reatment because in the last few days he had developed a
superficial ulcer in the left lower leg with some drainage and
brief period of swelling on the anterior lateral aspect. An
exam taken on that date showed the presence of a foreign body
in the leg. There was no evidence of any acute injury.
MacDonald was given antibiotics. A copy of the report was
directed to be sent to Col. Rich, the physician in charge of
MacDonald's care at WRAGH. No copy received at WRAGH or by Col.
72. MacDonald was again seen at USVAH-WB on July 23, 1974,
when he presented himself at the outpatient clinic with edema
of the left lower leg with superficial ulceration and skin
lesion of 4-5 toes of left foot. He was referred to
73. On July 23, 1974, upon referral from the outpatient
clinic at USVAH-WB, MacDonald was seen in the Dermatology
Clinic, where stasis dermatitis of the left leg and foot was
diagnosed as secondary to multiple shrapnel flesh wounds. He
was told to apply Aristocort cream and to use an elastic
stocking, and instructed to return August 6, 1974.
74. On August 6, 1974, MacDonald returned to the Dermatology
Clinic at USVAH-WB where the examining physician noted that the
stasis dermatitis had healed and referred him to Prosthetics
Clinic, where MacDonald was given an elastic stocking.
MacDonald was instructed to return to the Dermatology Clinic on
September 10, 1974.
75. On August 6, 1974, MacDonald was also referred by the
examining physician in the Dermatology Clinic to the Diabetes
Clinic, where he was examined and given a 1200-calorie diet for
weight reduction. MacDonald also received an elastic stocking,
and was measured for a more precise-fitting elastic stocking.
76. On September 10, 1974, MacDonald returned to the
Dermatology Clinic at USVAH-WB, where it was observed by the
examining physician that the eruption had improved except for
a small area on his hand. Because of what the examining
physician described as bizarre symptoms in his right leg, he
was referred to the Neurology Clinic.
77. At this visit to USVAH-WB, the examining physician
directed that a copy of the medical records at WRAGH be
obtained to be placed in MacDonald's file at the USVAH-WB. The
records from WRAGH were never obtained and, therefore, were not
available to the subsequent examining and treating physicians
of MacDonald at USVAH-WB.
78. On October 10, 1974, an eruption was observed on his left
leg. Therefore, the examining physician in the Dermatology
Clinic at USVAH-WB changed MacDonald's medication.
79. On December 4, 1974, at his visit to the Dermatology
Clinic at USVAH-WB, it was noted that the dermatitis on his
left leg persisted and the medication for application was again
80. On February 27, 1978, when MacDonald again presented
himself at the Dermatology Clinic at the USVAH-WB, the
examining physician noted that the dermatitis had recurred at
the post op site on the left leg. Aristocort was again
prescribed for application and the condition resolved itself.
81. MacDonald had no further complaints referable to the
lower left leg which were treated at USVAH-WB until January 23,
1986, when he was seen in the Primary Care Clinic of that
hospital, when it was noted that he was complaining of pain in
the left leg radiating up to the knee. The examining physician
noted that MacDonald gave a history that six months ago
MacDonald started to complain of cramps in his left calf while
walking up stairs, steep hills, or very briskly on a level
surface. This did not cause MacDonald to stop walking but
merely to slow down until the cramps ceased. MacDonald's
present complaint for which he presented himself was local
82. MacDonald continued to work as a letter carrier from July
21, 1984, until March 23, 1986, and was able to perform
his duties and to fulfill his employment obligations.
83. On January 24, 1986, MacDonald was seen in orthopedic
consultation with H.A. Smith, Jr., M.D. at the USVAH-WB who,
after examining him, referred MacDonald to the Vascular Clinic
at the hospital.
84. On February 24, 1986, MacDonald was seen in the
Outpatient Surgical Clinic at the USVAH-WB by Juan DeRojas,
M.D., who was a full-time employee of the defendant, United
States of America.
85. Dr. DeRojas noted that MacDonald's chief complaint was
"heaviness in the left calf" and further noted that he had a
history of an AV fistula which had been surgically treated by
86. Dr. DeRojas on this initial exam noted that MacDonald had
a good dorsalis pedis pulse but no posterior tibial pulse with
slight increase in volume of left lower leg.
87. On March 17, 1986, Dr. DeRojas noted that the Doppler
showed drop in left calf pressure. He noted that MacDonald had
pain in his left leg especially in calf area that increases
with exercise. He claimed that leg was warmer with prominent
superficial veins. Dr. DeRojas arranged for MacDonald to be
admitted for a left femoral arterial tibial artery by-pass
which was performed on April 2, 1986, using a reverse saphenous
C. Medical History — Post-Operative.
88. After the surgery, MacDonald developed swelling, pitting
edema and severe dermatitis in his left leg.
89. Because of the swollen left leg with plus () 2 pitting
edema which was apparent on April 9, 1986, MacDonald's
discharge from USVAH-WB was postponed.
90. When MacDonald was finally discharged on April 16, 1986,
he was not permitted to return to work for at least ninety (90)
days. He was instructed to return to the Surgery Clinic for
91. On September 19, 1986, MacDonald was seen in the Surgical
Clinic at the USVAH-WB, where his condition was diagnosed as
severe chronic venous insufficiency of the left leg, which is
a permanent disability, and the doctor stated that MacDonald
was unable to resume his previous employment or an employment
requiring standing. He was advised by the examining physician
to undergo extended bed rest with elevation of his left leg.
92. On September 19, 1986, MacDonald was seen at the Surgical
Clinic of the USVAH-WB where examination noted improvement. He
still had edema in the left leg. The examining physician noted
that MacDonald would be unable to work at any position
requiring prolonged sitting or standing because he is
compromised by the permanent disability. The examining
physician noted that MacDonald would have to develop collateral
venous channels to handle the increased arterial inflow.
93. Despite the continuous presence of stasis dermatitis
since April 3, 1986, MacDonald was first referred post op to
the Dermatology Clinic on October 1, 1986.
94. On May 8, 1987, MacDonald was seen in the Surgical Clinic
at USVAH-WB where he was diagnosed as having symptoms of venous
incompetence. A doppler study was found to be inconclusive and
it was recommended that MacDonald be further evaluated.
95. At the order of the examining physician, a venogram was
performed on MacDonald on June 2, 1987, and on June 5, 1987,
MacDonald returned to the previous examining physician and Dr.
DeRojas. Their interpretation of the venogram was:
A. Deep veins are normal.
B. Evidence of tortuous superficial veins in
area of calf.
C. No evidence of an AV fistula or venous
D. Incompetent perforating veins in the area of
E. Previous resection of saphenous vein.