BVA9503628 DOCKET NO. 93-00 191 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUES 1. Entitlement to service connection for residuals of parasites. 2. Entitlement to service connection for residuals of cuts on legs. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from August 1944 to August 1946. The veteran has been found to be entitled to nonservice-connected pension benefits from April 1991. The Department of Veterans Affairs (VA) Regional Office (RO) in San Francisco, California initially denied the veteran's claim for service connection for a "stomach disorder with high fever" and "fractured knees" in 1946 on the basis that such disorders were not found. This appeal is from an August 1991 decision by the RO on the recent claim by the veteran for service connection for residuals of parasitic infestations (specifically ankylostomiasis and Giardia Lamblia) and leg cuts. Although there are some parallels between the substantive natures of the 1946 and 1991 claims, as described below, there are also significant differences; the RO considered the current claim as on a de novo basis and the Board will do likewise. The veteran provided testimony before a traveling member of the Board of Veterans' Appeals (the Board) at the RO in October 1992. A Transcript is of record, hereinafter known as Tr. The case was remanded by the Board in March 1993 for development of the evidence. CONTENTIONS OF APPELLANT ON APPEAL The veteran argues that he had parasites while in service and that he now exhibits problems (probably of a musculoskeletal nature) as a result. He testified that some 8-11 months after his return from service, he was hospitalized for ova, reflecting ongoing parasitic infection. Tr. at 13. The veteran also testified that in service, a jeep slid in the mud while he was standing next to a truck, which then hit his legs and cut them; that he had treatment by a medic and walked peculiarly for awhile. Tr. at 11; and that he now has residual scars or "holes". In his Substantive Appeal, the veteran argued that he has 3 brothers, all of whom were raised in Wyoming and served in the Pacific, and of the 4, he was the only one to get hookworm, and now he is the only one with bone problems. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the veteran's claim for service connection for residuals of parasites and for residuals of cuts on legs, is not well-grounded. FINDINGS OF FACT 1. All relevant evidence for an equitable disposition of the issues on appeal is of record. 2. In the summer of 1946, the veteran had gastritis; his stools were positive for ankylostomiasis (hookworm ova) and Giardia Lamblia. 3. Evidence of record does not show that parasites have been documented since 1946. 4. Service medical records show no evidence of cuts on the legs. 5. There is no evidence or medical opinion that the veteran now has residuals of parasites or cuts on the legs that are related to service. CONCLUSION OF LAW The veteran's claim for service connection for residuals of parasites and for residuals of cuts on legs is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION In Boeck v. Brown, 6 Vet.App. 14 (1993), the United States Court of Veterans Appeals (the Court) held that A(n appellant) claiming entitlement to VA benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. See 38 U.S.C.A. § 5107, and see Tirpak v. Derwinski, 2 Vet. App. 609, 610-11 (l992). If a claim is not well grounded, the Board does not have jurisdiction to adjudicate that claim. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). The Board may dismiss any appeal which fails to allege specific error in fact or law in the determination being appealed. 38 U.S.C.A. § 7105(d)(5) (West 1991). The appellant is seeking service connection for residuals of parasites and residuals of cuts of the legs. Service Connection Service connection may be granted for disability which is the result of disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). Development of the Evidence The United States Court of Veterans Appeals (the Court) has held that pursuant to 38 U.S.C.A. § 5103(a) (West 1991), an obligation is imposed on the VA prior to the time when the duty to assist attaches under 38 U.S.C.A. § 5107(a), [namely upon submission of a well-grounded claim], to advise the claimant of the evidence necessary to complete the application for benefits. Morris v. Derwinski, 1 Vet. App. 260, 264 (1991); and Robinette v. Brown, No. 93-985, (U.S. Vet. App. Oct. 21, 1994) slip op. at 12-13. The veteran has been so advised by the RO including in the Statement of the Case, and by the Board member chairing the hearing in March 1992. The veteran has concomitantly demonstrated his understanding of what is required in his case. He has submitted copies of pages of the Merck's Manual and other texts reflecting that he was stationed in an endemic environment for parasites, that he and other soldiers wore low boots which permitted the parasites to permeate their skin; and that parasitic infections, like malaria, may tend to recur. He argues that he is afraid that he has had recurrence of the infestation which has caused his more recent gastrointestinal and possibly musculoskeletal problems. In that regard, in pertinent part, he sought additional testing. The Board remanded the case for development of the evidence to include comprehensive VA examination and testing. This development was all done prior to the veteran establishing a well-grounded claim. Evidentiary Record The veteran's service medical records show that in June 1946, he complained of gastritis. It was recorded on admission that on the evening of June 15, 1946, he had sampled several Japanese and American alcoholic beverages, and the following morning, he awakened with sore eyes, stomach and head ache; he could not urinate and vomited including after meals that whole day. He took the day off. The next afternoon, he developed abdominal cramping and loose stools. He was admitted with a non-tender abdomen. Initial diagnoses were chronic acute gastroenteritis and rule out amebiasis. His stool specimens were serially checked for ova and parasites. The specimens were several times positive for parasites, specifically including many cysts and a few trophozoites of Giardia Lamblia, and 1 (pecan-sized) hookworm ova. Amphojel, Atabrine, analgesics for pain, sodium sulphate and tetrachloroethylene were given. Diagnoses included gastritis, ankylostomiasis and Giardia infection. He was treated from June 17 to July 2, 1946, at which time he was returned to duty, improved on all counts. Service medical records further show that while treated in July 1946 for catarrhal nasopharyngitis, there were no noted complaints of gastritis or signs of parasites. The veteran's separation examination in August 1946 noted, in pertinent part, a history of stomach trouble and hookworms. No clinical abnormalities were identified on examination, and there was no history, complaint or findings of residuals of leg cuts. The veteran's separation document, a WD AGO Form 100, shows that in service, his occupational specialty was as a heavy truck driver; it was noted that he was in combat for four months in the Luzon Campaign. His awards include the Combat Infantryman Badge. The service records include no reference to a jeep or truck accident. On an examination in June 1949 by Dr. J. Edwards to determine whether he had recurrence of the intestinal infection (i.e. ankylostomiasis and Giardia), a fecal specimen was negative for ova or parasites. The veteran filed a VA Form 21-526 in 1991, stating that he was unable to walk for practical purposes. He described leg cuts in a jeep accident in June 1945 and parasites in June and July 1946. He did not list any post-service treatment for either. The veteran subsequently submitted private clinical evidence dating from 1985 from Fairmont Hospital relating to a number of complaints, none of which related either to residuals of leg cuts or parasitic infections. On a VA examination in 1991, the veteran referred to treatment for "bone troubles" at Fairmont Hospital since 1985. The examiner noted findings indicative of degenerative joint disease involving the wrists and knees. There was no opinion or evidence that any of the orthopedic problems were of service origin or related to any inservice accident including leg cuts. Pursuant to Board remand, the veteran was examined by the VA in June 1993. The veteran reported that after he had had parasites in service, he was told that he might continue to have difficulties with his legs. He reported that he had had no stomach troubles since then, but recently had developed diarrhea. He claimed that he had developed pain in his legs about 10 years before with intermittent swelling. The veteran expressed the opinion that the leg problems were the result of the hookworm infections since he had been told he might get leg problems at a later time. The examiner noted that the veteran complained of chronic intermittent leg swelling with onset 40 years after parasite infection, and there was no known recent evidence of parasitic infection. Examination showed no current leg swelling or pedal edema. On an examination to determine the presence of scars, the veteran said that a jeep had run into him and resulted in minor scars, nontender, with minimal symptoms. On examination there was a 2 cm. depression over the left thigh without a scar. There was no discernible scar over the right thigh. The diagnosis was localized subcutaneous atrophy. A stool specimen was submitted to the parasitology lab for evaluation for ova and parasites in April 1994. Results were negative (both by concentrate and trichrome). VA outpatient treatment records show that the veteran has more recently been seen for a number of complaints including arthritis. The veteran has periodically given a history of parasites, but there have been no recurrent findings thereof. He had his gallbladder removed in November 1991 with no untoward residuals. Analysis The veteran experienced parasitic infestation by Giardia Lamblia and hookworm, documented on laboratory evaluation of serial stool specimens, in June and July 1946, and for which he received appropriate care. However, since then, there has been no documentation of parasitic recurrence, including in specific testing in 1949 and 1994. There is no evidence or medical opinion of record to support that any of the veteran's post- service symptoms are the result of the inservice parasites. The veteran's argument that he alone, of 4 brothers, was the only one who had parasites and later developed bone problems, and that accordingly, the two incidents must thus be connected, is not persuasive. The veteran has identified texts and quotes service physicians to the effect that people who have had parasitic infections may develop musculoskeletal problems at a later date; however, there has been no factual or specific clinical application to the facts in this case. The veteran claims that he has residuals of parasites at this time, apparently referring to some musculoskeletal complaints, but he has not offered any medical opinion to support his theory, his arguments in this regard are unconvincing, and they are not supported by the recent clinical evaluations. Following examination in June 1993, it was concluded that there was no known evidence of (residuals of) the parasitic infection. Similarly, there is no service evidence of a jeep accident. However, this alone would not necessarily negate the possibility of service connection if a chronic disorder were subsequently shown. However, there is no evidence at separation or for some 40 years after service of leg scars (or any other symptomatology) which might be in any way the residual of such an incident. On a recent VA examination, conducted to determine whether the veteran now has residuals of leg cuts, he was found to have one small indentation in one thigh, described as subcutaneous atrophy, and no discernible scars on either thigh. Notwithstanding the veteran's expressed opinions, current orthopedic problems are not shown to be to be due to inservice leg trauma or lacerations. The veteran is not medically trained and is not qualified to render such a medical opinion, and this opinion is not otherwise borne out by the evidence of record. See Espiritu v. Derwinski, 2 Vet.App. 492 (1993). In reaching its decision, the Board has taken into consideration all of the evidence of record. However, absent evidence or medical opinion that he has any chronic residuals of parasites or leg cuts which are of service origin, the Board finds that the veteran's claim is not well-grounded, and therefore, must be dismissed. If the veteran were to submit medical evidence (such as an opinion) showing that he has any such disability which is related or proximate to service, his claim in this regard would be well grounded. See Robinette v. Brown, op. cit. ORDER The claim for service connection for residuals of parasites and for residuals of cuts on legs is not well grounded; the appeal is dismissed. THOMAS J. DANNAHER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.