BVA9502366 DOCKET NO. 93-06 602 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Fargo, North Dakota THE ISSUES 1. Entitlement to service connection for refractive error with strabismus. 2. Entitlement to service connection for a psychiatric disorder, to include post-traumatic stress disorder (PTSD). 3. Entitlement to service connection for an allergic reaction to insect bites. 4. Entitlement to service connection for a headache disorder. REPRESENTATION Appellant represented by: Minnesota Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL The veteran and her spouse ATTORNEY FOR THE BOARD Sabrina M. Tilley, Counsel INTRODUCTION The veteran served on active duty from February 1966 to February 1969. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 1992 rating decision. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that she has refractive error with strabismus because of eye strain due to poor lighting in her work area in service. She reports that she has an acquired psychiatric disorder, to include PTSD, as a result of the stress she experienced while working on a medical ward. She also attributes her headaches to poor lighting and eye strain. Finally, she argues that she experienced her first episode of an allergic reaction to insect bites while she served on active duty. 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 claims for service connection for acquired eye and psychiatric disabilities and for an allergic reaction to insect bites are not well grounded. It is also the decision of the Board that the claim for service connection for refractive error has no legal merit or entitlement under the law and that the preponderance of the evidence favors the veteran's claim for service connection for migraine/vascular headaches. FINDINGS OF FACT 1. No competent evidence has been received to show that the veteran currently has acquired eye and psychiatric disabilities, to include PTSD, as well as an allergic reaction to insect bites that may be associated with her active service. 2. The veteran has refractive error that is correctable with lenses. 3. The veteran's migraine or vascular headaches probably originated from her active service. CONCLUSIONS OF LAW 1. The veteran's claims for service connection for acquired eye and psychiatric disabilities, to include PTSD, as well as for an allergic reaction to insect bites are not well grounded. 38 U.S.C.A. §§ 1110, 5107, 7104 (West 1991). 2. The veteran has refractive error, a condition for which service connection is not authorized. 38 U.S.C.A. §§ 1110, 5107, 7104 (West 1991); 38 C.F.R. § 3.303(c) (1993). 3. Migraine or vascular headaches were probably incurred in the veteran's active service. 38 U.S.C.A. §§ 1110, 5107, 7104 (West 1991); 38 C.F.R. § 3.102 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I The law requires that a claimant shall have the burden of submitting a claim that is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). The VA benefits system requires more than just an allegation; a claimant must submit supporting evidence sufficient to justify a belief by a fair and impartial individual that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992). Although the claim need not be conclusive, the statute requires the claim must be accompanied by evidence. Id. Where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. See Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). Lay persons are not competent to offer medical opinions. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Lay assertions of medical causation cannot constitute evidence to render a claim well grounded under § 5107(a). Tirpak, 2 Vet.App. at 611. A February 1963 medical record from L. Hill, O.D., shows that the veteran, who had been wearing glasses since the 5th grade, was seen because she had broken her right lens. Dr. Hill noted that the veteran had a left eye that "swings up" and some blurring when she looked up too long. It is also noted that the veteran reported that she had headaches at times. The report of the veteran's enlistment examination shows that she had a visual acuity of 20/200 in the right eye and 20/70 in the left eye, correctable to 20/20 in each eye with lenses. She was noted to be myopic. In December 1968, she experienced a transient blurring of vision in the right eye, followed by a headache, that lasted 1 hour and would be relieved by the headache. On objective examination, her visual acuity was 20/200 in the right eye and 20/60 in the left eye. With correction, the veteran's vision was 20/20 in each eye. The impression was questionable ophthalmic migraine. The report of the medical examination for discharge from active service shows that the veteran's vision in the right eye was 20/300, correctable to 20/20. Vision in the left eye was 20/40, which was also correctable to 20/20. The veteran underwent a VA examination in October 1991. At that time, her corrected vision was variously noted to be 20/20 and 20/30 in each eye. There was a left lateral rectus palsy of the left eye, and Duane's syndrome was diagnosed and identified as a congenital disorder. While the veteran's allegations of entitlement have been considered as to the inservice origin of an existing eye disorder, she has not brought forth any evidence that would establish a nexus between such disabilities and her active service. Private medical records indicate that prior to her service she had an eye condition marked by blurring and drifting of the left eye. There is no reference made to this type of disorder in her service medical records, except for a transient episode of blurred vision in December 1968. Hence, there is no evidence demonstrating that such disability worsened during her service. Similarly, evidence relating Duane's syndrome or strabismus to service has not been presented. The veteran's lay assertions, as they pertain to a question of medical diagnosis or causation, are not supported by competent evidence and, as such, cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a). Grottveit v. Brown, 5 Vet.App. 91 (1993). Moreover, errors of refraction, to include myopia, were shown in preservice, inservice and postservice records. The veteran is advised that her claim for service connection for refractive error has no legal merit or entitlement under the law, as 38 C.F.R. § 3.303(c) provides that refractive error is not a disease or injury for which service connection may be established. II. The veteran's service medical records show that in October 1968 she was evaluated at a naval hospital for transient symptoms including deep chest discomfort with breathing. Also, she had an episode of lightheadedness, numbness in the arms and hands and nervousness during the previous evening. The recorded impression was transient anxiety reaction. The remainder of the veteran's service medical records make no further reference to any type of neuropsychiatric disorder. In fact, the report of the medical examination for separation from service is negative for any complaint or finding of a psychiatric disability. Reports of treatment obtained in the postservice years fail to show that the veteran currently has psychiatric disability of any type, including an anxiety disorder, or claimed PTSD. While "nervousness" was noted in an August 1971 report of private treatment, nothing pertinent has been shown over the subsequent twenty years. Moreover, the veteran has not brought forth any evidence to support her allegation that she currently has a psychiatric disability associated with her active duty. While the veteran's allegations of entitlement have been considered, her lay assertions, as they pertain to a question of medical diagnosis or causation, are not supported by competent evidence and, as such, cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a). Grottveit v. Brown, 5 Vet.App. 91 (1993). III. The veteran contends that she developed an allergic reaction to insect bites that commenced during her active service. Her service medical records show that in August 1966, she was treated for an allergic reaction to insect bites. No further reference is made as to this type of reaction. The record does not reflect and the veteran does not contend that she developed some type of ailment as a result. Her only contention is that she has experienced new reactions with subsequent insect bites. There is no indication that she has incurred any type of injury or disease inservice to which these subsequent reactions may be attributed. The veteran's allegations of entitlement have been considered. However, her lay assertions, as they pertain to a question of medical diagnosis or causation, are not supported by competent evidence and, as such, cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a). Grottveit v. Brown, 5 Vet.App. 91 (1993). IV. Reports of private treatment dated from February 1963 show that the veteran complained of headaches at times. No diagnosis was recorded. The report of the medical examination for entrance into active service showed no pertinent abnormalities. On the report of medical history, the veteran indicated that she had not had frequent or severe headaches. The veteran's service medical records show that in December 1968, the veteran complained of blurring vision of the right eye followed by a headache. The recorded impression was possible ophthalmic migraine. No further complaints were recorded in the veteran's service medical records, and the medical examination for separation was negative for any pertinent abnormalities. In the postservice years, a September 1973 private treatment report shows that the veteran was seen for complaints of intermittent headaches of one year's duration. The pain occurred over the left eye. Subsequent reports show additional complaints of a similar nature. The veteran was afforded a VA neurological examination in October 1991. At that time, she reported having chronic headaches since 1966, with blurred vision. More recently, she noticed a severe pressure sensation in the back of the head, with retro-orbital pain followed by a headache. These symptoms were precipitated by her being in a dark environment and were alleviated by Tylenol. The veteran reported that she had been told that there was nothing that could be done for her condition unless an attack was seen. The examination was thought to be consistent with various types of migraine/vascular headaches, which were somewhat atypical. A computerized tomogram was scheduled to rule out the presence of a mass, lesion, aneurysm or brainstem lesion. A November 1991 note shows that the veteran was seen for a follow-up visit for severe and chronic headaches. The CT scan, reportedly showed no pertinent abnormality. Likewise, no ocular cause or diagnostic findings were observed on ophthalmologic examination that would explain the headaches. The impression was that she had vascular headaches of an undetermined source. The veteran provided testimony and submitted lay statements from family and acquaintances who attest to knowledge of her complaints of headaches since her release from active service. The veteran's history of vascular-type headaches apparently commenced in her period of active service and were again noted in the postservice years. Her allegation of an inservice origin of these complaints have not been refuted by any competent evidence. Although some preservice origin of headaches has been indicated, there is no verification of either the type or chronicity of these complaints, particularly in the absence of a complaint or finding at the time of the veteran's entrance into active service. Accordingly, the preponderance of the evidence supports the claim for service connection for migraine/vascular headaches. ORDER The veteran's claims for service connection for an acquired eye disability, for a psychiatric disorder, to include PTSD, and for an allergic reaction to insect bites are not well grounded, and these claims are dismissed. The veteran's claim for service connection for refractive error is denied. Service connection for migraine/vascular headaches is granted. BARBARA B. COPELAND 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.