BVA9500715 DOCKET NO. 91-24 287 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES Entitlement to service connection for residuals of injuries to the knees. Entitlement to service connection for bilateral periostitis of the tibia. Entitlement to service connection for a low back disorder. Entitlement to service connection for residuals of a left thumb injury. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD James J. Dunphy, Counsel INTRODUCTION The veteran served on active duty from July 1989 to August 1989. This appeal to the Board of Veterans' Appeals (Board) arises from a March 1990 rating decision by the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in January 1992, at which time it was remanded for further development. It was returned to the Board in December 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that service connection is warranted for the disorders at issue. The veteran and his representative argue that he was treated for all these disorders during his period of service, and that they continue to cause difficulties. 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 preponderance of the evidence is against the veteran's claims for service connection for residuals of a left thumb injury. It is our decision, further, that the evidence supports the grant of service connection for a right knee injury and for a low back disorder. Finally, it is our decision that the veteran has not submitted evidence of a well-grounded claim with respect to his claims for service connection for residuals of a left knee injury and bilateral periostitis of the tibia. FINDINGS OF FACT 1. It is not shown that the veteran sustained a left knee injury in service or that he now has any left knee disability identifiable as a residual of an injury in service. 2. Inflammatory changes of the plica of the right knee found shortly after the veteran's discharge from active duty were more likely than not caused by the activities of service. 3. It is not shown that the veteran has bilateral tibial periostitis; a stress fracture of the left tibia in service healed without any residual disability. 4. The veteran has a low back disorder manifested by muscle spasm which may reasonably be related to his acute lumbar strain in service. 5. A left thumb injury in service produced only acute and transitory disability which resolved without residuals; no relationship between any current left thumb disorder and service is demonstrated. CONCLUSIONS OF LAW 1. The veteran has residuals of a right knee injury which were incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991). 2. The veteran's claims for service connection for residuals of a left knee injury and bilateral periostitis of the tibia are not well grounded. 38 U.S.C.A. §§ 1131, 5107 (West 1991). 3. A low back disorder manifested by lumbosacral muscle spasm was incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991). 4. Disability of the left thumb, claimed to be the residuals of an injury in service, was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we note that the case was referred to a Board Medical Adviser for an advisory opinion on medical questions arising in connection with the issues before us. Inasmuch as portions of the opinion received pertaining to the claims other than service connection for a low back disorder and service connection for residuals of a right knee injury are considered prejudicial to the veteran, per Austin v. Brown, 6 Vet.App. 547 (1994), those portions of the opinion will not be relied on in this decision. I. Entitlement to service connection for residuals of injuries to the knees. The threshold question here is whether the veteran has presented evidence of a claim which is plausible and capable of substantiation. If he has not, the claim is not well grounded, and the claim may proceed no further because the Board does not have jurisdiction to adjudicate the claim. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Boeck v. Brown, 6 Vet.App 14, 17 (1993). A well-grounded claim for service connection requires, at the least, evidence that the claimant has the claimed disability and evidence of a nexus between the claimed disability and service. With respect to the claim for service connection for a left knee disorder (residual of an injury in service), there is no evidence of current left knee pathology. Nor is there any evidence confirming that a left knee injury occurred in service. The veteran's service medical records document a fall in service, but do not show that the left knee was injured at the time. As there is neither evidence of current disability nor evidence of a nexus to service, the claim for service connection for residuals of a left knee injury is not well grounded. The veteran's claim for service connection for residuals of a right knee injury is well grounded. While his service medical records do not document such injury, soon after discharge from service he was found to have chronic right knee pathology which required surgical intervention. Medical opinions from a Board Medical Advisor and an employee of the Veteran's Health Administration relate the pathology noted at surgery to the rigors of basic training. Those opinions are persuasive. They provide a sound basis for concluding that a right knee disorder was incurred in service. II. Entitlement to service connection for bilateral periostitis of the tibia During service, the veteran was seen for left leg complaints. It was noted that a stress fracture of the left mid tibia had been diagnosed. He was followed by podiatry. On the following day he was seen for follow-up of bilateral lower leg periostitis. Examination was negative for pertinent abnormality, i.e., there was no pain to palpation, point tenderness, edema or erythema. Resolving bilateral periostitis of the tibia was diagnosed. When the veteran was examined for compensation purposes by the VA in February 1992, he walked without a limp. No signs or symptoms of periostitis were reported. To clarify the medical question involved, the Board obtained an advisory opinion from the Veterans Health Administration (VHA). This opinion (which was forwarded to the veteran's representative for review and reply - if desired) indicated that it was not unusual for basic trainees to undergo tibia stress fractures during basic training. These injuries were considered generally self-limiting, healing within six to twelve weeks upon removal from training. The VA opinion concluded that the normal X-rays on post-service examinations indicated that the alleged stress fracture had healed without difficulty. In the absence of a continuity of symptomatology or post-service residuals, there is no basis for finding that the veteran has bilateral periostitis of the tibia. In the absence of any showing of current disability, this claim, likewise, is not well grounded. Rabideau v. Derwinski, 2 Vet.App 141 (1992). III. Entitlement to service connection for a low back disorder This claim is well grounded in that it is plausible and capable of substantiation. The Board has extensively assisted in the development of the claim by remanding for an adequate examination, then obtaining first a staff Medical Adviser, then a VHA, advisory opinions. We find that the duty to assist a claimant is met. The veteran's service medical records show that he was treated in July 1989 for complaints of back pain. He stated the pain began after he was lifting weights. On examination, there was tenderness. The assessment was muscle strain of the back. When he was seen later, he indicated that he had re-injured his back when he fell on the obstacle course. The assessment again was low back strain. As was noted in the opinion of the Board Medical Advisor (which may be used because it is not prejudicial to the claimant), the findings on VA examination in April 1992, including muscle spasm, slight limitation of the motion, positive straight leg raising and X-rays showing loss of usual lumbar lordosis support a diagnosis of acute lumbar spasm. In service the veteran was found to have mild lumbar muscle spasm due to acute strain. The current low back pathology may not reasonably be disassociated from the complaint which first appeared in service. Thus, service connection for low back strain with muscle spasm is warranted. IV. Entitlement to service connection for residuals of a left thumb injury This claim, likewise, is plausible and this well grounded. The Board has assisted extensively in the development of the claim by obtaining, first, an adequate examination then an expert opinion from VHA. We find that the duty to assist is met. In July 1989, the veteran reported an injury to his left thumb, which he stated he sustained in a fall. However, examination and X-ray studies of the left thumb were reported to be normal. The veteran was returned to full duty. On VA examination for compensation purposes in February 1992, the examiner noted pain, ligament laxity and crepitus at the base of the left thumb. X-ray films of the left hand were reported to be normal. In a review of this history, the VHA opinion stated that had there been a significant strain or ligamentous injury to a thumb, this would have been noted on examination shortly after the injury. Here, examination soon after the injury produced normal findings. Thus the requisite nexus of pertinent pathology to service is not shown. All examinations have failed to reveal any evidence of radiographic changes in the thumb. The veteran has submitted no medical evidence relating any current ligament laxity and/or crepitus at the base of the left thumb to the injury in service. Hence, the preponderance of the evidence is against this claim. The evidence does not create a reasonable doubt which may be resolved in the veteran's favor. ORDER Service connection for residuals of a left thumb injury is denied. Service connection for residuals of a right knee injury and for low back strain with muscle spasm is granted. The claims for service connection for residuals of a left knee injury and for bilateral periostitis of the tibia are dismissed. GEORGE R. SENYK 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.