BVA9504721 DOCKET NO. 93-08 863 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUES 1. Entitlement to service connection for peptic ulcer disease. 2. Entitlement to service connection for hypertension. 3. Entitlement to service connection for incisional hernia. ATTORNEY FOR THE BOARD Suzie St. Vil, Associate Counsel INTRODUCTION The veteran had active military service from January 1955 to February 1958. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a rating decision of January 1992, from the Togus, Maine Regional Office (RO), which denied the veteran's claims for service connection for peptic ulcer disease, hypertension and incisional hernia. Following the receipt of VA medical records in August 1992, the RO, in a rating action of December 1992, confirmed its prior denial of the veteran's claims for service connection for peptic ulcer disease, hypertension and incisional hernia. The appeal was received at the Board in April 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran essentially contends that he is entitled to service connection for peptic ulcer disease, which had its onset while in service. The veteran maintains that he received treatment for stomach pain and discomfort during service. He maintains that he continued to receive treatment for stomach problems following his discharge from military service. The veteran asserts that he also suffers from hypertension and an incisional hernia which also resulted from military service. 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 claims for service connection for peptic ulcer disease and hypertension. Further, the veteran has not submitted evidence sufficient to justify a belief by a fair and impartial individual that his claim for service connection for incisional hernia is well-grounded and, accordingly, his appeal as to this issue is dismissed. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. During service, the veteran was treated for stomach pains and discomfort; his symptoms resolved without residual disability. 3. Peptic ulcer disease was not clinically established during the veteran's active service nor within one year following separation from service. 4. Hypertension was not clinically shown during the veteran's period of active service or manifested to a compensable degree within one year thereafter. 5. There is no objective evidence which shows the presence of an incisional hernia which can be associated with military service or disability incurred therein. CONCLUSIONS OF LAW 1. Peptic ulcer disease was not incurred in or aggravated by the veteran's active service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 2. Hypertension was not incurred in or aggravated by the veteran's active military service, nor may it be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1110, 1131, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 3. The veteran has not submitted a well-grounded claim for service connection for an incisional hernia. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we note that we have found that the veteran's claims with respect to hypertension and peptic ulcer are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); effective on and after September 1, 1989. That is, we find that he has presented claims which are plausible. Moreover, after careful review of the evidentiary record, we are also satisfied that all relevant facts have been properly developed. In this regard, it is noted that the RO has attempted to secure all records relating to treatment identified by the veteran. With respect to incisional hernia, he has not submitted a well-grounded claim. Therefore, no further assistance to the veteran is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). The basic facts in this case are not in dispute and may be briefly described. The records show that the veteran entered active duty in January 1955; an enlistment examination revealed a blood pressure reading of 120/80. There were no complaints or findings of an ulcer or hernia. The service medical records show that the veteran was seen in August 1955 for complaints of pain in the chest. The examiner found no evidence of pathology. He was again seen in October 1955 for complaints of upset stomach and pains in the belly; examination revealed tenderness in the right lower quadrant, with no spasms. No pertinent diagnosis was reported. On May 8, 1957, the veteran was seen for complaints of stomach pains; he reported poor appetite, but denied any vomiting or diarrhea. The following day, it was noted that the veteran had indigestion which was related to psychological problems; but no neuropsychiatric disorder was reported. X-ray study of the abdomen was negative. In October 1957, during hospitalization for viral influenza, his blood pressure was 120/50. Chest x-ray was negative. On November 29, 1957, the records show that the veteran was admitted to a base hospital for convalescence following an emergency appendectomy performed on November 23, 1957 in a private hospital while he was on pass. During a clinical visit in December 1957, it was noted that post-operative check was "OK". On the occasion of the separation examination in January 1958, blood pressure reading was 128/76. It was further noted that the veteran had a scar on the right lower quadrant from the appendectomy; no other findings were reported. Examination of the abdomen was normal. No hernia was reported. On a National Guard enlistment examination, conducted in February 1958, blood pressure was 128/78. The veteran reported that he was in good health, without complaints of high blood pressure, indigestion or stomach trouble. No gastrointestinal disability was noted. When the veteran filed his initial claim for disability compensation, in 1963, he reported treatment for ulcers post- service from Dr. Sturtevant from 1960 and from Dr. Veilleux in November 1963. Of record was a private medical statement from Lucien Veilleux, M.D., dated in December 1963, who indicated that he saw the veteran on November 27, 1963 in the emergency room after he had fainted. At that time, the veteran indicated that he had ulcers and was passing blood. Dr. Veilleux reported that the veteran refused treatment and went home. Also of record was a statement from Vaughn R. Sturtevant, M.D. dated in December 1963, indicating that he did not have any office record on the veteran, nor an account card on him. Received in February 1964 was a VA hospital summary which shows that the veteran was admitted to the hospital on November 27, 1963. The report indicated that the veteran had fainted earlier that day and was taken to a private hospital, where it was suggested that he might have bled from a peptic ulcer. The veteran reported passing black stool the previous day, and vomiting that evening. The veteran also reported an episode of abdominal pain and vomiting during service in 1957; he indicated that he was seen briefly on sick call and was told that it might be his appendix. The veteran further reported that he saw a Dr. Sturtevant 2 years ago because of vomiting and epigastric pain; he stated that he was told that he had a peptic ulcer. The veteran indicated that he was treated with diet and Maalox with relief. The veteran reported occasional mild epigastric burning pain in the past 6 months, relieved by milk. He indicated that he noted a flare-up of gastrointestinal symptoms the day before his admission. The veteran reported drinking heavily the weekend before his admission. On examination, blood pressure reading was 146/84. The veteran was described as thin and somewhat pale, but he did not appear acutely or chronically ill. There was a functional apical systolic cardiac murmur which disappeared when the veteran sat up. Abdominal, rectal and neurological examinations were negative. The attending physician observed that the veteran was admitted for a suspected gastrointestinal hemorrhage, but there was no objective evidence of such. He further stated that the veteran appeared to have had an acute gastroenteritis associated with alcohol indiscretion, and his symptoms rapidly subsided. A gastrointestinal (GI) series was reported to be normal. The pertinent diagnosis was gastritis, due to alcohol, acute, treated and improved. Based upon the above evidence, the RO, in its February 1964 rating decision, determined that the stomach condition treated during service had cleared when the veteran was discharged; it was also determined that gastritis due to alcohol recently diagnosed was not related to the condition treated during service. Service connection was established for appendicitis, postoperative. Received in November 1991 was a VA hospital report which shows that the veteran was hospitalized for 2 days in October 1991 with a history of atypical chest pain with epigastric discomfort. It was noted that an upper GI series conducted in September 1990 had been negative, but the veteran's symptoms persisted. No palpitations, syncope, dizziness or chest pressure were noted. Reportedly the veteran had a history of hypertension and hiatal hernia. An esophagogastroscopy was completely normal, and X-rays were normal. The diagnosis was chest pain, not diagnosed. No further gastrointestinal clinic follow-up was necessary. Received in August 1992 were VA outpatient treatment records covering the period from December 1988 to August 1992. These were furnished in response to a request by the VA for records dating back to 1958. These records essentially show that the veteran received clinical attention for recurring epigastric pain despite medication, as well as treatment for hypertension and ulcers. Blood pressure readings ranged from 114/74 to 192/112. A treatment note dated in February 1989 reported that the veteran was taking Zantac for hiatal hernia; blood pressure reading was 164/102. The diagnosis was hiatal hernia and hypertension, not controlled. In May 1990, it was reported that an upper GI series revealed active duodenal ulcers. A treatment noted dated in September 1990 reported diagnoses of peptic ulcer disease and hiatal hernia. Subsequently, the veteran was seen in April 1991 for complaints of pain to the right umbilicus. When seen in August 1991, the veteran complained of dehydration and fatigue; blood pressure reading was 192/112. The diagnosis was hypertension. In October 1991, after special VA gastroenterological consultation, it was noted that a GI series a year earlier had not shown signs of ulceration; it was suspected that his symptoms were functional. VA outpatient records repeatedly described the abdomen as nontender, with no masses. There were no references to residuals of the appendectomy or to incisional hernia. The Board notes that service connection requires that the facts, as shown by the evidence, establish that a particular injury or disease resulting in chronic disability was incurred coincident with service in the Armed Forces, or if pre-existing such service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Additionally, there are certain chronic disabilities, including hypertension and peptic ulcers which may be service connected if they are demonstrated to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1137; 38 C.F.R. §§ 3.307, 3.309. The service medical records show that the veteran was seen for complaints of stomach pains and discomfort; however, his symptoms appeared to have resolved without any residual disability. The separation examination of January 1958 reported the abdomen to be normal; no history or findings indicative of a peptic ulcer disease were recorded. We further note that while the records show that the veteran was hospitalized and diagnosed with gastritis in 1963, it was reported to have been due to alcohol and not related to military service. The earliest evidence of record showing treatment for peptic ulcer was in 1990, many years following the veteran's discharge from military service. Even this diagnosis of peptic ulcer disease has been called into question by subsequent VA examiners. Therefore, the Board finds that peptic ulcer disease, if now present, was not shown until a period much too remote in time to be related to service. In addition, the Board notes that there were no references to any clinical manifestation of hypertension during the veteran's period of active service. The recent medical evidence reveal that the veteran is currently diagnosed with hypertension. Inasmuch as hypertension was not shown to be present until many years after the veteran's separation from service and the current medical evidence does not provide a reasonable basis on which to associate his present diagnosis of hypertension with military service, a basis for a grant of service connection does not exist. In reaching this decision, the Board has considered the doctrine of granting the benefit of the doubt to the veteran but does not find the evidence is approximately balanced such as to warrant its application. 38 U.S.C.A. § 5107(b). Further, while the service medical records indicate that the veteran had an appendectomy in November 1957, no complaints or findings of postoperative incisional hernia were noted. On separation examination in January 1958, the veteran was reported to have an abdominal scar, but there was no indication of any disability of or related to the abdomen. There was no showing of an incisional hernia. We further note that while the current medical evidence reflects that a hiatal hernia has been diagnosed, there is no report of a finding of incisional hernia. Outpatient records show no evidence of incisional hernia in the abdomen, the site of the appendectomy, which is a service connected disorder. Indeed the veteran has failed to indicate exactly where the incisional hernia is located. The RO asked him to submit records from Dr. Hornberger, who allegedly treated him in the 1970's. (The veteran failed to provide the VA with a mailing address for this doctor.) The requested information was not secured. Consequently, the Board is compelled to find that the veteran has not met his initial burden of submitting a well- grounded claim for service connection for incisional hernia. ORDER Service connection for peptic ulcer disease and hypertension is denied. The claim for service connection for incisional hernia is dismissed, since it is not well-grounded. N. R. ROBIN 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.