BVA9505748 DOCKET NO. 90-49 621 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUES Entitlement to service connection for diabetes mellitus. Entitlement to service connection for a headache disorder. Entitlement to service connection for residuals of a left parietal laceration. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL The appellant ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from June 1970 to January 1972. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of March 1990 and September 1991 from the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. The case was previously before the Board in March 1991, in June 1992, and in December 1993, and was remanded to the RO on each occasion for additional development of the medical evidence. The requested development having been completed, the case is now before the Board for final appellate resolution. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that the RO erred in failing to grant service connection for diabetes mellitus, for a headache disorder, and for residuals of a head injury because it did not take into account or properly weigh the medical and other evidence of record. It is contended that symptoms of blurred vision, dryness of the mouth, continuous thirst, and weight loss experienced during active service were indicative of the presence of diabetes mellitus. It is contended that the veteran sustained a 3-inch laceration of the left parietal region when struck with a lead pipe or, in the alternative, with a baseball bat while on active duty in 1971 and that he is entitled to service connection for residuals of that injury. It is contended that the veteran's currently manifested headache disorder is a consequence of trauma sustained during active service when struck in the left parietal region and that the veteran has experienced constant headaches since that injury. 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 evidence of record supports a grant of service connection for a scar of the left parietal region. It is further the decision of the Board that the preponderance of the evidence is against the claims for service connection for diabetes mellitus and for a headache disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 2. Diabetes mellitus was not manifest during active service, on service separation examination, during the initial post service year, or at any time prior to October 1989, more than 17 years following final service separation. 3. A chronic headache disorder was not manifest during active service or on service separation examination, and was first clinically noted in VA outpatient clinic records dated in October 1990, more than 18 years following final service separation. 4. The veteran's service medical records show that he sustained a 3-inch laceration of the left parietal region, requiring sutures, during active service in January 1971. CONCLUSIONS OF LAW 1. Diabetes mellitus was not incurred in or aggravated by wartime service, and the service incurrence of diabetes mellitus may not be presumed. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 5107 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). 2. A chronic headache disorder was not incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110, 5107 (West 1991). 3. A 6-centimeter scar of the left parietal region was incurred during wartime service. 38 U.S.C.A. § 1110, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran's claims are plausible and thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), which mandates a duty to assist the veteran in developing all pertinent evidence. The RO has obtained the veteran's service medical records and has secured available medical evidence from all sources identified by the veteran. In addition, the veteran has been afforded a VA medical examination and has testified at a personal hearing held in August 1990 and at a Travel Board hearing held in July 1993. On appellate review, we see no areas in which further development might be productive. In order to establish service connection for claimed disability, the facts, as shown by evidence, must demonstrate that a particular disease or injury resulting in current disability was incurred during active service or, if preexisting service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection may also be granted on a presumptive basis for certain chronic disabilities, including diabetes mellitus, when manifested to a compensable degree within the initial post service year. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Factual Background A report of medical history prepared by the veteran in connection with his service entrance examination cited a history of frequent or severe headaches. A physician's summary of defects characterized the veteran's preservice headaches as "mild." His service entrance examination, conducted in October 1969, disclosed no pertinent abnormalities and urinalysis was negative for sugar. The veteran's weight at service entry was 190 pounds. Service medical records dated in January 1971 show that the veteran was seen for treatment of a 3-inch laceration of the left parietal region after being struck by a civilian. A skull X-ray series disclosed no evidence of fracture. His laceration was sutured. On followup visits, his wound was healing well and he was instructed to return for suture removal. No further complaint, treatment, or findings of a laceration of the left parietal region were shown during the veteran's remaining period of active service. His service medical records are silent for complaint, treatment, or findings of diabetes mellitus, headaches, blurred vision, dryness of the mouth, continuous thirst, or weight loss during the veteran's period of active service. His service separation examination, conducted in December 1971, disclosed no abnormalities of the head or scalp, his neurologic evaluation was normal, and urinalysis was negative for sugar. The veteran weighed 185 pounds at service separation. The veteran's original claim for VA disability compensation benefits, received in January 1990, indicated that diabetes began in 1970. The physician's name and the date of initial treatment for that disorder was shown as David Pickul, M.D., in 1988. Treatment records from T. O. Fitzpatrick, M.D., dated in February 1972, show that the veteran denied any history of diabetes or other serious illnesses. No clinical findings of diabetes mellitus, headaches, or residuals of a head injury were recorded. The veteran was reported to have a hernia. The record is silent for complaint, treatment, or findings of diabetes mellitus from the time of service separation until October 1989, more than 17 years following final service separation. A history of a headache disorder was first clinically noted on VA outpatient clinic treatment in October 1990, more than 18 years following final service separation. A hospital summary from St. John's Hospital, Lowell, Massachusetts, dated in October 1989, shows that the veteran was admitted with an 11-month history of diabetes mellitus, initially controlled with oral agents but with increasingly poor control. Physical examination on admission disclosed no other abnormalities. He was begun on long-acting insulin and supplemental regular insulin. VA outpatient clinic records dated from October 1989 to February 1994 show that in October 1989 the veteran offered a history of diabetes mellitus of two years' duration and of being on insulin for one month. In a history provided by the veteran in January 1990, he noted that he was in good health until November 1988, when he began to experience polyuria, polydipsia, polyphagia, a 7-pound weight loss (185-178), blurry vision, and disorientation. One month after the onset of these symptoms, the veteran was seen by Dr. Pickul. The veteran further stated that following institution of insulin therapy, his vision improved and he no longer needed the spectacles he had recently obtained. He denied any history of a sleep disorder or weight change. An entry dated in October 1990 cited the veteran's statement that he was appealing the VA's denial of his claim for service connection for a head injury sustained during service. He claimed headaches following service, currently on an intermittent basis and sometimes attributable to elevated blood sugar. Apart from that single entry, VA outpatient clinic records are silent for any reference to a headache disorder. The veteran's VA outpatient clinic treatment between October 1989 and February 1994 was primarily in the mental health clinic for disorders unrelated to those currently at issue. In addition, his blood sugar was monitored and his insulin dosage regulated. No treatment for residuals of a head injury or a chronic headache disorder was shown. Private treatment records from D. C. Pickul, M.D., dated from September 1990 to August 1991, reflect a clinical impression of insulin-dependent diabetes mellitus with intermittent poor dietary compliance. No reference was made to the date of onset or cause of the veteran's diabetes mellitus. A personal hearing on appeal was held at the RO in August 1990. The veteran testified that he began to experience symptoms which included blurred vision, dryness of the mouth, continuous thirst, and weight loss during active service in 1971, shortly after sustaining a head injury. He stated that he was unable to remember whether he went on sick call for those symptoms. He stated that following service, he received treatment for his head injury and for migraine at St. John's Hospital in Lowell, Massachusetts. He testified that he initially underwent blood chemistry studies and urinalysis in 1988. He indicated that he was required to take a physical examination in 1972 prior to returning to his former employment, and that a hernia was diagnosed. He acknowledged a family history of diabetes. A transcript of his testimony is of record. Following that hearing, the VA hearing officer continued the denial of entitlement to service connection for diabetes mellitus. A Travel Board hearing was held at the RO in July 1993 before a member of the Board section rendering this decision. The veteran testified that during active service in January 1971, he was struck on the head from behind with a baseball bat and knocked unconscious for an unknown period, that his wound was sutured, and that he has a residual scar which is sensitive to the touch. He stated that he was able to see the scar from his head injury when he pulled his hair back. He stated that he experienced intermittent symptoms of frequent urination and blurred vision during active service and thereafter. He stated that he never went on sick call for those symptoms and never discussed them with his doctors prior to 1988. He testified that he was initially treated for migraine headaches at Lowell General Hospital in 1972, during the initial post service year. He further stated that a Dr. Janas recommended that he take aspirin for his headache complaints. A transcript of his testimony is of record. A letter from J. J. Janas, M.D., submitted at the veteran's Travel Board hearing, stated that no medical records pertaining to treatment of the veteran were retained after seven years, and that none was now available. A report of VA examination, conducted in January 1994, cited a history offered by the veteran of sustaining a skull fracture and laceration when struck on the head with a baseball bat while on active duty in 1971. It was noted that the veteran did not have a plate in his skull. He stated that he had experienced "migraines" since that incident. Physical examination disclosed that his gait was normal and all musculoskeletal activity was normal. A well-healed, nontender scar, 6 centimeters in length, was seen in the left parietal region. The possibility of a slight bony ridge underneath the scar was noted. The diagnoses included postoperative left parietal head trauma, probably secondary to compound skull fracture, and post-traumatic headaches and visual problems, please see neurologist's note. A report of VA neurological evaluation, conducted in January 1994, noted a history recounted by the veteran of sustaining a head injury in 1971 when struck with a bat and of subsequently experiencing headaches, constant in nature, involving his entire head and varying in intensity. He reported that he was not on prescription medication for his headaches, but used Tylenol. A history of insulin-dependent diabetes, first diagnosed in 1988, was noted. The veteran denied any other significant medical problems. Neurological examination was essentially unremarkable. The diagnosis was post-traumatic headache syndrome. Skull X-rays conducted in connection with the cited VA examination of January 1994 disclosed no bony or soft tissue abnormality and no evidence of a skull fracture was detected. Analysis Entitlement to Service Connection for Diabetes Mellitus The veteran's service medical records are silent for complaint, treatment, or findings of diabetes mellitus, blurred vision, dryness of the mouth, continuous thirst, elevated blood sugar levels, sugar in the urine, or significant weight loss during his period of active service, and none was shown on service separation examination or during the initial post service year. Urinalysis conducted in connection with his service separation examination was negative for sugar, militating against a conclusion that diabetes mellitus was present at that time. The record thereafter is silent for complaint, treatment, or findings of diabetes mellitus from the time of service separation until October 1989, when that disorder was first clinically shown. While the veteran has asserted his belief that symptoms of blurred vision, dryness of the mouth, continuous thirst, and weight loss which he claims to have experienced during active service were indicative of the presence of diabetes mellitus during such service, we note that there is no contemporaneous medical evidence reflecting complaint or findings of such symptoms, and no medical evidence or authority has been presented which would relate such symptoms, if present, to his diabetes mellitus first shown more than 18 years following final service separation. In the absence of medical evidence establishing the presence of diabetes mellitus during active service, on service separation examination, or for many years following final service separation, the Board finds no reasonable basis for an allowance of service connection for that disorder. Entitlement to Service Connection for Residuals of a Head Injury, Including a Headache Disorder As noted, service medical records dated in January 1971 show that the veteran was seen for treatment of a 3-inch laceration at the left parietal region after being struck on the head. His laceration was sutured, and a skull X-ray series disclosed no evidence of fracture. On follow-up visits, his wound was healing well and he was instructed to return for suture removal. No further complaint, treatment, or findings of a laceration of the left parietal region were shown during the veteran's remaining period of active service. His service separation examination, conducted in December 1971, disclosed no abnormalities of the head or scalp, and neurologic evaluation was normal. No treatment or findings of residuals of a head injury were shown from the time of service separation until VA examination in January 1994. At that time, the veteran recounted a history of sustaining a skull fracture and laceration when struck on the head with a baseball bat while on active duty in 1971. On physical examination, the only evidence of a head injury was a well-healed, nontender, 6-centimeter scar of the left parietal region and a neurological examination was unremarkable. However, the diagnoses included postoperative left parietal head trauma, probably secondary to compound skull fracture. A subsequent skull X-ray disclosed no evidence of a skull fracture. The Board has the duty to assess the credibility and weight to be given the evidence. Wood v. Derwinski, 1 Vet.App. 190, 193 (1991). In assessing the veteran's credibility, the Board must review the entire record, with particular attention to consistency in the relation of events and continuity of reported symptoms. Having done so, we note that in a preservice medical history prepared by the veteran in October 1969, he offered a history of frequent or severe headaches, while at his Travel Board hearing and on VA examination in January 1994, he indicated that his headaches had their onset when he suffered his inservice head injury in January 1971. Although the veteran has asserted that he received post service treatment at several medical facilities for residuals of a head injury, specifically migraine headaches, that account is not substantiated in the medical record. The Board finds it particularly significant that the first reference to headaches contained in the postservice medical record is a history offered by the veteran on VA outpatient clinic treatment in October 1990, when he stated that he had experienced headaches since an inservice head injury. The Board further notes that, apart from that single reference, VA outpatient clinic records dated from October 1989 to February 1994 reflect no complaint or treatment for a headache disorder. In further considering the veteran's credibility, we note that in his substantive appeal submitted in May 1993, he asserted that he was struck on the head with a lead pipe, while he testified at his Travel Board hearing that he was struck on the head with a baseball bat. At that same Travel Board hearing, he testified that he was struck from behind, "didn't see it coming," lost consciousness, and remembers being driven to the outpatient [clinic]. Further, at the time of his VA examination in January 1994, he stated that he sustained a skull fracture when struck on the head and that he woke up in the hospital. There is nothing in the veteran's service medical records to indicate that his laceration of the left parietal region constituted anything more than a superficial injury. Certainly there is nothing that would account for the veteran's assertion to the examining VA physician, which is not reiterated at any other point in the evidentiary record, that he sustained a skull fracture during service. Based upon the foregoing, the Board finds that the inconsistencies, contradictions, and false statements contained in the veteran's written and oral statements militate against his credibility, and the Board finds such evidence not to be credible. The Board further finds that the diagnoses offered on VA examination in January 1994, including postoperative left parietal head trauma, probably secondary to compound skull fracture, post-traumatic headaches and visual problems, and post- traumatic headache syndrome, are likewise not credible. These diagnoses are evidently based upon a false, inaccurate, and clinically unsubstantiated medical history provided by the veteran. We note that X-ray studies taken at the time of the veteran's inservice head injury disclosed no evidence of a skull fracture, and that the veteran has never claimed an inservice skull fracture at any time prior to the VA examination in January 1994. Further, even a cursory review of the veteran's service medical records would have revealed to the examining physician that the veteran had not sustained a skull fracture in service, and that no treatment was provided for his head injury other than suturing his wound. An opinion based upon an inaccurate factual premise has no probative value. Hadsell v. Brown, 4 Vet.App. 208, 209 (1993); Reonal v. Brown, 5 Vet.App. 458, 461 (1993). The Board further notes that the reporting physicians appear to have ignored the results of their own examinations, which disclosed no evidence of a neurological disorder or of a skull fracture. The Board observes that the only residual of a head injury shown by objective clinical findings is a well-healed, nontender, 6- centimeter scar of the left parietal region. In our view, that scar constitutes the sole residual of the veteran's inservice head injury. Accordingly, a grant of service connection for a scar of the left parietal region is warranted. With respect to the veteran's claimed headache disorder, we note that a headache disorder was not manifest during active service or on service separation examination. No complaint, treatment or findings of a headache disorder are contained in the medical record prior to VA outpatient clinic treatment in October 1990, when only a history offered by the veteran of headaches following an inservice head injury was recorded. On VA examination in January 1994, neurological evaluation was reported to be normal and there is no clinical substantiation or documentation of the presence of a chronic headache disorder. Based upon the foregoing, the Board finds no basis in the evidentiary record for an allowance of service connection for a chronic headache disorder. ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for a scar of the left parietal region is granted. Entitlement to service connection for a chronic headache disorder is denied. F. JUDGE FLOWERS 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 (CONTINUED ON NEXT PAGE) 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.