Citation Nr: 0002471 Decision Date: 02/01/00 Archive Date: 02/10/00 DOCKET NO. 98-01 532A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for cardiovascular disease. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The veteran served on active duty from October 1991 until October 1995. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) from a rating decision of July 1996 from the Chicago, Illinois Regional Office (RO) which denied service connection for an abnormal heartbeat and murmur, subsequently characterized as a heart condition and hypertension. This case was remanded by a decision of the Board dated in May 1999 and is once again before the signatory Member for appropriate disposition. FINDING OF FACT The appeal for service connection for cardiovascular disability is not supported by clinical evidence showing that the claim is plausible or capable of substantiation. CONCLUSION OF LAW The claim for service connection for cardiovascular disease is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran asserts that he now has an irregular heartbeat and a heart murmur which first began or which were aggravated by active duty. He contends that service connection for a cardiovascular disorder should now be granted by the Board. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110, 1131. Where a veteran served continuously for 90 days during a period of war or during peacetime service after December 31, 1946, and cardiovascular disease becomes manifest to a degree of 10 percent or more within one year from the date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. § § 1101, 1112, 1113 (West 1991); 38 C.F.R. § § 3.307, 3.309 (1999). 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 legitimately be 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 (1999). The Board must now consider the threshold issue of whether the appellant has presented a well-grounded claim for service connection for cardiovascular disease. In this regard, he has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a) (West 1991); Grivois v. Brown, 6 Vet. App. 136, 140 (1994), Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). While the claim need not be conclusive, it must be accompanied by supporting evidence. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to the claim, and the appeal must fail. See Epps v. Gober, 126 F.3d 1464 (1997); see also Slater v. Brown, 9 Vet. App. 240, 243 (1996); Gregory v Brown, 8 Vet. App. 563, 568 (1996) (en banc). To establish a well-grounded claim for service connection in the instant case, the appellant must satisfy three elements. First, there must be a medical diagnosis of a current disability. Second, there must be medical, or in certain circumstances, lay evidence of incurrence or aggravation of a disease or injury in service. Third, there must be medical evidence of a nexus between the in-service disease or injury and the currently claimed disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps v. Gober, supra. The Boards notes in this instance, however, that pursuant to Board remand of May 1999, the veteran was scheduled for VA cardiovascular examinations in August 1999, but that he failed to report. As evidenced by a letter from his accredited representative dated in December 1999, it was reported that he did not receive notification of the examinations. The record reflects that new appointments were subsequently scheduled for the veteran in December 1999. The appellant was advised of the consequences of failure to appear in a letter to him dated in December 1999. The record reflects that he did not report for the December 1999 examinations and gave no explanation for his failure to appear. There is no indication in the record that he did not receive notification of the VA examination or that correspondence sent to him was returned. His address appears to have remained the same throughout the duration of the appeal. It is also shown that he was also asked to furnish the names and addresses of current providers of medical treatment for the claimed cardiovascular disability, but that he has not responded to this request, as well. In this regard, the Board finds that the duty to assist the appellant has been fully complied with to the extent feasible. However, the duty to assist is not a one-way street. See Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). See also Olson v. Principi, 3 Vet. App. 480, 483 (1992). The veteran must take some responsibility in helping to develop his claim. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. 38 C.F.R. § 3.655(b) (1999). The service medical records reflect that upon examination in December 1990 for enlistment into service, the veteran indicated that he had pain or pressure in his chest. It was recorded at that time that he had a past history of abnormal heartbeat and had had an echocardiogram in the Summer of 1990, but that there was not restriction. Further notations on the entrance medical examination sheet noted that there had been cardiology consultation in January 1991 resulting in a normal cardiac examination with no evidence of heart disease. The veteran underwent cardiac consultation in January 1991 for what was noted to be a suspected enlarged heart. He indicated that he had vague chest pains post prandially with exercise, or exercising without prior stretching. Examination disclosed a normal heart rate and rhythm. There was no murmur or click or other abnormal findings. It was reported that an electrocardiogram (EKG) was normal. Impressions of no evidence of organic heart disease and non- cardiac chest pain were rendered. Review of the service medical records show that the appellant's blood pressure was recorded on a number of occasions throughout active duty when he was seen for various complaints. These readings were recorded as 120/60 in April 1992, 120/80 in December 1992, 120/80 in April 1994, 124/87 in June 1994, 122/79 in June 1994, 122/82 in July 1994, 120/84 in October 1994, and 128/82 in December 1994. The service medical records also show that the appellant was seen in August 1993 for upper respiratory complaints and that a blood pressure reading of 138/98 was obtained at that time. No reference to elevated blood pressure was recorded at that time, but it was noted that the heart had regular rate and rhythm. In April 1995, the veteran was sent from the dental clinic in view of a history of heart murmur, with a blood pressure of 134/90. Upon ensuing examination, a blood pressure reading of 124/88 was obtained. It was reported that the heart rate was of regular rhythm and rate and that an EKG was within normal limits. An assessment of normal cardiac evaluation was rendered. Upon examination in August 1995 for release from active duty, a blood pressure reading of 120/60 was recorded. The veteran again indicated that he had pain or pressure in his chest. However, his heart was evaluated as normal and it was specifically noted that there was no murmur. Pursuant to the filing of a claim, the appellant was afforded a VA cardiovascular examination for compensation and pension purposes in April 1996. The veteran complained of occasional chest pain. A blood pressure reading of 140/90 was noted. The appellant underwent comprehensive physical examination. An EKG and chest X-ray were interpreted as within normal limits. Pertinent diagnoses of history of cardiac arrhythmia, and borderline blood pressure were noted. It was advised that his blood pressure be followed. An echocardiogram was subsequently performed in June 1996 which was interpreted as showing normal LV size and systolic function, normal mitral valve and aortic valve, no significant aortic regurgitation or mitral regurgitation and no pericardial effusion. The veteran underwent a VA cardiovascular examination in January 1998 whereupon he rendered a history of an elevated blood pressure reading at service discharge, with normal readings after that time. He related that he had an abnormal heart sound or beat prior to entering the military and said that it had been observed since that time. The appellant said that he had had an occasional non-radiating chest pain for the past four years unrelated to activity, and that there might have been some associated shortness of breath. He denied chest pain or discomfort upon strenuous exercise. The veteran recalled that no etiology had been determined for his symptomatology, and that he had been told to "exercise more." Upon physical examination, it was noted that the veteran's blood pressure was 120/94. His pulse rate was 72 and regular. The heart was of normal size with normal rhythm and a rate of 74. No murmur was appreciated. There was a widely split A2 P2, which was reported to be exaggerated by respiratory excursions in a normal manner. The examiner stated that in conclusion, the veteran had a normal cardiac examination. It was recorded that an echocardiogram was performed which revealed no significant valve lesion and that a treadmill test was normal. Diagnoses of history of hypertension with slight elevation of diastolic blood pressure noted on examination, chest pain not of cardiac origin, and no arrhythmia or heart murmur found on this examination were rendered. Analysis Although the veteran claims that he now has a heart disorder which is of service onset, or which was aggravated by the rigors of military duty, the record contains no competent evidence to support this conclusion. The service entrance examination report indicates that while he stated that he had a history of chest pain and an occasional irregular heartbeat, cardiology evaluation at that time and subsequently in January 1991 revealed no cardiac impairment. Although he was shown to have had elevated blood pressure readings on at least two occasions during service, there were many more instances in which his blood pressure was well within normal limits, including upon service discharge examination in August 1995. The postservice record shows that the appellant has continued to complain of chest pain and/or irregular heartbeat, but that no pathologic process involving the heart has been identified on any of the multiple diagnostic studies he has been afforded in this regard. While it is demonstrated he did have elevated blood pressure readings on VA examinations in April 1996 and January 1998, no diagnosis of essential hypertension was rendered in either instance. The veteran was reported to have stated on the latter examination that his physicians had obtained normal blood pressure readings on numerous occasions since service. No heart murmur has ever been found or diagnosed. The Board points out in this instance that the case was remanded by the Board in May 1999 specifically for additional cardiac evaluation to corroborate or rule out current disability in this regard. However, as the appellant failed to report for his appointments, the Board must evaluate the claim based on the evidence of record. Consequently, it is shown that there is no competent medical evidence or diagnosis of any ratable cardiovascular disability at this time for which service connection may be established, and the appellant himself has not presented any evidence to the contrary. A claim for service-connection must be accompanied by competent evidence which establishes that the claimed disability currently exists. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); see also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A well-grounded claim requires evidence of a present disability. Brammer at 223. Although the veteran now claims that he indeed has a heart disorder which is of service onset, the Board points out that as a lay person who is untrained in the field of medicine, he is not competent to provide a medical opinion as to this matter. Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). Consequently, his own assertions that he has such a disability do not constitute competent evidence upon which to reach the merits of this matter. The Board must also point out in this instance that a well- grounded claim must be supported by evidence, more than merely allegations. Tirpak at 609, 611. Accordingly, without the requisite competent evidence reflecting that the veteran currently has a ratable cardiac disability, his claim for service connection for such is not well grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993); Tirpak at 611. Accordingly, the appeal is denied. See Edenfield v. Brown, 8 Vet.App. 384 (1995). As the veteran's claim is not well grounded, the VA has no further duty to assist him in developing the record to support this appeal. See Epps, supra. Moreover, the Board is not otherwise aware of the existence of any relevant evidence which, if obtained, would make this claim well grounded. See McKnight v. Gober, No. 97-7062 (Fed.Cir. Dec. 16, 1997) (per curiam). As the foregoing explains the need for competent evidence of a current disability which is linked by competent evidence to service, the Board views its discussions above sufficient to inform the veteran of the elements necessary to complete his application for service connection for the above cited disorder. Robinette, 8 Vet.App. at 77. ORDER The claim for service connection for cardiovascular disease is not well grounded; the appeal is thus denied. U. R. POWELL Member, Board of Veterans' Appeals