Citation Nr: 0001784 Decision Date: 01/21/00 Archive Date: 01/28/00 DOCKET NO. 98-04 481 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to service connection for chronic liver disease, claimed as hepatitis. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Wm. Kenan Torrans, Associate Counsel INTRODUCTION The veteran served on active duty from April 1969 to October 1971, from June 1975 to June 1978, and from July 1980 to August 1996. This matter arises from an August 1997 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan, which denied the benefit sought. The veteran filed a timely appeal, and the case has been referred to the Board of Veterans' Appeals (Board) for resolution. FINDING OF FACT There is no competent medical evidence of a current medical diagnosis of any chronic liver disease, to include any form of hepatitis. CONCLUSION OF LAW The veteran's claim for service connection for chronic liver disease, claimed as hepatitis, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection may be granted for a disability resulting from a disease or injury that was incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). If a condition noted during service is not shown to be chronic, then continuity of symptomatology after service is generally required for service connection. See 38 C.F.R. § 3.303(b) (1999). In reviewing a claim for service connection, the initial question is whether the claim is well grounded. The veteran has the "burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." See 38 U.S.C.A. § 5107(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69, 73 (1995). A well- grounded claim is "a plausible claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive, but only possible to satisfy the initial burden of § [5107]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1995). To establish that a claim for service connection is well grounded, the claimant must satisfy three elements. First, there must be evidence of an incurrence or aggravation of an injury or disease in service. Second, there must be competent (i.e. medical) evidence of a current disability. Third, there must be evidence of a nexus or link between the in-service injury or disease and the current disability, as shown through the medical evidence. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). Lay or medical evidence, as appropriate, may be used to substantiate service incurrence. See Caluza v. Brown, 6 Vet. App. 489, 597 (1995); Layno v. Brown, 6 Vet. App. 465, 469 (1994). Alternatively, a claim may be well grounded based on the application of the rule for chronicity and continuity of symptomatology, set forth at 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). The veteran currently maintains that while in service, in approximately 1981, he was advised that the flu-like symptoms from which he then suffered were manifestations of hepatitis, and that he was also advised that the disease would always be present within his system. A review of the veteran's service medical records shows that in April 1982, he was seen for what was characterized as a "follow up" visit for hepatitis. At the time, the veteran complained of feeling tired, and of experiencing frequent bouts of diarrhea, but no vomiting. An undated treatment record indicates that the veteran was seen for flu-like symptoms, and an initial impression of "rule out hepatitis" was indicated, although no actual diagnosis of hepatitis is contained in any of the service medical records. In any event, the report of a medical examination dated in May 1993 indicates a history of hepatitis B incurred in 1981. The veteran underwent a VA rating examination in February 1997. The report of that examination shows that the veteran reported experiencing flu-like symptoms in 1980 for approximately one month, and that he indicated that he was advised that he had hepatitis B. He did not report any current symptoms of hepatitis, but indicated that after an ultrasound examination, he was advised that his liver was large and fatty. On examination, the veteran was not shown to have any symptoms of a chronic liver disease, to include any type of hepatitis. Hepatitis B antigen and antibody were not detected. The examiner concluded with an impression that there was no evidence of hepatitis B. Contemporaneous VA clinical treatment records dating from March 1996 through January 1998 show that in December 1996, the veteran was noted to have what was characterized as a "coarsened increase echogenicity compatible with fatty infiltration and/or hepatocellular disease (such as hepatitis and cirrhosis)." No other mention of liver disease or hepatitis was included in the VA treatment records. In September 1998, the veteran underwent an additional VA rating examination. He reported a history of hepatitis in 1980 or 1981, and stated that when he experienced his first episode of yellow jaundice, he was given gamma globulin IM. He denied having been hospitalized or having undergone any blood transfusions or IV drug use. There were apparently no subsequent episodes of hepatitis or jaundice. The veteran denied experiencing any symptoms associated with liver disease or hepatitis. Tests for hepatitis A, B, and C antigens were non-reactive. The veteran's liver was otherwise found to be normal. The examiner concluded with diagnoses of a history of jaundice in 1980 or 1981, no evidence of chronic liver disease, and no evidence of hepatitis A, B, or C. Ultrasound of the liver was normal. In November 1999, the veteran appeared before the undersigned Board Member at a personal hearing at the RO, and testified that in 1980 while working in Army recruiting, he was contacted by a physician at Selfridge Air National Guard Base and was informed that tests showed that he had hepatitis B. Following this, he testified that members of his immediate family were required to take a gamma globulin injection as a preventative measure for hepatitis. After this episode, the veteran stated that he was advised that he had a "fatty" liver, and that he was precluded from donating blood. The veteran testified that for a period of time following his initial diagnosis of hepatitis, he was required to undergo blood tests every three days. In addition, the veteran testified that a Dr. Milner of the Detroit VA Medical Center (VAMC) conducted a Persian Gulf examination in October 1996, and that he reported finding Hepatitis B in the veteran's blood at that time. The Board has evaluated the above medical evidence, and must conclude that the veteran has not presented evidence of a well-grounded claim for a chronic liver disease, claimed as hepatitis. The Board acknowledges that hepatitis was suspected in service. However, it was never definitively diagnosed in service. It is also acknowledged that he was advised at the VAMC that he had a "fatty" infiltrate in his liver which was suggestive of hepatitis. Even so, there is no competent medical evidence that he currently suffers from a chronic liver disease, to include hepatitis. The report of the veteran's service separation physical examination was negative for any indication of a chronic liver disease, and the reports of the February 1997 and September 1998 VA rating examinations contain the examiners' unequivocal conclusions that the veteran's tests were completely negative for any form of hepatitis or other liver disease. Moreover, ultrasound examinations of the veteran's liver were shown to be completely normal. The Board acknowledges the December 1996 VA treatment record indicating the presence of fatty infiltrates in the veteran's liver which were suggestive of hepatitis. However, the subsequent VA rating examinations of February 1997 and September 1998 failed to reveal any such findings. In short, the most recent medical evidence does not indicate the presence of a current disability for which service connection can be granted. In addition, lay statements and testimony by the veteran that he currently suffers from a chronic liver disease, claimed as hepatitis, do not constitute medical evidence. As a lay person, lacking in medical training and expertise, the veteran is not competent to address an issue requiring an expert medical opinion, to include medical diagnoses or opinions as to medical etiology. See Moray v. Brown, 5 Vet. App. 211, 214 (1995); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). What is missing in this case are medical opinions, supported by medical evidence, that the veteran currently suffers from a liver disease, to include hepatitis, that is related to service. Absent evidence of a present disability, the veteran's claim must be denied as not well grounded. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). For the above reasons, it is the decision of the Board that the veteran has failed to meet his initial burden of submitting evidence of a well-grounded claim for service connection for a chronic liver disease, claimed as hepatitis. The Board has not been made aware of any additional relevant evidence which is available which could serve to well ground the veteran's claim for service connection. As the duty to assist is not triggered here by a well-grounded claim, the Board finds that the VA has no obligation to further develop the veteran's claim. See 38 U.S.C.A. § 5103 (West 1991); McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Epps, supra; Grivois v. Brown, 6 Vet. App. 136 (1994). The Board also views its discussion as sufficient to inform the veteran of the evidence necessary to complete a well-grounded claim for service connection for a chronic liver disease, to include hepatitis. See Robinette, 8 Vet. App. at 77, 78. ORDER Evidence of a well-grounded claim not having been submitted, service connection for chronic liver disease, claimed as hepatitis, is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals