BVA9504429 DOCKET NO. 93-10 301 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Pittsburgh, Pennsylvania THE ISSUE Entitlement to a temporary and total convalescent rating based on a period of hospitalization at a VA medical center from April 10, 1990 to April 21, 1990. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. J. Bohanan, Associate Counsel INTRODUCTION The appellant served on active duty from November 1965 to November 1968. This appeal arises from a September 1990 Department of Veterans Affairs, Pittsburgh, Pennsylvania (VARO) rating decision, which denied the appellant entitlement to a temporary total convalescent rating. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that inpatient treatment from April 10 to April 21, 1990, entitles him to a temporary and total disability rating for convalescence after his total left hip replacement. 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 a temporary total disability rating based on a period of hospitalization from April 10 to April 21, 1990, is not warranted. FINDINGS OF FACT 1. The appellant served on active duty from November 1965 to November 1968. 2. The appellant is service connected for polyarthralgia with non-specific synovitis of multiple joints. 3. The appellant was hospitalized in April 1990 for a total left hip joint replacement pursuant to a diagnosis of avascular necrosis of the left hip. 4. No etiological relationship exists between the appellant's polyarthralgia with non-specific synovitis of multiple joints, and the avascular necrosis with total left hip joint replacement. CONCLUSION OF LAW The criteria for a temporary total disability rating for convalescence after a total left hip replacement during a period of hospitalization from April 10-21, 1990, are not met. 38 C.F.R. 4.30 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the appellant has satisfied his statutory burden of submitting evidence which is sufficient to justify a belief that his claim is "well-grounded." 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). It is also clear that the appellant's claim has been adequately developed for appellate review purposes by VARO, and the Board may therefore proceed to disposition of the matter. In the interest of clarity, the Board will first describe, in general, the appellant's medical history. 38 C.F.R. § 4.1 (1993); Peyton v. Derwinski, 1 Vet.App. 282 (1991). Medical history Service medical records reveal that the appellant was diagnosed as having polyarthralgia after he complained of a gradual onset of pain and swelling in multiple joints which began in 1966. A December 1969 VA examination reported a diagnosis of left carponavicular cyst, but noted no disease found related to arthritis. A VA examination was conducted in November 1973. The appellant complained of joint pain and swelling. X-rays revealed no arthritic changes. The appellant was hospitalized at a VA facility in May 1974 for rheumatoid synovitis of the right wrist. He received an excision of a ganglion sac with "rice bodies" from the right wrist and hand, indicative of rheumatoid arthritis. The appellant was also hospitalized at a VA facility in September 1981. He complained of increased swelling of the fingers of both hands and wrists, with progressive morning stiffness. He was prescribed medication and discharged. The appellant was again hospitalized in March 1983. He received aspiration of the left wrist and excision of a mass on the flexor surface of the left index finger. VA examinations conducted in July 1984 and 1986 reported that appellant continued to complain of migratory joint pains and stiffness with occasional night rises in temperature and warm, swollen joints. The diagnoses were polyarthralgia, rheumatoid variant with multiple joint involvement, and degenerative joint disease of the right knee. An April 1990 VA hospitalization summary reported that the appellant received a custom left total hip replacement due to avascular necrosis of the left hip. VA outpatient treatment records dated through June 1990 reported that the appellant received treatment for left hip replacement. A May 1990 radiology report indicated that the appellant was status post total hip prosthesis with no evidence of fracture or dislocation, and minimal myositis in the soft tissue. March 1992 x-rays of the appellant's left hip and pelvis revealed evidence of heterotopic bone around the joint; sclerotic changes, most likely due to degenerative changes; advanced narrowing of the right hip joint; cystic changes; and subchondral sclerotic changes. A March 1992 VA medical examination was conducted in order to determine the relationship between the appellant's service- connected polyarthralgia with non-specific synovitis of multiple joints, and his left hip replacement. The examining physician concluded that the polyarticular findings, excepting the hips, were due to rheumatoid arthritis. He noted that the hip findings were so much more advanced than any other arthritic manifestation to make it "unlikely" that they were an integral part of the rheumatoid arthritis. He opined that the only way aseptic necrosis could be related to the rheumatoid arthritis would be if the appellant had received corticosteroid therapy, which it appeared he had not. Therefore, the examiner concluded that the avascular necrosis and consequent arthroplasty were "not" related to the appellant's rheumatoid arthritis. In a September 1992 statement, the appellant denied any knowledge of receiving corticosteroid treatments. Analysis A temporary total disability rating may be granted for compensation following discharge from hospitalization for surgery on account of service-connected disability if it is established that the surgery necessitated at least one month of convalescence. 38 C.F.R. § 4.30 (1993). The appellant's medical history, in general, has been set out above. On April 10, 1990, he was admitted to a VA hospital for a left hip replacement attributed to avascular necrosis. As indicated above, a March 1992 VA examination was conducted to determine whether an etiological relationship existed between his service-connected polyarthralgia with synovitis of multiple joints, and his total left hip replacement. The examiner expressed the opinion that the avascular necrosis with consequent left hip replacement was unrelated to his service-connected disorder. Therefore, after having evaluated the medical record in this case, the Board believes that there was no relationship between the appellant's hospitalization for a left hip replacement and his service-connected polyarthralgia with synovitis of multiple joints. The Board has considered the written statements of the appellant claiming an etiological relationship between his service- connected polyarthralgia with synovitis of multiple joints and total left hip replacement. However, the Board finds that those statements have less probative value than the objective medical records. As the appellant is a layman, his contentions are not probative as he is not competent to provide a medical opinion. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). ORDER The criteria for a temporary total convalescent rating based on a period of hospitalization from April 10 to April 21, 1990, have not been met. C. P. RUSSELL 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.