Citation Nr: 0006947 Decision Date: 03/15/00 Archive Date: 03/23/00 DOCKET NO. 98-13 668 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for disability manifested by high liver enzymes. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. P. Simpson, Associate Counsel INTRODUCTION The appellant served on active duty from July 1975 to July 1997. This case comes before the Board of Veterans' Appeals (the Board) on appeal from a December 1997 rating decision of the Montgomery, Alabama, Department of Veterans Affairs (VA) Regional Office (RO). In that decision, the RO denied service connection for hypertension and for a disability manifested by high enzymes. The Board remanded these claims in April 1999. The requested development has been accomplished, and the case has been returned to the Board for further appellate review. FINDINGS OF FACT 1. There is evidence of hypertensive diastolic and systolic readings in service and immediately following service and a current diagnosis of hypertension. Current hypertension is related to inservice hypertensive readings. 2. Elevated liver enzymes is not a disability due to disease or injury for VA purposes. CONCLUSIONS OF LAW 1. Hypertension was incurred in service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 2. The claim for service connection for a disability manifested by high liver enzymes is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Service connection for hypertension may be granted if manifest to a compensable degree within one year of separation from service. Service connection may be granted for any disease diagnosed after service when all the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1999). In making a claim for service connection, the appellant 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). A well- grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim for service connection generally requires medical evidence of a current disability; evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Caluza v. Brown, 7 Vet. App. 498 (1995) aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1999); Layno v. Brown, 6 Vet. App. 465 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Alternatively, the nexus between service and the current disability can be satisfied by evidence of continuity of symptomatology and medical or, in certain circumstances, lay evidence of a nexus between the present disability and the symptomatology. See Savage v. Gober, 10 Vet. App. 488, 495 (1997). Establishing direct service connection for a disability that was not clearly present in service requires the existence of a current disability and a relationship or connection between that disability and a disease contracted or an injury sustained during service. Cuevas v. Principi, 3 Vet. App. 542 (19 92); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). With a "chronic disease," such as hypertension, service connection is warranted when the disease is manifested to a compensable degree within one year following service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309(a) (1999). Moreover, establishing a well-grounded claim for service connection for a particular disability requires more than an allegation that the particular disability had its onset in service. It requires evidence relevant to the requirements for service connection cited above and of sufficient weight to make the claim plausible and capable of substantiation. Tirpak v. Derwinski, 2 Vet. App. 609 (1992); see also Murphy, 1 Vet. App. at 81. The kind of evidence needed to make a claim well grounded depends upon the types of issues presented by the claim. Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993). For some factual issues, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit, 5 Vet. App. at 93. Service medical records reveal numerous blood pressure readings. The Board does not find it necessary to report all the blood pressure readings; however, it will report the readings that revealed hypertensive diastolic and systolic readings. The elevated blood pressure readings and the respective date that such reading was shown are as follows: September 1979 130/90 (diastolic/systolic) October 1979 110/90 April 1982 134/104 July 1982 136/90 August 1982 136/90 January 1984 110/88 January 1987 124/90 October 1987 140/105 December 1987 120/86 August 1993 150/90 September 1993 140/100 March 1995 166/90 July 1995 161/97 January 1997 140/92 June 1997 132/90 Additionally, the service medical records reveal a long history of elevated liver enzymes of unknown etiology. The appellant underwent a VA examination in September 1997. The VA examiner noted that the blood pressure was elevated. The VA examiner stated that the diastolic pressure never dropped below 105 with maximum of 110, recumbent, and that systolic pressure was around 140 all the time, sitting. The diagnosis was essential hypertension, labile. The appellant underwent a hepatitis screening in August 1998, which was negative. The appellant had a hearing before this Board Member in January 1999. The appellant stated that he was being treated for hypertension with medication and that it had helped lower his blood pressure. The appellant stated that he was still being evaluated for a determination as to what was causing the elevated liver enzymes. He stated that he had had a liver biopsy done while in service, which came back negative. VA outpatient treatment records dated in 1998 and 1999 reflect elevated diastolic blood pressures, and assessments of hypertension beginning in January 1998. The appellant underwent a VA examination in July 1999. The appellant reported that the increased liver enzymes had been followed since 1994. He stated that he had had a liver biopsy at that time, which was benign. The VA examiner stated that the appellant's liver function tests had been generally a hepatocellular profile, but now had elevated total bilirubin. The VA examiner stated that hepatitis C had been negative and that his hepatitis screens had been negative in the past. The VA examiner noted that iron and ferritin had been normal. Examination of the abdomen did not reveal hepatosplenomegaly. The impression was abnormal liver function tests with elevated bilirubin. The VA examiner stated that the appellant had had a history of a renal cyst, but that there was no liver dysfunction or abnormalities or gallstones. A CT scan of the abdomen revealed an unremarkable liver. I. Hypertension After having reviewed the evidence of record, the Board finds that the evidence supports service connection for hypertension. The appellant exhibited intermittently elevated blood pressure readings beginning in service, continuing in the months after service and culminating with a diagnosis of hypertension within one year of service separation. The Board finds that such diagnosis cannot be disassociated with the hypertensive readings in service and immediately following service and that service connection for hypertension is warranted. II. Disability manifested by high liver enzymes After having reviewed the evidence of record, the Board finds that the appellant's claim for service connection for high liver enzymes is not well grounded. Although it was noted during service and post service by medical professionals, high liver enzymes is not a disability due to disease or injury for VA purposes. Service connection is warranted for a "[d]isability resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty . . ." 38 U.S.C.A. §§ 1110, 1131. It was noted that the appellant had not tested positive for hepatitis C. Additionally, a biopsy of his liver done during service was negative, as was a post-service CT scan of the liver. In short, the medical evidence does not show that he suffers from chronic disability manifested by elevated liver enzymes. Findings that the appellant has high liver enzymes of unknown etiology does not establish that there is a disability resulting from an injury or a disease. See id. Absent a disease or injury, service connection may not be granted and thus the claim for service connection for disability manifested by high liver enzymes is not well grounded and must be denied. Although the VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim when it is determined to be not well grounded, it may be obligated under 38 U.S.C.A. § 5103(a) (West 1991) to advise a claimant of evidence needed to complete his application. This obligation depends on the particular facts of the case and the extent to which the Secretary has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). Here, VA fulfilled its obligation under section 5103(a) by issuing a statement of the case in July 1998 and a supplemental statement of the case in September 1999. Additionally, the Board remanded the claim for an attempt to determine what the cause was for the elevated liver enzymes, but to no avail. In this respect, the Board is satisfied that the obligation imposed by section 5103(a) has been satisfied. See Franzen v. Brown, 9 Vet. App. 235 (1996) (VA's obligation under sec. 5103(a) to assist claimant in filing his claim pertains to relevant evidence which may exist or could be obtained). See also Epps v. Brown, 9 Vet. App. 341 (1996) (sec. 5103(a) duty attaches only where there is an incomplete application which references other known and existing evidence that pertains to the claim under consideration); Wood v. Derwinski, 1 Vet. App. 190 (1991) (VA's duty is just what it states, a duty to assist, not a duty to prove a claim). ORDER Service connection for hypertension is granted. Service connection for a disability manifested by high liver enzymes is denied. NANCY I. PHILLIPS Member, Board of Veterans' Appeals