BVA9501470 DOCKET NO. 92-16 944 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for defective hearing. 2. Entitlement to service connection for Reiter's syndrome. 3. Entitlement to service connection for urethral discharge. 4. Entitlement to service connection for conjunctivitis. REPRESENTATION Appellant represented by: Kentucky Division of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD T. S. Kelly, Associate Counsel INTRODUCTION The veteran had active military service from March 1969 to September 1970. In a September 1994 letter, copies of the medical literature cited in this decision were furnished to the veteran in accordance with Thurber v. Brown, 5 Vet.App. 119 (1993). The veteran was given a 60 day period to provide additional argument, comment, or evidence. As no further response was received during this time period, the matter is now ready for appellate review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his currently diagnosed Reiter's syndrome had its origins in service and is related to three episodes of gonorrhea that he claims he received treatment for in service. He further maintains that his urethral discharge and conjunctivitis are related to Reiter's syndrome. In the alternative, the veteran contends that his conjunctivitis is a residual from measles, which he claims he contracted while in service. He also contends that he sustained a hearing loss in service as a result of a rifle being fired in close proximity to his right ear. DECISION OF THE BOARD The Board of Veterans' Appeals (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 preponderance of the evidence is against the claims of service connection for Reiter's syndrome, conjunctivitis, urethral discharge and a hearing loss. FINDINGS OF FACT 1. All relevant evidence for an equitable disposition of the veteran's appeal has been obtained insofar as possible. 2. A hearing loss was not shown during service or within the one year presumptive period following service, and is not of service origin. 3. Reiter's syndrome was not present during service, nor were any of the diseases known to be etiologically related to Reiter's syndrome, and the post-service Reiter's syndrome is unrelated to service. 4. Conjunctivitis was not present in service, and the post- service complaints are unrelated to service. 5. Urethral discharge was not present in service, and the post- service complaints are unrelated to service. CONCLUSIONS OF LAW 1. A hearing loss was not incurred in or aggravated by service, nor may a sensorineural hearing loss be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 2. Reiter's syndrome was not incurred in or aggravated by service nor may arthritis be presumed to have been so incurred. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107(West 1991); 38 C.F.R. §§ 3.303(d), 3.307, 3.309 (1993). 3. Conjunctivitis was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). 4. Urethral discharge was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. 3.303(d), 3.310 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran has submitted well-grounded claims under the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, we find he has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed and that no further assistance is required to comply with the duty to assist him as mandated by 38 U.S.C.A. § 5107(a) (West 1991). Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of a preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C.A. § 1110 (West 1991). Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). If the disorder is a chronic disease, such as a sensorineural hearing loss or arthritis, service connection may be granted if manifest to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). In determining whether service connection is warranted for a disability, the Department of Veterans Affairs (VA) is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). A. Hearing Loss A review of the veteran's service medical records indicate that at the time of the veteran's January 1969 enlistment examination, speech reception thresholds were 0, 0, 0, 0, and 0 decibels in the right ear and 5, 5, 5, 5, and 10 decibels in the left ear, respectively, at the frequencies of 500, 1000, 2000, 3000, and 4000 Hertz. On his enlistment report of medical history, the veteran indicated having ear, nose, and throat trouble, with the notation of an occasional earache being listed in the physician's summary box. There was no evidence of any ear trouble in service and an undated service audiogram revealed no decibel level readings above 5 in the right ear and above 15 in the left ear between 500 and 6000 Hertz. While the veteran again noted ear, nose, and throat trouble on his separation report of medical history, the service separation examination reported normal clinical evaluations for both his ears and eardrums. Moreover, 15/15 hearing was reported for whispered voice testing. While the foregoing test is crude compared to audiometry examination, it is a time-honored method for rapid and approximate testing of hearing acuity. The test result is reported on the following basis: The first figure represents where the tested individual heard the stimulus, while the second figure represents where an average "otologically normal" person understands that stimulus. H. Davis, M.D., and S. R. Silverman, Ph.D., Hearing and Deafness 181-82 (3d ed. 1970). Thus, the hearing results at service separation were considered normal. While the veteran testified at his January 1992 personal hearing that the service separation examiner told him he had a hearing impairment, there is none noted on the separation report. We believe that the absence of complaints of, or treatment for, a hearing loss in service, when combined the silence of the record in close proximity to separation, as well as the lack of credible, objective evidence attributing the claimed disability to service, are more probative than statements based on remote memory. As such, the preponderance of the evidence is against the claim of entitlement to service connection for hearing loss. B. Reiter's Syndrome The United States Court of Veterans Appeals (hereinafter, Court) has recognized Reiter's syndrome as a triad of symptoms of unknown etiology comprising urethritis, (inflammation of the urethra), conjunctivitis, and arthritis (the dominant feature)...chiefly affecting young men, and usually running a self-limited but relapsing course. Tozian v. Derwinski, 3 Vet.App. 268 (1991). A review of the record indicates that the veteran did not report any complaints of Reiter's syndrome or its symptoms at the time of his January 1969 enlistment report of medical history. Normal clinical evaluations were also reported for all extremities at the time of his enlistment examination. No evidence of Reiter's syndrome or its symptoms was present during the veteran's period of service and no signs or symptoms of Reiter's syndrome were reported by the veteran on his service separation report of medical history. Finally, normal clinical evaluations for all extremities and systems were reported at the time of the veteran's service separation examination. The first objective medical finding of possible Reiter's syndrome did not occur until January 1975, when the veteran was hospitalized at the St. Louis VA hospital for left knee swelling. At the time of the hospitalization, the veteran reported having had several episodes of gonorrhea in the past. Pertinent past history included an episode of urethral discharge at the age of 16 after having had sexual contact. He also indicated that he had been receiving treatment for urethral discharge for a period of approximately three weeks prior to his knee swelling up. Following examination of the left knee, the examiner indicated that a definitive diagnosis could not be rendered but felt that three possibilities existed to explain the veteran's swollen knee, namely, Reiter's syndrome, gonococcus arthritis, and gout. The veteran was re-hospitalized in March 1975. Examination revealed that the veteran had resolving Reiter's syndrome with minimal residual joint involvement. A flare-up of Reiter's syndrome was again noted by the veteran's private physician, Fredericka C. Lockett, M.D., in October 1988. A December 1991 letter from Dr. Lockett indicated that the veteran's Reiter's syndrome with arthritis was causing him so much pain that he was unable to get up. In January 1992, Dr. Lockett indicated that she was treating the veteran on a day to day basis for Reiter's syndrome. The veteran underwent a VA general medical examination in May 1991. At the time of the examination, the veteran reported that he had been treated for gonorrhea once in the past. Following physical examination, diagnoses of Reiter's syndrome and polyarticular arthritis of the shoulders, elbows, lumbosacral spine, hips, knees, ankles and feet were rendered. There was no evidence of conjunctivitis or urethritis on examination. At his January 1992 personal hearing, the veteran indicated that he had been treated for gonorrhea on three separate occasions during service. He further submitted an article (Complete Home Guide page unknown (1985)) indicating that Reiter's disease was found mostly in young men and might be associated with sexual exposure, often without development of any known venereal disease, or with bacterial infections of the intestine. Following either of these, the classic symptoms of Reiter's could appear. The veteran indicated his belief that his present Reiter's syndrome was directly related to his episodes of gonorrhea in service. As previously noted, the veteran's service medical records do not demonstrate any complaints of painful urination, urethral discharge, or treatment for any sexually transmitted disease during his period of active military service. Moreover, on his service separation report of medical history, the veteran checked the "no" box when answering the question of whether he ever had a "VD-syphilis, gonorrhea, etc." The Board also notes that the veteran reported having received treatment prior to service for urethral discharge at the age of sixteen after a sexual contact. While two clinical forms of Reiter's syndrome are recognized, postvenereal and the postdysenteric, with the former usually prevailing in North America, the cause and pathogenesis of Reiter's syndrome remains speculative. It is recognized, however, that an infectious process of the urogenital tract or the gut coupled with a specific genetic background in some patients can trigger the development of Reiter's syndrome. Through epidemiologic and serologic studies, Chlamydia trachoma and Mycoplasma have been implicated as the most common agents associated with the postveneral Reiter's syndrome. H. M. Moutsopoulos, Reiter's Syndrome and Behcet's Syndrome in Harrison's Principles of Internal Medicine 1436 (E. Braunwald, M.D., et.al. eds., 11th ed. 1987). Assuming arguendo that gonorrhea is implicated in the development of the veteran's Reiter's syndrome, there is no objective, medical evidence that the veteran contracted gonorrhea in service. This is confirmed by the absence of pertinent treatment during service and by the veteran's negative response to the question of whether he ever had "VD-syphilis, etc." on his service separation report of medical history. We believe that the absence of complaints of, or treatment for, Reiter's syndrome or its associated symptoms in service when combined the silence of the record in close proximity to separation as well as the lack of credible, objective evidence attributing the claimed disability to service, are more probative than statements provided by the veteran. As such, the preponderance of the evidence is against the claim of entitlement to service connection for Reiter's syndrome. C. Urethral Discharge A review of the veteran's service medical records does not demonstrate any complaints of painful urination, urethral discharge, or treatment for any sexually transmitted disease during the veteran's period of active military service. Moreover, on his service separation report of medical history, the veteran checked the "no" boxes when answering the questions of whether he had ever had frequent or painful urination or "VD, syphilis, gonorrhea, etc." The first reported objective finding of urethral discharge occurred during the veteran's January 1975 hospitalization. At the time of the hospitalization, the veteran reported a history of urethral discharge for approximately ten years, including an episode at age 16. He indicated that he been receiving treatment for urethral discharge for approximately 10 days prior to his hospitalization. No evidence of urethritis was present at the time of the veteran's May 1991 VA examination. At the time of his May 1992 personal hearing, the veteran reported that he was having yellowish discharge from his penis and was having to frequently urinate. He also reported having had urethritis at the time of his January 1975 hospitalization. While the Board notes that the veteran received treatment for urethral discharge in the past, there was no objective reported finding of urethral discharge until January 1975, more than four years after his separation from service. Although the veteran reported receiving treatment for gonorrhea and urethral discharge in service at the time of his January 1975 hospitalization, by indicating a ten year history of urethral discharge at that time, and also testified as to having received treatment for gonorrhea in service on three separate occasions, as previously noted, there is no evidence of treatment for a sexually transmitted disease or urethral discharge in service. Furthermore, the veteran did not report having frequent or painful urination or gonorrhea on his report of medical history. We believe that the absence of complaints of, or treatment for, urethral discharge or gonorrhea in service when combined the silence of the record in close proximity to separation as well as the lack of credible, objective evidence attributing the claimed disability to service are more probative than medical history or testimony provided solely by the veteran. As such, the preponderance of the evidence is against the claim of entitlement to service connection for urethral discharge on a direct basis. D. Conjunctivitis A review of the veteran's service medical records does not demonstrate any complaints of conjunctivitis or eye disorders during his period of active military service. Moreover, on his service separation report of medical history, the veteran checked the "no" box when asked whether he had ever had eye trouble. Normal clinical findings for the veteran's eyes were also reported on his service separation medical examination. At his January 1992 personal hearing , the veteran testified as to having received treatment for conjunctivitis in 1974 and 1975 at the St. Louis VA Hospital. He also reported having received no treatment for conjunctivitis prior to 1974. He further testified that he continued to have a burning sensation in his eyes, which he indicated might be related to allergies, that went away on its own after awhile. He also indicated that this condition had caused him to have gone blind in one-half of his eye for approximately thirty minutes in June 1990. From a review of the hospital treatment records, it does not appear that the veteran had any form of conjunctivitis at the time of his January 1975 VA hospitalization. Specific reference is made to a January 1975 rheumatology report in which the examiner noted the lack of conjunctivitis when attempting to reach a definitive diagnosis concerning the veteran's swollen left knee. There were also no findings of conjunctivitis in reports and letters received from the veteran's private physicians subsequent to the hospitalization. The May 1991 VA medical examiner also indicated that the veteran did not have conjunctivitis at the time of the examination. We believe that the absence of complaints of, or treatment for, conjunctivitis in service when combined with the silence of the record in close proximity to separation as well as the lack of credible, objective evidence attributing the claimed disability to service are more probative than statements and medical history provided by the veteran. As such, the preponderance of the evidence is against the claim of entitlement to service connection for conjunctivitis. The veteran also maintains that service connection is warranted for conjunctivitis as a residual of the measles, which he indicates that he had in service. The Board notes that conjunctivitis is regularly seen in the course of uncomplicated measles and may occasionally progress to corneal ulceration and blindness. C. George Ray, Measles (Rubeola), in Harrison's Principles of Internal Medicine 682 (E. Braunwald, M.D., et al. eds., 11th ed. 1987). However, a review of the veteran's service medical records does not demonstrate that he was hospitalized or received treatment for measles in service. Moreover, no treating physician, either private or VA, has indicated that the veteran has conjunctivitis as a residual of the measles. ORDER Service connection for a hearing loss, Reiter's syndrome, urethral discharge, and conjunctivitis is denied. M. SABULSKY 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.