BVA9500070 DOCKET NO. 93-03 622 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to service connection for pancreatitis. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. A. McDonald, Associate Counsel CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he incurred pancreatitis while in service and therefore, service connection for this disorder is warranted. He states he was seen as an outpatient at Fort Knox and was hospitalized at Fort Dix. He further states that due to his physical condition, he had to be recycled a number of times to pass basic training. DECISION OF THE BOARD The Board of Veterans' Appeals (hereinafter 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 veteran's claim of entitlement to service connection for pancreatitis. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the Department of Veterans Affairs Regional Office in Indianapolis, Indiana (hereinafter RO). 2. Pancreatitis was not shown in service, and the veteran's current pancreatitis is not shown to be of service origin. CONCLUSION OF LAW Pancreatitis was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Upon review of the record, the Board concludes that the veteran's claim is well-grounded within the meaning of the statute and judicial construction. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (hereinafter VA) therefore has a duty to assist the veteran in the development of facts pertinent to his claim. In this regard, we note that the veteran's service medical records, available post-service private clinical data, and VA hospitalization reports have been included in his file. It is noted that the veteran has claimed treatment for abdominal pain subsequent to service in the 1970's. However, an attempt to obtain any pertinent records from the hospitals was futile, as the VA was informed that all hospital records are routinely destroyed after ten years. The United States Court of Veterans Appeals (hereinafter Court) has held that the VA has a statutory duty to assist the veteran in obtaining military service records. Jolley v. Derwinski, 1 Vet.App. 37 (1990). As noted above, the RO obtained the veteran's service medical records in February 1990, in order to properly adjudicate his claim. In a statement in February 1991, the veteran reported that he was hospitalized at the base hospital at Fort Dix in January or February 1970. Indeed, this information is noted in the veteran's service medical records. However, it is noted in the veteran's service medical records that he was hospitalized at Fort Dix for an upper respiratory infection. Therefore, the Board finds that the RO's search was reasonably exhaustive, and a further effort to obtain the general clinical data due to the hospitalization at Fort Dix would not be justified. Upon review of the entire record, the Board concludes that the data currently of record provide a sufficient basis upon which to address the merits of the veteran's claim and that he has been adequately assisted in the development of his case. The veteran seeks service connection for pancreatitis. Entitlement to service connection generally requires that it be shown not only that disease or injury was present in service, but also that the disease or injury has resulted in continuing or residual disability. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(b). For the showing of a 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". 38 C.F.R. § 3.303(b). Continuity of symptomatology is required where the disorder noted during service is not shown to be chronic or where the diagnosis of chronicity may be legitimately 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. Id. The veteran had military service from August 1969 to September 1971. The veteran's service entrance examination showed no physical abnormalities, although a traumatic splenectomy at the age of eight years was reported. His service medical records reflect that on a number of occasions, the veteran complained of abdominal pain. In August 1969, it was noted that the veteran complained of a painful scar from the splenectomy, questionably due to adhesions. However, the veteran complained of stomach pains in August and September 1969. No findings were made. From September to November 1969, left upper quadrant abdominal pain, noted to be allegedly due to adhesions from a splenectomy, was noted. However, a hernia in the incisional scar or other reason for difficulty could not be found. In December 1969, the veteran was placed on limited duty due to a "painful abdomen." An x-ray revealed no abnormalities of the abdomen. It is noted that the veteran's personnel file revealed that the veteran was recycled through basic training and advanced infantry training, but the records give no indication whatsoever as to the reason why. The Board does note however, that the veteran advanced from basic training to advanced infantry training during the time period he complained of abdominal pain as noted in his service medical records, and was assigned to limited duty. However, there were no further complaints of stomach pains, or abdominal pains, for approximately twenty months prior to discharge in September 1971. The service separation examination showed no physical complaints or abnormalities. The veteran was hospitalized at a private facility in July and August 1986 for alcoholism. The veteran gave a twenty-one year history of drinking heavily. He stated he got drunk for the first time when he was eight years old. No complaints of abdominal pain were made, and no findings of pancreatitis were reported. The veteran was admitted to a hospital in October 1989, with complaints of abdominal pain and weakness, as well as melena for three days. An ultrasound of the abdomen and pelvis, with oral contrast, showed the body and the tail of the pancreas was normal in appearance. However, the head of the pancreas showed some enlargement and the fat around the head of the pancreas had hazy increased density. It was reported that these findings were consistent with and rather typical of pancreatitis. The discharge diagnosis was pancreatitis and ethanol intoxication. The veteran was hospitalized in December 1989, with complaints of acute abdominal pain and melanotic stools. The discharge summary reported that a computerized tomography scan showed acute inflammation of the pancreas; however, the computerized tomography scan report noted the pancreas was normal. The discharge diagnoses included pancreatitis, secondary to alcohol. The veteran was hospitalized in March 1990, with complaints of nausea and vomiting bloody material. A history of chronic pancreatitis, alcohol related, was given. An ultrasound was conducted, which showed the pancreas was normal in appearance. The discharge summary gave diagnoses of chronic relapsing pancreatitis, alcohol abuse, and upper gastrointestinal bleeding. In April 1990, the veteran was seen in the emergency room for intense back pain. A history of pancreatitis and alcoholism was given. The diagnoses were abdominal pain and alcoholism. The veteran was seen two days later complaining of abdominal pain. The diagnoses included acute abdominal pain, pancreatitis; alcohol intoxication; and alcoholism. The veteran presented the next day with a rash. The diagnoses included ringworm and chronic pancreatitis. The veteran was hospitalized in May 1990 with complaints of right upper quadrant pain. A history of pancreatitis was given, and the veteran stated that he started drinking to quell his pancreatic symptoms. The veteran reported he fell on his right ribs while intoxicated. The x-rays show a minimally displaced fracture of the anterior end of the right eighth rib. An abdominal ultrasound showed the pancreas was echogenic, which was noted as possibly being due to fatty infiltration. The pancreas was normal in contour, with no hydronephrosis. The assessment was alcoholic pancreatitis, improved from the last admission. The veteran was hospitalized in a private facility in July 1991, for abdominal pain and vomiting. The discharge diagnoses included chronic pancreatitis with acute exacerbation and chronic alcoholism. The veteran was then transferred to a VA facility, with complaints of abdominal pain, nausea, and vomiting, consistent with recurring pancreatitis. An upper gastrointestinal series was consistent with a small hiatal hernia without reflux and some extrinsic pressure from an enlarged pancreas. The discharge diagnoses included recurrent pancreatitis and alcohol abuse. Upon review of the evidence of record, the Board concludes that the complaints and clinical data in service and the post-service evidence, including the absence of objective evidence shortly after service, the history subsequently reported by the veteran, and the current medical evidence demonstrate that the preponderance of this evidence is against the veteran's claim of entitlement to service connection for pancreatitis. Although the veteran complained of abdominal pain in service over a period of six months, no organic bases for these complaints were ever found. Further, for the last year and a half of military service, there were no complaints of abdominal pain, and the veteran's service separation examination is negative for findings or complaints of abdominal pain or pancreatitis. Furthermore, the veteran has failed to submit any clinical data of continuity of symptomatology pertinent to his claim that pancreatitis had its onset while in service. The Board notes that the veteran has claimed he was treated at various hospitals in the 1970's and further notes that the hospitals informed the veteran that they no longer have records from that time frame. As such, the Board has carefully examined the subjective evidence for consistency. Significantly, in the veteran's original claim with the VA received in December 1989, the veteran reported that his symptoms for pancreatitis began in approximately 1979. Moreover, the current clinical data does not suggest or report a history of pancreatitis beginning in service or soon after service discharge in 1971, either by the findings of the health care providers or as supplied by the veteran. The first clinical documentation of record of pancreatitis is in 1989, eighteen years after service. Thereafter, the veteran was diagnosed with pancreatitis, secondary to alcoholism. The recent evidence on a consistent basis relates his pancreatitis to his bouts of alcohol abuse. As pancreatitis was not shown in service, and there is no evidence correlating the veteran's current pancreatic disability to any incident in service, service connection for pancreatitis is not warranted. The veteran's representative claims that the veteran is entitled to the benefit of the doubt in this matter; however, the Board does not agree that the doubt raised here is reasonable. As noted earlier, service connection of a disorder must be established by affirmative evidence, and a reasonable doubt is "one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim." 38 C.F.R. §§ 3.303(a), 3.102. This latter regulation goes on to state that such a doubt must be a "substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility." 38 C.F.R. § 3.102. In this case, the only clinical finding of pancreatitis is eighteen years after service discharge and the history noted in the medical records consistently dates pancreatitis to the post service period. This disorder was reported by the objective evidence of record to be due to chronic alcoholism. The record is absent of affirmative evidence placing the appearance of characteristic symptomatology of pancreatitis in service or soon thereafter, or associating the veteran's current pancreatitis to service, and to find otherwise on this record would require that the Board resort to speculation. ORDER Entitlement to service connection for pancreatitis is denied. E. W. SEERY 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.