Citation Nr: 0000532 Decision Date: 01/07/00 Archive Date: 01/11/00 DOCKET NO. 98-06 125 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUES 1. Determination of a proper initial evaluation for residuals of a Bennett's fracture of the right first metacarpal, initially assigned a noncompensable evaluation. 2. Entitlement to service connection for residuals a medial collateral ligament strain of the left knee. 3. Entitlement to service connection for residuals of a concussion to the head. 4. Entitlement to service connection for a nonspecified stomach disorder. ATTORNEY FOR THE BOARD Wm. Kenan Torrans, Associate Counsel INTRODUCTION The veteran served on active duty from July 1950 to August 1954. This matter arises from a January 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which granted service connection for residuals of a Bennett's fracture of the right first metacarpal, assigning an initial zero percent rating, and which denied the remaining benefits sought. The veteran filed a timely appeal, and the case has been referred to the Board of Veterans' Appeals (Board) for resolution. The issue of a determination of a proper initial rating for the veteran's residuals of a Bennett's fracture of the right first metacarpal will be addressed in the Remand portion of this decision. FINDINGS OF FACT 1. There is no competent medical evidence of a currently diagnosed disability with respect to the veteran's claimed residuals of a medial collateral ligament strain of the left knee. 2. There is no competent medical evidence of a currently diagnosed disability with respect to the veteran's claimed residuals of a head concussion. 3. There is no competent medical evidence of a currently diagnosed disability with respect to the veteran's claimed nonspecified stomach disorder, and no competent medical evidence to show a nexus or link between the veteran's burp- producing gas attacks and any incident of his active service. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for residuals of a medial collateral ligament strain of the left knee is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim for service connection for residuals of a concussion to the head is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim for service connection for a nonspecified stomach disorder 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 a disability resulting from a disease or injury that was incurred in or aggravated by service. See 38 U.S.C.A. § 1110 (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 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). The veteran maintains that he currently suffers from residuals of a medial collateral ligament strain of the left knee, from residuals of a head concussion, and from a nonspecified stomach disorder. The veteran contends, in substance, that he sustained these injuries and disorders in service, and that he continues to suffer from their residuals at the present time. The veteran's service medical records show that in October 1952, he was diagnosed with a medial collateral ligament strain of the left knee. Shortly thereafter, in December 1952, he was diagnosed with a derangement of the internal medial collateral ligament of the left knee. At the time, he was advised to avoid strenuous activity involving his left knee, and by December 1953, was found to have no residuals and was pronounced fit for full duty. In October 1952, the veteran was also noted to have sustained a "brain concussion" from which he was rendered unconscious for approximately 40 to 45 minutes. The follow- up treatment records show that he had fully recovered with no residuals. The service medical records are negative for any indication of complaints of or treatment for any stomach disorders. In addition, the report of the veteran's service separation examination shows that he had sustained a left knee injury, as discussed above, and that he had sustained a head concussion. The examiner found that the veteran had fully recovered and did not have any residuals from either injury. A report of inpatient medical treatment dating from October through November 1954 shows that the veteran was seen for complaints of sharp abdominal pain, with fever, nausea, and vomiting. There were no physical symptoms noted, and after a course of treatment, he was given a tentative diagnosis of acute enteritis of an unknown cause. The veteran's overall condition was found to have improved, and he was subsequently discharged. VA outpatient treatment records dating from December 1997 through January 1998 show that the veteran was seen for chest pains and for a medical problem resulting in burp-producing gas. There was no indication in the records submitted to show treatment for or complaints of residuals of a knee injury or head concussion. In addition, the etiology of the veteran's burp-producing gas attacks was not indicated. In addition, there was no medical opinion of record suggesting any sort of link between the veteran's burp-producing gas attacks and the acute enteritis with which he was diagnosed in November 1954. The veteran also submitted photographs of his hands and left knee, dated in February 1998, purporting to show that he has disorders of his hands and left knee. The Board has evaluated the above medical evidence, and must conclude that the veteran has not presented evidence of well- grounded claims for service connection for residuals of a medial collateral ligament strain of the left knee, residuals of a head concussion, and for an unspecified stomach disorder. The Board acknowledges that the veteran sustained a injuries to his left knee and to his head in service. Further, the Board acknowledges the veteran's contentions that he had suffered a blow to the stomach while playing football in service, and that he had been hospitalized in October 1954 for what had been diagnosed as acute enteritis. However, the veteran has not presented any medical evidence that he currently suffers from residuals of a left knee strain, a head concussion, or from a stomach disorder. Moreover, while the medical evidence submitted by the veteran shows that he suffered from burp-producing gas in December 1997 and January 1998, there is no medical opinion of record suggesting a nexus or link between the veteran's burping and his active service. In short, while the veteran maintains that he suffers from residuals of his left knee injury, from his head concussion, and that he suffers from an unspecified stomach disorder, he has not presented any medical evidence to show continuity of symptomatology from the time he was discharged from service to the present time. The medical evidence he has presented, consisting of VA outpatient treatment records dating from December 1997 through January 1998 does not contain any medical evidence to that effect. In addition, lay statements by the veteran that he currently suffers from residuals of a medial collateral ligament strain of the left knee, residuals of a head concussion, and from a nonspecified stomach disorder, do not constitute medical evidence. As a lay person, lacking in medical training and expertise, the veteran is not competent to address issues 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 treatment records showing continuity of symptomatology relating to the claimed disorders, from the time of the veteran's discharge from service to the present time. In addition, the record fails to contain any medical opinion establishing the required medical nexus between any diagnosed disorders and the veteran's active service, to include injuries sustained therein. Absent such evidence, the veteran's claim is not well grounded, and must be denied on that basis. 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 well-grounded claims for service connection for residuals of a medial collateral ligament strain of the left knee, residuals of a head concussion, and for an unspecified stomach disorder. The Board has not been made aware of any additional relevant evidence which may be available and which could serve to well ground the veteran's claims for service connection. As the duty to assist is not triggered here by well-grounded claims, the Board finds that the VA has no obligation to further develop the veteran's claims. 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 views its discussion as sufficient to inform the veteran of the evidence necessary to complete well-grounded claims for service connection for the above-discussed disorders. Se Robinette, 8 Vet. App. at 77-78. ORDER Evidence of a well-grounded claim not having been submitted, service connection for residuals of a medial collateral ligament strain of the left knee is denied. Evidence of a well-grounded claim not having been submitted, service connection for residuals of a concussion of the head is denied. Evidence of a well-grounded claim not having been submitted, service connection for a nonspecified stomach disorder is denied. REMAND By a rating decision of January 1998, the RO granted service connection for residuals of a Bennett's fracture of the right first metacarpal. The record does not reflect that a VA rating examination was ever conducted or that any evidence of a present disability with respect to residuals of a Bennett's fracture of the right first metacarpal was produced in connection with the claim for service connection, other than the veteran's own statements to that effect. Nonetheless, as service connection has been established, the VA has a duty to ensure that all relevant facts have been established and that all necessary evidentiary development has been properly conducted. See 38 U.S.C.A. § 5107(a). The veteran has asserted that he currently suffers from weakness of grip strength, restricted range of motion in his right hand, and from arthritis resulting directly from his now service-connected residuals of a Bennett's fracture of the right first metacarpal. The Board finds that in order to properly adjudicate his claim, additional development, to include a VA rating examination must be conducted in order to properly evaluate the severity of his service-connected disability. The Board also notes that this issue involves an appeal from the initial assignment of a disability rating. An appeal from the initial assignment of a disability rating requires consideration of the entire time period involved, and contemplates staged ratings where warranted. See Fenderson v. West, 12 Vet. App. 119 (1998). Accordingly, the Board finds that upon completion of the veteran's rating examination, the RO should readjudicate his claim for determination of a proper initial rating for his residuals of a Bennett's fracture of the right first metacarpal. Accordingly, in order to afford the veteran every consideration with respect to the present appeal, it is the Board's opinion that further development of the case is necessary. Therefore, the case is REMANDED for the following action: 1. The RO should contact the veteran, and after obtaining any necessary authorization, should obtain and associate with the claims file any medical treatment records pertaining to the veteran's residuals of a Bennett's fracture of the right first metacarpal, dated since the time of the last request for such information. If no such records are available, the RO should so indicate. 2. The veteran should be scheduled to undergo a VA rating examination by the appropriate specialist to evaluate the severity of his service-connected residuals of a Bennett's fracture of the right first metacarpal. The examiner is requested to determine the extent to which, if at all, the veteran suffers from arthritis, limitation of motion, and/or weakness as a result of his service-connected disability. If no such symptoms are found, or if such symptoms complained of are found, but are determined to be the result of some other disease or injury, the examiner should so state. All indicated studies and tests should be performed. In addition, the veteran's claims folder should be made available to the examiner for review in advance of the scheduled examination. The examiner is requested to include a complete rationale for all opinions expressed. 3. The RO should review the examination report to ensure full compliance with the directives set forth above. If not, the RO should undertake all action necessary to ensure compliance with the Board's directives. Thereafter, the RO should adjudicate the issue of determination of a proper initial rating for the veteran's service-connected residuals of a Bennett's fracture of the right first metacarpal, taking into consideration all relevant evidence, statutes, and regulations. If the RO's determination remains unfavorable to the veteran, he should be furnished with a supplemental statement of the case, and be afforded an opportunity to respond prior to referring the case back to the Board for further action. The purpose of this REMAND is for additional development. The Board does not intimate any opinion as to the merits of this case, either favorable or unfavorable, at this time. The veteran is free to submit any additional evidence he desires to have considered in connection with the current appeal. See Kutscherousky v. West, 12 Vet. App. 369 (1999). No action is required of the veteran until he is notified. WARREN W. RICE, JR. Member, Board of Veterans' Appeals