Citation Nr: 0000965 Decision Date: 01/12/00 Archive Date: 01/27/00 DOCKET NO. 98-15 235 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for a heart disability. 3. Entitlement to service connection for hypercholesterolemia. REPRESENTATION Appellant represented by: Military Order of the Purple Heart WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Thomas D. Jones, Associate Counsel INTRODUCTION The veteran served on active duty from August 1986 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 1998 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA), which denied the veteran's claims for service connection for hypertension, a heart disability, and hypercholesterolemia. He filed a timely notice of disagreement, initiating this appeal. He also requested a personal hearing before a member of the Board, and such was afforded him in September 1999. FINDINGS OF FACT 1. The veteran was not diagnosed with hypertension during service, or within a year thereafter. 2.. The evidence of record does not indicate the veteran's current hypertension had its onset during service or within a year thereafter. 3. The veteran was not diagnosed with a heart disability during service, or within a year thereafter. 4. The evidence of record does not indicate the veteran's current heart disability had its onset during service or within a year thereafter. 5. Hypercholesterolemia is not a disability for which VA compensation is payable. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for hypertension is not well grounded, and must be denied. 38 U.S.C.A. §§ 1112, 1113, 1131, 1137, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (1999). 2. The veteran's claim for service connection for a heart disability is not well grounded, and must be denied. 38 U.S.C.A. §§ 1112, 1113, 1131, 1137, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (1999). 3. The veteran's claim for service connection for hypercholesterolemia is not well grounded, and must be denied. 38 U.S.C.A. §§ 1131, 5107 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.304 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background The veteran was afforded a service entrance medical examination in August 1986. He reported no history of heart problems, and his heart and vascular systems were without abnormality upon objective examination. His blood pressure was 120/60, sitting, and his chest X-ray was within normal limits. He was accepted as fit for military service. An annual medical examination was afforded the veteran in October 1987. He reported pain or pressure in his chest, and shortness of breath. His heart and vascular systems were without abnormality, and his blood pressure was 120/80, sitting. A chest X-ray revealed his heart and chest vessels to be within normal limits. The veteran was seen for evaluation of blood pressure in October 1988. A daily series of blood pressure readings were taken for a week, and the results were as high as 152/90, standing. The lowest reading was 110/70, lying down. A week later, readings of 150/90 were recorded, and the impression was of no evidence of hypertension. However, his cholesterol was 308, and cholesterol reduction was recommended. Blood pressure in November 1988 was 142/66. By May 1989, his cholesterol was 256. His blood pressure at the same time was 120/80. A June 1989 chest X-ray showed his heart and surrounding vessels to be within normal limits. No service separation medical examination is of record. Subsequent to the veteran's discharge from service, he has been afforded medical care at VA facilities. Treatment notes from November 1989 reflect blood pressure readings of 156/68. A December 1989 VA medical examination revealed blood pressure readings of 130/72, sitting, and 122/84, standing. A chest X-ray report described his heart as normal in size, and noted no cardiovascular abnormalities. A cardiovascular disability was not diagnosed. Another VA medical examination was afforded the veteran in June 1991. Blood pressure readings of 136/74, sitting, 130/80, lying down, and 130/89, standing, were recorded. No cardiovascular disabilities were diagnosed. A private physical examination, with blood test, was afforded the veteran in July 1997. He reported such symptoms as chest pain and headaches. Blood pressure readings were 135/100 on the right arm, and 120/98 on the left. Elevated blood pressure was diagnosed. His total cholesterol was 385. This result was noted to be high for his age group. In May 1998, the veteran filed a claim for service connection for a heart condition. That same month, he was hospitalized at a VA medical center for treatment of coronary artery disease and elective cardiac catheterization and coronary angioplasty. Other admitting diagnoses included hypertension and a history of myocardial infarction. He reported a history of chest pain, headaches, and shortness of breath, with onset one year prior. Surgery was performed without complications, and the veteran was discharged for post- operative follow-up on an outpatient basis. The RO reviewed the evidence of record and in a June 1998 rating decision, denied service connection for hypertension, a heart condition, and elevated cholesterol. That same month, the veteran filed a notice of disagreement on all issues. A statement of the case was sent to him in August 1998. The veteran then filed a VA Form 9 in September 1998, perfecting his appeal. He also requested a personal hearing before a member of the Board. A videoconference hearing was afforded the veteran in September 1999. He testified that during his term of service, his younger brother died unexpectedly, and the stress associated with this loss adversely affected his health. He began to experience such symptoms as chest pain and elevated blood pressure. He also began to drink alcohol heavily, and his eating habits were poor. In the veteran's opinion, this period was when his hypertension began, and this hypertension eventually resulted in more serious cardiac disabilities. He currently takes medication for hypertension and heart disease. Analysis I. Service connection - Hypertension The veteran seeks service connection for hypertension. Service connection will be awarded for any disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). Additionally, certain statutorily enumerated disabilities, such as hypertension, will also be granted service connection if they manifest to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). In evaluating a claim, the VA must extend the benefit of the doubt to any claimant whenever the evidence is in balance between the positive and the negative. 38 U.S.C.A. § 5107(b) (West 1991). However, the preliminary requirement for establishing entitlement to any VA benefit is that the applicant submit a claim which is 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). The U. S. Court of Appeals for Veterans Claims (Court) has defined a well- grounded claim as "a plausible claim, one which is meritorious on its own or capable of substantiation." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). Such a claim need not be conclusive, but only possible, to satisfy the initial burden of § 5107. Id. Case law promulgated by the Court has resulted in what is in effect a three pronged test to determine whether a claim is well grounded. There must be competent evidence of a current disability (medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the injury or disease in service and the current disability (medical evidence). See Rabideau v. Derwinski, 2 Vet. App. 141 (1992); Grottveit v. Brown, 5 Vet. App. 92 (1993); Grivois v. Brown, 6 Vet. App. 136 (1994); Caluza v. Brown, 7 Vet. App. 498 (1995). To be well grounded, a claim must be supported by evidence that suggests more than a purely speculative basis for an award of benefits; evidence is required, not just allegations. Tirpak v. Derwinski, 2 Vet. App. 609 (1992); Dixon v. Derwinski, 3 Vet. App. 261 (1992). After review of all evidence of record, the veteran's claim for service connection for hypertension must be denied as not well grounded. According to the service medical records, hypertension was suspected at one time during the veteran's service period, and he was afforded a regular schedule of blood pressure readings. A daily series of blood pressure readings were taken for a week, and the results were as high as 152/90, standing. The lowest reading was 110/70, lying down. A week later, readings of 150/90 were recorded, and the impression was of no evidence of hypertension. The veteran's service separation examination is unavailable, but he was afforded VA medical examinations in December 1989 and June 1991, and on neither occasion was hypertension diagnosed. The first diagnosis of elevated blood pressure dates to a private July 1997 medical examination, when readings of 135/100, right arm, and 120/98, left arm, were recorded. However, this diagnosis was received almost 9 years after the veteran's separation from service, and the private medical examiner did not date the onset of the veteran's hypertension to his service period, or within a year thereafter. For this reason, the veteran's claim lacks evidence that his current disability is due to a disease or injury incurred during service, or within a year thereafter, and is thus not well grounded. See Wade v. West, 11 Vet. App. 302, 305-6 (1998) (citing Caluza, supra). The veteran has himself asserted that his hypertension began during service, after he was informed of the untimely death of his younger brother. However, the veteran is shown to be a lay person, and as such is not qualified to present his own medical opinions and diagnoses to the Board. See Pearlman v. West, 11 Vet. App. 443, 447 (1998) [citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)]. Thus, the evidence of record does not reflect the onset of hypertension during service or within a year thereafter. In the absence of an in-service disease or injury, or the onset of hypertension within a year of service, the veteran's claim is not well grounded, and must be denied on that basis. See Wade, supra. II. Service connection - Heart disability The veteran seeks service connection for a heart disability. Service connection will be awarded for any disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). Additionally, certain statutorily enumerated disabilities, including several forms of heart disease, will also be granted service connection if they manifest to a compensable degree within one year of separation from service. 38 U.S.C.A. §§ 1112, 1113, 1137 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.307, 3.309 (1999). In evaluating a claim, the VA must extend the benefit of the doubt to any claimant whenever the evidence is in balance between the positive and the negative. 38 U.S.C.A. § 5107(b) (West 1991). However, the preliminary requirement for establishing entitlement to any VA benefit is that the applicant submit a claim which is 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). The requirements of a well grounded claim for VA benefits are noted above. For the reasons to be discussed below, the veteran's claim for service connection for a heart disability must be denied as not well grounded. At the time of his entrance into active military service, the veteran had no noted abnormality of the cardiovascular system. However, on the occasion of an October 1987 annual medical examination, he complained of chest pain or pressure, and shortness of breath. A chest X-ray taken at the time revealed his heart and chest blood vessels to be within normal limits, and no cardiovascular disability was diagnosed. Likewise, VA medical examinations in December 1989 and June 1991 did not demonstrate any cardiac abnormalities. The first diagnosis of record of a cardiovascular disability dates to a July 1997 private medical examination, when elevated blood pressure was observed. Subsequently, in 1998, the veteran was hospitalized at a VA medical center for treatment of coronary artery disease and hypertension. His medical history was noted to include a prior myocardial infarction, although no date was given. Cardiac catheterization and coronary angioplasty were performed, and the veteran was discharged for outpatient follow-up care. According to the evidence of record, the first diagnosis of any form of heart disease dates to 1998, approximately ten years after the veteran's separation from service. Additionally, no medical expert has dated the onset of the veteran's heart disability to his service period, or within a year thereafter. Thus, it has not been shown that the veteran's current heart disability results from a disease or injury in service, or within a year thereafter. For this reason, the veteran's claim for service connection for a heart disability is not well grounded, and must be denied. See Wade v. West, 11 Vet. App. 302, 305-6 (1998) (citing Caluza, supra). The veteran and his accredited representative have also asserted that even if his heard disease did not begin during service, it is due to or the result of his hypertension, which did begin during service, and therefore service connection for a heart disability is warranted. See 38 C.F.R. § 3.310(a) (1999). However, because service connection for hypertension is denied within this decision, any service connection claim for a heart disability secondary to hypertension must likewise fail. Also, because the veteran is a lay person, his assertions regarding medical diagnosis and causation are not binding on the Board. See Pearlman v. West, 11 Vet. App. 443, 447 (1998) [citing Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992)]. In conclusion, the evidence of record does not reflect the onset of a heart disability during service or within a year thereafter. In the absence of an in-service disease or injury, or the onset of a heart disability to a compensable degree within a year of service separation, the veteran's claim for service connection for a heart disability is not well grounded, and must be denied on that basis. See Wade, supra. III. Service connection - Hypercholesterolemia The veteran seeks service connection for hypercholesterolemia. Service connection will be awarded for any disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1999). However, the preliminary requirement for establishing entitlement to any VA benefit is that the applicant submit a claim which is 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). The requirements of a well grounded claim for VA benefits are noted above. In the present case, the veteran has not identified a disability for which compensation is payable. Hypercholesterolemia is an excess of cholesterol in the blood. Dorland's Illustrated Medical Dictionary, 28th Ed., pp. 792 (1994). As such, it represents only a laboratory finding, and not an actual disability in and of itself for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996). As the veteran has not identified a current disability, as defined by the applicable laws and regulations, his claim is not well grounded, and must be denied. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). ORDER 1. The veteran's claim for service connection for hypertension is denied. 2. The veteran's claim for service connection for a heart disability is denied. 3. The veteran's claim for service connection for hypercholesterolemia is denied. G. H. SHUFELT Member, Board of Veterans' Appeals