Citation Nr: 0005088 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 98-08 536 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for a right elbow disability. 2. Entitlement to service connection for a right shoulder disability. 3. Entitlement to service connection for a right ankle disability. 4. Entitlement to service connection for a low back disability. 5. Entitlement to service connection for a psychiatric disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. L. Wasser, Associate Counsel INTRODUCTION The veteran served on active duty from July 1970 to October 1972. This case comes to the Board of Veterans' Appeals (Board) from a January 1998 RO decision which denied service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, a psychiatric disorder, and a bilateral knee disability; the veteran appealed all of the denials. In May 1999, the Board remanded the case to the RO for an RO hearing. A personal hearing was held before an RO hearing officer in July 1999. The case was subsequently returned to the Board. The Board notes that in a July 1999 written statement, the veteran withdrew his appeal on the issue of entitlement to service connection for a bilateral knee disability. Accordingly, this issue is not in appellate status and will not be addressed by the Board. 38 U.S.C.A. § 7105 (West 1991); 38 C.F.R. §§ 20.200, 20.204 (1999). FINDING OF FACT The veteran has not submitted competent evidence to show plausible claims for service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder. CONCLUSION OF LAW The veteran has not submitted well-grounded claims for service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background The veteran served on active duty in the Navy from July 1970 to October 1972. A review of his service medical records shows that on medical examination performed for induction purposes in June 1970, his upper extremities (with the exception of his left 5th finger), lower extremities, spine, and psychiatric system were all normal. A November 1970 treatment note shows that the veteran presented with complaints of right elbow pain for the past two weeks; he reported that he bumped the elbow. On examination, there was slight tenderness to palpation over the prominence of the olecranon and there was possible slight induration of the underlying tissues with no synovial fluid collection or remarkable swelling. There was no epicondylar tenderness and there was full passive and active range of motion of the elbow with subjective pain on extension. An X- ray study was unremarkable except for some slight possible soft tissue thickening over the olecranon. The diagnostic impression was mild olecranon bursitis, traumatic and/or minimal contusion. A January 1971 treatment note shows that the veteran reported a one week history of low back pain with no history of injury. On examination, there was bilateral tenderness of the low back, with some limitation of motion with pain; a course of muscle relaxants was prescribed. About a week later, the veteran reported continued complaints of low back pain; an examination was within normal limits, including normal deep tendon reflexes and normal X-ray studies. Medication, exercise, and swimming were prescribed. The next day, the veteran reported that he felt much better since performing exercises. In late January 1971, the veteran reported that his ankle gave out occasionally. On examination, there was no pathology, and the examiner indicated that the veteran had been advised to discontinue visits to sick bay for manufactured illnesses, and was returned to duty. A May 1971 treatment note shows that the veteran complained of lumbosacral pain and ache; on examination, there was minimal paraspinal spasm. The examiner prescribed valium, aspirin, heat, exercises, and use of a bedboard. A May 1972 treatment note shows that the veteran complained of vomiting and diarrhea; the diagnostic impression was viral illness versus psychophysiological bowel reaction, versus rule out hiatal hernia. A May 1972 treatment note indicates that the veteran's "stomach disorder" was improving, with no more diarrhea and only occasional dry heaves. The examiner noted that the veteran had been charged with an unauthorized absence in the past two days. A psychiatric consult was recommended. A May 1972 consultation request notes that the veteran had poor performance in the Navy with an inability to adjust; the provisional diagnosis was questionable personality disorder. A May 1972 treatment note shows that the veteran's stomach condition was much improved, and the veteran had been staying on a bland diet with frequent feeding. The veteran's medications included Reopan, Donnatal, and Librium. On psychiatric consultation in May 1972, the examiner noted that the veteran had been a poor performer in his squadron and apparently had a tendency to provoke superiors and get into disciplinary difficulties. On examination, the veteran was alert, oriented, and pleasant, with average intelligence. There was no thought disorder and the veteran was not depressed. The examiner stated that the veteran had poor judgment on numerous occasions, and seemed anxious to "make it" in the Navy. The diagnostic impression was immaturity - immature personality. The examiner opined that the veteran was still "growing up" and said he expected the veteran to gradually improve. He stated that if the veteran became a major problem to his command, an administrative separation should be considered. A September 1972 treatment note shows that the veteran had soft tissue damage to the left elbow; an X-ray study was negative for fracture. On medical examination performed for discharge purposes in October 1972, the veteran's upper extremities, lower extremities, spine, and psychiatric system were listed as normal. Service medical records are negative for diagnoses of a chronic right elbow disability, a chronic right shoulder disability, a chronic right ankle disability, a chronic low back disability, or a chronic psychiatric disorder. Private medical records dated from 1987 to 1991 from Irongate Family Practice Associates reflect treatment for a variety of conditions, including complaints of right elbow pain and left shoulder pain. A May 1987 treatment note shows that the veteran complained of right elbow pain which had been intermittent for the past month, and reported that he had no previous injury to his elbow. The diagnosis was tendonitis of the right elbow. A subsequent May 1987 note reflects that the veteran telephoned the office and reported that his elbow was improved with rest and medication. A November 1989 treatment note shows that the veteran's present illnesses included gastritis and anxiety. The examiner noted that the veteran had a history of a cyst of the right elbow. On examination, the veteran's musculoskeletal system was listed as normal. There are no subsequent medical records reflecting treatment for a right elbow condition or a psychiatric disorder, and the private medical records are negative for a right shoulder disability, a right ankle disability, or a low back disability. In September 1997 the veteran submitted claims for service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder. He did not report any post- service treatment for these conditions. At a November 1997 VA examination, the veteran reported that he fell on his right elbow in 1971, and subsequently had occasional infrequent pain. He reported pain and aching in the right elbow for the past three years since he banged it on a work truck. He complained of intermittent pain and stiffness of the elbow, and said a doctor had diagnosed the condition as "tennis elbow." He complained of right shoulder pain, and said he knew of no specific shoulder injury. He said his shoulder pain might be related to a fall in which he injured his right elbow. He stated that he started having right shoulder pain two years previously, and the pain began in the scapular region and radiated up into the joint. With respect to his back, he said he fell on his tailbone at the time of his in-service elbow injury in 1971, and he had intermittent aching ever since. He also reported pain in the lower thoracic area. The examiner noted that there were no prior medical records associated with the veteran's file. On examination of the right shoulder, there was full range of motion, and no tenderness to palpation. There was crepitation with palpation and a palpable popping. On examination of the right elbow, there was tenderness to palpation over the medial aspect of the elbow over the epicondylar area. There was full range of motion. On examination of the ankles, there was full range of motion, and no tenderness to palpation. There was tenderness over the medial aspect just superior to the ankle on the right. On examination of the back, there was normal alignment, and no tenderness of the spine with palpation. There was mild paravertebral tenderness bilaterally with palpation in the lower thoracic lumbar area. The pertinent diagnoses were low back pain, of questionable etiology, symptomatic, status post injury to the coccyx area with residual pain and a negative X-ray study; right shoulder pain, intermittently symptomatic, possible arthritis; and right elbow tendonitis, intermittently symptomatic. A right ankle disability was not diagnosed. X-ray studies were performed after the VA examination: an X-ray study of the right elbow showed normal alignment with no evidence of fracture, dislocation, or arthritic changes; an X-ray study of the right shoulder showed normal alignment with no evidence of fracture, dislocation, or arthritic changes; and an X-ray study of the lumbosacral spine showed no significant abnormality. At a November 1997 VA psychiatric examination, the veteran denied any previous hospitalization or outpatient treatment for any psychiatric or emotional condition. He said he was once placed on "nerve medication" after the death of a relative. He said he had been unable to work since 1994 due to pain in all of his joints. He reported symptoms including being tense and irritable, an inability to be around large numbers of people, difficulty tolerating noise, and sleep impairment. He said he had these symptoms for the past ten years, and stated that approximately 90 percent of his emotional difficulties were due to his inability to work and his financial difficulties. He said he had not had alcohol for the past three and one-half months, but that prior to that he was a heavy drinker for the past four or five years. The examiner noted that there were no prior medical records associated with the veteran's file. The Axis I diagnoses were adjustment disorder with anxiety, and alcohol abuse, early full remission. The examiner opined that the adjustment disorder was a result of the veteran's unemployment due to his chronic pain. The examiner noted that psychosocial stressors included lack of income and lack of employment, presumably due to chronic pain. By a statement dated in February 1998, the veteran said he was attempting to obtain private medical records dating from soon after separation from service. By a statement dated in February 1999, the veteran's representative asserted that the VA doctors who examined the veteran did not review his complete medical history, and suggested that such should be done. In May 1999, the Board remanded the case to the RO for an RO hearing. At a July 1999 RO hearing, the veteran testified that during service he fell down some stairs and injured his right elbow. He said that during service his right elbow "popped" and felt as if it were about to dislocate, and he had sharp pain. He stated that he was treated for the condition more than once or twice during service, and said an X-ray study of his right elbow was not performed during service. He stated that after separation from service, he continued to have the same symptoms on a constant basis. He said that at first he treated the condition by himself, with ointment or a heating pad, and he was later treated for this condition by a private physician, Dr. Toping, in 1975, who told him to put Ben Gay on his elbow. He testified that Dr. Toping's medical records were unavailable. He said he was treated by another physician, Dr. Evans, in 1986, who diagnosed tendonitis. He stated that he had been treated for this condition by Dr. Wiggly for the past two years, and he was taking medication for it. He said that the condition was currently diagnosed as tendonitis. With respect to his right shoulder, the veteran said that he injured it during service in the same accident in which he injured his right elbow, and he had symptoms ever since. He said that he reported his shoulder symptoms at that time, and the medical corpsman told him it was not fractured or dislocated, and did not treat his shoulder. He said he did not receive treatment for his right shoulder until 1997, and he was diagnosed with tendonitis, and given medication. He stated that he injured his right ankle during service in the same accident in which his right elbow was injured. He said he was treated for the ankle injury, and given an Ace bandage. He stated that he sought treatment for his ankle condition 8 or 9 months later, and was told that his ankle was badly sprained. He said he occasionally had problems with giving way of the ankle ever since then. He denied receiving treatment for this condition within the first year after separation from service. He stated that his low back was injured in the same incident in which he injured his right elbow, and he had back pain and difficulty bending ever since. He said that during service he was treated for the back complaints but he was told that there was nothing wrong with his back. He stated that he purchased a back brace for himself which he wore during service. He said he was first treated for a back condition in 1997. He testified that during service, his grandmother died and he became really "stressed out," and was treated two times by a psychiatrist. He said he sometimes became uptight and nervous, and he had not sought treatment for this condition since separation from service. By a statement dated in January 2000, the veteran's representative asserted that the case should be remanded for another VA examination, with a review of the veteran's service medical records by the examiner. II. Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service incurrence will be presumed for certain chronic diseases, including arthritis, if manifest to a compensable degree within the year after active service. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. The Board notes that a personality disorder is not a disability for VA compensation purposes, and provides no basis for service connection. 38 C.F.R. §§ 3.303(c), 4.9, 4.127. The veteran claims service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder, all of which he asserts were incurred during military service. His claims present the threshold question of whether he has met his initial burden of submitting evidence to show that his claims are well grounded, meaning plausible. If he has not presented evidence that his claims are well grounded, there is no duty on the part of the VA to assist him with his claims, and the claims must be denied. 38 U.S.C.A. § 5107(a); Grivois v. Brown, 6 Vet. App. 136 (1994). For the veteran's claims for service connection to be plausible or well grounded, they must be supported by competent evidence, not just allegations. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). In order for a service connection claim to be well grounded, it must be supported by competent evidence of a current disability (medical evidence of a diagnosis), competent evidence of incurrence or aggravation of a disease or injury in service (medical evidence or, in some circumstances, lay evidence), and competent evidence showing causality between service and a current disability (medical evidence). Caluza v. Brown, 7 Vet. App. 498 (1995); Grivois, supra; Grottveit v. Brown, 5 Vet. App. 91 (1993). Service medical records from the veteran's 1970-1972 period of active duty are negative for complaints or treatment of a chronic right shoulder disability. In November 1970, the veteran reported that he bumped his right elbow and was treated for complaints of right elbow pain; the diagnostic impression was mild olecranon bursitis, traumatic and/or minimal contusion. The service medical records do not reflect that the veteran fell downstairs or that he injured his right shoulder, right ankle, or low back in such an incident. In January 1971 the veteran was treated for low back pain of one week's duration with no history of injury; one week later the veteran reported that his back was much better. In late January 1971, the veteran reported that his ankle gave out occasionally; on examination, there was no pathology. In May 1971, the veteran complained of lumbosacral pain and ache; on examination, there was minimal paraspinal spasm. A May 1972 consultation request notes that the veteran had poor performance in the Navy with an inability to adjust; the provisional diagnosis was questionable personality disorder. On psychiatric consultation in May 1972; the diagnostic impression was immaturity - immature personality. On separation medical examination in October 1972, the veteran's upper extremities, lower extremities, spine, and psychiatric system were listed as normal. Service medical records are negative for a diagnosis of a chronic right elbow disability, right shoulder disability, right ankle disability, low back disability, or psychiatric disorder. The first post-service medical evidence of a right elbow disability is dated in May 1987, when the veteran was diagnosed with tendonitis of the right elbow. The first post-service medical evidence of a psychiatric disorder is dated in November 1989, when he was diagnosed with anxiety. At a VA examination in November 1997, the examiner diagnosed low back pain, of questionable etiology, symptomatic, status post injury to the coccyx area with residual pain and a negative X-ray study, right shoulder pain, intermittently symptomatic, possible arthritis, and right elbow tendonitis, intermittently symptomatic. (X-ray studies of the right shoulder, right elbow, and low back were negative for arthritis). Post-service medical records are negative for diagnoses of chronic disabilities of the right shoulder, a right ankle, and low back. The Board notes that although the 1997 VA examiner diagnosed pain of the right shoulder and low back, chronic disabilities were not diagnosed. Pain alone, without a diagnosed related medical condition, does not constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, No. 97-1948 (U.S. Vet.App. Dec. 29, 1999). At a November 1997 VA psychiatric examination, the examiner diagnosed adjustment disorder with anxiety, and alcohol abuse, early full remission. The examiner opined that the adjustment disorder was a result of the veteran's unemployment due to his chronic pain. The veteran has asserted that he incurred a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder during his period of active service. As a layman, he is not competent to render an opinion regarding diagnosis or etiology and his statements do not serve to make his claim well grounded. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Similarly, the veteran's self-reported lay history, transcribed in some of the post-service medical records, that his disabilities began in service, does not constitute competent medical evidence of causality as required for a well-grounded claim. LeShore v. Brown, 8 Vet. App. 406 (1996). The veteran has not presented medical evidence of a current right shoulder disability, a current right ankle disability, or a current low back disability, as required for well- grounded claims. Even if these conditions were currently shown, there is no medical evidence to link them to service, as required for well-grounded claims. The veteran also has not submitted competent medical evidence of service linkage as to the current tendonitis of the right elbow and the current adjustment disorder with anxiety, as required for well grounded claims. Without such competent medical evidence, all the claims for service connection are implausible and must be denied as not well grounded. 38 U.S.C.A. § 5107(a); Caluza, supra. ORDER Service connection for a right elbow disability, a right shoulder disability, a right ankle disability, a low back disability, and a psychiatric disorder is denied. L. W. TOBIN Member, Board of Veterans' Appeals