BVA9503455 DOCKET NO. 93-11 760 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES 1. Entitlement to service connection for a right forearm disorder. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for a right hip disorder. 4. Entitlement to service connection for headaches. 5. Entitlement to service connection for a bilateral hand disorder. 6. Entitlement to service connection for a neck disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Sandra L. Smith, Associate Counsel INTRODUCTION The veteran had active service from January 1943 to March 1946. This appeal is before the Board of Veterans' Appeals (the Board) from a June 1992 rating decision of the Regional Office (RO) which denied service connection for disorders of the right forearm, right knee, right hip, neck and both hands and a headache disorder. The case is now ready for appellate review. The Board notes that the veteran, in the Substantive Appeal dated in December 1992 , raised the issue of entitlement to service connection for osteoarthritis of the spine. As this additional issue has not been adjudicated and developed, and as it is not intertwined with the issues developed, it is referred to the RO for appropriate action. See Kellar v. Brown, 6 Vet.App. 157 (1994). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he is entitled to service connection for the various claimed disorders because they resulted from injuries he received in a motorcycle accident while in service. The veteran's representative requests that any and all reasonable doubt be resolved in the veteran's favor. DECISION OF THE BOARD The 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 for service connection. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The injuries to the scalp, right forearm, right knee and right hip suffered by the veteran in a motorcycle accident in service were acute and transitory and resulted in no chronic residuals. 3. A chronic headache disorder was not present in service, nor is there medical evidence of chronicity of symptomatology following service discharge. 4. There is no evidence of any bilateral hand disorder, disability, or injury during service or for many years thereafter. 5. There is no evidence of any neck disorder, disability, or injury during service, or for many years following service discharge. CONCLUSIONS OF LAW 1. Disorders of the right forearm, right knee, right hip, neck, and both hands were not incurred in service, nor may arthritis of the neck 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, 3.307, 3.309 (1994). 2. A headache disorder was not incurred in service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A person who submits a claim for benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107. After reviewing the evidence on file we conclude that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the claim presented is not inherently implausible. Furthermore, we conclude that all facts pertinent to the plausible claim have been developed and that as such, there is no further duty to assist in developing the claim as contemplated by 38 U.S.C.A. § 5107(a). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. Service connection may also 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 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d). With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. For the showing of 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." Continuity of symptomatology is required where the condition noted during service is not, in fact, 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. 38 C.F.R. § 3.303(b). A review of the veteran's service medical records discloses that the service entrance examination report, dated in October 1942, was negative for any relevant medical disorder or disability. Service treatment records show that the veteran was hospitalized following a motorcycle accident in July 1944. He initially complained of injury to his scalp, right arm and right knee. He had not lost consciousness. During his hospital stay it was noted that he complained of pain in his right hip. X-rays of the skull and right hip were negative. The final diagnoses were lacerations of the right parietal region of the scalp and abrasions of the right forearm and right knee. He was returned to duty one week later with no residuals noted. The veteran's service treatment records contained no reference to any complaint, finding, or treatment relative to headaches. The service separation examination report, dated in March 1946, was negative for any disorder or disability, other than malaria and dysentery, incurred in service. However, in the space for "neurological diagnosis" the word "headache" had been typed. History was given of a head injury in August 1945. The veteran submitted a statement in August 1981, which indicated that he suffered a head injury during service and had not "seen a well day since then." Medical records from a private physician, dated from 1977 to 1979, and a lab report dated in 1992, show that the veteran was treated for bronchitis, tonsillitis, sinusitis and gastritis, and back and leg pain. In 1978 and 1979 complaints of back and leg pain with a note of traumatic arthritis were reported. Elevated blood pressure readings were also regularly noted. The medical records contained no reference to any complaint or finding of any headache disorder, or right arm, right knee, right hip, or bilateral hand disorders. An x-ray report from a private medical facility, dated in October 1977, indicated that the veteran had degenerative disease at vertebrae C5-6, and C6-7. There were accompanying hypertrophic arthritic changes in the cervical and thoracic spine along with some generalized demineralization. There was also generalized demineralization in the lumbar spine with presumed degenerative disc disease at vertebrae L5-S1. In his substantive appeal dated in December 1992 the veteran indicated that he had suffered from continual headaches and back pain since the motorcycle accident in service. He cited a section of the Merck Manual of Diagnosis and Therapy for the proposition that degenerative arthritis could be caused by acute or chronic trauma. The veteran also stated that the only trauma he had ever experienced was the motorcycle accident in service. He also explained that, although he was experiencing back and leg problems at the time of his service separation examination, he did not tell the examiner for fear his return home would be delayed. Since service he had mostly self-medicated with non- prescriptive drugs. Two of the doctors he had seen had died and he was unable to obtain copies of his medical records. Service connection for headache disorder The Board finds, based on the evidence of record, that service connection is not warranted for a headache disorder. The Board has considered the one notation on the separation examination report, but finds it insufficient to establish chronicity during service. The Board has also considered the statement of the veteran as to continual headaches since the motorcycle accident. However, there is no evidence of complaints, findings, or treatment for headaches in the service treatment records. Furthermore, there is no medical evidence of continuity of symptomatology following discharge from service. The private medical records in the claims folder contain no reference to any headache disorder. Thus, the claim for service connection for a headache disorder must be denied. Service connection for right forearm, right knee, and right hip disorders The Board finds, based on the evidence of record, that service connection is not warranted for disorders of the right forearm, right knee, and right hip. The service medical records do show that the veteran suffered contusions and abrasions to his right forearm and right knee from the motorcycle accident in July 1944. In addition, the treatment records disclose that he complained of right hip pain but x-rays were negative. The veteran's service medical records contain no later complaints, findings or treatment of any right forearm, knee or hip disorder(s). The service separation examination was negative for these disorders and there is no medical evidence of treatment following service discharge or for many years thereafter. In addition, the Board notes that the veteran presented an excerpt from a medical treatise to the effect that trauma could cause arthritis. However, the Board notes that there is no medical evidence that the veteran has traumatic arthritis of the right forearm, right knee, or right hip. Thus, the Board concludes that the injuries incurred in service were acute and transitory with no chronic residuals. Consequently, the claims for service connection for right forearm, right knee, and right hip disorders must be denied. Service connection for bilateral hand disorder The Board finds, based on the evidence of record, that service connection for a bilateral hand disorder is not warranted. There is no evidence of a hand disorder or disability during service. Nor is there any evidence of an in-service injury to the hands. Consequently, the claim for a bilateral hand disorder must be denied. Service connection for a neck disorder The Board finds, based on the evidence of record, that service connection for a neck disorder is not warranted. There is no evidence of any in-service neck disorder or disability. Nor, is there any evidence of a neck injury during service. The service treatment records pertaining to the veteran's motorcycle accident contain no reference to any complaint, finding or treatment for a neck injury. The service separation examination is negative for any neck disorder, disability, or injury. In addition, there is no medical evidence of continuity of symptomatology following the veteran's discharge from service and no evidence of arthritis of the neck within one year of service discharge. The incurrence of arthritis of the neck may not be presumed. 38 U.S.C.A. §§ 1101, 1112, 1113. The Board further notes that there is no clinical evidence or medical opinion that any current neck pathology is related to any incident of service. Although the private medical records made reference to traumatic arthritis, this was approximately 32 years after service, and the records contained no history of any trauma to form the basis of the conclusion that the arthritis was trauma-induced. Traumatic arthritis was not attributed to inservice trauma in the records. Consequently, service connection for a neck disorder must be denied. Finally, the Board finds the preponderance of the evidence is against the veteran's claims for service connection for a right forearm, right knee, right hip, bilateral hand, and neck disorders, and headache disorder. As such, the record does not present an approximate balance of positive and negative evidence with respect to the merits of the veteran's claims. Accordingly, the benefit of the doubt is not for application in this case. ORDER Service connection for a right arm, right knee, right hip, bilateral hand, and neck disorders, and for a headache disorder, is denied. HOLLY E. MOEHLMANN 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.