BVA9505431 DOCKET NO. 92-18 762 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Togus, Maine THE ISSUES 1. Entitlement to service connection for a disability of the back. 2. Entitlement to service connection for residuals of an injury to the kidneys and adrenal glands. 3. Entitlement to service connection for residuals of a nasal fracture. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Connolly, Associate Counsel INTRODUCTION The veteran had active service from January 1964 to July 1966. This matter came before the Board of Veterans' Appeals (Board) on appeal from an August 1991, rating decision of the Togus, Maine, Regional Office (RO) of the Department of Veterans Affairs (VA). The notice of disagreement was received in August 1991. The statement of the case was sent to the veteran in September 1991. The substantive appeal was received in October 1991. In a July 1993 decision, this case was remanded to the RO for further development. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he sustained a back injury in service while aboard a ship when a moor line snapped and hit him in the back. He contends that this injury resulted in kidney problems. Specifically, he asserts that he had to undergo a bilateral adrenalectomy in 1970 after discharge. The veteran further contends that he suffers from residuals of a nasal fracture sustained in service. He relates that he cannot inhale, has trouble breathing, and suffers from a constant dry mouth. 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 veteran's claim of entitlement to service connection for disabilities of the back, residuals of an injury to the kidneys and adrenal glands, is not well-grounded. Further, it is the decision of the Board that the veteran is entitled to service connection for residuals of a nasal fracture. FINDINGS OF FACT 1. The veteran was treated for lumbar and mid-dorsal back pain during service but there is no medical evidence of a back disorder after service. 2. The evidence does not establish the presence of an injury to the kidneys, adrenal glands or back in service nor does it establish the presence of a kidney disorder after service. 3. The medical evidence does not establish a disorder of the adrenal glands until many years after service. 4. The veteran sustained a nasal fracture in service which resulted in lasting residuals consisting of a perforation of the septum and a deviation of the septum. CONCLUSIONS OF LAW 1. The claim of entitlement to service connection for disabilities of the back, kidneys and adrenal glands is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran has residuals of a nasal fracture sustained in service consisting of a perforation of the septum and a deviation of the septum. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board notes that there are currently three issues in appellate status. The Board will review each issue separately, however, the Board will first review the veteran's pre-service and service medical records as they are common to all three issues. Prior to service, private medical records reveal that the veteran was treated in 1960 and in 1962 for rheumatic fever. One of his problems in 1960 was epistaxis. The veteran underwent an enlistment examination in 1963 which did not reveal any abnormalities of the spine, kidneys, adrenal glands, or nose. In January 1964, the veteran was treated when he fell and hit his head on the deck. In May 1965, the veteran was treated for frequent nosebleeds. It was noted that he had sustained a nasal fracture the year prior to treatment, which would have been during service. The examiner did not indicate what caused the original nasal fracture. In September 1965, he was treated for pain in the lumbar area, possibly due to strain. Also, in September 1965, he fell off a ladder and contused his right eye, then in November 1965, he was seen for cuts and abrasions to the face and skull. In May 1966, he was treated for mid-dorsal back pain not due to trauma. The findings on examination were negative and myalgia, cause undetermined, was noted. In June 1966, he underwent a discharge examination which was entirely negative. At that time, the veteran himself completed a report of medical history, but did not report any complaints regarding his spine, kidneys, adrenal glands, or nose. I. and II. Entitlement to Service Connection for Disabilities of the Back and Residuals of an Injury to the Kidneys and Adrenal Glands Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. In order to grant service connection for a disorder of the endocrine system, in this case, a disorder of the adrenal glands, manifestations must have appeared while the veteran was in service or had become manifest to a degree of 10 percent within one year from the date of termination of such service. 38 U.S.C.A. §§ 1110, 1112, 1131 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). The appellant has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). A well-grounded claim is a plausible claim, one which is meritorious on its own or is capable of substantiation. Such a claim need not be conclusive, but only possible to satisfy the initial burden of 38 U.S.C.A. § 5107(a) (West 1991). Murphy v. Derwinski, 1 Vet.App. 78, 80 (1990) The claim must be accompanied by supporting evidence; an allegation is not enough. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). If service medical records do not show the claimed disability and there is no medical evidence to link a current disability with events in service or with a service-connected disability, then the claim is not well-grounded. Montgomery v. Brown, 4 Vet.App. 343 (1993). Likewise, if there is no evidence of, or any allegation of, any current disability associated with events in service, the claim is not well-grounded. Rabideau v. Derwinski, 2 Vet.App. 141 (1992). In regard to the issue of entitlement to service connection for a disability of the back, as noted, the veteran was treated for back pain in service, however, his discharge examination was normal and he made no further complaints of back pain at that time. There are no medical records pertaining to complaints, treatment, or findings of a back disability following service. In addition, although the veteran testified at a personal hearing in December 1991, he did not present any complaints of a current back disability. Since there are no complaints, findings or treatment of a back disability following discharge, the Board finds that back pain noted during service was acute in nature and resolved with treatment leaving no residuals. As noted above, if there is no evidence of, or any allegation of, any current disability associated with events in service, the claim is not well-grounded. Rabideau. Accordingly, the Board concludes that the veteran's claim for entitlement to service connection for a disability of the back is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). In regard to the issue of entitlement to service connection for residuals of an injury to the kidneys and adrenal glands, a review of the service medical records does not disclose any trauma or injury to the kidneys or adrenal glands. A review of the medical records following service indicates that the veteran was first treated for Cushing's disease in 1969 and underwent a bilateral adrenalectomy in 1970, which was several years after discharge. Hospitalization reports dated in January and February 1970 document the bilateral total adrenalectomy surgery. At that time, the veteran reported significant weight gain, fatigue, and weakness in the thighs as of December 1969. The examiner noted that the veteran had had hypertension, slight diabetes, weight gain, and other changes characteristic of Cushing's disease over the past year. At no time was it documented that the veteran reported or received an injury to the spine, kidneys, or adrenal glands during service, nor was there any medical support that the veteran's disorder of the adrenal glands was attributed to any incident in service whatsoever. In 1976, the veteran was treated for further symptomatology. At that time, the examiner noted a history of Cushing's disease since 1969 and also noted the veteran's childhood history of rheumatic fever. Again, at no time was it documented that the veteran reported an injury to the spine, kidneys, or adrenal glands during service, nor was there any documentation that the veteran's disorder of the adrenal glands was medically attributed to any incident in service whatsoever. In support of his claim, at the December 1991 personal hearing, the veteran presented his own statements that he believed an injury to his back that he alleged occurred in service resulted in his disorder of the adrenal glands. He has also submitted a lay statement from an individual who served with him in service. That individual related that he did not actually witness any injury in service, but remembered that a cross deck line had snapped and struck the veteran. The Board notes that although the individual is capable of stating what he observed happened to the veteran in service, he has not been shown to be capable of making medical conclusions, so his statement is not probative as to the medical causation of the veteran's disability. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). Likewise, the veteran has also not been shown to possess the medical expertise necessary to opine as to the medical causation of his disability. The record may be summarized as follows: the veteran did not undergo treatment for a disorder of the kidneys or adrenal glands in service and his discharge examination was normal, the veteran was first treated for a disorder of the adrenal glands several years after discharge, and there is no medical substantiation that his disorder of the adrenal glands or manifestations or residuals thereof are related to service in anyway. Therefore, the Board finds that the veteran has not presented any competent medical evidence that he has a disorder of the adrenal glands as a result of service. The United States Court of Veterans Appeals (Court) has stated that, in determining whether a claim is well grounded, where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993) citing Murphy. The veteran does not meet the burden imposed by 38 U.S.C.A. § 5107(a) (West 1991), merely by presenting his own lay testimony because lay persons are not competent to offer medical opinions. Grottveit citing Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Consequently, lay assertions of medical causation cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a) (West 1991); if no cognizable evidence is submitted to support a claim, the claim cannot be well-grounded. Grottveit citing Tirpak. Therefore, the Board finds that since the veteran has only submitted his own unsubstantiated allegation as evidence that his disorder of the adrenal glands is due to an alleged injury to the back, kidneys, or adrenal glands in service, he has not submitted evidence that would justify a belief by a fair and impartial individual that his claim is well-grounded. Accordingly, due to the lack of supporting medical evidence, the Board concludes that the veteran's claim for entitlement to service connection for residuals of an injury to the kidneys and adrenal glands is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). III. Entitlement to Service Connection for Residuals of a Nasal Fracture The veteran's claim as to this issue is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). That is, the Board finds that he has presented a plausible claim. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107 (West 1991). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). As previously noted, the veteran apparently sustained a nasal fracture in service and was subsequently treated for frequent nosebleeds. At his personal hearing, the veteran related that he was struck in the nose in service by a spring-loaded door. He further related that currently he cannot inhale, has trouble breathing, and suffers from a constant dry mouth. In support of his claim, he submitted a lay statement from an individual who served with him at the time of his alleged accident in service. That individual related that he did not witness the accident, but recalled that the veteran was injured when a door latch spring hit him in the face. In order to resolve whether the veteran currently has residuals attributable to the nasal fracture sustained in service, the Board remanded this case in July 1993 for a VA examination. In July 1993, the veteran was afforded a VA examination of his nose. At that time, the veteran reported that he had sustained a nasal fracture in service and has had difficulty breathing since that time. He related that his nose has been cauterized on several occasions. He further related that he presently has occasional nosebleeds with sneezing. Physical examination revealed a fairly symmetrical nasal dorsum. The septum was slightly deflected to the left and he had a large cartilaginous nasal septal perforation. There was some crusting around the perforation, but there were no mass lesions within the nose. The examiner opined that the perforation causes the veteran's nosebleeds and that the slight deflection of the septum to the left may cause some obstruction. The examiner was requested to provide the etiology of the veteran's current nasal problems. The examiner stated that "(w)hether the perforation is a result of the accident, or whether it is the result of the cauterizations, or whether it has some other etiological factor, I cannot determine. All I can state with any certainty is that he indeed does have nasoseptal perforation, which is probably the etiology of many of his complaints at the present time." The record may be summarized as follows: the veteran sustained a nasal fracture in service of undocumented origin, was treated for nosebleeds in service, testified that he sustained the nasal fracture when he was struck in the nose by a door latch spring, a lay individual confirmed that the veteran was struck in the face by a door latch spring during service, and the veteran currently has a large cartilaginous nasal septal perforation which the examiner concluded may be the result of an accident sustained in service. Therefore, although the examiner's statement was rather equivocal, the Board finds that the veteran must be afforded the benefit of the doubt under 38 U.S.C.A. § 5107(b) (West 1991). Accordingly, the Board concludes that the veteran has residuals of a nasal fracture sustained in service consisting of a perforation of the septum and a deviation of the septum. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991); 38 C.F.R. §§ 3.303, 3.304 (1994). ORDER The appeal is dismissed as to the issues of entitlement to service connection for a disability of the back and residuals of an injury to the kidneys and adrenal glands. The appeal is granted as to the issue of entitlement to service connection for residuals of a nasal fracture consisting of a perforation of the septum and a deviation of the septum. E. M. KRENZER 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. (CONTINUED ON NEXT PAGE) 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.