Citation Nr: 0003727 Decision Date: 02/14/00 Archive Date: 02/15/00 DOCKET NO. 97-13 757 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a vascular disability, to include headaches and dementia. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant, R. J. ATTORNEY FOR THE BOARD W. R. Steyn, Associate Counsel INTRODUCTION The veteran had active military service from July 1956 to June 1959, and from October 1961 to November 1978. This appeal arises before the Board of Veterans' Appeals (Board) from a February 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina, which denied the veteran's claim seeking entitlement to service connection for vascular dementia. The veteran's claim was initially before the Board in January 1999, at which time it was remanded for additional development. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran's vascular dementia began many years after service; it is not related to his headaches in service, or to any other disease or injury in service. 3. The veteran's current headaches are not related to the headaches that the veteran suffered from in service; the headaches that the veteran suffered from in service were not of a chronic nature. CONCLUSION OF LAW Service connection for a vascular disability, to include headaches and dementia is not warranted. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991), 38 C.F.R. §§ 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background Service medical records show that at the veteran's enlistment examination in July 1956, his vascular and neurologic systems were evaluated as normal. At his separation examination in April 1959, his vascular and neurologic systems were evaluated as normal. On his report of medical history form from April 1959, the veteran placed a check in the "no" box in response to whether he either had or had ever had frequent or severe headaches. At the veteran's October 1961 examination, his vascular and neurologic systems were evaluated as normal. On his October 1961 report of medical history form, he placed a check in the "no" box in response to whether he either had or had ever had frequent or severe headaches. At the veteran's March 1965 examination, his vascular and neurologic systems were evaluated as normal. On an undated report of medical history form, the veteran placed a check in the "yes" box in response to whether he either had or had ever had frequent or severe headaches. On the back of the form, the medical examiner explained that the veteran had had migraine headaches starting in 1968, averaging three attacks per year. In February 1968, the veteran sustained an injury to his left eye. The veteran was seen in December 1969 complaining of headaches for 3 days. The veteran was seen in October 1970 for severe headaches. He stated that he had been treated for his headaches with no results, and that his headaches were continuous. The veteran was seen and treated in January and February 1972 for left headaches beginning in the eye for 2 years. Impression was headaches, possible migraine. The veteran was seen in March 1972 for his headaches. He related the onset of his headaches to mild trauma to his left eye 3 years prior. Medication was prescribed. The veteran was seen in November 1973 complaining of severe headaches that had gotten worse over the past month. Medication was prescribed. The veteran was seen in March 1974 complaining of headaches. The veteran was seen in September 1974 complaining of severe headaches for 10 days. Impression was rule/out sinus headaches. At medical examinations in May 1973 and November 1974, the veteran's vascular and neurologic systems were evaluated as normal. The veteran was seen in June 1975 complaining of severe headache pain. The veteran was seen in October 1975 complaining of headaches for a week. He stated that the headaches started on the left side above the eye to the back of the head, and that he had had a past history of headaches since 1969. Medication was prescribed. The veteran was seen in January 1977 for sinus headaches starting one week prior. He was seen in February 1977 for sinus headaches, which he said he had every day, especially in the morning. He was seen in March 1977 for rule/out tension headaches. At the veteran's August 1978 retirement examination, his vascular and neurologic systems were evaluated as normal. His blood pressure was 108/78. On his report of medical history form from August 1978, he placed a check in the "yes" box in response to whether he either had or had ever had frequent or severe headaches. On the back of the form, the examiner explained that the veteran had occasional headaches without sequelae. Dr. S. G. submitted copies of treatment records from February 1976 to March 1991. In 1982, it was noted that the veteran still had headaches all the time. Dr. J. B. submitted copies of treatment records from July 1995 to January 1997. In May 1996, the veteran was diagnosed with memory loss, progressive, and stable hypertension. In a letter dated September 1996, the examiner wrote that it was his opinion that the veteran was suffering of vascular dementia of mild severity. The treatment records show that the veteran was diagnosed with vascular dementia. A copy of a treatment report was submitted from the Memory Disorders Clinic from September 1996. Diagnosis was dementia due to multiple small strokes. In November 1996, the Social Security Administration (SSA) determined that the veteran was disabled due to organic mental disorders (chronic brain syndrome) and essential hypertension since April 1996. The functional capacity assessment from the SSA noted that the veteran had been diagnosed with dementia and that he displayed memory concentration deficits. The examiner opined that it did not appear that the veteran had the ability to perform simple tasks for 2 or more hours at a time without special supervision. Records from 1996 that the SSA had considered from the Medical University of South Carolina, and from Dr. R. J. H. were also submitted. The majority of the treatment records (and all of the relevant ones) were duplicates of the records from July 1995 to January 1997 submitted by Dr. J. B. In a statement dated November 1996, the veteran asserted that when he was stationed at Fort Hood, he started having severe headaches and was treated for them there. He stated that after service he continued to have these headaches and learned that they were small strokes which was the onset of dementia. In the veteran's March 1997 Substantive Appeal, he stated that the records clearly showed that his headaches began as early as 1968. He stated that this could have been the onset of dementia even though it was diagnosed as tension headaches. The veteran was afforded a hearing before the RO in August 1997, a transcript of which has been associated with the claims folder. The veteran testified that he had headaches on many occasions. He testified that he was treated for headaches with medication. The veteran stated that he was not treated for his headaches until 7 or 8 years after service. He stated that he was receiving regular treatment for his headaches. The veteran's wife testified that immediately after service, she treated the veteran for his headaches with non prescription medicine. Copies of treatment records were submitted from Medical Park Family Medicine from February 1998 to December 1998. They show that the veteran was diagnosed and treated for multi- infarct dementia and hypertension during this time period. On one occasion, in October 1998, the veteran complained of a headache and received medication for such headache. In April 1999, efforts were made to obtain VA records from the VA Medical Centers in both Charleston and Columbia. The medical centers both replied that they did not have any records of the veteran's. In a statement dated April 1999, the veteran referred to a letter written by the RO to him indicating that efforts to obtain records from the VA hospitals in Charleston and Columbia had been unsuccessful. The veteran clarified that instead of the VA hospital in Charleston it should have been the Medical University of South Carolina at Charleston. He wrote that he was enclosing information from the disorder clinic pertaining to memory, and specifically enclosed a duplicate copy of a report from the Memory Disorders Clinic from September 1996. The veteran underwent a VA examination in May 1999. The examiner noted that he had reviewed the veteran's claims file. The examiner noted that the veteran was obviously demented, and that most of the information had to come from his wife. The examiner's impression was multi-infarct dementia. He stated that he did not see evidence for other subcortical dementia such as Parkinson's disease. He stated that the veteran had had occasional headaches, but that he was not able to get a good feel for how often he had headaches. The examiner noted that the veteran reported having headaches more in the service than he did at the present time. The examiner commented that multi-infarct dementia was a disease that takes a long time to be recognizable. The examiner commented that it was not possible for him to state exactly when his dementia would have begun, but commented that it appeared his symptoms were most noted in 1996. The examiner commented that the veteran's blood pressure may have had some problems with it. The examiner commented that he found it unlikely that the veteran's headaches that he suffered in service were secondary to vascular disease, and that he did not find any evidence of hypertension while the veteran was in service. The examiner commented that he felt it more likely that the veteran's disease developed after discharge from service since he had approximately 24 years from the time of discharge until he began showing symptoms. The examiner opined that it was much more likely that the veteran's disease began during that time period than prior to that time period, especially since the veteran had an electrocardiogram that showed evidence for left ventricular hypertrophy based on voltage criteria. The examiner commented that he did not see any evidence of ischemia or other hypertrophy. In June 1999, the RO wrote a letter attempting to obtaining treatment records from Dr. J. K. No reply was received from the physician. Analysis The law provides that service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § §1110, 1131 (West 1991). The veteran's claim for service connection for a vascular disability, to include headaches and dementia, is well grounded, meaning plausible, and the file shows that the VA has fulfilled its duty to assist him in developing facts pertinent to the claim. 38 U.S.C.A. § 5107 (a). (West 1991). Specifically, the service medical records show treatment for headaches, the veteran has testified that he continued to have headaches after service, and the medical evidence shows that the veteran still suffers from headaches. The veteran's statements as to his continued headaches after service is competent evidence for well-groundedness purposes regarding his claim for service connection for a vascular disability, to include headaches and dementia. Falzone v. Brown, 8 Vet. App. 398, 405-406 (1995) For the showing of a 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); see also Savage v. Gober, 10 Vet. App. 488, 495-498 (1997). Service connection may also be granted for a chronic disability on a presumptive basis if such is shown to be manifested to a compensable degree within one year after the veteran was separated from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may 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 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 303, 305 (1992). Presumptive periods, as noted above, are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and the implementing VA regulations are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d); see Douglas v. Derwinski, 2 Vet. App. 103, 108-09 (1992). As will be discussed below, the preponderance of the evidence is against the veteran's claim for service connection for a vascular disability, to include headaches and dementia. The service medical records show that the veteran was seen for headaches on numerous occasions in service. At separation, the examiner noted that the veteran had occasional headaches without sequelae. The service medical records do not show that he was seen for dementia. It is clear that the veteran currently has dementia. Specifically, the veteran was diagnosed with vascular dementia by Dr. J. B. in 1996, and dementia due to multiple small strokes by the Memory Disorders Clinic in 1996. He was diagnosed with multi-infarct dementia by Medical Park Family Medicine in 1998 and at a VA examination in May 1999. At the veteran's May 1999 VA examination, the examiner specifically commented that it was not possible for him to state exactly when the veteran's dementia began, but that it appeared that the veteran's symptoms were most noted in 1996, and that it was more likely that the veteran's disease developed after discharge than during service due to the gap in time for which the veteran did not show symptoms. The veteran asserts that his headaches in service were the onset of dementia, or that the headaches were actually small strokes which were the onset of dementia. However, the veteran is not a physician and lay persons are not competent to provide evidence that requires medical knowledge, such as linking his current disorders to his headaches in service. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The competent evidence, that is the medical evidence, does not show that the veteran was diagnosed with dementia of any kind until 1996, and in May 1999, the VA examiner commented that it was more likely that the veteran's dementia developed after service. Regarding the veteran's headaches, a 1982 treatment record from Dr. S. G. noted that the veteran still had headaches all the time. Efforts by the RO to obtain additional records to which the veteran alluded were not successful. The veteran was also seen for headaches in October 1998 at Medical Park Family Medicine. Although the veteran was seen for headaches on numerous occasions in service, the medical evidence shows that the headaches were not chronic within the meaning of 3.303 (b). As earlier noted, the examiner at separation noted that the veteran had occasional headaches without sequelae. The first medical evidence after service showing that the veteran was seen for headaches was in 1982, more than 3 years after service. It is true that the veteran stated at his May 1999 VA examination that he still had occasional headaches. However, besides the 1982 notation, there is only an October 1998 notation from Medical Park Family Medicine showing that the veteran was seen for his headaches. Such a large gap is not adequate to show continuity of headaches after service. Also, no medical examiner has stated that the veteran's current headaches the same type of headaches that the veteran suffered from in service. In summary, the evidence does not adequately demonstrate that it is at least as likely as not that the veteran's current vascular disorders, to include dementia and headaches, resulted from a disease or injury incurred in service. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and the claim for service connection for a vascular disability, to include headaches and dementia, must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). ORDER Entitlement to service connection for a vascular disability, to include headaches and dementia, is denied. G. H. SHUFELT Member, Board of Veterans' Appeals