BVA9502026 DOCKET NO. 93-06 931 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Denver, Colorado THE ISSUES 1. Entitlement to service connection for pericarditis. 2. Entitlement to service connection for hypoglycemia. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Nancy R. Kegerreis, Associate Counsel INTRODUCTION The veteran served on active duty from January 1972 to April 1992. This matter comes before the Board of Veterans' Appeals (Board) from a July 1992 rating decision by the Department of Veterans' Affairs (VA) Regional Office (RO) in Denver, Colorado, which denied service connection for pericarditis and hypoglycemia. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, essentially, that he had viral pericarditis in service and has been seen for this condition since every six months since 1978. He states that he had had problems with hypoglycemia since 1973 or 1974 and that even though tests currently show normal blood sugar readings, instances of hypoglycemia come on without warning. He thus believes that he should be service connected for both of these disorders. 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 has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claims are well grounded. FINDINGS OF FACT 1. The veteran's recurrent pericarditis resolved in service, and there is no evidence or allegation of any current disability. 2. The veteran currently does not have any disease related to service which could reasonably be associated with hypoglycemia. CONCLUSIONS OF LAW 1. The veteran has not submitted evidence of a well-grounded claim for service connection for pericarditis. 38 U.S.C.A. §§ 1110, 1131, 5107(a), 7105(d)(5) (West 1991); 38 C.F.R. § 3.303 (1993). 2. The veteran has not submitted evidence of a well-grounded claim for service connection for hypoglycemia. 38 U.S.C.A. §§ 1110, 1131, 5107(a), 7105(d)(5) (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Background The threshold question to be answered in this case is whether the veteran has presented a well-grounded claim within the meaning of 38 U.S.C.A. § 5107 (West 1991). That is, the claim must be plausible and capable of substantiation. If he has not, his appeal must fail. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). A claim which is not well grounded must be dismissed. See Boeck v. Brown, 6 Vet.App. 14, 17 (1993). The Board finds that neither of the veteran's claims is well grounded. Although the veteran's earliest service medical records have not been located, a report of a medical examination, dated in March 1977, refers to an acute attack of pericarditis in October 1976, from which the veteran made a good recovery. It was recommended that he continue to be followed up for pericarditis. A cardiology consultation in April 1977 noted a history of pericarditis with effusion in November 1976. The only symptom present at the time of the consultation was a slight pain when he first lay down at night, which lasted less than 15 seconds and then resolved. The veteran denied shortness of breath or dyspnea, and reported that he played tennis and bowled. On examination, his blood pressure was 140/85 and his chest was clear. His heart was regular, with a normal S1 and S2 and intermittent S4. An electrocardiogram (EKG) was normal, the previous T changes having resolved. A chest x-ray showed cardiac size to be 1 cm. larger than previous chest x-ray of March 1977, but still smaller than in November 1976. A repeat chest x-ray in May 1977 showed a normal heart size. There had been no change from January and March 1977. An echocardiogram showed no fluid and a normal left ventricle dimension. The diagnostic impression was viral pericarditis, resolved. In September 1977, the veteran reported to an outpatient clinic with complaints of chest pain for three days, which was described as a sharp pain in the sternal area with some radiation to left neck area, which became worse when he moved around. He had no shortness of breath. He had had a history of viral pericarditis. An examination showed a clear chest and a regular rhythm and rate, without murmur, rub, or gallop. There was no paradoxical pulse. The pulses were good and an EKG was within normal limits. The assessment was chest pains of an etiologically unknown disorder and rule out myocardial infarction or pericarditis. Later that month, the veteran was seen again with continued complaints of a sharp pain in the mid-sternal area. Examination revealed findings similar to those on the previous examination. There was no chest wall tenderness, and an EKG showed no change from the previous one. No abnormalities were noted. The examiner provided an assessment of chest pain, but doubted coronary insufficiency or pericarditis. He noted that there was some component of anxiety. Toward the end of September 1977, the veteran experienced another incidence of chest pain. Regular sinus rhythm was found, but no murmur and no friction rub. An EKG showed no gross change compared to the previous EKG. The diagnosis was angina pectoris vs. pericarditis. In October 1977, the veteran again had chest pain, a pressured feeling as though someone were sitting on his chest. The pressure went up into his shoulder. An EKG showed a slight ST elevation. During air evacuation to a hospital, the veteran had chest pain with tachycardia and elevated blood pressure. A hospital admission report, dated in October 1977, noted that the veteran had had chest pain for approximately two weeks prior to admission, beginning in September. It had become worse upon deep respiration and movement. The CBC, EKG and chest x-rays at that time were all reported to be normal. However, pain still persisted. On September 22, a cardiac rub was heard, and the veteran was placed on steroids with moderate improvement. An October echocardiogram showed evidence of pericardial effusion, and an EKG showed inverted T-waves and episodes of sinus tachycardia. He was placed on steroids again with marked improvement of symptoms. A physical examination was unremarkable. The chest and lungs were clear to auscultation and percussion. The heart showed a normoactive precordium. There were no murmur or gallops or rubs heard in different positions. The S1 and S2 were normal. Medications were prescribed, including Demerol for pain. During his hospitalization, the veteran improved markedly and became asymptomatic on the 10th hospital day. The EKG upon admission had shown minimal inversion of T waves on lateral leads which returned to normal at time of discharge. All other laboratory and x-ray findings were normal. The final diagnosis was acute idiopathic recurrent pericarditis. Follow up examinations in November 1977 noted that the veteran claimed to have some episodes of chest pain lasting about 15-20 seconds when he lay down, but otherwise he remained asymptomatic. A scan was normal, and there was no evidence of any pericardial effusion. An Air Force periodic medical examination in April 1981 made no mention of pericarditis. Follow up examinations in September and October 1988, showed normal EKG's, and a normal echocardiogram. An exercise tolerance test also showed normal results. An EKG in June 1990 showed a normal sinus rhythm with occasional premature supraventricular complexes, but was otherwise normal. A May 1991 EKG also showed a normal sinus rhythm. A retirement examination, dated in May 1991, revealed that the veteran had received diagnoses of acute idiopathic pericarditis. He had been treated with hospitalization and medications for three weeks. The last episodes had been in 1988. Echocardiograms, treadmill tests, and EKG's had been performed. All findings were within normal limits. In April 1992, the veteran was afforded a VA disability evaluation examination, during which he reported a history of viral pericarditis in 1976, 1977 and 1978. It was noted that he had had sharp chest pain that radiated to the left arm, which was aggravated by deep breaths. He had been treated with bed rest, intravenous steroids, and pain medication. The pain had resolved, except for occasional twinges of pain not associated with activities. A chest x-ray and an EKG were normal. He had been evaluated by a cardiologist, and no ischemia or other abnormalities had been found with the treadmill. He continued to smoke more than a pack of cigarettes per day. The diagnosis was history of viral pericarditis. Relative to the veteran's episodes of hypoglycemia, he first experienced symptoms in November 1980. He reported to the outpatient clinic with slurred speech, disorientation, and impaired motor coordination. There had been no incidence of trauma and he had taken no medications, although he had a history of mild hypoglycemia. He was admitted to the hospital via ambulance. Examination the following day revealed that the veteran felt tired. His blood sugar on admission the previous night had been 65 mg percent. His skin was warm and dry. Vital signs were within normal limits. He was alert, with clear speech. Motor coordination appeared normal, as he was lying and sitting in bed without difficulty. The diagnosis was reactive hypoglycemia. An Air Force periodic medical examination in April 1981 noted a history of hypoglycemia, which was controlled by diet. A June 1990 periodic non-flying examination and the veteran's report of medical examination failed to mention either pericarditis or hypoglycemia, even by history. The retirement examination, dated in May 1991, noted a history of hypoglycemia in November 1980, which had been treated with medication with good results. The veteran's VA disability evaluation examination in March 1992 noted a history of hypoglycemia since 1973. Blood sugar was 65 at that time. The veteran continued to get "attacks" of hypoglycemia which were not associated with activities or diet. He admitted to skipping meals at times and reported eating breakfast about four times a month. He was able to resolve his symptoms by drinking orange juice or eating a chocolate bar and resting. A glucose test showed a normal result of 102 within a reference range of 78-110. The diagnosis was history of hypoglycemia. II. Analysis Service connection means, essentially, that the facts, as shown by evidence, establish that a particular injury or disease resulting in disability was contracted in line of duty coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C.A. § 1110, 1131 (West 1991). Additionally, 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) (1993). Each disorder for which a veteran seeks service connection must be considered on the basis of evidence, including that shown by his service records, his medical records, and pertinent medical and lay evidence. 38 C.F.R. § 3.303 (a) (1993). Having reviewed the evidence and arguments of record, it is the Board's opinion that the claim for service connection for pericarditis is not well grounded. The veteran's service medical records clearly show that the veteran had been treated for viral pericarditis in October 1976 and that by April 1977, the disorder had resolved. In September and October of 1977, he suffered another episode of pericarditis, but following hospitalization, this also resolved by November 1977. Since that time, tests in September 1988, October 1988, June 1990, May 1991, and March 1992 show no cardiac abnormalities. In addition, three Air Force physical examinations, dated in April 1981, June 1990, and May 1991, make no reference to pericarditis, even by history. The veteran's April 1992 VA disability evaluation examination did refer to pericarditis by history, but, as all tests were negative for the presence of the disorder, the examiner was not able to provide a current diagnosis. The Board concludes, therefore, that although the veteran had had the disorder twice in service, it had resolved by November 1977 and had not recurred. To be service connected, a disease must show chronicity or continuity. 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. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. See 38 C.F.R. § 3.303(b) (1993). The Board acknowledges that the veteran has been regularly tested for a heart disorder throughout the years. However, the test findings provided in his claims file show negative results. He has produced no clinical evidence showing that he currently has any type of cardiac disorder. The veteran's own opinion that he continues to suffer from pericarditis is not sufficient. See Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). When there is no current disorder, a claim is not plausible and, therefore, not well grounded. See Rabideau v. Derwinski, 2 Vet.App. 141, 144 (1992). In reference to the veteran's claim for service connection for hypoglycemia, the Board notes that this condition constitutes a symptom, not a disease entity. Generally, for purposes of establishing service connection, the evidence must demonstrate that a particular injury or disease resulting in disability was incurred or aggravated in service. A combination of manifestations sufficient to identify the disease entity is required, unless a disease is actually identified in service. Id. Here there has been no diagnosis of a disability manifested by hypoglycemia. Although the veteran states that he has repeated "attacks" of hypoglycemia, his claims file documents only one instance of low blood sugar. Therefore, the Board is unable to find that the claim for hypoglycemia is well grounded. Accordingly, both of the veteran's claims must be dismissed. ORDER The claim for service connection for pericarditis is dismissed. The claim for service connection for hypoglycemia is dismissed. WARREN W. RICE, JR. 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.