BVA9500086 DOCKET NO. 93-05 832 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUES 1. Entitlement to service connection for post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for a left leg tumor. 3. Entitlement to service connection for hiatal hernia. 4. Entitlement to service connection for bleeding ulcer. 5. Entitlement to service connection for a low back disability. 6. Entitlement to service connection for folliculitis. 7. Entitlement to service connection for asthma. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States INTRODUCTION The veteran had active service from November 1975 to December 1980. This matter comes before the Board of Veterans' Appeals (the Board) on appeal from February 1992 and October 1992 rating decisions of the Department of Veterans Affairs (VA) Seattle, Washington, Regional Office (RO). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that asthma was shown on his service separation examination but not on the service entrance examination, and, therefore, the presumption of soundness applies. There is no clear and unmistakable evidence that asthma existed prior to service, and he has not been given a VA examination to determine the extent of his asthma. He was treated for folliculitis in service and it is an ongoing problem. He has been treated for bleeding ulcer and hiatal hernia at a VA medical center since 1981 and had surgery for the bleeding ulcer in 1990. The left leg tumor removed at a VA hospital in 1990 is from the neurofibroma taken out in service, in 1977, and his separation examination shows pigmentation and and abnormal skin lymphatics. He contends that his back problems are a result of a right hip injury sustained in July 1977. His PTSD is a result of problems with his supervisor in service, problems with weight in service and having been counseled in service regarding neurofibroma and the increased chance of having retarded children. 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 for a left leg tumor, hiatal hernia, bleeding ulcer, a back disorder, folliculitis and asthma, and that the claim for service connection for PTSD is not well grounded. 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. A left leg tumor was not shown in service, and a nevus of the left thigh shown many years after service is not related to service or to fibromas treated in service. 3. Hiatal hernia and ulcer were first shown many years after service and are not related thereto. 4. A chronic low back disorder was first shown many years after service and began with injuries sustained in a postservice motor vehicle accident. 5. Folliculitis is not shown in the postservice medical record. 6. The inservice respiratory episode assessed as bronchial asthma was acute and transitory, and chronic asthma has not been demonstrated. 7. There is no competent medical evidence that the veteran has or has ever had PTSD, and this claim is not plausible. CONCLUSIONS OF LAW 1. A left leg tumor, low back disorder, folliculitis and asthma were not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). 2. Hiatal hernia and ulcer disease were not incurred in or aggravated by service, and ulcer disease may not be presumed to have been incurred therein. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). 3. The claim for service connection for PTSD is not well grounded. 38 U.S.C.A. §§ 1131, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that, except for the claim for service connection for PTSD, the veteran's claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented claims which are plausible. The Board is also satisfied that all relevant facts have been properly developed. Va medical records from 1982 have been made a part of the record along with clinical records and a statement from Douglas E. Newton, M.D. There is no indication that there are other records available which would aid a decision. The Board concludes that the record is complete and there is no further duty to assist the veteran in developing his claims under 38 U.S.C.A. § 5107(a). The Board must determine whether the evidence supports the claims or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claims, in which case the claims must be denied. 38 U.S.C.A. § 5107(a); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131. With chronic disability shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at a 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." 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). In this case, service medical records reflect no abnormality of the skin, lower extremities, spine, lungs and chest or abdomen and viscera at entrance. A history of mild hay fever was noted. A clinical record cover sheet shows treatment for bronchitis in December 1975, and in January 1976 he was seen with resolving pneumonia. Chest X-rays in December 1975 and January 1976 showed no significant abnormality. He was treated on numerous occasions for upper respiratory infections. In October 1976 when seen because of concern about a flu shot, he reported a history of upper respiratory infections and asthma as a child. A March 1977 physical profile shows that shaving restrictions were instituted because of pseudofolliculitis, and pseudofolliculitis was subsequently treated in June 1977. In July 1977 the veteran complained of right hip pain and related a history of recurrent pain for the past six years since injuring the hip playing football. Physical examination and X-ray of the hip were within normal limits. In August 1977 he was seen for a hyperpigmented rash on the elbows, forearms and hands, assessed on dermatology examination as atopic dermatitis. When seen for cold symptoms in November 1977 examination revealed bilateral wheezes and rales, but the impression was upper respiratory infection. Chest X-ray was normal. A rash on the chest, abdomen and back was also noted at that time. Two days later wheezes and rales persisted and the examiner's impression was bronchial asthma. In November 1977 the veteran was also seen for multiple brown macules on the thorax, and punch biopsy results showed neurofibroma. He was counseled about the potential future problems, including genetic problems on future children. In September 1978 he was treated for acute gastroenteritis and he was again seen in the shaving clinic in October 1980. On service separation examination in November 1980 history was given of hay fever, asthma and shortness of breath, all noted as "EPTS" and treated with unknown medications, and of recurrent back pain in 1978, treated with BenGay, with no complications or sequelae. He denied having or having had skin diseases. Physical examination of the lungs and chest, abdomen and viscera, lower extremities and spine was normal, and examination of the skin revealed multiple areas of pigmentation. Chest X-ray was negative. Postservice medical records include VA inpatient and outpatient treatment from 1982 to 1992, Dr. Newton's November 1991 statement and clinical records from 1989 to 1990 and a private hospital record with a report of a December 1991 CT scan. The relevant information from these records will be discussed below. Left Leg Tumor Va outpatient and inpatient treatment records from August 1982 to January 1992 show that in June 1991 a mole was removed from the veteran's left thigh. The pathological diagnosis was benign nevus. The evidence shows that, contrary to the veteran's belief that this left leg tumor was a neurofibroma, it was a nevus, not a neurofibroma. The veteran is not competent to provide an opinion as to medical causation or diagnosis, Espiritu v. Derwinski, 2 Vet.App. 492 (1992), and there is no medical opinion or evidence relating the lesion excised from his left thigh more than 10 years after service to service or any condition or incident in service. The preponderance of the evidence is against this claim. Hiatal Hernia and Bleeding Ulcer Service medical record show treatment on one occasion for acute gastroenteritis, but no evidence of hiatal hernia or ulcer disease. A hiatal hernia was first shown on upper gastrointestinal series (UGI) in January 1986, at which time there was no mention of ulcer being found on the UGI. A history of ulcer disease in 1988 was given on VA hospital summary in 1989, and the veteran was treated for gastrointestinal bleeding during hospitalization in November and December 1989. However, this is too remote from service to be related thereto, and there is no competent medical opinion of such relationship. Similarly, the hiatal hernia first found 5 years after service has not been attributed to service by any competent medical opinion or evidence. Service connection may be granted for ulcer disease if shown to a degree of 10 percent within one year after discharge. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R.§§ 3.307, 3.309. As noted, ulcer was first reported in the late 1980's, more than one year after service discharge. The only positive evidence is the veteran's opinion, but that is not competent medical evidence. Espiritu. The preponderance of the evidence is against these claims. Low Back Disability The only evidence of back problems prior to 1989 is the history reported on the service separation examination of low back pain in 1978. This was, however, noted to have been treated and to have no sequelae, indicating that it was acute and transitory, not resulting in chronic residuals. The first postservice evidence of a low back disability is that reported by Dr. Newton who first saw the veteran in 1989 after he had injured his back in a motor vehicle accident. Subsequently, he was treated by Dr. Newton and at a VA facility for low back problems, and symptoms suggestive of herniated nucleus pulposus were noted on VA outpatient treatment in March 1990. A CT scan in December 1991 showed an essentially negative lumbar spine. It is apparent that the veteran's chronic low back problems had their onset with the 1989 motor vehicle accident, as there is no evidence of a continuity of low back symptoms from service to the time of that accident, a period of more than 8 1/2 years. There is no medical evidence or opinion linking his back problems to service, and the preponderance of the evidence is against this claim. The Board notes the veteran's contention that his back disorder is related to a right hip injury in service. However, although the veteran complained of right hip pain on one occasion in service, the injury he described was a preservice football injury to his hip. There simply is no competent evidence that his back disability is related to a hip injury which he allegedly sustained in service, but which is also not shown. Folliculitis Service medical records show that the veteran was treated on several occasions for pseudofolliculitis barbae and was put on shaving restriction. However, the relatively detailed postservice medical records, although showing an episode of rash on the arms and hands in August 1982 and of eczema of the elbow in July 1986, do not show folliculitis. Although there has been no examination specifically for this condition, the Board notes that on physical examination on hospitalization in May and June 1991, a mole was noted on the neck, but no other skin abnormality was reported. This indicates that there was no other abnormality of the skin on the face or neck. Moreover, on a social work service reprt on October 1991 the veteran was noted to have a mustache, but not a beard and he gave no medical history of shaving problems or folliculitis. The evidence does not show that he currently has folliculitis, and, therefore, this claim must be denied. Asthma Although the veteran was treated for upper respiratory infections on numerous occasions in service, bronchial asthma was reported on only one occasion in November 1977. Although there was no evidence of asthma on the service entrance examination, he did give a history of hay fever at that time, and in October 1976 reported a history of upper respiratory infections and asthma in childhood. On the service separation examination asthma existing prior to service was reported, and there were no abnormalities of the lungs and chest on physical examination and X-ray study at that time. Service medical records did not show chronic asthma nor was a chronic respiratory disease diagnosed during service. Postservice medical records also show no findings of asthma or any other chronic bronchial or pulmonary disease. The veteran was treated for colds on several occasions in 1986, 1987 and 1990, but there was no reference to asthma. In 1990 he complained of a productive cough, but, again there were no findings or reference to asthma. When he was interviewed by the VA social worker in October 1991 his medical history did not include any chronic respiratory disease, and in January 1992 he related that he had had hay fever all his life. The medical records as as a whole do not show chronic asthma, and the only chronic respiratory demonstrated is hay fever which was reported at the time of entry into service. There is no competent medical evidence or opinion that the veteran now has or has had chronic asthma, and it must be concluded that the episode assessed as bronchial asthma in service was acute and transitory and did not represent the onset or aggravation of a chronic respiratory disease. The presumption of soundness is not dispositive of this issue and, in fact, is not relevant given the conclusion reached. The preponderance of the evidence is against this claim. PTSD "The initial burden is on the shoulders of the veteran or the claimant: '[A] person who submits a claim . . . shall have 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(a)]." Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). "To be well grounded, a claim 'need not be conclusive,' . . . but must be accompanied by evidence that suggests more than a purely speculative basis for granting entitlement to the requested benefits." Dixon v. Derwinski, 3 Vet.App. 261, 262-63 (1992). In this case, the Board concludes that the veteran has not met the burden of submitting such evidence, and, therefore, the claim is not well grounded. The service medical records are devoid of findings of a psychiatric disability. Postservice medical records show complaints of anxiety and depression because of family problems in 1986, and thereafter, there were periodic assessments of anxiety. Reports of VA hospitalizations from 1989 to 1991 show treatment and diagnoses of drug dependence and alcohol dependence and of related physical disabilities, but they do not show any chronic psychoneurosis or psychosis, not is there any reference to PTSD. On the social work service interview in October 1991 he gave a history of supervisory problems in service and complained of being upset and angry over his poor experiences in service. The social worker did not provide any opinion that the veteran had PTSD. He served during peacetime service and had no exposure to combat. The veteran has not alleged any incident in service immediately life-threatening to him or others. There is no competent evidence that he has PTSD, the only opinion to that effect being his own, which is not sufficient to present a well- grounded claim. Grottveit v. Brown, 5 Vet.App. 91 (1993). This claim must be dismissed as not well grounded. ORDER Service connection for a left leg tumor, hiatal hernia, bleeding ulcer, a low back disorder, folliculitis and asthma is denied. The claim for service connection for PTSD is dismissed. 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.