BVA9504960 DOCKET NO. 92-05 752 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for a psychiatric condition secondary to the veteran's service-connected ulcer disease. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Patrick J. Costello, Associate Counsel INTRODUCTION The veteran had active military service from December 1940 to September 1943. This matter came before the Board of Veterans' Appeals (hereinafter the Board) on appeal from an August 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), in Waco, Texas, which denied the veteran's claim for service connection for a mental disorder secondary to a service- connected disability. After developing additional evidence in this case, the Board, in accordance with Thurber v. Brown, 5 Vet.App. 119 (1993), informed the appellant's representative in a November 1994 letter of the additional evidence developed, and provided an opportunity to respond. No additional argument or comment was provided. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his current nervous condition had its inception during his military service, developing along with his service-connected ulcer disease. He avers that the nervous disorder is causally related to the ulcer disease, and that each disorder has increased in severity concomitantly over the years due to their interrelationship. Thus, he argues that service connection on a secondary basis for his nervous disorder is warranted. 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 veteran's claim for service connection for a psychiatric condition secondary to his service-connected ulcer disability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the agency of original jurisdiction. 2. The veteran's service medical records are negative for a diagnosis of, or treatment for, any type of psychiatric condition or illness. 3. The veteran applied for VA compensation benefits for a duodenal ulcer in 1944. He did not apply for benefits for a psychiatric condition. Medical records from 1944 to 1958 are devoid of indicia, findings, or diagnoses of a nervous condition, and there is no record that the veteran filed a claim for service connection for any mental disorder during that period. 4. Between 1958 and 1992, the veteran was seen by private and VA doctors, and a nervous disorder was diagnosed; however, no examiner associated the disorder with the service-connected gastrointestinal disorder. 5. An independent medical expert has opined that the two conditions are not etiologically related. CONCLUSION OF LAW The veteran's psychiatric condition is not proximately due to or the result of his service-connected gastrointestinal disorder. 38 C.F.R. § 3.310 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION In accordance with 38 U.S.C.A. § 5107 (West 1991), and Murphy v. Derwinski, 1 Vet. App. 78 (1990), the appellant has presented a well-grounded claim. The facts relevant to this appeal have been properly developed and the obligation of the Department of Veterans Affairs (VA) to assist the veteran in the development of his claim has been satisfied. Id. Following the veteran's release from active duty in 1943, service connection was established for a duodenal ulcer condition. VA Form P-80a-Rev. June, 1943, Award of Disability Compensation or Pension (Service Connected), March 30, 1944. A 30 percent evaluation was assigned for this condition. Then in October 1948, the disability evaluation was increased to 40 percent because the disability was adjudged to be more debilitating than previously rated. VA Form 8-564, Rating Sheet, October 4, 1948. Over the next three years, the disability became less severe, and in 1951, the veteran was rated as 10 percent disabled. VA Form 564, Rating Sheet, July 30, 1951. In 1956, a gastrectomy was performed to correct a bleeding ulcer. The veteran's disability evaluation was increased from 10 to 60 percent. VA Form VB 8-564, Rating Sheet, July 9, 1956. One year later, after it was determined that the veteran's condition had become stable, the disability was evaluated as 40 percent disabling. VA Form VB 8-564, Rating Sheet, December 23, 1957. Then in 1958, fourteen years after the veteran's first claim, he was hospitalized for soreness of right upper side, weakness, and nervousness. Prior to the hospitalization, the veteran had not complained of nor had he been diagnosed as suffering from any type of psychiatric condition. Following an examination, the examiner reported that the veteran was very nervous most of the time but progressed reasonably well as long as he was not doing any sort of physical activity. Interim report, October 6, 1958. The Board further notes that nowhere in the report was it recorded that the nervousness was related to or caused by the gastrointestinal disorder. Seven years later, the veteran was diagnosed as suffering from a moderate psychoneurotic anxiety state and dumping syndrome with hypoglycemia. Report from Dr. J. O. Ravel, May 24, 1965. Although he was suffering from a psychiatric condition, the veteran did not request service connection for said condition. The veteran continued to see Dr. Ravel for treatment of the mental condition. Over the next thirty-six years, the veteran continued to be seen by private and VA doctors for his gastrointestinal illness. He also received occasional treatment for his nervous disorder. Finally, in July 1991, the veteran applied for VA compensation benefits for his psychiatric disability; he claimed that this condition was a residual of his gastrointestinal condition. Under 38 U.S.C.A. § 1110, 1131 (West 1991), compensation will be provided if it is shown that the veteran suffers from a disease or injury incurred in or aggravated by service. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1994). Moreover, under 38 C.F.R. § 3.310 (1994), a disability that is proximately due to or the result of a service-connected disease or injury shall be service-connected. When service connection is established for a secondary condition, the secondary condition shall be considered as part of the original condition. The RO initially denied the veteran's petition for compensation for his mental disability. VA Form 21-6796, Rating Decision, August 27, 1991. Upon receiving notification of the RO's decision, the veteran appealed the decision to the Board. We then reviewed the claims folder and determined that additional medical information was needed prior to the issuance of an appellate decision. Hence, the case was remanded. In October 1992, for the first time since the veteran originally applied for VA benefits in 1944, a physician related his psychiatric condition to the gastrointestinal illness. The claim was then returned to the Board for further review. To ensure that the veteran's claim received every consideration, we requested an independent medical opinion from VA Health Services. We specifically requested that a physician review the entire evidential file and offer an opinion as to whether the veteran's psychiatric illness was related to, or associated with, the veteran's gastrointestinal illness. A summary of his opinion is provided below: I have conducted a review of this appellant's file in order to determine whether he has a ratable psychiatric disorder associated with his military service. . . . .... On October 13, 1992, the veteran received a Mental Disorders examination by N. Kommareddi, M.D. At that time the veteran was 74 years-old and 40% service connected for his ulcer and gastrectomy. Dr. Kommareddi diagnosed "Psychological Factors effecting physical conditions (peptic ulcer) and multi-infarct dementia." this veteran also suffers from ulcers and anxiety associated with hypoglycemia from gastrointestinal dumping. Dr. Kommareddi speculates that he has a strong regressive wish to be nurtured and fed along with repressed, unconscious feelings of revenge. These issues were exacerbated by this patient's dementia and its consequent effects on his self-esteem, work capacity, and fear. .... Based on my review of the appellant's file, I conclude that there is insufficient evidence that this veteran's psychiatric symptoms constitute a ratable psychiatric disorder associated with his military service. There is no question that this veteran had a duodenal ulcer during military service, and that this service connected condition was treated with a subtotal gastrectomy in May 1956. Thereafter, the veteran continued to experience abdominal pain, and he developed a "dumping syndrome" resulting in episodes of hypoglycemia with anxiety. The veteran received antianxiety [sic] medications for a number of years. However, there was never a determination that this anxiety was a separate disorder that independently contributed to an increase in his service connected disability rating. At this time the veteran is suffering from multi-infarct dementia, in addition to his gastrointestinal condition and its associated anxiety. Although the dementia has markedly affected the veteran's mental state, the dementia is not related to his ulcer and is not service connected. In determining whether service connection is warranted, the VA must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case service connection must be denied. 38 U.S.C.A. § 5107 (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). In this situation, the service medical records are negative for any complaints or treatment of a psychiatric condition. Moreover, between 1943 through 1958, the veteran's medical records are negative for any treatment of a mental disorder. It is not until 1991, forty-eight years after the veteran's discharge, that he actually claimed that the gastrointestinal disorder is related to his mental condition. During those forty-eight years, none of the of physicians who treated the veteran ever linked the two conditions. Finally, in 1992, a doctor speculated that the two disorders might be related. In evaluating the veteran's claim we have placed considerable weight on the actual service records, the contemporaneous medical documentary records, and the medical data obtained between 1944 through 1991. The Board believes that this clinical information is far more probative than the unsubstantiated diagnoses of the examiner who saw the veteran in 1992. As far as can be told, the examiner based his conclusion solely on the history given by the veteran, rather than upon an objective review of the record. This diagnosis, therefore, can be no better than the facts alleged by the claimant, and may be accorded little weight with regard to the causation of the veteran's current disability. Swann v. Brown, 5 Vet.App. 229, 233 (1993). Additionally, we believe that the independent medical opinion that the Board sought in 1994 further corroborates our conclusion that the two conditions are not related. Thus, service connection for a psychiatric condition secondary to a service-connected gastrointestinal disorder is denied. ORDER Entitlement to service connection for a psychiatric condition secondary to a service-connected gastrointestinal disorder is denied. JACK W. BLASINGAME 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.