Citation Nr: 0006996 Decision Date: 03/15/00 Archive Date: 03/23/00 DOCKET NO. 98-13 303 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for a visual disorder. 2. Entitlement to service connection for a right knee disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD B. N. Booher, Associate Counsel INTRODUCTION The veteran had active service from November 1987 through August 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia which denied the benefits sought on appeal. The Board initially notes that in the informal hearing presentation submitted on behalf of the veteran in January 1999, the veteran's representative makes reference to the "sworn testimony of record." However, a review of the file does not reflect that the veteran requested a hearing and a hearing transcript has not been associated with the claims file. Additionally, a hearing transcript was not considered as evidence in this matter by the RO in the rating decision, or in the Statement of the Case (SOC). Therefore, the Board will adjudicate the veteran's appeal based on a review of the evidence currently of record, which does not include a hearing transcript. The Board also acknowledges that in a notice of disagreement (NOD) submitted in June 1998, the veteran indicated that he was seeking appellate review of the issues of entitlement to service connection for a visual disorder, a right knee disorder, a neck disorder and a shoulder disorder. However, in a VA-Form 9, (Appeal to Board of Veterans' Appeals) submitted in July 1998, the veteran indicated that he was only appealing the issues of entitlement to service connection for a visual disorder and a right knee disorder. FINDINGS OF FACT 1. There is no competent medical evidence of record which establishes that the veteran has a current diagnosis of a visual disorder. 2. There is no competent medical evidence of record linking the veteran's currently diagnosed right knee pain to his period of active service, or to any right knee disorder shown during service. CONCLUSIONS OF LAW 1. The veteran's claim for service connection for a visual disorder is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran's claim for service connection for a right knee disorder is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran and his representative allege that he is entitled to service connection for a visual disorder and a right knee disorder. The VA may pay compensation for "disability resulting from personal injury or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in the active military, naval or air service." 38 U.S.C.A. § 1110 (West 1991). However, the threshold question that must be answered in this case is whether the veteran has presented well-grounded claims for service connection. A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. In this regard, the veteran has "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) (West 1991); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). If the evidence presented by the veteran fails to meet this threshold level of sufficiency, no further legal analysis need be made as to the merits of the claim. Boeck v. Brown, 6 Vet. App. 14, 17 (1993). For a claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service disease or injury and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997). For disorders subject to presumptive service connection, the nexus requirement may be satisfied by evidence of manifestation of the disease to the required extent within the prescribed time period, if any. See Traut v. Brown, 6 Vet. App. 495, 497 (1994); Goodsell v. Brown, 5 Vet. App. 36, 43 (1993). A claimant may also establish a well-grounded claim for service connection under the chronicity provision of 38 C.F.R. § 3.303(b)(1999), which is applicable where the evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period, and that same condition currently exists. Such evidence must be medical unless the condition at issue is one which, under case law, lay observation is considered competent to prove its existence. If the chronicity provision is not applicable, a claim still may be well- grounded pursuant to the same regulation if the evidence shows that the condition was observed during service or any applicable presumption period and continuity of symptomatology was demonstrated thereafter, and includes competent evidence relating the current condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-98 (1997). The veteran argues that time spent on submarines during his period of active service caused his ability to focus on distant objects to deteriorate. He further alleges that during service, he was informed by medical personnel that this phenomenon occurred due to the fact that he was not required to focus on anything more than 20 feet away while serving on submarines, and that his eyesight would have to correct itself after his service on submarines ended. The veteran argues that his eyesight never corrected itself and that he is entitled to service connection for a visual disorder. A July 1987 enlistment examination and a December 1987 submarine duty examination are negative for any notation regarding any type of visual disorder. In March 1992, the veteran was seen for complaints of blurry vision when focusing on distant objects and experiencing a burning sensation and headaches when driving. The veteran was shown to have visual acuity for near and distant vision of 20/20 in both eyes. A subsequent March 1992 examination revealed that the veteran had distant visual acuity of 20/30 in the left eye and 20/20 in the right eye and corrected visual acuity 20/20 in each eye. The veteran was diagnosed with a refractive error, which was not considered disabling and he was approved for duty. In May 1996 the veteran was shown to have visual acuity of 20/20 in both eyes and he complained of having decreased vision at night. A May 1997 separation examination shows that the veteran's visual acuity in each eye was 20/20, but that he had difficulty focusing on distant objects. The veteran was afforded a VA eye examination in November 1997. The report indicates that the veteran had no significant ocular complaints. Examination showed visual acuity of 20/15 in both eyes with minimal retinoscopic refraction. The veteran did not complain of diplopia, or any visual field deficit. The veteran refused dilation and had no complaints of photopsia. Undilated fundus examination revealed normal disks, vessels and macula bilaterally. The examiner concluded that the veteran had a normal eye examination. While the veteran clearly believes that he has a visual disorder which was caused by the circumstances of his period of active service, the veteran, as a lay person is not competent to offer an opinion that requires medical expertise, such as the underlying cause of a visual disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). In this case, the veteran has not submitted evidence that he has a current visual disorder, or evidence linking any visual disorder to his period of active service. The most recent examination of record shows that the veteran had a normal eye examination. In the absence of competent medical evidence of a current disability, the veteran has not submitted a well- grounded claim for service connection and his claim must be denied on this basis. The veteran and his representative also allege that the veteran is entitled to service connection for a right knee disorder. Service medical records show that the veteran developed a knot or cyst on the anterior aspect of the right thigh during service in September 1995. The veteran underwent surgery for the excision of a ganglion cyst of the right knee in October 1995. A May 1997 separation examination report reflects that the veteran reported occasional pain and swelling in his right knee. A November 1997 VA examination report indicates that the veteran presented with complaints of bilateral knee problems which he attributes to climbing ladders while carrying a fire extinguisher in the Navy. He reported that his right knee hurts more than his left knee and that he experiences daily discomfort and occasional locking of the right knee. Physical examination showed that the veteran had 10 degrees of knee flexion. He had no swelling, crepitus or any visible pain or instability on abduction, adduction, or AP draw and McMurray's was negative. Deep knee bends, hopping and heel- toe walking were done with some discomfort and straight leg raises were negative for visible pain at 90 degrees. X-rays of the right and left knees were normal. The veteran was diagnosed with bilateral knee pain without physical findings. Again, it is clear that the veteran believes that his current right knee disorder is related to his period of active service. However, the veteran has not submitted competent medical evidence linking his currently diagnosed right knee disorder to his period of active service, or to a right knee disorder shown during service. As previously discussed, while the veteran may believe that his current right knee disorder is related to his period of active service, as a lay person, he is not competent to offer an opinion that requires medical expertise, such as the underlying cause of his currently diagnosed right knee disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Without competent medical evidence establishing, or suggesting a link between the veteran's current right knee disorder and his period of active service, the veteran has not submitted a well-grounded claim and his claim must be denied. The Board is unaware of the existence of any relevant evidence, if obtained, that would serve to well ground either of the veteran's claims for service connection. Should the veteran obtain such evidence, he may request that the RO again consider his claims for service connection. See McKnight v. Gober, 131 F.3d 1483, 1485 (Fed. Cir. 1997) (per curiam). ORDER 1. Evidence of a well-grounded claim not having been submitted, service connection for a visual problem is denied. 2. Evidence of a well-grounded claim not having been submitted, service connection for a right knee disorder is denied. WARREN W. RICE, JR. Member, Board of Veterans' Appeals