Citation Nr: 0001927 Decision Date: 01/24/00 Archive Date: 02/02/00 DOCKET NO. 95-31 899 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for a claimed left foot disorder. 2. Entitlement to service connection for a claimed left ankle disorder. 3. Entitlement to service connection for a claimed right ankle disorder. 4. Entitlement to service connection for diabetes mellitus. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD Scott Craven INTRODUCTION The veteran had active military service from January 1965 to January 1968. The veteran claims that he is entitled to an earlier effective date for the service-connected residuals of gunshot wound of the right thigh. However, this issue has not been properly developed for appellate review and is referred to the RO for appropriate action. FINDINGS OF FACT 1. All relevant evidence for an equitable disposition of the veteran's appeal has been obtained. 2. No competent evidence has been presented to show that the veteran currently has a left foot disability due to disease or injury which was incurred in or aggravated by service. 3. No competent evidence has been presented to show that the veteran currently has a left ankle disability due to disease or injury which was incurred in or aggravated by service. 4. No competent evidence has been presented to show that the veteran currently has a right ankle disability due to disease or injury which was incurred in or aggravated by service. 5. No competent evidence has been presented to show that the veteran currently has diabetes mellitus due to disease or injury which was incurred in or aggravated by service. CONCLUSIONS OF LAW 1. A well-grounded claim of service connection for a left foot disorder has not been presented. 38 U.S.C.A. §§ 1101, 1131, 5107, 7104 (West 1991 & Supp. 1999); 38 C.F.R. § 3.303 (1999). 2. A well-grounded claim of service connection for a left ankle disorder has not been presented. 38 U.S.C.A. §§ 1101, 1131, 5107, 7104 (West 1991 & Supp. 1999); 38 C.F.R. § 3.303 (1999). 3. A well-grounded claim of service connection for a right ankle disorder has not been presented. 38 U.S.C.A. §§ 1101, 1131, 5107, 7104 (West 1991 & Supp. 1999); 38 C.F.R. § 3.303 (1999). 4. A well-grounded claim of service connection for diabetes mellitus has not been presented. 38 U.S.C.A. §§ 1101, 1131, 5107, 7104 (West 1991 & Supp. 1999); 38 C.F.R. § 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual History A careful review of the service medical records shows that, in January 1965, the veteran's entrance examination reported that his lower extremities were clinically normal. The veteran indicated that he had never had swollen or painful joints. In May 1967, the veteran was reported to have sustained a gunshot wound of the right thigh. He was reported to have small entrance and exit wounds of the right thigh. Pulses were reported to be good. The veteran was reported to have debridement of his wounds. On discharge examination in December 1967, the veteran's lower extremities were reported to be clinically normal. The veteran indicated that he had never had swollen or painful joints or foot trouble. On VA examination in March 1968, the veteran was reported to have sustained a shell fragment wound of the right thigh in March 1995 while in service. He was reported to have been taken to a station hospital where the wound was debrided and healed uneventfully. He was reported to presently have occasional shooting pain in the right thigh with no specific weakness or limp. The veteran was reported to have a small wound of entry in the right groin near the right ischial tuberosity and a wound of exit in the anterior midthigh approximately 8" proximal to the knee. There was reported to be no loss of motion of the right hip or knee and the quadriceps mechanism on the right side was normally strong. Heel and toe walking and deep knee bending were reported to be performed. A radiographic report of the right femur and thigh was reported to show multiple metal fragments in the soft tissues of the thigh. The femur was reported to be intact and there was no significant abnormality otherwise. The veteran was diagnosed with residuals of shell fragment wound of the right thigh involving muscle group XIV, with minimal orthopedic disability. In May 1968, the veteran's commanding officer in service reported that, during his association with the veteran, he had not observed anything unusual about his physical or mental condition other than his being wounded in the right leg in the shooting incident. On VA outpatient treatment records, reflecting treatment from April 1980 to December 1980, the veteran was reported to complain of pain in the deep inner aspect of the right thigh that radiated to in between his thighs. On VA examination in April 1982, the veteran's deep tendon reflexes were reported to be active and equal, bilaterally. The impression was that of residual of gunshot wound of the right thigh manifested by pain in the distribution of the right anterior femoral cutaneous branch. Received in March 1993 were VA outpatient treatment records, reflecting treatment from November 1978 to August 1983. In December 1980, the veteran was reported to complain of pain in the right low back and in the anterior and medial aspects of the right thigh. He was assessed with post-traumatic pain in the low back and right thigh. On a VA muscles examination in July 1993, the veteran reported that he had had right thigh discomfort with prolonged standing and walking. The right leg was reported to be otherwise asymptomatic. The veteran was reported to have normal gait without assistive device and he could hop on either foot, heel and toe walk and squat and rise normally. He was diagnosed with residual discomfort and mild weakness of the right thigh following gunshot wound. In February 1994, a member of the veteran's platoon and squad in service reported that he recalled that the veteran had been taken to the hospital in a jeep on the day he was injured. He reported that the veteran had been gone one to two weeks before he went back to the platoon. During a hearing at the RO in May 1994, the veteran reported that his right leg was tender. He reported that he had a depressed scar on the right leg. On a VA muscles examination in June 1994, the veteran was reported to have had increased pain and weakness in the right leg for the past seven months. He was reported to have right ankle pain secondary to an injury that impaired his ability to kneel, squat and climb stairs. He was reported to have a tender scar on the right thigh. Hip flexors were reported to measure 3/5, hip extenders 5/5, knee extender 3/5 and knee flexor 4/5. The impression was that of a shell fragment wound of the right thigh. There was reported to be evidence of previous debridement and probable sloughing and intramusculature cicatrizations secondary to the shell fragment wound, although these were reported to be old events and the veteran had not had this problem recently. On VA medical records, reflecting treatment from July 1994 to August 1994, the veteran reported that he had been a borderline diabetic and that he had been on Diabinese at one time, but had not received any recent treatment. He was reported to have mild edema of both ankles. The veteran was reported to have been referred to diabetic teaching classes because his fasting blood sugar was slightly high and it was felt that diet by itself was enough and put his diabetes under fair control. A urinalysis was reported to measure 4+ for glucose. In August 1994, a VA outpatient treatment record reported that the veteran had bilateral heel pain. He was reported to have been treated three years before for this condition. He was reported to be a diet-controlled diabetic. The veteran was assessed with bilateral heel spur syndrome and bilateral plantar fasciitis. In September 1994, a VA outpatient treatment record reported that the veteran had had a history of non-insulin dependent diabetes mellitus for the previous 20 years. He was assessed with non-insulin dependent diabetes mellitus and well groomed feet in good condition. Received in November 1994 were private medical records from St. Luke's Hospital Medical Center, reflecting treatment in July 1980. The veteran was diagnosed, in part, with history of gunshot wound without sequelae. On VA medical records, reflecting treatment from October 1994 to January 1995, the veteran was diagnosed, in part, with calcaneal spurs and status post gunshot wound to the right hip and pelvic area from Vietnam experiences. In October 1994, a member of the veteran's platoon in service reported that the veteran had injured his ankles in service when he tripped while running to a training site. The veteran was reported to have been away from the company area for about four days while in the hospital. In February 1995, records from the U.S. Postal Service medical office diagnosed the veteran, in part, with calcaneal spurs. During a hearing at the RO in March 1996, the veteran reported that he had incurred a left foot injury while in service and that he had been treated for the injury after service. He reported that two of his friends from service had indicated that the veteran had had symptoms relating to right and left ankle disabilities. The veteran reported that he had injured his ankles in service while running to a training field and that he had been in a hospital for about three days. He reported that he had been treated by a Dr. Grath for his ankles, but that he had been unable to obtain his records because the doctor had died. During a hearing before this Member of the Board in May 1999, the veteran reported that he had first injured his ankles and feet in 1965 while in basic training while running to a rifle range. He reported that he had been put on light duty for about eight to nine days. He indicated that he had worn Ace bandages around his ankles. He reported that he had never had surgery on his feet. II. Analysis Service connection may be granted for a disability resulting from a disease or injury which was incurred or aggravated during active duty. 38 U.S.C.A. § 1110 (West 1991 & Supp. 1999); 38 C.F.R. § 3.303 (1999). That an injury or disease occurred in service alone is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b) (1999). The regulations also provide that 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) (1999). The threshold question to be answered is whether the veteran has presented a well-grounded (i.e., plausible) claim. If he has not, the claim must fail and there is no further duty to assist in the development of the claim. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1999); Murphy v. Derwinski, 1 Vet. App. 78 (1990). In order to show that a claim of service connection is well grounded, there must be competent evidence of (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the in-service injury or disease and the current disability. See Caluza v. Brown, 7 Vet. App. 498 (1995). Although the claim need not be conclusive, it must be accompanied by evidence, not just allegations, in order to be considered well grounded. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). In a claim of service connection, this generally means that evidence must be presented which in some fashion links a current disability to a period of military service or to an already service-connected disability. 38 U.S.C.A. § 1110 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.303, 3.310 (1998); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Montgomery v. Brown, 4 Vet. App. 343 (1993). The evidence submitted in support of the claim is presumed to be true for purposes of determining whether the claim is well grounded. King v. Brown, 5 Vet. App. 19, 21 (1993). The veteran claims, in essence, that he currently has disabilities of the left foot, left ankle and right ankle due to disease or injury incurred in or aggravated by service. He claims that he injured his ankles and feet in service after tripping while running to a rifle range during basic training. The service medical records show that, in May 1967, the veteran sustained a gunshot wound to the right thigh. However, on discharge examination in December 1967, his lower extremities were reported to be clinically normal. The veteran indicated that he had never had swollen or painful joints or foot trouble. On VA examination in March 1968, the veteran was diagnosed with residuals of shell fragment wound of the right thigh involving muscle group XIV, with minimal orthopedic disability. There was no report of complaint, treatment or diagnosis of an ankle or foot disability. On VA examination in July 1993, the veteran was reported to have normal gait, without assistive device, and to be able to hop, heel and toe walk and squat and rise normally. There was no report of complaint, treatment or diagnosis of a foot or ankle disability. On VA records, reflecting treatment from July 1994 to August 1994, the veteran was reported to have mild edema of both ankles. In August 1994, a VA outpatient treatment record assessed the veteran with bilateral heel spur syndrome and bilateral plantar fasciitis. The Board is cognizant of the veteran's assertions regarding his left foot and ankle disorders. While the veteran has presented lay evidence that he tripped and injured his ankle in service, he has presented no objective evidence of a nexus between the currently demonstrated disability and any in- service injury. In addition, while the veteran has consistently been reported to have symptomatology relating to the service-connected residuals of gunshot wound of the right thigh, there is no demonstrated continuity of symptomatology of a left foot, left ankle or right ankle disorder since service. Lay assertions concerning questions of medical diagnosis or causation cannot constitute competent evidence sufficient to render a claim well grounded. Grottveit v. Brown, 5 Vet. App. 91 (1992); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Absent competent evidence of linkage of a current disability to a disease or injury in service, the claims of service connection for left foot, left ankle and right ankle disabilities must be denied as not well grounded. Caluza, supra. The service medical records show that, on discharge examination in December 1967, the veteran's urinalysis was reported to be negative for sugar. The veteran indicated that he had never had sugar or albumin in his urine. In October 1979, a VA outpatient treatment record reported that the veteran had been a known diabetic for four years. He was reported to have been taking Diabinese four times daily from a private medical doctor. On VA records, reflecting treatment from October 1994 to January 1995, the veteran was diagnosed, in part, with Type II diabetes mellitus. The record, however, fails to reveal any link from competent medical sources between the veteran's diabetic disorder and his military service. In claims that are not well grounded, VA does not have a statutory duty to assist the veteran in developing facts pertinent to his claim. VA, however, may be obligated under 38 U.S.C.A. § 5103(a) (West 1991 & Supp. 1999) to advise a veteran of evidence needed to complete his application. This obligation depends upon the particular facts of the case and the extent to which the Secretary of VA has advised the veteran of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69 (1995). The Board finds that a remand is not required in this case. The veteran has not put VA on notice that competent evidence exists that supports his claim that he currently has a left foot, left ankle or right ankle disability due to disease or injury which was incurred in or aggravated by service. With respect to diabetes, the supplemental statement of the case of February 16, 1999, specifically informed the veteran of the need to identify evidence linking that disorder to PTSD. ORDER Service connection for a left foot disorder is denied, as a well-grounded claim has not been submitted. Service connection for a left ankle disorder is denied, as a well-grounded claim has not been submitted. Service connection for a right ankle disorder is denied, as a well-grounded claim has not been submitted. Service connection for diabetes mellitus is denied, as a well-grounded claim has not been submitted. John E. Ormond, Jr. Member, Board of Veterans' Appeals