BVA9506218 
DOCKET NO.  92-13 767     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Montgomery,
Alabama

THE ISSUE

Entitlement to service connection for residuals of fractures of
the right ribs.

REPRESENTATION

Appellant represented by: Disabled American Veterans

ATTORNEY FOR THE BOARD

L. B. Wirt, Associate Counsel

INTRODUCTION

The veteran had a period of active duty for training from
June 11, 1963, to June 16, 1963, and periods of active duty from
September 10, 1963, to September 21, 1963, from October 1977 to
March 1980, and from September 1983 to March 1988.

This appeal arises from a May 1991 rating decision of the
Department of Veterans Affairs (VA) Montgomery, Alabama, Regional
Office (RO), which denied the veteran entitlement to service
connection for residuals of right rib fractures.  The case was
remanded by the Board of Veterans' Appeals (Board) in February
1993 and June 1994.

The veteran's representative has also raised the issue of
entitlement to service connection for a residual scar from a
right pneumothorax incurred in July 1986, at the same time as the
right rib fractures.  This issue has not been addressed by the RO
and is referred for appropriate action.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that he currently experiences residuals from
fractures of the right ribs sustained while on active duty in
July 1986.

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 evidence is in favor of the grant of entitlement
to service connection for residuals of right rib fractures.

FINDING OF FACT

The veteran sustained fractures to his right sixth, seventh and
eighth ribs as a result of a blow to the right chest area in July
1986 while on active duty.  He also experienced right
pneumothorax at that time.  Evidence of rib fracture, right rib
cage pain and scarring over the right anterior chest is still
present.

CONCLUSION OF LAW

Residuals of fractures of the right sixth, seventh and eighth
ribs with right pneumothorax were incurred in service, and
evidence of these fractures is visible on X-ray.  38 U.S.C.A.
§§ 1131 (West 1991); 38 C.F.R. § 3.303 (1994).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board notes that the veteran's claim is well grounded within
the meaning of 38 U.S.C.A. § 5107(a) (West 1991).  The Board is
also satisfied that all relevant facts have been properly
developed and that no further assistance to the veteran is
required to comply with the statutory duty to assist mandated by
38 U.S.C.A. § 5107(a).

The veteran has appealed a denial of entitlement to service
connection for residuals of fractures of the right ribs.  Service
connection may be established for disabilities resulting from
injury or disease incurred in or aggravated by service.
38 U.S.C.A. § 1131; 38 C.F.R. § 3.303(a).

The veteran's service medical records show that he received a
blow to the right chest area in July 1986 while on active duty.
He was initially taken to Baptist Memorial Hospital in Gadsden,
Alabama, for treatment.  X-rays taken on admission revealed
tension pneumothorax of the right chest, secondary to blunt
trauma, and a "possible fractured rib."  He was transferred to
Noble Army General Hospital at Fort McClellan, Alabama, four days
later.  Private chest X-rays taken in August 1986 revealed
healing fractures of the right sixth, seventh and eighth ribs in
the mid axillary line.

The veteran underwent a VA examination in June 1989.  The report
from a chest X-ray taken pursuant to this examination makes no
mention of any residuals from the right rib fractures.  The
veteran was given another VA examination in December 1990, and
reported a history of fractures of the right sixth, seventh and
eighth ribs in July 1986.  No exterior evidence of rib fractures
was seen, although a scar consistent with a right pneumothorax
was noted.  The relevant impression was history of rib fractures
and traumatic pneumothorax in July 1986.  X-rays of the ribs to
rule out fractures were recommended, but apparently were not
done.

The veteran was hospitalized at the VA Medical Center (VAMC) in
Birmingham, Alabama, from October to November 1991, for shortness
of breath.  His previous rib fractures were noted in the medical
history portion of the report.  The report from chest X-rays
taken during this hospitalization did not mention any residuals
of fractured ribs.  The diagnoses included status post rib
fractures.

In April 1992, the veteran was hospitalized at the Birmingham
VAMC complaining of shortness of breath, cough productive of
yellow sputum, fever and chills.  A chest X-ray revealed
deformity of the anterior arch of the left sixth and seventh
ribs.  A left rib detail was recommended, but it showed no
significant abnormality.  An irregular appearance of the right
eighth rib was also noted, and a bone scan was recommended to
rule out obstruction.  The bone scan was apparently not done.  No
specific diagnosis regarding his ribs was made.

The veteran was hospitalized again at the Birmingham VAMC from
June to September 1992, for exacerbations of chronic obstructive
pulmonary disease.  A chest X-ray taken on admission reportedly
revealed emphysematous lungs and flattened diaphragms, but no
infiltrates.  No mention of any rib fracture residuals was made.

In October 1992, Cheryl K. McDonald, M.D., Chief Medical Resident
at the University of Alabama at Birmingham School of Medicine,
who was also listed as the veteran's attending physician during
his June to September 1992 hospitalization at the Birmingham
VAMC, submitted a letter on the veteran's behalf regarding his
previous rib fractures.  Dr. McDonald related the veteran's
in-service history regarding the incurrence of the fractures,
although she referred to the blows having been suffered to the
left chest rather than the right.  Inasmuch as the veteran's
service medical records clearly and consistently indicate that
his injury was to the right side of his chest, involving his
right ribs, the Board assumes that Dr. McDonald's referral to the
left side was merely an inadvertence.  Dr. McDonald further
stated that "for technical reasons," chest X-rays do not always
reveal evidence of old rib fractures, and noted the rib
deformities/irregularities seen on the April 1992 X-rays.

The veteran was hospitalized at the Birmingham VAMC in October
1992, for swelling of his face, neck, abdomen and feet, as well
as dyspnea on exertion and a cough productive of yellow sputum.
Chest X-rays reportedly showed flattened diaphragms, no
cardiomegaly and no obvious infiltrate.  No mention of rib
fractures was made.

In November 1992, the veteran was hospitalized again at the
Birmingham VAMC for chest pains.  A chest X-ray reportedly showed
a flapping of the diaphragm with no infiltrates.  No diagnosis
pertaining to rib fractures was made.

The veteran underwent a VA examination in August 1994, pursuant
to the Board's June 1994 remand, which was specifically requested
to determine whether the veteran has any residuals from his right
rib fractures.  Physical examination revealed generalized
tenderness to palpation of the right rib cage region,
particularly on the anterior and lateral aspects.  The examiner
also noted the presence of a well-healed surgical scar over the
right anterior chest wall secondary to his pneumothorax.  X-rays
showed an old healed fracture of the right seventh rib.  The
impression was residual right rib cage soreness, and history of
prior fractures of the right sixth, seventh and eighth ribs with
pneumothorax in service.

According to 38 U.S.C.A. § 5107(b), when there is an approximate
balance of the positive and negative evidence regarding the merits
of a claim, the benefit of the doubt is to be given to the
claimant.  This is a codification of the long-standing policy of
the VA set out at 38 C.F.R. § 3.102 (1994), which provides that
when "a reasonable doubt arises regarding service origin, the
degree of disability, or any other point, such doubt will be
resolved in favor of the claimant."  The Court of Veterans Appeals
discussed the history and meaning of these provisions in Gilbert
v. Derwinski, 1 Vet.App. 49, 54-55 (1990), stating that "[w]hen
all of the evidence is assembled, the Secretary, or his designee,
is then responsible for determining whether the evidence supports
the claim or is in relative equipoise, with the veteran prevailing
in either event, or whether a fair preponderance of the evidence
is against the claim, in which case the claim is denied."  Id. at
55.  Jurisdiction in this determination is conferred on the Board
at 38 U.S.C.A. § 7104(a) (West 1991) and 38 C.F.R. § 20.101
(1994).

In light of the foregoing, the Board finds that the existence of
residuals of in-service right rib fractures have been shown.
Therefore, service connection for these fractures is granted.

ORDER

Service connection for residuals of fractures of the right ribs
is granted.

          SAMUEL W. WARNER
          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.