Citation Nr: 0000717 Decision Date: 01/10/00 Archive Date: 01/19/00 DOCKET NO. 98-12 456A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to service connection for glaucoma with cataracts. 2. Entitlement to service connection for arthritis of multiple joints. REPRESENTATION Appellant represented by: Arizona Veterans Service Commission ATTORNEY FOR THE BOARD Stephen F. Sylvester, Counsel INTRODUCTION The veteran served on active duty from January 1946 to January 1973. For reasons which will become apparent, additional development regarding the issue of service connection for arthritis of multiple joints will be the subject of the REMAND portion of this decision. FINDINGS OF FACT 1. The claim for service connection for glaucoma with cataracts is not supported by cognizable evidence showing that this disability was present in service, or is otherwise of service origin. 2. Following a Department of Veterans Affairs (VA) orthopedic examination in May 1998, it was the opinion of the orthopedic examiner that the nature of the veteran's work during military service contributed to the onset of his osteoarthritis. CONCLUSIONS OF LAW 1. The claim for service connection for glaucoma with cataracts is not well grounded. 38 U.S.C.A. § 5107 (West 1991 & Supp. 1998). 2. The veteran's claim for service connection for arthritis of multiple joints is well grounded. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As to the issues currently before the Board, the threshold question which must be resolved is whether the veteran's claims are well grounded. See 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well grounded claim is a plausible claim, meaning a claim which appears to be meritorious. See Murphy, 1 Vet. App. 81. A mere allegation that a disability is service connected is not sufficient; the veteran must submit evidence in support of his claims which would "justify a belief by a fair and impartial individual that the claims are plausible. 38 U.S.C.A. § 5107(a) (West 1991 & Supp. 1998); Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). In order for a claim to be well grounded, there must be competent evidence of current disability (medical diagnosis), of incurrence or aggravation of a disease or injury in service (lay or medical evidence), and of a nexus between the inservice injury or disease and the current disability (medical evidence). See Caluza v. Brown, 7 Vet. App. 498 (1995); see also Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Heuer v. Brown, 7 Vet. App. 379 (1995); Grottveit v. Brown, 5 Vet. App. 91 (1993). The second and third elements of this equation may also be satisfied under 38 C.F.R. § 3.303(b) (1998) by (a) evidence that a condition was "noted" during service or during an applicable presumptive period; (b) evidence showing post service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post service symptomatology. See 38 C.F.R. § 3.303(b) (1998); Savage v. Gober, 10 Vet. App. 488 (1997). Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by evidence of (i) the existence of a chronic disease in service or during an applicable presumptive period, and (ii) present manifestations of the same chronic disease. Ibid. For the purpose of determining whether a claim is well grounded, the credibility of the evidence in support of the claim is presumed. See Robinette v. Brown, 8 Vet. App. 69 (1995). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 1998). In the present case, service medical records are entirely negative for history, complaints, or abnormal findings indicative of the presence of either glaucoma or cataracts. While on service separation examination in June 1972, the veteran exhibited uncorrected visual acuity of 20/30 in his left eye, representative of the presence of refractive error, this is not a disability for which service connection may be granted under the applicable law and regulations. See 38 C.F.R. § 3.303(c) (1998). Of some significance is the fact that, during the course of an optometric examination at a service medical facility in August 1976, the veteran stated that he had no personal or family history of either cataracts or glaucoma. Indeed, the earliest clinical indication of the presence of either of those disabilities is revealed by a private medical record dated in March 1987, fully 14 years following the veteran's discharge from service, at which time the veteran received a diagnosis of glaucoma. Cataracts, the other ocular-related pathology for which service connection is currently being sought, were first noted no earlier than August 1995, more than 22 years following the veteran's service separation. The Board acknowledges that, during the course of a service medical facility hospitalization in December 1989, the veteran gave a history of increased intraocular pressure for which he had been followed "for 14 years." However, this would place the origin of the veteran's glaucoma at a point in time no earlier than 1975, two years following his discharge from service. The veteran argues that, while in service, and, specifically, in 1969 or 1970, he received his initial diagnosis of glaucoma. However, as noted above, service medical records are entirely negative for any such evidence. As previously stated, in order for a claim to be well grounded, there must be competent evidence not only of current disability, but of a nexus between some inservice injury or disease and that disability. See Caluza v. Brown, 7 Vet. App. 498 (1995). Notwithstanding the current diagnoses of open angle glaucoma and nuclear cataracts, the only evidence which the veteran has submitted which supports a finding of a nexus to service is his own statements. Evidence of such a nexus, however, cannot be provided by lay testimony, inasmuch as "lay persons are not competent to offer medical opinions." Grottveit, supra; see also Meyer v. Brown, 9 Vet. App. 425 (1996); Edenfield v. Brown, 8 Vet. App. 384 (1995) (en banc); Grivois v. Brown, 6 Vet. App. 136 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Moreover, the veteran has failed to provide evidence of continuity of symptomatology under 38 C.F.R. § 3.303(b). See Savage, 10 Vet. App. at 498. His statements, in and of themselves, are insufficient to relate his current ocular symptoms to his period of service. See Savage, supra. Based upon a full review of the pertinent evidence of record, the Board is unable to conclude that the veteran's glaucoma or cataracts, first persuasively documented a number of years following service discharge, were present in service, or are otherwise of service origin. Under such circumstances, his claim is not well grounded, and must be denied. Turning to the issue of service connection for arthritis of multiple joints, the Board notes that service medical records are negative for evidence of any such pathology. However, following radiographic studies of the veteran's chest in December 1992, there was noted the presence of moderate degenerative disease of the thoracic spine. The veteran argues that his current arthritis of multiple joints is the result of "27 years of working outside in the rain, cold, snow, heat, wind, dust, and sun" as an aircraft mechanic. In that regard, at the time of a VA orthopedic examination in May 1998, the examiner stated that, in his opinion, it was "highly likely" that the nature of the veteran's work during military service contributed to the onset of his osteoarthritis. The Board notes that the above opinion was, in fact, rendered without benefit of the veteran's claims folder. Nonetheless, that opinion suggests some relationship between the veteran's current osteoarthritis and his active military service. Under such circumstances, the veteran's claim for service connection for arthritis of multiple joints is well grounded. ORDER Service connection for glaucoma with cataracts is denied. The veteran has submitted a well grounded claim for service connection for arthritis of multiple joints. REMAND As noted above, the Board has concluded that the veteran's claim for service connection for arthritis of multiple joints is well grounded. Nonetheless, there exists some question as to the exact nature and etiology of the veteran's current osteoarthritis. This is particularly the case given the veteran's age (71) at the time of the aforementioned VA orthopedic examination, and the fact that arthritis was first shown no earlier than 1992. Moreover, as previously noted, the aforementioned orthopedic opinion was rendered without benefit of the veteran's claims folder. Under such circumstances, the Board is of the opinion that further development is appropriate prior to a final adjudication of the veteran's claim for service connection for arthritis of multiple joints. Accordingly, the case is REMANDED to the Regional Office (RO) for the following actions: 1. Any pertinent VA or other inpatient or outpatient treatment records, subsequent to May 1998, the date of the most recent VA orthopedic examination of record, should be obtained and incorporated in the claims folder. The veteran should be requested to sign the necessary authorization for release of any private medical records to the VA. 2. The veteran should then be afforded an additional VA orthopedic examination, to include all appropriate studies, in order to more accurately determine the exact nature and etiology of his current osteoarthritis of multiple joints. This examination should be conducted by a physician who has not heretofore seen or examined the veteran. All pertinent symptomatology and findings should be reported in detail. Following completion of the orthopedic examination, the examiner should specifically comment as to whether the veteran's osteoarthritis as likely as not had its origin during his period of active military service. All information and opinions, when obtained, should be made a part of the veteran's claims folder. The claims file and a separate copy of this REMAND must be made available to and reviewed by the examiner prior to conduction and completion of the examination. Any opinions expressed must be accompanied by a complete rationale. 3. Thereafter, the RO should review the claims file to ensure that all of the foregoing requested development has been completed. In particular, the RO should review the requested examination report and required opinion to ensure that they are responsive to and in complete compliance with the directives of this REMAND, and if they are not, the RO should take corrective action. 4. After undertaking any development deemed appropriate in addition to that requested above, the RO should readjudicate the issue of service connection for arthritis of multiple joints. Should the benefit requested on appeal not be granted to the veteran's satisfaction, the RO should issue a supplemental statement of the case. A reasonable period of time for a response should be afforded. Thereafter, the case should be returned to the Board for final appellate review, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is so notified by the RO. John E. Ormond, Jr. Member, Board of Veterans' Appeals