BVA9504719 DOCKET NO. 93-10 364 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUE Entitlement to service connection for coronary artery disease, to include hypertension. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD G. Wm. Thompson, Counsel INTRODUCTION The veteran had active service from September 1955 to April 1959. This appeal arises from an August 1992 Department of Veterans Affairs (VA) San Francisco, California, Regional Office (RO) rating decision that denied service connection for coronary artery disease. In deciding the claim the RO clearly considered and addressed the evidence on file of the veteran's blood pressure during and after service. Accordingly, the issue is properly framed as shown on the preceding page. It appears that the veteran may also be claiming service connection for his cardiovascular disease as secondary to service-connected residuals of a head injury, although to date there is no medical evidence of the claimed relationship. That matter has not been specifically adjudicated by the RO and is referred for consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in essence, that the RO erred in not finding that the evidence of record supports his claim for a hypertensive heart condition. He points out that service medical records show elevated blood pressure readings, even before a serious accident. He asserts that he had undiagnosed hypertension during service, and that the condition was finally recognized after service. 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 claim of entitlement to service connection for coronary artery disease, including hypertension, is not well grounded. FINDINGS OF FACT 1. Evidence sufficient for an equitable disposition of this appeal has been obtained by the RO. 2. The veteran had elevated and normal blood pressure in service, without a diagnosis of hypertension or evidence of coronary artery disease. 3. There is no medical evidence or opinion linking current hypertension and coronary artery disease with the veteran's blood pressure in service about 20 years earlier or any other incidents of his remote service. CONCLUSION OF LAW The claim of entitlement to service connection for coronary artery disease, to include hypertension, is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Pursuant to 38 U.S.C.A. § 5107(a), a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. The United States Court of Veterans Appeals (Court) has held that a well-grounded claim is a "plausible" claim, one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive but only possible to satisfy the initial burden of § [5107(a)]." Murphy v. Derwinski, 1 Vet.App. 78,81 (1990). The Court has also held that although a claim need not be conclusive, the statute provides that it must be accompanied by evidence that justifies a "belief by a fair and impartial individual" that the claim is plausible. Tirpak v. Derwinski, 2 Vet.App. 609, 610 (1992). The Court has also held that "where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is 'plausible' or 'possible' is required." Grottveit v. Brown, 5 Vet.App 91, 93 (1993) (citing Murphy, at 81). The basic law and regulations pertinent to the veteran's claim for service connection provide that service connection can be established if a particular disease or injury, resulting in disability, is incurred coincident with service; or it if arteriosclerotic cardiovascular disease, including hypertension, is manifested to a compensable degree within one year after service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. For a showing of chronic disease in service there is a required combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis of "Chronic." Where the disease identity is established, there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service or the presumptive period is not, in fact, shown to be chronic. Where the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support the claim. 38 U.S.C.A. §§ 1112, 1113, 1131 (West 1991); C.F.R. §§ 3.303(a)(b)(d), 3.307, 3.309 (1994). The Facts The veteran, in a statement dated in March 1993, has referred to medical literature that defines systolic blood pressure above 140 and diastolic blood pressure above 90 as hypertensive. The service medical records show that the veteran's blood pressure was 150/50 when he was examined for enlistment into service in September 1955. In February 1956, when he was hospitalized for tonsillitis, his blood pressure was 120/88. He underwent a tonsillectomy. After the operation was completed his blood pressure was 130/90. When he was hospitalized in March 1956 for a excision of a perianal growth, his blood pressure was 146/100. The records pertaining to the above periods of hospitalization do not reflect references to hypertension or cardiovascular disease. The veteran suffered a severe head injury on April 4, 1956, and multiple blood pressure readings were recorded from April 4th through the 13th. It appears that the initial readings, taken at intervals of one hour or less, were 180/50, 120/84, 122/90, 120/100, 126/95, 130/86, 136/86, 150/90 and 140/90. According to a narrative summary, the veteran underwent emergency cranial surgery and had a "stormy" post-operative course. He underwent additional surgery on the third post-operative day and again in June 1956. The medical records pertaining to his period of hospitalization reflect numerous blood pressure readings which, using the criteria mentioned by the veteran in support of his claim, were normal on some occasions and elevated on many others. The veteran was discharged from the hospital in August 1956. The records of hospitalization do not contain any diagnoses of hypertension or coronary artery disease. When the veteran was hospitalized in March 1959 for coccygeal surgery, there was no finding of high blood pressure reported. When he was examined in April 1959, prior to discharge from service, his blood pressure was 114/68. There was no history or diagnosis of hypertension noted on the examination report. Service connection has been granted for the residuals of the veteran's head injury and for other disabilities. When the veteran was examined by the VA in April 1960, his blood pressure was 120/80. No abnormalities were found on clinical examination of the cardiovascular system and the heart was described as "normal in all respects." A chest X-ray was normal. The diagnoses did not include hypertension or cardiovascular disease. The earliest subsequent evidence regarding the veteran's blood pressure is a May 1981 VA outpatient treatment record that shows pressure of 132/92 and refers to the medications Dyazide and Propanolol. When the veteran was treated by the VA in June 1981 for a condition not at issue, his blood pressure was 158/100. During hospitalization later that month for hemorrhoid surgery, hypertensive vascular disease was diagnosed. In hearing testimony in November 1992 the veteran indicated that he had memory loss associated with his service-connected head injury, and did not remember being given medication for hypertension in 1981. VA outpatient records dated in the late 1980's indicate continued treatment for hypertension. According to a record of March 1989, hypertension had been found "a few years ago." In June 1992 the veteran reported having recently undergone open heart surgery at a hospital in Palo Alto, California. He did not identify the facility or request that hospital records be obtained. The veteran testified in November 1992 that he first learned of his high blood pressure when donating blood and that he began donating blood in about 1959 or 1960. He also testified that he was told at blood banks that his blood was "on the border," but that "[I]t wasn't high blood pressure." Transcript, 4. He did not believe that any pertinent records were still available. Transcript, 8. Analysis Under the standards cited by the veteran, he had elevated systolic blood pressure on entering service and entirely normal blood pressure at discharge. In the interim, he had both elevated and normal readings. The elevated readings often, but not always, were contemporaneous with illnesses, injuries and surgery. Subsequent to the normal pressure noted on the service discharge examination, the next blood pressure of record was a 120/80 (normal under the standards mentioned by the veteran) reading on a VA examination in April 1960. The veteran's cardiovascular system was found to be normal at that time. The next pertinent evidence was about 20 years later, when a diagnosis of hypertensive vascular disease was recorded. There has been no competent evidence presented or identified tending to show that chronic high blood pressure or coronary artery disease was present during service or compensably manifested within a year thereafter. Also, there is no medical evidence that relates the veteran's current coronary artery disease with hypertension to the elevated blood pressure readings or any other incidents of service. The veteran's testimony regarding the early post-service period was to the effect that he was told at a blood bank that his blood pressure was borderline but that it "wasn't high blood pressure." Even if a doctor, rather than the veteran, presented this testimony, it would not establish a well-grounded claim inasmuch as the statement indicates that the veteran did not have actual high blood pressure. According to the veteran and his representative at the hearing, any records of his donating blood more than 30 years ago likely would no longer be available. Transcript, 8. There is no objective medical evidence that the blood pressure readings in service represented hypertensive disease and there is no evidence of coronary artery disease until decades after service. Further, there is no medical evidence linking the veteran's blood pressure in service to the hypertensive vascular disease and the coronary artery disease shown in the early 1980's, at which time it was noted that hypertension had been found only "a few years ago." The veteran himself is not shown to possess the medical expertise to determine the etiology or time of onset of his cardiovascular system disorders or their relationship, if any, to service. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Accordingly, it is concluded that the claim for service connection is not well grounded. In a March 1993 statement, the veteran cited Satchel v. Derwinski, 1 Vet.App. 258 (1991) in support of his claim for service connection. The issue before the Court in Satchel was an earlier effective date for payment of dependency and indemnity compensation, a different issue from that now before the Board. While the veteran has argued that in the Satchel case, service connection had been granted based on 26 high blood pressure readings during hospitalization in service and that his service medical records reflect more than 26 elevated readings, the entire facts of that case were not set forth in the Court opinion. Moreover, regulations provide that although the Board strives for consistency in issuing its decisions, previously issued Board decisions will be considered binding only with regard the specific case decided. Prior decisions in other appeals may be considered in a case to the extent that they reasonably relate to the case, but each case presented to the Board will be decided on the basis of the individual facts of the case in light of applicable procedure and substantive law. 38 U.S.C.A. § 7104(a) (West 1991); 38 C.F.R. § 20.1303 (1994). Accordingly, the Court's decision in Satchel does not reasonably relate to the veteran's claim, and prior Board decisions are nonprecedential in nature. 38 C.F.R. § 20.1303. ORDER The claim of entitlement to service connection for coronary artery disease, including hypertension, is dismissed. JANE E. SHARP 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.