BVA9501355 DOCKET NO. 93-05 232 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for a bilateral knee disability. 2. Entitlement to service connection for a neck disability. 3. Entitlement to service connection for a psychiatric disorder. 4. Entitlement to service connection for residuals of a head injury, to include a disability manifested by headaches. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C.M. Flatley, Counsel INTRODUCTION The veteran had active service from December 1971 to December 1973. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he experiences bilateral knee impairment as a result of engaging in parachute jumps in service. It is also asserted that such activity resulted in an injury to the neck which required sutures. In addition, the veteran essentially maintains that he experiences residuals of an in- service head injury and that a psychiatric disorder is present which is associated with his period of active service. DECISION OF THE BOARD The Board of Veterans' Appeals (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 well-grounded claims have not been submitted for entitlement to service connection for a bilateral knee disability, a neck disability, and a psychiatric disorder and that the preponderance of the evidence is against the claim of service connection for residuals of a head injury, to include a disability manifested by headaches. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. Competent evidence has not been submitted which establishes the presence of a bilateral knee disability and a neck disability or which relates the veteran's claimed post-service bilateral knee and neck symptomatology to his period of active service. 3. Competent evidence has not been submitted which relates the veteran's post-service psychiatric pathology to his period of active service. 4. Chronic residuals of a head injury in service, to include a disability manifested by headaches have not been demonstrated. CONCLUSIONS OF LAW 1. The veteran's claims of service connection for a bilateral knee disability, a neck disability, and a psychiatric disorder, are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. Chronic residuals of a head injury, to include a disability manifested by headaches, were not incurred in or aggravated by the veteran's period of active service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We note that in the course of the veteran's appeal, he has been requested to provide evidence which may be pertinent to his case. In his application for benefits received in December 1991, the veteran listed only a Department of Veterans Affairs (VA) Hospital, from which information has been obtained, as a facility from which he had obtained treatment. We also note the veteran's assertions generally as to conclusions reached by private physicians regarding his claimed disabilities, reported in pertinent part below. In response, we point out that the United States Court of Veterans Appeals (Court) has held that a layman's account of a physician's purported statement is too attenuated and inherently unreliable to constitute "medical" evidence. Robinette v. Brown, No. 93-985, slip op. at 12 (U. S. Vet. App. Sept. 12, 1994). I. A Bilateral Knee Disability Review of the veteran's service medical records shows that in August 1972, the veteran complained that he had hit his left knee cap the previous day. He related having pain in the patellar tendon. There was no swelling or erythema; the pain was described as "not great." On examination in November 1973 for separation from service, evaluation of the lower extremities revealed normal findings. A May 1990 VA outpatient report reflects that the veteran requested medical care for a knee condition. A ten-year history of "achiness" in the knees was reported; both knees would pop now and then, and a "vague ache" was noted. It was also noted that the veteran had been told by a private physician that bursitis was present. On examination, a full range of motion, with no effusion or tenderness was present. An x-ray study of the knees revealed normal findings. The diagnosis was knee "arthralgias." At his personal hearing in August 1992, the veteran testified that his military occupational specialty had been that of a paratrooper. Transcript (T.) at 1. He reported that he sustained trauma to the knees due to parachute jumping and that . he had often sought treatment for knee symptomatology in service and had been placed on "profile for a while." T. at 1, 2. He noted that he currently experiences popping and giving way of the knees. T. at 3. The remaining evidence of record pertaining to the veteran's knees consists of a report of the veteran's VA examination in June 1992, at which time the veteran reported a history of bilateral knee pain of 20 years' duration. He reported that the symptomatology had its onset in service; no specific injury or trauma was described. On examination, no pertinent abnormalities were found. An x-ray study of the knees revealed normal findings. The diagnoses included chronic knee pain, no deficits, no active disease. Adjudication of a claim for veterans' benefits presupposes the submission of a well-grounded claim, that is, one which is meritorious on its own or capable of substantiation. Murphy, 1 Vet.App. at 81; 38 U.S.C.A. § 5107(a). The claim must be accompanied by supporting 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); Tirpak v. Derwinski, 2 Vet. App. 609, 610-611 (1992). Upon review of the record in this case, the Board concludes that the veteran's claim of entitlement to service connection for a bilateral knee disorder is not well- grounded. In this regard, we stress that the Court has determined that in cases in which the veteran has submitted no cognizable evidence to support a claim, the claim cannot be well- grounded. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). In this instance, the record contains a brief notation in service of the veteran's complaint of left knee pain after hitting his knee cap, with no clinical abnormality noted. The veteran's symptomatology clearly resolved with conservative treatment. No complaint or finding indicative of a bilateral knee disability was made throughout the remainder of the veteran's period of active service. Further, post-service data are silent for many years as to any pertinent complaint, and a bilateral knee disability has not been clinically identified. Currently, bilateral knee pathology is limited to pain, as demonstrated by the recent diagnosis of chronic knee pain, and aside from the veteran's unsubstantiated assertion, the record fails to establish any persuasive linkage between such pain and the veteran's period of service. As no evidence has been presented to establish the presence of a chronic bilateral knee disability in service or an identifiable knee disorder since service, and the veteran's current symptomatology is not shown to be related to service, the Board concludes that the veteran's claim is not plausible and must be dismissed. 38 U.S.C.A. § 5107. II. A Neck Disability Service medical records are silent as to any complaint, finding, or treatment of a neck disability. In a May 1990 VA outpatient report, the veteran reported that he required treatment for migraine headaches. He noted a history of headaches for ten years or more and reported that they were present in the posterior neck. The diagnostic assessments included probable "musc. contr" headache. Evidence of record also includes a report of a VA hospitalization in February and March 1991. Physical examination on admission was essentially unremarkable; no pertinent complaint, finding, or diagnosis was made. At his personal hearing in August 1992, the veteran reported that parachute jumping in service resulted in a neck disability. T. at 5. He stated that he experienced radiating pain into the arms and through the shoulders, mostly on the left side. T. at 6. On VA examination in June 1992, the veteran reported a history of a neck injury in 1972. He noted that he had stiffness in the neck and an inability to move the neck. He also complained of headaches. On examination, pain on movement of the cervical spine was found; examination was otherwise essentially unremarkable. An x-ray study of the cervical spine revealed normal findings. The diagnoses included the examiner's conclusion that there was no evidence of a pinched nerve in the neck. Although the examiner noted that the veteran's headaches were likely related to degenerative joint disease of the cervical spine, radiographic examination failed to establish any evidence of degenerative joint disease. As indicated by review of the pertinent evidence of record, set forth above, evidence of a chronic neck disability is absent in service and since. Although pain on movement of the cervical spine was recently demonstrated, pathology of the cervical spine has not been confirmed. In addition, although the veteran has recently provided a history of neck pain since service and attempts to relate his current complaints to service, the evidence of record fails to support such a relationship. As noted above, adjudication of a claim requires that the claim be well-grounded, and accompanied by supporting 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); Tirpak, 2 Vet.App. at 610, Murphy, 1 Vet.App. at 81. In this regard, we stress that evidence of the onset of a neck disability in service is clearly absent. At most, the veteran's recent complaints of pain in the cervical spine are currently documented, and in spite of the veteran's assertion, the evidence of record fails to establish an etiologic relationship between these complaints and his period of service. The veteran has submitted no competent evidence to support his claim. Grottveit, at 93. Upon review of the record, therefore, the Board concludes that the veteran's claim of service connection for a neck disability is not plausible and must be dismissed. 38 U.S.C.A. § 5107. III. A Psychiatric Disorder Service medical records are silent as to any complaint, finding, or treatment of a psychiatric disorder. In a May 1990 VA outpatient report, it was noted that the veteran presented to the emergency room requesting alcohol and drug treatment. A long history of alcohol and drug abuse was noted; recent participation in two alcohol rehabilitation programs was reported. Evaluation led to diagnostic assessments of antisocial personality traits, alcohol dependence, and crack cocaine abuse. The evidence of record also includes a report of a VA hospitalization in February and March 1991. He reported that he had no psychiatric history or treatment in the past and it was noted that he was asymptomatic at present. On mental status examination, no evidence of major depression, mania, or psychosis was present; clinical findings were essentially unremarkable. The discharge diagnoses were alcohol dependence, cocaine dependence, and polysubstance abuse. An October 1991 VA outpatient report reflects that the veteran sought treatment at the emergency room requesting admission. His complaints included anxiety and depression. Upon initial evaluation, the diagnostic assessments were polysubstance abuse and antisocial personality disorder. Further evaluation led to diagnoses of anxiety and substance abuse. Essentially similar evidence is presented in a report of the veteran's October 1991 VA hospitalization and VA social work entries in 1991 and 1992. At his hearing in August 1992, the veteran also stated that his psychiatric disorder had its onset in service, as a result of an instance in which his parachute did not properly open and as a result of his involvement in an incident in which he sustained a laceration of his head. T. at 7. He stated that he experienced nightmares regarding such events. T. at 8. The veteran stated that his depression was related to in-service occurrences. T. at 9. He reported that he initially sought treatment for a "nervous condition" in 1987. T. at 10. On VA psychiatric examination in June 1992, the veteran reported that in 1985, he had been told that he had a "manic-depressive condition." The veteran reported that he was depressed most of the time. It was noted that the veteran exhibited hostility on examination; clinical findings were otherwise in large part unremarkable. Evaluation led to diagnoses including dysthymia by history, chronic alcohol and cocaine abuse, in partial remission, and sociopathic personality disorder. As illustrated above, there is no indication that a psychiatric disorder was present in service. Reference to psychiatric disorders post-service, including a notation of anxiety, but primarily in the form of a personality disorder, initially became manifest long after service. There is no evidence of an etiologic link between the veteran's period of service and "service-connectable" psychiatric symptomatology experienced many years after separation therefrom. Competent evidence to support a link to service has not been submitted. Grottveit, at 93. A plausible claim has not been submitted. 38 U.S.C.A. § 5107(a); Tirpak, 2 Vet.App. at 610. IV. Residuals of a Head Injury, to Include A Disability Manifested by Headaches An emergency room report, dated August 8, 1972, shows treatment for a laceration to the back of the head on glass; the wound was sutured. An entry dated the following day notes the presence of "some headache." A neurologic examination was described as "OK." On examination in November 1973 for separation from service, no pertinent complaint or abnormality was found. Service medical records include a clinical record cover sheet, dated which reflects that in August 1972, the veteran received treatment for a head injury from "fighting;" it was noted that he was in "quarters or dispensary" for a period of three days. As noted above, pertinent post-service data include a May 1990 VA outpatient report, which shows that the veteran reported that he required treatment for migraine headaches. He noted a history of headaches for ten years or more and reported that they were present in the posterior neck. The diagnostic assessment was probable "musc. contr" headache. At his personal hearing in August 1992, the veteran testified that while in service, he sustained an injury in which his head went through a glass window and he "severed" the back of his head. T. at 3. He noted that he began to experience headaches approximately two days after the incident. T. at 4. He stated that his headaches currently form a "skull cap" position and last up to two to three days. T. at 4. The veteran stated that physicians had related his headaches to trauma he sustained in service. T. at 5. He also reported that after the incident in service, rather than adhering to the physician's orders to place the veteran on light duty, he was required to engage in parachuting, which caused his stitches to tear and require re- suturing. T. at 11. On VA examination in June 1992, the veteran reported an essentially similar history to that noted above with respect to his head injury and noted that he had experienced headaches since 1970. The headaches were reportedly localized to the posterior aspect of the head and neck without radiation; no associated visual or neurological symptoms were noted. Examination, including neurologic evaluation, revealed normal findings. An x- ray study of the cervical spine revealed normal findings. The diagnoses included chronic headache, likely secondary to cervical degenerative joint disease, mild, no deficits. With respect to the veteran's claim of service connection for residuals of a head injury, the Board concludes that the evidence of record indicates that his claim is well-grounded. 38 U.S.C.A. § 5107(a); Murphy, 1 Vet.App. at 81. With regard to the VA's duty to assist the veteran, we note that the VA, throughout the course of the veteran's appeal, has requested that he provide information or evidence regarding the disability at issue; information provided has been limited to reference to VA treatment, including on the veteran's VA Form 21-526 regarding his claim for benefits. VA treatment records have been obtained. The Board concludes that the veteran has been adequately assisted in the development of his case. 38 U.S.C.A. § 5107(a). Although we note the veteran's reference to conclusions allegedly drawn by private physicians, no specific information has been forthcoming. Further, as noted above, the Court has held in this regard that a layman's account of a physician's purported statement is too attenuated and inherently unreliable to constitute "medical" evidence. Robinette, slip op. at 12. Review of the record illustrates that the veteran sustained an injury to the head in service. The record also establishes, however, that the veteran's injury was apparently completely resolved prior to his service separation, as evidenced by the absence of any further complaint or treatment throughout the veteran's period of active service or thereafter. We recognize the veteran's contentions in this regard, including his description of the required re-suturing of his laceration of the head. We also must point out, however, that residuals of the veteran's laceration of the head have not been demonstrated. No mention was made of the injury for many years after service. On VA examination in June 1992, for example, no abnormalities of the head or skin were found and no neurologic abnormality was present. We note the veteran's complaints of headaches, and his reported history as to their onset shortly after the head injury in service. The veteran's complaints of headaches were also recognized on recent VA examination. We must stress, however, that an etiologic relationship between the veteran's in-service laceration of the head and a disability manifested by headaches has not been demonstrated. Overall, there is no residual disability associated with the veteran's laceration of the head shown in service, and post-service data fail to establish a relationship between the in-service incident and any claimed post-service residual disability. The Board, therefore, has no foundation upon which to conclude that residuals of a head injury, to include a disability manifested by headaches, was incurred in service. The key consideration is the absence of continuity of symptomatology required under 38 C.F.R. § 3.303 (b). ORDER The veteran's claims of service connection for a bilateral knee disability, a neck disability, and a psychiatric disorder are dismissed. Entitlement to service connection for residuals of a head injury, to include a disability manifested by headaches, is denied. JOHN E. ORMOND 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.