BVA9501358 DOCKET NO. 92-17 734 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: AMVETS ATTORNEY FOR THE BOARD Christopher Maynard, Associate Counsel INTRODUCTION The veteran had active service from November 1941 to September 1961. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1992 rating decision. In November 1993, the Board remanded the case to the RO for additional development. Postservice treatment records were obtained and associated with the claims folder. CONTENTIONS OF APPELLANT ON APPEAL The appellant argues that the veteran had hypertension and was hospitalized for a myocardial infarction while in service. It is argued that these were early manifestations of his later- developed arteriosclerotic heart disease which was the underlying cause of his death in 1991. 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 appellant has not met the initial burden of submitting sufficient evidence to justify a belief by a fair and impartial individual that the claim of service connection for the cause of the veteran's death is well grounded. FINDINGS OF FACT 1. Essential hypertension, cerebrovascular accident, atherosclerotic coronary artery disease, ischemic cardiomyopathy or congestive heart failure was not demonstrated in service or until many years after service separation. 2. The veteran's death in November 1991 was caused by respiratory arrest due to brain stem herniation due to cerebrovascular accident. Other significant conditions contributing to death but not resulting in the underlying cause include atherosclerotic coronary artery disease, rule out ischemic cardiomyopathy and congestive heart failure. 3. At the time of death, service connection was in effect for chronic obstructive pulmonary disease, residual of tuberculous pleurisy, rated 10 percent disabling. 4. The veteran is not shown to have demonstrated cerebrovascular accident, atherosclerotic coronary artery disease, ischemic cardiomyopathy, congestive heart failure, essential hypertension or cardiovascular disease in service or until many years thereafter. 5. The veteran's cardiovascular disease, cerebrovascular accident, atherosclerotic coronary artery disease, ischemic cardiomyopathy and congestive heart failure are not shown to have been causally or etiologically related to service or a service- connected disability. 6. A disability of service origin is not shown to have caused or contributed materially to the veteran's death. CONCLUSION OF LAW The appellant has not submitted evidence of a well-grounded claim for service connection for the cause of the veteran's death. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137, 1310, 5107, 7104 (West 1991); 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310, 3.312 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION The threshold question to be answered is whether the appellant has presented evidence of a well-grounded claim, that is, a claim which is plausible. A plausible claim is one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). Under the law, the claimant has the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. § 5107(a). While the claim need not be conclusive, it must be accompanied by some evidence; a mere allegation will not suffice. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). The appellant's statements alone are not sufficient to establish a well-grounded claim in cases involving questions of medical diagnosis or causation. Grottveit v. Brown, 5 Vet.App. 91, (1993) The veteran died in November 1991 at the age of 72 years, due to respiratory arrest due to brain stem herniation due to cerebrovascular accident. Other significant conditions contributing to death but not resulting in the underlying cause were listed as atherosclerotic coronary artery disease, rule out ischemic cardiomyopathy and congestive heart failure. The veteran was seen at a dispensary in early August 1957, complaining of severe chest pain of sudden onset. It was noted that he had a history of increased pressure in the past and was seen by a civilian doctor in 1954. The examining physician described him as in acute distress with cyanosis, marked respiratory embarrassment and foaming frothy material from his mouth. On initial examination, the veteran's blood pressure was 180/100 and on repeat, was 120/75. An EKG was interpreted as compatible with pulmonary infarction. The veteran was admitted to the hospital with a diagnostic impression of possible myocardial or pulmonary infarct. On hospital admission, his blood pressure was 130/96. Severe tenderness of the left hemithorax prevented palpation and percussion. Examination of the heart revealed a sinus tachycardia with no murmurs or rubs, and a subsequent report indicated that the initial EKG was considered unreliable (apparently because the electrodes were incorrectly connected at the time of the initial EKG). Subsequent evaluations, including additional EKG's and chest X-ray studies, suggested that the veteran did not suffer an acute myocardial infarction. The diagnoses at the time of transfer to another hospital were pneumonia and pleurisy. Upon transfer to another hospital in late August, the veteran's blood pressure was 125/80. During hospitalization, there was progressive clearing of a pneumonic process at the left lung base and fluid in the left hemithorax. A biopsy disclosed a chronic fibrosing pleuritis of nonspecific etiology. It was felt that he should be treated for possible tuberculous pleurisy. The diagnosis upon transfer to another hospital was tuberculous pleurisy with effusion, not proven. A hospital report dated in November 1957 indicated that the veteran's blood pressure was 134/86 on admission. Current chest X-ray studies were completely normal with no evidence of parenchymal disease or pleural effusion. The examiner indicated that he did not concur in the earlier diagnosis of tuberculous pleurisy with effusion, and entered a diagnosis of infarction of the lung due to embolus. In December 1957, a blood pressure reading of 152/92 was recorded. When seen later that month for followup after hospitalization, the veteran complained of some lower left chest pain. On examination, there were decreased breath sounds. Examination of the heart revealed a normal sinus rhythm, with no murmur. His blood pressure was 135/85. The diagnosis was referred pain from pleural biopsy scar (thoracotomy), rule out underlying disease. Several days later, a chest X-ray was noted to be negative. In January 1958, another physician agreed that the veteran was experiencing referred pain from the thoracotomy scar. Additional chest X-ray studies taken in December 1957, October 1959 and January 1960 showed the veteran's heart, lungs and bony thorax were normal. A July 1958 X-ray of the chest was negative. The veteran's report of medical history for retirement from service in July 1961 noted a history of a high blood pressure reading on one occasion with no recurrence. On examination, the veteran's blood pressure was 140/86 and a clinical evaluation of his heart was normal. An EKG and chest X-ray study were also normal. Postservice medical records showed that the veteran was seen in August 1971 for transient dizziness and diplopia. A general examination at that time was within normal limits, although the veteran's blood pressure was 148/92 and he was recommended for a neurology consult to rule out cerebrovascular insufficiency. The impression was probable postural hypotension. The record indicates that an EEG was performed in August 1971 and was attached to the report. However, a copy of that test result is not of record. Service department medical records dated in December 1978 show treatment for complaints of headaches of about one month's duration. The veteran reported having elevated blood pressure "years ago" but that he had never been evaluated or been placed on medication. Funduscopic examination showed moderate A-V nicking and the veteran was referred to hypertension clinic for early evaluation. His blood pressure at that time was 184/110 in the right arm and 162/92 in the left arm, using a large cuff. A subsequent treatment record in January 1979 showed treatment with medication for systolic hypertension. The evidentiary record indicates that the veteran underwent five-vessel coronary artery bypass grafting in 1984 and that he suffered an acute myocardial infarction secondary to left anterior descending occlusion in August 1986, and another anterior myocardial infarction in November 1987. A service department record dated in November 1987 included the diagnoses of acute anterior myocardial infarction, congestive heart failure, peripheral vascular disease, atherosclerotic coronary vascular disease, hypertension and insulin-dependent diabetes mellitus. Despite the appellant's assertions to the contrary, the service medical records fail to show evidence of essential hypertension or any other chronic cardiovascular disorder during service or during the one-year presumptive period thereafter. The first evidence of possible hypertension was noted on service department records dated in August 1971. It is significant to note that no cardiac or cardiovascular disorder was diagnosed following inservice hospitalization during service, in 1957, which totaled more than 3½ months. The medical evidence of record indicates that after 1957 the veteran had no further cardiac symptoms during service or until many years after service separation. There is nothing in the evidence of record to suggest that the veteran's demise in November 1991 was related in any way to service so as to support the appellant's lay assertions of matters concerning medical diagnosis or causation. Grottveit. Inasmuch as the appellant has presented no cognizable evidence, such as a medical opinion, to show that the veteran's later- developed essential hypertension and arteriosclerotic heart disease were due to disease or injury in service or were the result of a service-connected disability, or that a service- connected disability contributed substantially or materially to cause death, a well-grounded claim has not been presented. Similarly, no evidence has been presented which links cerebrovascular accident, atherosclerotic coronary artery disease, ischemic cardiomyopathy or congestive heart failure to service or a service-connected disability. The appellant's representative has requested the Board to obtain an opinion from an independent medical expert. As a well- grounded claim has not been presented, however, the duty to assist does not arise. 38 U.S.C.A. § 5107(a) (West 1991). ORDER As a well-grounded claim of service connection for the cause of the veteran's death has not been presented, the appeal is dismissed. The RO should take all indicated adjudicatory action consistent with this decision. BARBARA B. COPELAND 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.