Citation Nr: 0003972 Decision Date: 02/15/00 Archive Date: 02/23/00 DOCKET NO. 94-08 521 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for a back disorder. 2. Entitlement to service connection for a right knee disorder. 3. Entitlement to service connection for a bilateral ankle disorder. 4. Entitlement to service connection for a bilateral wrist disorder. 5. Entitlement to service connection for a bilateral hand disorder. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Terence D. Harrigan, Counsel INTRODUCTION The veteran had active military service from August 1979 to June 1992. These matters came before the Board of Veterans' Appeals (Board) on appeal from a March 1993 decision of the Chicago, Illinois, Regional Office (RO) of the Department of Veterans Affairs (VA). This appeal also initially involved additional issues. In January 1997, the Board issued a decision denying entitlement to service connection for a disorder manifested by chest pain and for an eye disorder, and granted service connection for pes planus. The Board then remanded the remaining issues on appeal for further development. In a rating action in November 1998, the RO granted service connection for left knee tendonitis; hence, that issue is no longer before the Board. The remaining issues as set forth above were again denied by the RO and are now before the Board for further appellate review. FINDINGS OF FACT 1. There is no competent evidence of a current low back disability. 2. There is no competent evidence of a current right knee disability. 3. There is no competent evidence of a current bilateral ankle disability. 4. There is no competent evidence of nexus between any current bilateral wrist disorder and the veteran's active military service. 5. There is no competent evidence of a nexus between any current bilateral hand disorder and the veteran's active military service. CONCLUSION OF LAW The veteran's claims for service connection for a back disorder, a right knee disorder, a bilateral ankle disorder, a bilateral wrist disorder, and a bilateral hand disorder are not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background A medical report dated in October 1978 reveals that the veteran complained of discoloration of the left ring finger and the right ring finger. He reported that he had dislocated the proximal inter phalangeal joint of left ring finger one year earlier and later the metacarpal phalangeal joint of the left thumb. He had injured the right ring finger in August while playing basketball. Examination revealed mild swelling of the proximal inter phalangeal joints of both ring fingers. There was slight tenderness on the ulnar side with a few degrees of radial deviation. X- rays were reported to be normal. Service medical records reveal that in August 1979 the veteran complained of left ankle pain. Examination revealed that there was edema, effusion and tenderness along the Achilles tendon. A gel cast was applied. A few days later the veteran had full range of motion without pain. In March 1980, the veteran complained of left ankle pain for nine months. Examination was reported to be normal. In October 1980, the veteran complained of lower back pain after strenuous lifting and carrying. Examination revealed pain in the right paravertebral muscles. In November 1980, the veteran complained of pain in the right lower leg. Examination revealed tenderness at the tibial tuberosity and in the patellar tendon. In April 198l, he complained of lower back pain and stated that he had fallen while playing basketball. The impression was contusion of the back. In December 1981, the veteran complained of right knee pain over the insertion of the lateral hamstring. He reported pain with flexion of the hip. Range of motion was full. On examination the lateral collateral ligament and medial collateral ligament were intact; there was no effusion; there was tenderness over the insertion of the lateral hamstrings. The assessment was possible tendinitis. In September 1982, the veteran complained of a chronic Achilles tendon problem when wearing safety shoes. There was no swelling or deformity at the insertion of the Achilles tendon. In June 1983, the veteran complained of aching and stiffness of the proximal interphalangeal joints of the fingers of the right hand, which he indicated was worse after he used his hand for writing. He also reported that he injured his right ankle when a bowling ball fell on it. Examination revealed that the medial side of right ankle was slightly reddened and painful to pressure. He had good range of motion. There was no swelling or discoloration of the fingers of the right hand. On orthopedic examination of the right hand in July 1983, there was no swelling or tenderness; there was no motor loss or sensory loss; range of motion was full. The proximal interphalangeal joints of the fingers of the right hand were slightly larger than the rest of the fingers. X-rays of both hands showed no evidence of fracture, dislocation or other bony abnormality. In June 1984, the veteran complained of back pain during physical training. On examination there was tenderness to deep palpation. The assessment was possible acute sprain or soft tissue injury. In July 1984, the veteran complained of right knee pain during physical training. On examination, retropatellar tenderness, without effusion, was found; range of motion was full; the knee was stable. The impression was patellofemoral syndrome. In September 1984, he complained of lower back pain after heavy lifting. Flexion was to 30 degrees. The assessment was low back strain. In October 1984, the veteran complained of left knee pain. On examination, tenderness near the lateral edge of the patella and swelling beneath the patella were noted; range of motion was full. The assessment was patellofemoral syndrome. In December 1984, he complained of lower back pain that did not radiate. On examination muscle spasms on the left were noted. The assessment was back muscle spasm. In March 1986, the veteran complained of pain and swelling of the right middle finger. In May 1986, a swollen, tender, non-erythematous lesion was found on the volar aspect of the proximal phalanx of the right middle and, to a lesser extent, right ring fingers. A biopsy was performed, and tissue was sent to the Armed Forces Institute of Pathology. The diagnosis was cyst with fibrinoid change and reactive vascular proliferation, right middle finger. At discharge from a service department hospital in August 1986, the veteran still had chronic pain in the right middle and ring fingers. In August 1986, the veteran was seen complaining of an injury to the left knee and right ankle. He had limited motion when the knee was extended and the medial side of the knee appeared swollen. A torn ligament was suspected. A few days later he reported that the swelling was gone, but the knee still popped. It was ultimately concluded that he had a tear of the medial collateral ligament. In October 1986 bilateral chondromalacia of the patellae was diagnosed. In December 1986, the veteran was seen complaining of bilateral knee pain and swelling. Examination revealed crepitation in both knees on bending. There was no locking, buckling or giving way of the knees. The knee pain reportedly increased with activity and decreased with rest. There was peripatellar pain without redness, edema, atrophy, laxity or deformity. He had full range of motion of the knee. The diagnosis was chondromalacia patella. In February 1987, the veteran complained of left ankle pain after he was hit with a bowling ball. Examination revealed that the ankle was discolored and swollen. He had full range of motion of the ankle. X-rays were negative. The assessment was possible contusion. In March 1987 there was no swelling, edema or deformity of the left ankle. The assessment was resolving contusion. In March 1987, the veteran complained of pain and swelling of the right middle and ring fingers. Examination revealed mild swelling of the right middle finger along the proximal phalanx. There was a little tenderness over the incision from previous surgery. He had full range of motion. There was a slightly tender 0.25 cm mass over the ring finger at the proximal interphalangeal joint. A low grade inflammatory condition involving the ring finger proximal inter phalangeal joint was suspected. In July 1987, the veteran complained of lower back pain after a fall. He reported that he had had previous back problems. On examination he had pain in the lumbar area on forward bending. Range of motion was full with discomfort. On bending over the muscles over the left lumbar region were tense. The assessment was mechanical lumbar region back strain. In February 1990, the veteran complained of right ankle pain after being hit while playing basketball. On examination there was mild edema of the right ankle; range of motion was normal. The assessment was right ankle sprain. In April 1990 the veteran again complained of right ankle pain after playing basketball. A little swelling over the anterior ligament was noted. The assessment was sprained anterior ligament of the right ankle. In May 1990, the veteran stated that he had stepped on a rock and twisted his right knee. He complained of swelling and pain at the bottom of the foot. Examination revealed pain on palpation of the dorsal portion of the ankle. X-rays revealed a questionable fracture at the right tibial styloid process. A cast was applied. In June 1990 range of motion of the right ankle was full. There was lateral discoloration, mild tenderness over the talofibular ligament and no swelling. The assessment was right ankle sprain, improving. A radiologist reported that there was no fracture of the ankle. In July 1990, the veteran continued to complain of right ankle discomfort. In August and September 1990, he complained of right ankle soreness after running. In January 1991, the veteran complained of pain on the right side of the dorsal spine. On examination pain in the right trapezius muscle, which was contracted, was noted. He had full range of motion of the spine. The assessment was trapezius strain. Several days later, he reported that he was 95 percent better. In January 1992, the veteran complained of pain in the right lower back after physical training. On examination range of motion was full, with slight pain. The assessment was probable muscle pull. In a report of medical history for separation in April 1992, history of painful joints in the fingers and a biopsy of a benign mass on the right ring finger were noted. The veteran reported that he did not have a trick or locked knee. He reported that he had had recurrent back pain. A history of mechanical lower back pain was noted On examination for separation in April 1992 his lower and upper extremities were evaluated as normal. His spine and musculoskeletal system were reported as normal. On VA general medical examination in December 1992, the veteran's complained of pain in the wrists and ankles, worse with movement. On examination, minimal pain on movement of the wrists and ankles was noted. There was some decreased motion, particularly of the left ankle. Diagnoses included nonspecific joint discomfort in the wrists and ankles. On a VA joints examination it was reported that there was no particular swelling of the lower extremities. No impairment of the knees was appreciated. Range of motion of the wrists was minimally restricted. Range of motion of the left ankle was limited. X-rays revealed no acute fracture or bony abnormality of the wrists or ankles. On VA examination in May 1998, the veteran complained of stiffness in the right hand and a little shooting pain occasionally. He reported that he had had a surgical release at the base of the right thumb in January 1998. Examination of the hands revealed no gross deformity. There was a fresh scar near the snuff-box of the left thumb. It was well healed with minimal tenderness to deep palpation. The wrists dorsiflexed to 45 degrees and plantarflexed (sic) to 60 degrees bilaterally. The veteran reported sharp pain momentarily in the right wrist on palmerflexion. There was no discomfort on the left. There was no tenderness of the digits and no swelling was noted. Range of motion of the hands was full and painless. The grip was very good in both hands. The diagnosis was status post surgery of the right thumb, reportedly a nerve release. On knee examination the veteran stated that it was primarily his left knee that bothered him. He stated that he could walk indefinitely without knee pain and that he had no problem at work. He complained that once in a while he had a little soreness on the inside of the knee. Going down steps caused some discomfort in the knee. Examination revealed that there was no deformity of the knee. The thigh circumference was equal bilaterally and there was no effusion. There was no tenderness in the right knee. Ligaments were intact. He had full range of motion of the knees. The ankle joints showed no deformity and the veteran reported no symptoms in the ankles. Range of motion of the ankles was from 15 degrees dorsiflexion to 35 degrees plantar flexion. Inversion and eversion were normal. The veteran reported that he had very little trouble with his back. He stated that walking did not bother it much. Every few months he had to march with a heavy rucksack and he tolerated it without any problems. He stated that once in a great while he felt a little aching in the low back. Examination revealed that there was no tenderness or muscle spasm. He could touch his fingertips to the floor and return to the upright position without difficulty. In the seated position he could flex forward to 75 degrees. He could get his shoulders almost to his knees. He could extend to about 25 degrees without discomfort. Rotation to the left was to 70 degrees with a mild pulling sensation along the left flank area. Rotation to the right was to 65 degrees with a mild pulling sensation on the right flank area at the end points, but not really pain. Side bending was to 35 degrees without discomfort. X-rays of the hands, wrists and lumbosacral spine revealed no abnormality. Essentially normal spine examination was reported as a diagnosis. Analysis Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by a veteran's active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). However, the threshold question to be answered in this case with regard to each of the veteran's claims for service connection is whether the veteran has presented a well- grounded claim. The veteran has "the burden of submitting 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); Robinette v. Brown, 8 Vet. App. 69, 73 (1995). 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]." Murphy v. Derwinski, 1 Vet. App. 78, 81 (1991). In the absence of evidence of a well-grounded claim, there is no duty to assist the claimant in developing the facts pertinent to the claim, and the claim must fail. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997); Slater v. Brown, 9 Vet. App. 240, 243 (1996); Gregory v Brown, 8 Vet. App. 563, 568 (1996) (en banc); Grivois v. Brown, 6 Vet. App. 136, 140 (1994); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In order for a claim for service connection to be well- grounded, there must be competent evidence (lay or medical, as appropriate) of: (1) a current disability; (2) an in- service injury or disease; and (3) a nexus between the current disability and the in-service injury or disease. Epps, 126 F.3d at 1468; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995). The chronicity provision of 38 C.F.R. § 3.303(b) (1999) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service or during an applicable presumption period and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the case law of the United States Court of Appeals for Veterans Claims (formerly, the United States Court of Veterans Appeals) (Court), lay observation is competent. If the chronicity provision is not applicable, a claim may still be well grounded or reopened on the basis of 38 C.F.R. § 3.303(b) if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology. Savage v. Gober, 10 Vet. App. 488, 498 (1997). In this case, with regard to the veteran's claim for service connection for residuals of a back disorder, there is evidence of the veteran being treated for low back pain in service and he complained of recurrent back pain at the time of his discharge examination, however, no back disability was shown on the most recent VA examination. Since he has failed to demonstrate any medical evidence of current disability resulting from a lower back, there is no basis for finding that he has presented a well-grounded claim with regard to that issue. During service the veteran complained of right knee pain on several occasions. Diagnoses included possible tendonitis, patellofemoral syndrome and chondromalacia of the patella. However, no right knee disability was shown on VA examination in May 1998. In the absence of a showing of current disability of the right knee, there is no basis for finding that he has presented a well-grounded claim with regard to that issue. During service the veteran reported injuries to each ankle in separate incidents involving being hit by bowling balls. In the second incident, involving the left ankle a diagnosis of contusion was reported. In 1990 he reported an injury to his right ankle during a basketball game. The assessment was sprain of the anterior ligament. Another sprain of the right ankle was reported a few months later. However, no ankle disability was shown on VA examination in May 1998. In the absence of a showing of current disability of the ankles, there is no basis for finding that he has presented a well- grounded claim with regard to the issue of entitlement to service connection for a bilateral ankle disorder. With regard to the veteran's claimed bilateral wrist disability, the Board notes that service medical records reveal no evidence of complaints or findings of or treatment for a wrist disorder. Additionally, no wrist disorder was shown in service. The earliest evidence of a wrist disorder is the veteran's complaint of wrist pain at the time of VA examination in December 1992. On VA examination in May 1998 the veteran reported some pain on motion of the wrists and tenderness, but there is no medical evidence linking any present wrist disability with any incident of service. In the absence of such evidence, the Board finds no basis for finding that he has presented a well-grounded claim with regard to that issue. During service, the veteran had a cyst removed form his right middle and ring fingers. In January 1998 he reportedly had a surgical nerve release at the base of the right thumb. He has presented no medical evidence of a nexus between these apparently unrelated disorders. On VA examination in May 1998 the only abnormal finding was the surgical scar near the snuff-box of the left thumb. Since his only present disability of the hands is not medically linked to his period of military service and there is no medical evidence of present disability of the hands related to the cyst removal which the veteran had during service or to any other incident of service, the Board concludes that the veteran has not presented a well-grounded claim for service connection for a bilateral hand disorder in this case. The Board has considered the veteran's assertions in reaching the above conclusions. However, as a lay person without medical training or expertise, he is not competent to render a probative opinion on a medical matter, such as the diagnosis and/or etiology of a disability. Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992). As the veteran has failed to present evidence that any of his current claims is plausible, VA is under no duty to assist the veteran in developing the facts pertinent to the claim. See Epps, 126 F.3d at 1468. Furthermore, the Board is aware of no circumstances in this matter that would put the VA on notice that any additional relevant evidence may exist which, if obtained, would well-ground any of the claims of entitlement to service connection currently under consideration. See McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). As the RO also denied each of the veteran's claims as well grounded (see November 23, 1998 Supplemental Statement of the Case), there is no prejudice in the Board doing likewise. The Board also finds that inasmuch as the veteran has clearly been provided with the basis for the denial of each claim, the duty to inform has been met. See 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). ORDER In the absence of evidence of well grounded claims, service connection for a back disorder, a right knee disorder, a bilateral ankle disorder, a bilateral wrist disorder and a bilateral hand disorder, is denied. JACQUELINE E. MONROE Member, Board of Veterans' Appeals