Citation Nr: 0004325 Decision Date: 02/17/00 Archive Date: 02/23/00 DOCKET NO. 94-24 154 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for a disability manifested by chest pains. 2. Entitlement to service connection for a disability claimed as swelling of the right ankle and foot. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD L.J. Bakke, Associate Counsel INTRODUCTION The veteran served on active duty from July 1976 to January 1993. In addition, his Form DD 214 indicates that he has prior active duty of seven years. This appeal arises before the Board of Veterans' Appeals (Board) from a rating decision in which, inter alia, service connection for chest pain and swollen right foot and ankle was denied. In August 1997, the Board Remanded this case to the RO for further development. Specifically, the Board requested that the RO obtain VA and private treatment records, and records of private treatment accorded the veteran on referral from the military while he was on active service; and to conduct additional medical examination, to include procuring opinions concerning the etiology of currently manifested disabilities. A review of the record reveals that the RO has obtained the requested private and VA medical records. In addition, VA examination reports, dated in March 1999 and containing opinions as to the etiology of manifested disabilities, are of record. The Board thus finds that the RO has complied with the terms of the Remand. The report of VA examination for heart conditions, dated in March 1999, reflects a diagnosis of hypertensive cardiovascular disease, and the examiner specifically opined that this condition is secondary to his hypertension, for which he is service-connected. In pertinent part, the physician stated: The [veteran's] discharge electrocardiogram showed evidence of left ventricular hypertrophy and the EKG from September of 1992 which had revealed left ventricular hypertrophy findings are secondary to the hypertension. Hence, the Board infers a claim for service connection for hypertensive cardiovascular disease, as secondary to the service-connected hypertension. This matter is referred to the RO for appropriate action. FINDINGS OF FACT 1. Service medical records reflect complaints of and treatment for chest pain and swelling. 2. The veteran's reports of medical history and examination at discharge from active service show complaints of pain and pressure in the chest; history of arthritis, pain and pressure in the chest; but no clinical findings of defects, abnormalities, or diagnoses concerning the chest. 3. The veteran has not presented competent medical evidence that he has been diagnosed with a disability manifested by chest pains other than his service-connected right sternoclavicular arthritis. 4. All relevant evidence necessary for a fair and informed decision concerning the claim for service connection for a disability claimed as swelling of the right ankle and foot has been obtained by the originating agency. 5. Service medical records show inservice treatment for right ankle and right foot conditions. 6. The veteran's reports of medical history and examination at discharge from active service reflect complaints of foot trouble, arthritis, and swollen or painful joints; a history of swelling in the right foot and ankle; and clinical findings of moderate swelling around the lateral malleolus and of flat feet. CONCLUSIONS OF LAW 1. The claim for service connection for a disability manifested by chest pains, separate and apart from the service-connected right sternoclavicular arthritis, is not well grounded. 38 U.S.C.A. § 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 2. Polyarthropy of the right ankle and foot, with limitation of right ankle joint motion, and plantar fasciitis of the right foot, was incurred in active service. 38 U.S.C.A. § 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.102, 3.303 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran must submit evidence that the claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). A well- grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A well-grounded claim requires more than mere allegations that the veteran's service, or an incident which occurred therein, resulted in illness, injury, or death. The veteran must submit supporting evidence that would justify the belief that the claim is plausible. See Tirpak v. Derwinski, 2 Vet. App. 609 (1992); Grivois v. Brown, 6 Vet. App. 136 (1994). Evidentiary assertions by the claimant must be accepted as true for the purpose of determining if a claim is well- grounded, except when the assertions are inherently incredible or beyond the competence of the person making them. King v. Brown, 5 Vet. App. 19 (1993). Service connection may be established for disability resulting from personal injury or disease incurred in or aggravated by service. 38 U.S.C.A. § 1110, 1131 (West 1991). In the absence of chronicity at onset, a grant of service connection requires evidence of continuity of symptomatology demonstrating that a current disability was incurred in service. 38 C.F.R. § 3.303(b) (1999). Regulations also provide that service connection may be established where all the evidence of record, including that pertinent to service, demonstrates that the veteran's currently disability was incurred in service. 38 C.F.R. § 3.303(d) (1999). The three elements of a "well grounded" claim for service connection are (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the inservice disease or injury and the current disability, as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498, 506 (1994), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). The regulations provide that certain chronic diseases will be considered to have been incurred in service if manifested to a degree if 10 percent or more within one year from the date of separation from active service, where the veteran has served for 90 days or more during a period of war, or after December 31, 1946, even though there is no evidence the disease existed during service. 38 C.F.R. § 3.307 (1999). Arthritis is among the chronic diseases for which the presumption is granted. 38 C.F.R. § 3.309(a) (1999). A. Disability Manifested by Chest Pain The veteran argues that he experiences chest pain that is the result of his active service. However, the medical evidence does not show that he has a diagnosis of a disability manifested by chest pains other than his service-connected right sternoclavicular arthritis. Service medical records reflect frequent complaints of and treatment for chest pain throughout the veteran's active service. This condition was diagnosed in service variously as chronic, recurrent costochondritis and as subacute inflammatory arthritis. In 1992, the military referred the veteran to a private physician who diagnosed right sternoclavicular arthritis. The Board notes that the RO granted service connection for right sternoclavicular arthritis by a rating decision dated in September 1993, and later evaluated it as 10 percent disabling, effective February 1993, immediately following the veteran's discharge from active service. In March 1999, the veteran underwent further examination for heart and hypertension. The examiner noted that while review of the medical evidence in the claims folder revealed findings of pain, tenderness, swelling and soreness of the right sternoclavicular area, there was no evidence of anginal pain. In addition, the examiner observed no current findings of anginal pain. Rather, the examiner opined that the symptoms of chest pain, tenderness, and swelling which the veteran manifested are due to his service-connected sternoclavicular arthritis. As the veteran is currently service-connected for right sternoclavicular arthritis, for which he is currently receiving compensation, separate, additional compensation for these symptoms is impermissible under 38 C.F.R. § 4.14 (1999). The evidentiary record presents no other medical evidence or opinions establishing that the veteran's disability manifested by chest pains is diagnosed as a disability related to active service separate and apart from the right sternoclavicular arthritis, for which he is already service- connected and receiving compensation. Without current evidence of such a disability, the claim cannot be well- grounded. The Board notes that the present case may be distinguished from Hampton v. Gober, 10 Vet. App. 481 (1997). As noted above, the veteran's service medical records do contain numerous entries concerning complaints of and treatment for chest pain. In addition, his reports of medical history and examination at discharge reflects complaints of pain and pressure in the chest, and findings of hypertension and left ventricular hypertrophy. Nonetheless, the service medical records as a whole-including the report of medical examination at discharge-contain no diagnoses, abnormalities, defects or other findings which identify a disability manifested by chest pains that is separate and apart from the right sternoclavicular arthritis, for which the veteran is already service-connected. The veteran has presented his own statements regarding the cause of his disability manifested by chest pains. However, the record does not show that he is a medical professional, with the training and expertise to provide clinical findings regarding the nature and extent of his disability manifested by chest pains or its etiologic relationship to service. Consequently, his statements are credible concerning his subjective complaints and his history; but they do not constitute competent medical evidence for the purposes of showing a nexus between current complaints and service. See Espiritu v. Derwinski, 2 Vet. App. 492 (1992); Grottveit v. Brown, 5 Vet. App. 91 (1993). As the veteran has presented no evidence, other than his own allegations, to establish that he suffers from a disability manifested by chest pains that is separate and apart from the service-connected right sternoclavicular arthritis and which is etiologically linked to his active service, his claim for service connection for a disability manifested by chest pains is not well grounded. 38 U.S.C.A. § 5107 (West 1991); Caluza, supra. Where a claim is not well grounded, VA does not have a statutory duty to assist a claimant in developing facts pertinent to the claim. Nevertheless, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise the claimant of evidence needed to complete his application. These obligations depend on the particular facts of the case and the extent to which VA has advised the claimant of the evidence necessary to be submitted with a VA benefits claim. Robinette v. Brown, 8 Vet. App. 69, 77-80 (1995). Here, the RO fulfilled its obligation in its statement of the case and its supplemental statement of the case, which informed the veteran of the reasons his claims had been denied. The Board also notes that, unlike Robinette, the veteran in this case has not put VA on notice of the existence of specific evidence which, if submitted, might make his claim well- grounded. See also Epps v. Brown, 9 Vet. App. 341, 344 (1996). B. Swelling of Right Ankle and Right Foot The Board finds that the veteran has presented a well- grounded claim concerning his claim for service connection for a disability claimed as swelling of the right ankle and right foot, within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), as defined by Caluza, supra. Concerning this claim, the Board finds that the veteran's reports of medical history and examination at discharge meet the three requirements for a well-grounded claim. See Caluza, supra, and Hampton, supra. First, the reports of medical history and examination at discharge reflect complaints of swollen and painful joints, arthritis, and foot trouble; a history of arthritis, swollen and painful joints, and swelling of the right foot and ankle; and clinical observations of moderate swelling around the lateral malleolus and of flat feet. Second, the service medical records document complaints of and treatment for these conditions throughout his active service, including assessments and diagnoses of, variously, venous insufficiency, X-ray evidence of soft tissue swelling, right ankle sprain, capsulitis, tendonitis, and arthritis. Concerning presumptive service connection for arthritis, the Board notes that VA treatment records in May 1993 -- within the one-year presumptive period afforded for arthritis in 38 C.F.R. § 3.307, 3.309 - contain a diagnostic impression of arthritis of the right ankle. Nonetheless, the regulations require arthritis to be manifested by X-ray evidence. See 38 C.F.R. § 4.71(a), Diagnostic Code 5003 (1999). In this case, X-ray results consistently reveal a normal right ankle. Consequently, the Board concludes that arthritis in either the right ankle or right foot was not manifest to a degree of 10 percent disabling within the initial post-service year. Nonetheless, the most recent medical evidence-the March 1999 VA examination report-establishes that the veteran does have a right ankle and foot disability, diagnosed respectively as polyarthropy and arthralgia of the right ankle, and plantar fasciitis and arthralgia of the right foot. Concerning the etiology of these disabilities and any causal link to the veteran's active service, the examiners indicated that the etiology was unclear. Yet, the examination reports document a history of complaints of and treatment for right ankle and right foot problems since discharge from active service. The medical evidence confirms this history. For example, VA treatment records document complaints of and treatment for right ankle and right foot problems from May 1993 through October 1998, including, as noted above, diagnoses of arthritis and degenerative joint disease. Private medical records in the claims file also document complaints of and treatment for right ankle and foot conditions including fibromyalgia, osteoarthritis, and plantar fasciitis. Hence, in the present instance, the Board finds that the medical evidence establishes that the veteran exhibits chronic disease of the right ankle and right foot, diagnosed in March 1999 as polyarthropy and arthralgia of the right ankle and plantar fasciitis and arthralgia of the right foot, which has been continuously present from active service to the present. Thus, service connection for these disabilities is appropriate. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 1991); 38 C.F.R. §§ 3.102, 3.303(b) (1999); Savage v. Gober, 10 Vet. App. 488, 497 (1997). ORDER The claim for service connection for a disability manifested by chest pain is denied. The claim for service connection for polyarthropy and arthralgia of the right ankle, and plantar fasciitis and arthralgia of the right foot is granted. MARY GALLAGHER Member, Board of Veterans' Appeals