Citation Nr: 0006436 Decision Date: 03/09/00 Archive Date: 03/17/00 DOCKET NO. 96-14 377 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUES 1. Entitlement to service connection for hypertension as secondary to service-connected post-traumatic stress disorder (PTSD). 2. Entitlement to service connection for diabetes mellitus as secondary to service-connected post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C. Hancock, Counsel INTRODUCTION The veteran served on active duty from June 1969 to December 1970. The issues currently on appeal come before the Board of Veterans' Appeals (Board) from a July 1995 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) located in New Orleans, Louisiana. The Board, in July and November 1998, remanded these claims to the RO in order to address the veteran's right of due process. A hearing was conducted before a member of the Board at the RO in December 1997. The veteran was notified by the Board that the Board member who conducted the hearing was, due to an extended illness, was unable to participate in deciding his appeal. That Board member has since retired from the Board. The veteran was asked if he desired another hearing. He responded in the affirmative. Subsequently, in August 1998 he indicated that he no longer wanted a hearing. FINDINGS OF FACT 1. The veteran has presented no competent medical evidence linking his hypertension with his service-connected PTSD. 2. The veteran has presented no competent medical evidence linking his diabetes mellitus with his service-connected PTSD. CONCLUSIONS OF LAW 1. The veteran's claim of entitlement to service connection for hypertension as secondary to service-connected PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim of entitlement to service connection for diabetes mellitus as secondary to service-connected PTSD is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for a disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (1999). In addition, service connection may also be granted for disability which has been aggravated by a service-connection disease or injury. Allen v. Brown, 7 Vet. App. 439 (1995). A claim for secondary service connection, like all claims, must be well grounded. Reiber v. Brown, 7 Vet. App. 513, 516 (1995). The veteran has the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). A well-grounded claim is one that is plausible, capable of substantiation, or meritorious on its own. 38 U.S.C.A. § 5107(a) (West 1991); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In a case such as this, where the determinative issue involves a question of medical causation, i.e., whether the claimed condition is etiologically linked to a service- connected disability, competent medical evidence in support of the claim is required for the VA to find the claim well grounded. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). Hypertension The veteran claims that his service-connected post-traumatic stress disorder (PTSD) caused his hypertension. Service connection is in effect for PTSD currently evaluated as 50 percent disabling. A review of the evidence reflects that the veteran's service medical records contain no complaint or finding indicative of hypertension nor is it contended otherwise. The veteran received treatment at a private facility from 1988 to 1994 for several disorders, including hypertension. A VA psychiatric examination was conducted in March 1993. At that time the diagnoses included history of hypertension. The report did not, however, demonstrate a relationship between the veteran's service-connected PTSD and the diagnosed history of hypertension. A VA cardiovascular examination was conducted in June 1995. The clinical history indicated that he had a four year history of hypertension. He was taking medication. The diagnosis was hypertension. A hearing was conducted before a member of the Board sitting at the RO in December 1997. At that time the veteran testified that he was under a lot of stress, both in his employment as a teacher as well as in his personal life. He added that he had not had any health problems before he began to have nightmares associated with his PTSD. The representative cited a particular study in the American Heart Journal which studied the relationship between PTSD and hypertension. A copy of the study was not supplied. To summarize, where the determinative issue involves a question of medical diagnosis or medical causation, competent medical evidence to the effect that the claim is plausible or possible is required to establish a well-grounded claim. Grottveit v. Brown, 5 Vet.App. 91, 93 (1993). Lay assertions of medical causation, or substantiating a current diagnosis, cannot constitute evidence to render a claim well grounded under 38 U.S.C.A. § 5107(a); if no cognizable evidence is submitted to support a claim, the claim cannot be well grounded. Id. While the veteran is competent to describe symptoms associated with his hypertension and PTSD, a diagnosis and an analysis of the etiology regarding such complaints requires competent medical evidence and cannot be evidenced by the veteran's lay testimony. See Espiritu v. Derwinski, 2 Vet.App. 492, 494 (1992). In VA Form 646, Statement of Accredited Representation in Appealed Case, dated in July 1996, the representative discussed and cited a 1972 and 1978 medical studies, one of which was previously noted in the course of the December 1997 hearing, in support of the veteran's claims. These studies deal in the percentages of individuals who have hypertension and a psychiatric disorder The Board notes that in the recent case of Wallin v. West, 11 Vet. App. 509, 513-514 (1998), the Court found that a treatise, standing alone, that discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least a plausible causality, is sufficient to well ground a claim. In this case, the Board is of the opinion that the information gleaned from the cited medical studies does not supply the Board with a "degree of certainty," under the facts of this case, to find the veteran's claim well-grounded. The veteran has not submitted any competent medical evidence nor is there any competent medical evidence of record which establishes a nexus between the hypertension and the PTSD. Accordingly, the claim of entitlement to service connection for hypertension as secondary to service-connected PTSD is not well grounded. Diabetes Mellitus Review of the veteran's service medical records do not reveal that the veteran had diabetes mellitus during his period of service. Various private medical treatment records dated between 1988 and 1994 have been associated with the veteran's claims folder. These records show that he was seen for elevated glucose beginning in 1993. Follow-up evaluations confirmed the presence of diabetes mellitus. A VA diabetes mellitus examination was conducted in June 1995. The clinical history shows that he was seen for glucosuria on a routine physical. Follow-up confirmed the presence of diabetes mellitus. The veteran was on a 1500 calorie diet. He did not use insulin. The diagnosis was diabetes mellitus. During the December 1997 the veteran testified that he essentially believed that his diabetes mellitus disorder had its onset as of result of stressors which were brought about by his PTSD. He added that he had not experienced any health problems before he began to have nightmares associated with his PTSD. The Board notes that the veteran's contentions are the only evidence linking the diabetes mellitus with the service- connected PTSD. As discussed above, the veteran is a layperson with no medical training or expertise, and his contentions by themselves do not constitute competent medical evidence of a nexus between the diabetes mellitus and his service-connected PTSD. See Espiritu, supra. The veteran has not submitted any competent medical evidence nor is there any competent medical evidence of record, which establishes a nexus between the diabetes mellitus and the PTSD. Accordingly, the claim of entitlement to service connection for diabetes mellitus as secondary to service- connected PTSD is not well grounded. ORDER Entitlement to service connection for hypertension as secondary to service-connected PTSD is denied. Entitlement to service connection for diabetes mellitus as secondary to service-connected PTSD is denied. ROBERT P. REGAN Member, Board of Veterans' Appeals