Citation Nr: 0002061 Decision Date: 01/27/00 Archive Date: 02/02/00 DOCKET NO. 98-06 573 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for headaches. 2. Entitlement to service connection for a stomach condition. 3. Entitlement to service connection for a left wrist disorder. 4. Entitlement to service connection for degenerative arthritis of the lumbar spine. REPRESENTATION Appellant represented by: John Stevens Berry ATTORNEY FOR THE BOARD Douglas E. Massey, Associate Counsel INTRODUCTION The veteran had active military service from February 1941 to July 1945, during which time he was awarded the Purple Heart Medal for injuries sustained in combat. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1998 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri, which denied the benefits sought on appeal. The Board notes that the January 1998 rating decision on appeal also denied claims for service connection for hearing loss, tinnitus, residuals of a shrapnel wound of the right knee, as well as a total disability rating based on individual unemployability due to service-connected disabilities. In February 1998, however, the RO granted each of these claims. Further, in a September 1998 rating decision, the RO granted the claim of entitlement to service connection for cervical spine traumatic arthritis. As such, these issues are no longer in appellate status. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997). FINDINGS OF FACT 1. No competent medical evidence of record establishes that the veteran currently suffers from a disability manifested by headaches. 2. No opinion from a medical professional links the veteran's stomach condition to his period of military service. 3. No competent medical evidence of record establishes that the veteran currently suffers from a left wrist disorder. 4. No opinion from a medical professional links the veteran's current degenerative arthritis of the lumbar spine to his period of military service or to any event thereof. CONCLUSIONS OF LAW 1. The veteran's claim of entitlement to service connection for headaches is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 2. The veteran's claim of entitlement to service connection for a stomach condition is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 3. The veteran's claim of entitlement to service connection for a left wrist disorder is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). 4. The veteran's claim of entitlement to service connection for degenerative arthritis of the lumbar spine 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 resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303(a) (1999). Certain chronic diseases such as arthritis may be presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. See 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). In addition, if a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptoms after service is required for service connection. See 38 C.F.R. § 3.303(b) (1999). The preliminary question to be answered, however, is whether the veteran has presented evidence that each of his claims is well grounded. A well-grounded claim is not necessarily a claim that will ultimately be deemed allowable; rather, it is a plausible claim, properly supported with evidence. See 38 U.S.C.A. § 5107(a); Epps v. Gober, 126 F.3d 1464, 1468 (1997); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to the claim, and the claim must fail. See 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). Three types of evidence must generally be presented in order for a claim for service connection to be well grounded: (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. Where the determinative issue involves medical causation, competent medical evidence to the effect that the claim is plausible is required. See Epps, 126 F.3d at 1468. Alternatively, the United States Court of Appeals for Veterans Claims (Court) has indicated that a claim may be well grounded based on application of the rule for chronicity and continuity of symptomatology, set forth in 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488, 498 (1997). The Court held that the chronicity provision applies where there is evidence, regardless of its date, which shows that a veteran had a chronic condition either in service or during an applicable presumption period and that the veteran still has such condition. That evidence must be medical, unless it relates to a condition that the Court has indicated may be attested to by lay observation. If the chronicity provision does not apply, a claim may still be well grounded "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." Id. I. Service Connection for Headaches, a Stomach Condition, a Left Wrist Disorder, and Degenerative Arthritis of the Lumbar Spine A. Headaches The veteran claims that he currently suffers from occasional headaches as a result of an injury he sustained in service. The veteran maintains that he was hit in the back of the head with a metal tripod while stationed in Ireland, after which time he began experiencing occasional headaches. After a review of the record, however, the Board finds that no competent evidence of record shows that the veteran currently suffers from a disability manifested by headaches. Accordingly, his claim for service connection must be denied as not well grounded. See Epps 126 F.3d at 1468. The veteran's service medical records show no complaint, treatment or finding for any headaches. More importantly, no competent medical evidence has been submitted which establishes that the veteran currently suffers from a disability manifested by headaches. The Board has considered VA examination reports dated in August 1946, September 1947, April 1982, August 1997, and March 1998, none of which include a diagnosis of headaches. In fact, the only medical report in the record which mentions headaches is a VA outpatient treatment report dated in November 1981, more than thirty-five years after the veteran left service. That entry included the veteran's statement concerning a recent headache located behind the eyes. No diagnosis was provided. Indeed, the only evidence that the veteran currently suffers from a disability manifested by headaches are the veteran's own lay statements submitted in support of his claim. However, the Court has clearly stated that where, as in this case, the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994); Espiritu v. Derwinski, 2 Vet. App. 492 494-95 (1991). Since the record does not show that the veteran possesses the medical training and expertise necessary to render an opinion as to either the cause or diagnosis pertaining to headaches, his lay statements cannot serve as a sufficient predicate upon which to find his claim for service connection to be well grounded. See Heuer v. Brown, 7 Vet. App. 379, 384 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 93 (1993)). Under these circumstances, the Board finds that the veteran has not met his initial burden of submitting evidence of a well-grounded claim of entitlement to service connection for headaches, and that the claim must be denied on that basis. See Epps, 126 F.3d at 1468; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that in the absence of evidence of a currently claimed condition, there can be no valid claim). B. Stomach condition The veteran alleges that he currently suffers from a stomach condition which initially began in service. The evidence shows that the veteran currently suffers from a hiatal hernia and possible gastritis. However, since no medical evidence has related either condition to service, the Board can only conclude that the claim for service connection for a stomach condition is not well grounded. See Epps 126 F.3d at 1468. Service medical records show no complaint, treatment or finding for any stomach problems. Post-service medical reports show that the veteran first reported stomach problems in 1980, approximately thirty-five years after he left service. The veteran was seen by a VA nutritionist in March 1980 and was placed on a diet to lose weight. He told the nutritionist that he could not tolerate milk and that he suffered from stomach aches. No diagnosis was recorded in connection with this complaint. In addition, a March 1990 VA outpatient treatment report included a diagnosis of history of peptic ulcer disease (PUD). It was further noted that the veteran had a history of gastrointestinal bleeding associated to certain medications; however, no current findings were reported. In June 1990, the veteran reported occasional episodes in which he would experience palpations, nausea and sweats. Again, however, no diagnosis pertaining to a stomach condition was provided. The veteran was hospitalized by VA from July to August 1992 for stomach pain at the right side of the abdominal area. During his admission, the pain resolved as a result of the veteran possibly passing a gallbladder stone. The diagnoses at discharge were abdominal pain, possible kidney stone, and hematuria. No medical opinion was provided as to the etiology or date of onset of either disorder. In connection with this claim, the veteran was afforded a VA examination in August 1997. The veteran told the examiner that he would experience occasional pain in his lower abdominal area and significant bloating after eating lettuce or broccoli. He said that the frequency of such episodes depended on what he ate. It was noted that an upper GI series performed in January 1997 revealed a small hiatal hernia with a normal esophagus. Based on these findings, the examiner concluded with diagnoses of hiatal hernia and possible esophagitis; however, he did not comment as to the etiology of either disorder. After reviewing the foregoing evidence, the Board finds that the veteran has failed to present competent evidence of a nexus between a currently diagnosed stomach condition and his period of military service. The only evidence in the record which attributes the veteran's stomach problems to service are the veteran's own lay statements. The veteran, however, as a lay person, is not competent to give a medical opinion as to the issue of causation. See Grottveit, 5 Vet. App. at 93 (lay assertions of medical etiology cannot constitute evidence to render a claim well grounded under section 5107(a)). Hence, the Board finds that the veteran's claim for service connection for a stomach condition is not well grounded and must be denied. C. Left wrist disorder The veteran claims that he currently suffers from a left wrist disorder as a result of an injury he sustained in service. He maintains that his vehicle went off the road after being struck by an artillery shell, thereby causing the door to slam into his left wrist. He alleges that pieces from his wrist watch became embedded in the bone. However, no competent evidence has been submitted showing that the veteran currently suffers from a left wrist disorder. Accordingly, his claim for service connection must be denied as not well grounded. See Epps 126 F.3d at 1468. The veteran's service medical records make no reference to a left wrist injury. Nevertheless, the Board accepts the veteran's account of how he injured his left wrist in service. The Board notes that 38 U.S.C.A. § 1154(b) provides a relaxed evidentiary standard of proof to determine service connection for injuries alleged to have been incurred in combat. See also Collette v. Brown, 82 F.3d 389 (1996). Service personnel and medical records confirm that the veteran sustained injuries to his right hand from an artillery blast which blew his vehicle off the road. Thus, the veteran is unquestionably a "combat" veteran. Nevertheless, the reduced evidentiary burden only applies to the issue of service incurrence, and not to the issue of a current disability or of a nexus to service, both of which generally require competent medical evidence. Brock v. Brown, 10 Vet. App. 155, 162 (1997); Libertine v. Brown, 9 Vet. App. 521 (1996); Beausoleil v. Brown, 8 Vet. App. 459, 464 (1996). In this case, the veteran has not submitted any competent evidence that he currently suffers from a left wrist disorder. VA examination reports dated in August 1946, September 1947, March 1982, and August 1997 make no reference to the veteran's left wrist. At a VA orthopedic examination performed in March 1998, the examiner recorded the veteran's statement of having shrapnel and pieces of a wrist watch embedded in his left wrist after an exploding artillery shell blew his truck of the road. However, physical examination revealed no pertinent findings, and no diagnosis pertaining to the left wrist was provided. Despite contentions by the veteran that he currently suffers from residuals of a left wrist injury, as a layperson without medical expertise or training, his statements alone are insufficient to establish the presence of this claimed disability. See Grottveit, 5 Vet. App. at 93 (lay assertions of medical etiology cannot constitute evidence to render a claim well grounded under section 5107(a)); Espiritu v. Derwinski, 2 Vet. App. 492, 494-495 (1992) (laypersons are not competent to render medical opinions). In conclusion, the Board finds that the veteran has not met his initial burden of submitting evidence of a well-grounded claim of entitlement to service connection for a left wrist disorder, and that the claim must be denied on that basis. See Epps, 126 F.3d at 1468; Brammer, 3 Vet. App. at 225 (holding that in the absence of evidence of a currently claimed condition, there can be no valid claim). D. Degenerative arthritis of the lumbar spine The veteran has filed a claim of entitlement to service connection for degenerative arthritis of the lumbar spine, but has not identified any specific injury to account for this disability. While the record discloses that the veteran currently suffers from degenerative arthritis of the lumbar spine, no medical evidence of record has attributed this disability to the veteran's period of active military service. Thus, this claim must be denied as not well grounded. See Epps 126 F.3d at 1468. Service medical records make no reference to any low back problems, nor has the veteran alleged that he injured his lower back during combat in service. The first documented evidence of low back problems is contained in a March 1982 VA examination report, more than thirty years after the veteran's separation from service. X-rays associated with that report show minimal hypertrophic degenerative changes located predominately at the L5-S1 level. The examiner concluded with a diagnosis of chronic low back pain. No opinion as to the etiology or date of onset of this condition was provided. The veteran was afforded several VA orthopedic examinations in connection with this claim. A report from a VA examination performed in August 1997 included a diagnosis of degenerative joint disease of the lumbar spine with spondylolisthesis. Again, however, no medical opinion was offered as to the etiology of this disability. As a result, the veteran underwent an additional VA orthopedic examination in March 1998 to determine the nature and etiology of this disability. The examiner reviewed the veteran's claims file in conjunction with the examination. Based on this review, it was concluded that the veteran's degenerative joint disease of the lumbar spine was not related to service but likely due to the normal aging process. Accordingly, as the veteran has failed to prove the essential element of a nexus between his current degenerative arthritis of the lumbar spine and his period of active military service, this claim must be denied as not well grounded. See Epps 126 F.3d at 1468. E. Conclusion The Board has considered the argument advanced by the veteran's attorney that the VA has failed to properly assist the veteran in the development of these claims by not affording him appropriate medical examinations. However, since each of the above claims for service connection is not well grounded, the VA has no further duty to assist the veteran in developing the record to support these claims. See Epps, 126 F.3d at 1469 ("[T]here is nothing in the text of § 5107 to suggest that [VA] has a duty to assist a claimant until the claimant meets his or her burden of establishing a 'well grounded' claim."). The Board is also unaware of any information in this matter that would put VA on notice that any additional relevant evidence may exist which, if obtained, would well ground any of the veteran's claims. See generally, McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997); Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). The Board views the above discussion as sufficient to inform the veteran of the elements necessary to present a well-grounded claim for each of the benefits sought, and the reasons why the current claims have been denied. Id. ORDER In the absence of evidence of a well-grounded claim, service connection for headaches is denied. In the absence of evidence of a well-grounded claim, service connection for a stomach condition is denied. In the absence of evidence of a well-grounded claim, service connection for a left wrist disorder is denied. In the absence of evidence of a well-grounded claim, service connection for degenerative arthritis of the lumbar spine is denied. S. L. KENNEDY Member, Board of Veterans' Appeals