Citation Nr: 0004683 Decision Date: 02/23/00 Archive Date: 02/28/00 DOCKET NO. 98-14 270 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUE Entitlement to service connection for ischemic heart disease and hypertension. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD R. M. Panarella, Associate Counsel INTRODUCTION The veteran served on active duty from August 1940 to June 1946, including confinement as a prisoner of war (POW) of the Japanese Government from May 1942 to September 1945. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the September 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office in Des Moines, Iowa (RO). FINDINGS OF FACT 1. There is no competent medical evidence of a current diagnosis of ischemic heart disease. 2. There is no competent medical evidence linking the veteran's hypertension to his period of active service. CONCLUSION OF LAW The claim of entitlement to service connection for ischemic heart disease and hypertension is not well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran contends that he should be service connected for ischemic heart disease and hypertension secondary to beriberi as a POW during service. In pertinent part, service connection for beriberi heart disease (which includes ischemic heart disease in a former POW who experienced localized edema during captivity) may be presumed if a veteran develops this disease to a compensable degree at any time following discharge from active service. 38 C.F.R. §§ 3.307, 3.309(c) (1999). The law provides that service connection for hypertension may be presumed if a veteran served for 90 days or more during a period of war or after January 1, 1947, and the condition manifested to a compensable degree within one year of service. 38 C.F.R. §§ 3.307, 3.309(a) (1999). The Board acknowledges the veteran's contentions; however, it must first be determined whether the veteran has satisfied his burden of presenting a well-grounded claim for service connection. A well-grounded claim is a plausible claim, one that is meritorious on its own or capable of substantiation. See 38 U.S.C.A. § 5107(a) (West 1991); Grivois v. Brown, 6 Vet.App. 136, 140 (1994); Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). To establish that a claim for service connection is well- grounded, generally, a veteran must present (1) competent medical evidence of a current disability; (2) lay or medical evidence, as appropriate, of incurrence or aggravation of a disease or injury in service; and (3) competent medical evidence of a nexus between the in-service disease or injury and the current disability. In the absence of evidence of a well-grounded claim, there is no duty to assist the veteran in developing the facts pertinent to his claim, and the claim must fail. Epps v. Gober, 126 F.3d 1464, 1467-1468 (Fed. Cir. 1997). The veteran's service medical records confirm that he was a POW from May 1942 to September 1945. He reportedly lost about 50 pounds. He had beriberi and other diseases due to inadequate nutrition during his confinement and was treated for malnutrition upon repatriation. The service medical records contain no evidence related to ischemic heart disease, hypertension, or other cardiovascular disability. Likewise, VA examinations dated March 1949, March 1954, and March 1983 found the veteran's cardiovascular system to be normal. A VA examination in November 1983 diagnosed the veteran with borderline hypertension. An x-ray of the veteran's chest performed at that time suggested the presence of hypertensive heart disease. VA hospital records dated April to May 1997 included an unremarkable cardiopulmonary examination and a diagnosis of hypertension. During a VA examination in May 1997, the veteran reported that his hypertension manifested during the 1960's and that he had been on medication since the late 1970's. His blood pressure was recorded as 140/70 lying, 145/68 sitting, and 140/90 standing. The cardiovascular examination was otherwise normal. The veteran's diagnoses included hypertension, well controlled by medication. A July 1998 letter from John P. Jacobs, M.D., stated that the veteran had an increase of neurological symptoms in February 1997 and that he presently had objective evidence of neurological deficit, including foot drop and decreased sensitivity of the left lower extremity. These symptoms could occur as sequelae of stroke or neuropathy. A VA outpatient record dated September 1998 shows that the veteran began to have neurological symptoms in April 1997. He had improved but still had difficulty with speech and language. Current findings were consistent with anterior left frontal lobe damage. An MRI of the brain performed in November 1998 disclosed watershed ischemic changes of the left hemisphere, left basal ganglia lacune, and small vessel ischemic disease within the white matter. VA routine follow- ups in October 1998, February 1999, and April 1999 disclosed that the veteran continued to control his hypertension with medication and that cardiac examinations were normal. A history of left frontal lobe deficit, with improvement, was noted. During a VA examination in May 1999, the veteran reported a recent history of becoming confused and obtunded, and developing weakness of the left leg. He had been diagnosed with a cerebrovascular accident. The veteran presently complained of poor memory, speech difficulties, and residual weakness. He also reported treatment for hypertension for the past ten years. The cardiac examination was normal. The veteran's diagnoses included essential hypertension, not well controlled. The veteran appeared at a hearing before the undersigned Board Member in November 1999. He testified that he presently suffered from several symptoms which he believed were manifestations of beriberi heart disease and that he had swelling of the legs while a POW. He also testified that he thought that his hypertension was a result of his heart disease and that the MRI of his brain showed ischemic heart disease. Based upon the aforementioned evidence, the Board finds that the veteran's claim of entitlement to service connection for ischemic heart disease must be denied as not well grounded because there is no current medical diagnosis of such a disability. The medical evidence of record following the veteran's discharge from active service includes no documentation that the veteran has ever been diagnosed with ischemic or beriberi heart disease. The Board recognizes that the veteran reportedly has ischemic changes of the brain and that he believes that he suffers from ischemic heart disease. However, the record does not show that any ischemic damage of the brain would support a diagnosis of ischemic heart disease. Lay testimony cannot provide such medical evidence because lay persons are not competent to offer a diagnosis or opinions requiring medical expertise. See Stadin v. Brown, 8 Vet. App. 280, 284 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the evidence of record contains no competent medical opinion relating the veteran's hypertension to any incident of active service. The first documented diagnosis of hypertension in the record is dated November 1983 and the veteran has stated that he was first diagnosed with hypertension in the 1960's. Both dates are many years following active service and no medical professional has related the hypertension back to the veteran's period of active service. Nexus evidence may not be provided by lay testimony. See Brewer v. West, 11 Vet.App. 228 (1998). In this case, service connection may not be presumed under the applicable presumptive provisions, including the lifetime presumptive provisions for beriberi/ischemic heart disease in certain former POW's. According to the medical evidence of record and information provided by the veteran, hypertension was not evident until many years following service. In addition, although the veteran is already service connected for beriberi, and he has not been shown to have ischemic heart disease. It is, of course, beyond question that the veteran suffered extreme hardship as a POW for over three years during World War II, having been captured with the fall of Corregidor in May 1942. The Board appreciates his service on behalf of his country. He is currently service-connected for post- traumatic stress disorder, rated at 70 percent, and other disabilities due to service. Inasmuch as the record does not include a medical diagnosis of ischemic heart disease or competent medical evidence linking hypertension to service, however, the veteran's current appeal must be denied as not well grounded. The Board is unaware of the existence of additional evidence currently available that might well ground his claim and trigger notification requirements pursuant to 38 U.S.C.A. § 5103(a) (West 1991). See McKnight v. Gober, 131 F.3d 1483, 1484-1485 (Fed. Cir. 1997). The veteran may reapply to the RO for compensation at any time with medical evidence of ischemic heart disease or appropriate evidence linking his hypertension to service. ORDER Evidence of a well-grounded claim not having been submitted, service connection for ischemic heart disease and hypertension is denied. CHARLES E. HOGEBOOM Member, Board of Veterans' Appeals