Citation Nr: 0006054 Decision Date: 03/07/00 Archive Date: 03/14/00 DOCKET NO. 97-21 827 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for a left ankle disability. 3. Entitlement to service connection for renal disease. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael F. Bradican, Associate Counsel INTRODUCTION The veteran served on active duty from October 1991 to January 1996. This case arises before the Board of Veterans' Appeals (Board) on appeal from a rating decision of October 1996, from the St. Petersburg, Florida, Regional Office (RO) of the Department of Veterans Affairs (VA). The Board notes that the veteran entered a notice of disagreement and VAF-9 with regard to service connection for thyroid cancer. This claim appears to have been developed separately from the three issues in appellate status. No statement of the case has yet been produced for the issue of service connection for thyroid cancer. The veteran had initially requested a travel board hearing in connection with his appeal, but later canceled this request. He then reinstated the request for a hearing, but accepted a local hearing and provided testimony solely on the issue of service connection for thyroid cancer. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claim has been developed. 2. The evidence does not show a diagnosis of hypertension during active military service. 3. The evidence does not show systolic readings predominantly 160 or more, or diastolic readings predominantly 100 or more within one year of active service. 4. The evidence does not show that the veteran required continuous medication for control of hypertension within one year of active service. 5. The veteran incurred a severe sprain of the left ankle during active service and continues to experience pain and intermittent instability. 6. The veteran's service medical records, as well as post service medical records, are negative for any diagnosis of a chronic kidney disability or renal disease. CONCLUSIONS OF LAW 1. The veteran's hypertension disability did not originate during his active service and did not manifest itself to a degree of 10 percent or more during the presumptive period. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.309, 3.321, 4.104 Diagnostic Code 7101 (1999). 2. A left ankle disability was incurred in active military service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1999). 3. The veteran's claim for service connection for renal disease is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 1. Entitlement to service connection for hypertension. Initially, the Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); that is, he has presented a claim that is plausible. He has not alleged that any records of probative value that may be obtained and which have not already been associated with his claims folder are available. The Board accordingly finds that the duty to assist him, as mandated by 38 U.S.C.A. § 5107(a) (West 1991), has been satisfied. A review of the veteran's service medical records is negative for a diagnosis of hypertension. His separation examination shows readings of 148/86 sitting, 132/78 recumbent, and 142/82 standing. The report of a VA General Medical examination, conducted in January 1997, shows a diagnosis of mild diastolic hypertension, currently not treated. A VA hypertension examination, conducted on January 6, 1997, less than one year after the veteran's separation on January 25, 1996, shows blood pressure readings of 152/94 sitting, 146/88 lying and 136/92 standing. The examiner stated that the veteran's blood pressure appeared to be somewhat elevated by all readings on this examination. He recommended that he have his blood pressure re-checked, but felt that he would likely need anti-hypertensive medication. He stated that an ACE inhibitor would be a good choice, such as Lisinopril. Service connection may also be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. 38 U.S.C.A. §§ 1110, 1112, 1131 and 1137 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.303, 3.304, 3.307 and 3.309(a) (1999). Service connection for cardiovascular-renal disease, including hypertension, may be established based on a legal "presumption" by showing that it was manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. § 1112 (West 1991 & Supp. 1998); 38 C.F.R. §§ 3.307 and 3.309 (1999). 38 C.F.R. § 4.104 Diagnostic Code 7101 provides that hypertensive vascular disease warrants a 10 percent evaluation if diastolic pressure is predominantly 100 or more, or; systolic pressure is predominantly 160 or more, or; there is a history of diastolic pressure predominantly 100 or more requiring continuous medication for control. A review of the objective medical evidence of record does not show that the veteran's hypertension disorder manifested itself to a degree of 10 percent within one year of his separation from service. Although a diagnosis of hypertension was entered on two VA examinations in January 1997, there is no indication that the veteran had systolic readings predominantly 160 or more, or diastolic readings predominantly 100 or more, either at that time or prior to that time. It must also be noted that, although the VA examiner, on January 6, 1997, indicated that he considered that the veteran would need anti-hypertensive medication; he also recommended that he be re-checked before such medication could be started. There is no indication that the veteran was prescribed medication for continuous control of hypertension within one year following his separation from service. 2. Entitlement to service connection for a left ankle disorder. A review of the veteran's service medical records indicates that he was treated for a severe grade III sprain of the left ankle in 1993. There was no evidence of fracture or dislocation. The condition was treated conservatively, but the veteran continued to voice complaints through the remainder of his service. The report of his separation examination shows him reporting that he lacked full extension of his left ankle and was unable to crouch for any period of time. The report of a VA examination, conducted in December 1996, showed the veteran giving a history of an inservice injury while on a road march. He reported that he was told that he could either put up with the pain or have his ankle fused. He reported that he dislocated the ankle three times since his separation. He stated that he takes Darvon for the pain and wears supportive shoes. He complained of a constant throbbing pain with occasional sharp shooting pain in the lateral aspect of his right foot. He reported the pain was aggravated by standing and that he experienced occasional swelling and discoloration on the lateral aspect of his left foot and ankle. Examination showed muscle strength was 5/5 on the right lower extremity. The examiner was unable to complete muscle testing on the left due to the veteran's pain. There was positive pain on palpation of sinus tarsi on the left and on palpation of the anterior talofib ligament and the calcaneo- fibular ligament on the left ankle. There was a positive inversion stress test on the left compared to the right. There was pain on palpation of the proximal Achilles tendon just proximal to the insertion site. There was positive pain on range of motion of the subtalar joint and ankle joint. No crepitus was noted. X-ray examination showed a sclerotic line in the area of the distal epiphysis. The veteran related that he had problems with the epiphysis fusing to the rest of the tibia as a child. He stated that he was in and out of a walking cast from age 10 to 14. The examiner commented that this finding might be related. Joint space of the ankle and subtalar joint were within normal limits. No gross deformities were noted. No evidence of fracture or dislocation was noted. The assessment was status post left ankle injury with continued pain with instability noted on manual stress testing. Treatment records subsequent to this examination show the veteran continuing to complain of pain in the left ankle. The VA treatment records from July 1998 show tenderness of the left ankle with no instability. There was a full range of motion with no swelling but diffuse tenderness about the ankle. X-ray examination noted very little degenerative joint disease. The Board concludes that the veteran currently has residual disability related to his inservice injury, therefore, a grant of service connection for a left ankle disability is in order. 3. Entitlement to service connection for renal disease. It is the responsibility of a person seeking entitlement to service connection to present a well-grounded claim. 38 U.S.C.A. § 5107 (West 1991). Generally, 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). In order to be well grounded, a claim for service connection must be accompanied by supporting evidence that the particular disease, injury, or disability was incurred in or aggravated by active service; mere allegations are insufficient. Tirpak v. Derwinski, 2 Vet. App. 609, 610-611 (1992); Murphy, 1 Vet. App. at 81. A claim for service connection requires three elements to be well grounded. It requires competent (medical) evidence of a current disability; competent (lay or medical) evidence of incurrence or aggravation of disease or injury in service; and competent (medical) evidence of a nexus between the in- service injury or disease and the current disability. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 504 (1995); aff'd 78 F.3d 604 (Fed. Cir. 1996) (table). The Board has reviewed all the evidence of record, which consists of the veteran's contentions, service medical records, private medical records, and reports of VA treatment and examinations conducted subsequent to his active service. There is no indication in the veteran's service medical records that he was treated for or diagnosed with a chronic kidney disorder. Post-service medical records likewise fail to show a diagnosis of a chronic kidney disorder. VA general medical examination, conducted in January 1997, shows no complaints or findings regarding a chronic renal disorder. The veteran's claim for service connection is not well grounded as there is no evidence of an inservice diagnosis or of a current disability. The Board has thoroughly reviewed the claims file, but finds no evidence of a plausible claim for service connection for a renal disorder. Since the appellant has not met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded, it must be denied. Where an appellant has not met the burden of presenting evidence of a well grounded claim, VA has no duty to assist him any further in developing facts pertinent to his claim, including any duty to provide him with a medical examination. 38 U.S.C.A. § 5107(a)(West 1991); 38 C.F.R. § 3.159 (1999); Rabideau, 2 Vet. App. at 144 (where the claim was not well grounded, VA was under no duty to provide the appellant with an examination). However, where a claim is not well grounded, it is incomplete, and depending on the particular facts of the case, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his application. Robinette v. Brown, 8 Vet. App. 69, 77 (1995). In this case, however, the RO has complied with this obligation in the June 1997 statement of the case, the subsequent supplemental statements of the case, and in the above discussion. ORDER Entitlement to service connection for hypertension is denied. Entitlement to service connection for a left ankle disorder is granted. Entitlement to service connection for a renal disorder is denied. M. W. GREENSTREET Member, Board of Veterans' Appeals