BVA9505708 DOCKET NO. 91-22 873 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for residuals of a left hip injury. 2. Entitlement to service connection for chronic residuals of an infectious disease, claimed as hepatitis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert P. Regan, Counsel INTRODUCTION The appellant served on active duty from August 1951 to August 1955. This matter came before the Board of Veterans' Appeals (Board) on appeal of an August 1990 rating determination by the Department of Veterans Affairs (VA) Regional Office (RO) located in St. Louis, Missouri. CONTENTIONS OF APPELLANT ON APPEAL The appellant maintains that the RO erred in not granting the benefits sought. The appellant states that, while in basic training, he sustained an injury to the left hip for which he was hospitalized for approximately three weeks. He states that he was not officially informed as to the nature of the injury, but was led to believe that he had a fracture of the left hip or pelvis. He states that he now has Paget's disease and has been informed that Paget's disease could be caused by the type of injury he sustained in service. He further asserts that, while stationed at Mitchell Air Force Base, he contracted hepatitis along with many other fellow servicemen and was treated at the base hospital. He reports there was a big investigation and it was determined that the base housing water supply system was the cause of the hepatitis. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material in the appellant's claims folder and for the following reasons and bases, it is the decision of the Board that the weight of the evidence is against the appellant's claim of entitlement to service connection for residuals of an injury to the left hip and supports his claim for service connection for hepatitis A. FINDINGS OF FACT 1. A left hip injury in service, if any, was acute and transitory and did not result in any residual disability. 2. Type A hepatitis is of service origin. CONCLUSIONS OF LAW 1. Chronic residuals of a left hip injury were not incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(b) (1994). 2. Type A hepatitis was incurred in military service. 38 U.S.C.A. §§ 1131, 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board has found that the appellant's claims are well grounded pursuant to 38 U.S.C.A. § 5107 (West 1991), in that his claims are plausible, that is meritorious on their own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). This finding is based, in part, on the service medical records showing in service treatment for possible hepatitis and the appellant's evidentiary assertions regarding a left injury in service, where the service medical records are incomplete, that appeared to make the claim for service connection "capable of substantiation." Godwin v. Derwinski, 1 Vet.App. 419 (1991); King v. Brown, 5 Vet.App. 19 (1993). Once it has been determined that a claim is well grounded, VA has the statutory duty to assist the appellant in the development of evidence pertinent to that claim. As such, in May 1992 and in March 1994 the Board remanded the case to the RO for additional development of the evidence, which included current VA examinations. Those actions have been completed. The Board is satisfied that the statutory duty to assist the appellant in the development of evidence pertinent to his claim has been met. In order to be entitled to service connection for disease or disability, the evidence must reflect that a chronic disease or disability was either incurred in or aggravated by military service. 38 U.S.C.A. §§ 1110, 1131 (West 1991). For the showing of a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic". Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1994). I. Service Connection for Residuals of an Injury to the Left Hip The available service medical records, which cover a period of treatment from June to July 1955, contain no reference to an injury or treatment for a left hip disability. At the time of the August 1955 separation examination, the musculoskeletal system was clinically evaluated as normal. No reference was made to an injury to the left hip. The appellant's original application for compensation benefits was received in May 1990. At that time he indicated that he had sustained a hip injury in 1951 and that he had not received any treatment for his left hip since his release from active duty. A hearing was held at the RO in November 1990. At that time the appellant indicated that he sustained an injury to the left hip during boot camp when he fell on the canister of his gas mask. He indicated that he was hospitalized for approximately one month. He testified that the left hip or left leg was not casted. He was X-rayed. A doctor never informed him exactly what was wrong. A corpsman told him he had a broken bone. A month after he was released from the hospital he had no real pain or discomfort. He further testified that his left hip did not really bother him today, but his doctors had informed him that he had probable Paget's disease in the same area. Received in June 1992 were a private intravenous urogram and a bone scintigraphy, dated in September and November 1987, respectively. The intravenous urogram revealed findings which in part were interpreted as showing enlargement and "corasening" of the trabeculae of the left inferior pubic ramus and the left ischial tuberosity. It was remarked that these findings may have been due to Paget's disease of the bone. A clinical correlation was recommended. The bone scintigraphy revealed findings which were interpreted as showing probable Paget's disease of the left innominate bone. A VA examination was conducted in June 1992. The appellant indicated that he had injured his left hip when he fell on a metal canister while in basic training in 1951. He was hospitalized for 2 to 3 weeks. He stated that there were no fractures and that no surgery was done. He was taking over-the- counter pain medication for his hip. He reported that his left hip was nonsymptomatic. There was no pain or stiffness reported. The examination showed that the left hip was cool. There was no erythema or increased temperature. There were no swelling and no deformity of the left hip. Flexion of the left hip was 130 degrees, extension 30 degrees, internal rotation 40 degrees and abduction 40 degrees. The examiner described the range of motion as being full. X-rays of the left hip showed no abnormality. The diagnosis was status post remote injury to the left hip and rule out traumatic arthritis, no residual impairment. To summarize, the service medical records are apparently incomplete. The records on file do not substantiate the appellant's claim of a left hip injury during basic training. In this regard, the absence of even any statements of medical history at separation from service is significant. However, assuming, without conceding, that the appellant sustained a left hip injury while on active duty, this injury, in and of itself, is an insufficient basis on which to predicate a grant of entitlement to service connection for the residuals of that injury. The United States Court of Veterans Appeals (Court) has held that, in order for a veteran to be granted entitlement to service connection for a disease or disability, the law requires that there must be evidence both of a service-connected disease or injury and a present disability which is attributable to such disease or injury. Rabideau v. Derwinski, 2 Vet.App. 141, 143 (1992). The appellant during his hearing at the RO testified that, approximately a month following his release from the hospital during service, his left hip did not result in any real pain or discomfort. The appellant further testified that his left hip did not actually currently bother him. These statements are confirmed in part by the service separation examination, dated in August 1955, which found no clinical abnormality regarding the left hip, and the recent VA examination, conducted in June 1992, which found no residual disability relative to the reported in service left hip injury. The appellant further testified at his hearing that he was informed by a private physician that he has probable Paget's disease in the left hip and that this could be caused by an injury in that area. However, he has not submitted medical evidence which substantiates this testimony. When the determinative issue involves a question of medical causation, only individuals possessing specialized training and knowledge are competent to render an opinion. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). The evidence does not show that the appellant possesses medical expertise, nor is it contended otherwise. The Court has also held that a statement from a lay party as to what a medical provider told him is insufficient to provide competent evidence on a matter requiring medical expertise. Warren v. Brown, 6. Vet.App. 4, 6 (1994). Private medical records, dated in 1987, indicate the presence of probable Paget's disease of the left innominate bone. However, there is no subsequent medical evidence which has confirmed the presence of Paget's disease. Additionally, there is no medical evidence of record relating the probable Paget's disease specifically to the claimed in service left hip injury in 1953. Accordingly, without any current medical evidence showing the presence of a left hip disability which is a residual of, or related to, the claimed in service left hip injury, service connection is not warranted. Finally, the evidence regarding this claim is not in equipoise and the benefit of the doubt doctrine is not applicable. 38 U.S.C.A. § 5107 (West 1991). II. Service Connection for Residuals of a Chronic Infectious Disease, Claimed as Hepatitis The service medical records reflect that the appellant was seen on several occasions during June 1955 for complaints of being tired, weak and loss of appetite. The impression was infectious mononucleosis and rule out hepatitis. Several blood studies were performed without a definitive diagnosis being rendered. The service separation medical examination report, dated in August 1955, contains no clinical finding diagnostic of hepatitis. Private medical records dated in 1987 and 1988 contain no definitive finding indicating the presence of hepatitis or residuals thereof. VA examinations were performed in June 1992. During an examination for hematological disorders, the appellant indicated that he may have had mononucleosis while on active duty in 1954- 1955. The examiner stated that the appellant apparently had infectious hepatitis and was told that he might have had mononucleosis. A mononucleosis test was not done. There was no history of any hematologic disorders. During the examination, the appellant had no complaints. There were no symptoms reported. The examination showed no abnormality. The diagnosis was possible history of mononucleosis. A VA examination for disorders involving alimentary appendages revealed a history that the appellant developed jaundice in 1954 and 1955 and was told he had "infectious hepatitis". He was not hospitalized. His treatment consisted of rest, diet and medications. He remained jaundiced for six weeks. The appellant reported no recurrent liver disease. During the examination the appellant reported no complaints. There were no symptoms evident. The examination showed no abnormality. The diagnosis was remote history of probable Type A hepatitis without residuals. VA examination for alimentary appendages was performed April 1994. At that time the appellant gave a history of developing infectious hepatitis while stationed at Mitchell Air Force Base in Long Island, New York, in June 1955. The appellant reported he developed fatigue and was found to be jaundiced. After he was evaluated, a military physician informed him that he had infectious hepatitis. He was also told that a large number of service personnel also had the disease because of a breakdown in the water and sewer services on Long Island. He was treated with a large number of pills. He was jaundiced and had symptoms for three weeks after being diagnosed. The illness eventually cleared and has not recurred. The appellant reported that he had no further problems with the infection. Liver function studies done in June 1992, in conjunction with VA examinations, were all within normal limits except an AST of 46 (normal, 5-35). Bilirubin was 1.3 and TSP 7.7, with albumin of 4.9. Mononucleosis screen was negative. Hepatitis screening was negative. The appellant had no liver symptoms. During the examination the appellant reported no gastrointestinal or abdominal symptoms. The examination showed no abdominal discomfort, food intolerance, nausea, vomiting, pain, anorexia, or malaise. Examination of the abdomen showed no abnormalities. There was no weight loss or generalized weakness. The diagnosis was status post probable infection with Type A hepatitis in 1955. The examiner noted that, although hepatitis screening antibodies had been negative, the examiner believed that the appellant probably did have Type A hepatitis in 1955. The Type A hepatitis was apparently related to a contaminated water supply at Mitchell Air Force Base on Long Island, New York. There are no residuals. The appellant was told that he may have had mononucleosis, but he was jaundiced and mononucleosis usually does not cause jaundice. A VA hematologic examination was also performed in April 1994. At that time, the appellant reported no symptoms of blood disease, the examination was within the range of normal limits. The diagnosis was hematologic diseases/disorders not diagnosed. Diagnostic code 7345 of VA's Schedule for Rating Disabilities provides a no percent evaluation for healed, nonsymptomatic infectious hepatitis. 38 C.F.R. Part 4 (1993). VA examinations, conducted in 1992 and 1994, indicated that the appellant did, in fact, probably have hepatitis Type A while on active duty. The evidence does not contradict this assessment. Although no associated disability is currently shown, none is required under diagnostic code 7345. Accordingly, service connection for Type A hepatitis is warranted. ORDER Service connection for residuals of a left hip injury is denied. Service connection for Type A hepatitis is granted. RICHARD B. FRANK Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.