Citation Nr: 0002884 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 98-04 864A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to service connection for leg ulcers. REPRESENTATION Appellant represented by: Non Commissioned Officers Association of the U.S.A. ATTORNEY FOR THE BOARD Jason R. Davitian, Associate Counsel INTRODUCTION The veteran served on active duty from August 1954 to August 1956. This case is before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 1998 rating decision of the Department of Veterans Affairs (VA) Regional Office in Detroit, Michigan, which denied the benefit sought on appeal. FINDINGS OF FACT The veteran's claim for service connection for leg ulcers is not plausible. CONCLUSION OF LAW The veteran's claim for service connection for leg ulcers is not well-grounded. 38 U.S.C.A. § 5107(b) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran maintains, in substance, that his current leg ulcers are the result of injuries incurred and leg ulcers suffered while on active duty. Accordingly, a favorable determination is requested. The threshold issue is whether the veteran has presented a well-grounded claim for service connection for leg ulcers. In this regard, the veteran has "the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well-grounded." 38 U.S.C.A. § 5107(a)(West 1991); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Grivois v. Brown, 6 Vet. App. 136, 140 (1994). The veteran must satisfy three elements for the claim for service connection for leg ulcers to be well-grounded. Initially, there must be competent (i.e. medical) evidence of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) and Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992). Secondly, there must be evidence of an incurrence or aggravation of a disease or injury in service, as shown through lay or medical evidence. Layno v. Brown 6 Vet. App. 465, 469 (1994). Finally, there must be evidence of a nexus between the in-service injury or disease and the current disability, as shown through medical evidence. Latham v. Brown, 7 Vet. App. 359, 365 (1995). The veteran's service medical records include the report of the veteran's August 12, 1954, pre-induction medical examination. A scar on the right shin bone was noted. No pertinent defect or diagnosis was identified. The veteran's August 12, 1954, pre-induction report of medical history is negative for relevant complaints. An outpatient medical record dated August 20, 1954, provides that the veteran was in an auto accident two weeks earlier. He had a draining lesion on the right leg that was noted to smell like "osteo." He was to be admitted to surgery. Hospital records show that on August 20, 1954, the veteran was hospitalized for treatment of superficial ulcerations of the right anterior leg. It was noted that about one year earlier, he had been in an automobile accident sustaining severe skin abrasions on both shins. About two weeks earlier, he had sustained multiple ulcerations of the skin over the right third of the tibia. On current physical examination, it was noted the veteran had thin scar tissue over both shins, with multiple superficial ulcers of scar tissue on the right shin of the mid third of the right tibia. The veteran was discharged on October 2, 1954. His ulcers of the right leg were noted to have healed completely. The final diagnosis was "[u]lceration, superficial, right anterior leg, [accidentally incurred] approximately two weeks prior to hospital admission while playing basketball at Camp Gordon, Georgia. Treated. Improved. [Line of duty.]" In December 1954, the veteran fell on a foot locker and complained of a sore left leg. An abrasion was dressed. The veteran's May 1956 separation report of history is negative for pertinent complaints, and includes a physician's summary that the veteran had no serious illness or injury while in service. The report of the veteran's May 1956 separation medical examination provides that the veteran's skin and lower extremities were normal on clinical evaluation. No defects or diagnoses were summarized. A February 1970 report from Grace Hospital shows that the veteran was admitted because of a left leg wound incurred when the veteran had his legs caught between the bumpers of two cars. The report notes that an old wound over the veteran's right leg was well healed. The impression was post-traumatic wound of the left lower leg. A March 1996 hospital discharge summary from Harper Hospital provides a pertinent secondary diagnosis of venous stasis ulcers, bilateral lower extremities. The recommended treatment was dressing changes, lower extremity elevation. No opinion was offered as to the etiology of the ulcers. Turning to post-service VA treatment, the veteran has alleged treatment for leg ulcers in 1956 at the Atlanta VA Medical Center (VAMC). However, correspondence received in April 1998 from the Atlanta VAMC provides that a thorough search of the medical files at that facility did not reveal any records for the veteran. VA outpatient treatment records dated from January to March 1997 show treatment for stasis ulcers, venous ulcers and chronic leg ulcers. No opinions as to the etiology of the ulcers was provided. A January 1997 VA hospital discharge summary provided that the veteran had a history of venous stasis ulcers secondary to varicose veins for the past more than ten years. VA hospital discharge summaries dated in March and April 1997 provide pertinent diagnoses of venous stasis ulcers. The ulcers were described as being on the veteran's legs. No opinion as to their etiology was offered. The report of a June 1997 VA general medical examination includes the veteran's own history of recurrent ulcers in both legs since the age of ten or eleven years. Presently, he had one ulcer, about one inch long, on the right lower leg and one ulcer over the left thigh, about six inches long. The ulcers were dry and had been present for the last eight to nine months. Their bases were covered by granulation tissues. No varicose veins were present. The pertinent diagnosis and impression was chronic leg ulcers. No opinion was offered as to the etiology of these ulcers. A January 1998 VA medical opinion, based on a review of the veteran's records, notes that his service medical records indicate that he injured his right leg on two separate occasions in service. It was also noted that the service medical records indicated that there had been complete healing of the lesions on the right leg at the time of his separation. It was further noted that, in February 1970, at which time the veteran sustained trauma to his left lower leg, it was noted in the physical examination that the veteran's old wound over the right lower leg was well healed. It was cited that more recent examinations between March 1996 and April 1997 have resulted in the veteran's lower extremities ulcers being described as varicose ulcers by several different physicians. In view of these findings, the VA examiner concluded that it was less than likely that the veteran's right leg ulcerations are due to or the result of any injury during service. The veteran's post-service private and VA medical records do show a current diagnosis of leg ulcers. However, they do not provide competent evidence, such as a medical opinion, showing a nexus or link between the veteran's current leg ulcers and his inservice leg injuries or leg ulcerations. Ideally, such an opinion would be based on a review of the record. In fact, the only opinion as to the etiology of the veteran's current leg ulcers indicates that they are not related to his active service. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Because of the lack of competent evidence of such a positive relationship in this case, the veteran's claim for service connection for leg ulcers is not well- grounded and the appeal must be denied. The Board recognizes that the veteran has made his own contentions that his current leg ulcers are the result of injuries and leg ulcers he suffered while on active duty. While the veteran is competent to describe his observations, as a layperson, he is not competent to provide an opinion requiring medical knowledge, such as a medical diagnosis or etiology. Id. Accordingly, his testimony does not constitute competent medical evidence that his current leg ulcers are the result of injuries or leg ulcers incurred during his active service. Because of the lack of competent medical evidence linking the veteran's current leg ulcers to injuries incurred or leg ulcers suffered during his active duty, his claim is not well-grounded and the appeal is thus denied. The Board views its discussion as sufficient to inform the veteran of the elements necessary to complete his application for a claim for service connection for the claimed disability. See Robinette v. Brown, 8 Vet. App. 69, 77-78 (1995). ORDER Evidence of a well-grounded claim for service connection for leg ulcers not having been received, the appeal is denied. U. R. POWELL Member, Board of Veterans' Appeals