Citation Nr: 0010343 Decision Date: 04/19/00 Archive Date: 04/28/00 DOCKET NO. 97-34 029 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for gender identification disorder. 2. Entitlement to service connection for irritable bowel syndrome. 3. Entitlement to service connection for bilateral pes planus. 4. Entitlement to service connection for bilateral hearing loss. ATTORNEY FOR THE BOARD David S. Nelson, Associate Counsel INTRODUCTION The veteran had active military service from June 1969 to September 1971. This matter arises from a November 1997 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The veteran has requested hearings before a Member of the Board, and such hearings were scheduled for February 1998 and January 2000. However, documentation in the file indicates that the veteran did not appear for the scheduled hearings. FINDINGS OF FACT 1. There is no medical evidence of a nexus between the veteran's identification disorder and active service. 2. There is no medical evidence of a nexus between the veteran's irritable bowel syndrome and active service. 3. The veteran's bilateral pes planus preexisted service but was chronically worsened on active duty. 4. There is no medical diagnosis of current bilateral hearing loss. CONCLUSIONS OF LAW 1. The veteran's claim of entitlement to service connection for gender identification disorder is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran's claim of entitlement to service connection for irritable bowel syndrome is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 3. Bilateral pes planus was aggravated during active service. 38 U.S.C.A. §§ 1110, 1111, 1153 (West 1991); 38 C.F.R. §§ 3.303, 3.306 (1999). 4. The veteran's claim of entitlement to service connection for bilateral hearing loss is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The law provides that a veteran is entitled to service connection for disability resulting from a disease or injury incurred or aggravated while in service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection for certain chronic disabilities, such as psychoses, will be presumed if manifest to a compensable degree within the year after service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Board must first determine whether the veteran has submitted a well-grounded claim as required by 38 U.S.C.A. § 5107(a). To establish that a claim for service connection is well grounded, there must be a medical diagnosis of a current disability; evidence of inservice incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed inservice disease or injury and the present disease or injury. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). A claim may also be well grounded based on chronicity and continuity of symptomatology. 38 C.F.R. § 3.303(b); see also Savage v. Gober, 10 Vet. App. 488 (1997). I. Gender identification disorder Service medical records reflect that in August 1970 the veteran was evaluated to determine fitness for duty; the impression was passive-aggressive personality with many immature features. An April 1971 psychiatric consultation report noted that the veteran still had traits of immaturity but no formal diagnosis was rendered. A May 1971 service medical record indicated that the veteran had an immature personality. The May 1971 record also reflected that the veteran had "identity problems," the nature and type of which were not described. The veteran's psychiatric system was clinically evaluated as normal on the August 1971 service separation examination. Private and VA medical records indicate that the veteran began estrogen treatment in 1975. An October 1975 document indicates that the veteran legally changed his name to that of a female. VA medical records indicate that the veteran married a man in 1979. The VA records reflect that the veteran has been diagnosed with gender identity disorder. A June 1998 private physician described the veteran as a "40 year old transsexual who has been living as a female for the last 23 years." In this case, there is no medical evidence of a nexus or link between the veteran's gender identification disorder, which was first diagnosed some years after service, and any incident of active duty. There is some indication that the disability may have preexisted service. The veteran reported in a lengthy and detailed September 1996 statement pre- service gender identity problems and struggles, which were also noted in various VA and private psychiatric medical records. Since the preenlistment examination was normal, the Board finds that the veteran's mental status was sound upon entry into service but a diagnosis of a gender identity disorder was not recorded during service. It was noted in May 1971 that the veteran had "identity problems," but the nature and type of problems were not described, and the only psychiatric disorder recorded during service was a personality disorder, which is not recognized as a disease or disability for VA compensation purposes. 38 C.F.R. § 3.303 (c). The veteran has submitted detailed descriptions of actives and events during service relating to claimed gender identify difficulties encountered during service, in support of the argument that the disability at issue either began during or was aggravated by service. However, being a layperson, the veteran is not competent to give an opinion regarding medical causation or diagnosis, and her statements on such matters do not serve to make the claim well grounded. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). In the present case, and in despite of multiple post-service VA and private psychiatric treatment records, there is no competent medical evidence (i.e., a physician's opinion) that shows a link between a gender identity disorder and service. Under these circumstances, the claim must be denied as not well grounded. Epps, supra. II. Irritable bowel syndrome The veteran's service medical records, including the veteran's August 1971 separation examination, contain no references to treatment for or diagnosis of a digestive disorder or of irritable bowel syndrome. Read in the light most favorable to the veteran, a November 1996 private medical record seems to indicate that the veteran suffered from irritable bowel syndrome. However, a review of the record shows that there is no medical evidence linking the veteran's irritable bowel syndrome to the veteran's active military service or any incident during such service. As there is no competent medical evidence that the veteran currently suffers from irritable bowel syndrome related to service, and as there is no medical evidence linking any continuity of symptomatology which the veteran may claim to the irritable bowel syndrome, the claim for service connection for irritable bowel syndrome is not well grounded and must be denied on that basis. 38 U.S.C.A. § 5107(a). See Savage, supra. III. Pes planus The report of the veteran's June 1969 service entrance examination noted pes planus. As pes planus preexisted service, the question before the Board is whether the preexisting pes planus was aggravated during service. The service medical records show no complaints associated with flat feet. However, on the medical history portion of an undated flight examination, the veteran indicated the existence of foot trouble. The August 1971 separation examination noted second degree pes planus. An August 1998 VA treatment record indicated that the veteran suffered from collapsed arches and was seeking physical therapy for a flat feet condition. It was also noted that flat feet "threw" the veteran off stride when walking. The diagnosis included pes planus. In this case, there is evidence that the severity of the veteran's condition increased during service. Although the veteran's pes planus was noted on the June 1969 entrance examination, the disability was not noted to be symptomatic. However, the veteran's pes planus was described as "second degree" on the August 1971 separation examination. In this case, the service medical evidence appears to indicate that during service the underlying bilateral pes planus condition worsened. Jensen v. Brown, 4 Vet. App. 304 (1993). The post-service relevant medical evidence is consistent with a worsening of the underlying condition. Accordingly, the Board finds that the evidence supports the award of service connection for bilateral pes planus. IV. Bilateral hearing loss There is no competent medical evidence demonstrating that the veteran currently suffers from hearing loss of either ear as defined by 38 C.F.R. § 3.385 (1999). Accordingly, the claim for service connection for bilateral hearing loss is not well grounded and must be denied on that basis. 38 U.S.C.A. § 5107(a); Epps. V. Conclusion The Board is aware of no circumstances in this matter which would put VA on notice that relevant evidence may exist or could be obtained, which, if true, would make the claims for service connection "plausible." See generally McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). By this decision, the Board is informing the veteran that his service connection claims require medical evidence of a nexus to service to meet the requirements of a well-grounded claim. See 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69 (1995). ORDER Service connection for gender identification disorder is denied. Service connection for irritable bowel syndrome is denied. Service connection for pes planus, by aggravation of a preexisting disability, is granted. Service connection for bilateral hearing loss is denied. R. F. WILLIAMS Member, Board of Veterans' Appeals - 8 - - 1 -