Citation Nr: 9906212 Decision Date: 03/05/99 Archive Date: 03/11/99 DOCKET NO. 98-02 750 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for asthma. WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD S. J. Janec, Associate Counsel INTRODUCTION The veteran had active air service from March 26, 1986 to April 9, 1986 and from December 10, 1986 to January 22, 1987. This matter comes before the Board of Veterans' Appeals (Board) from a February 1997 rating decision of the Chicago, Illinois Regional Office (RO) of the Department of Veterans Affairs (VA) which denied service connection for asthma. FINDING OF FACT The medical evidence shows that the veteran's asthma pre- existed service and was not aggravated by active service. CONCLUSION OF LAW Asthma was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1131, 1137, 5107 (West 1991 & Supp. 1998); 38 C.F.R. § 3.306. REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background Service records demonstrate that the veteran first served on active duty in the Air Force from March 26, 1986 to April 9, 1986. She was discharged because she was pregnant. She reenlisted again and served from December 10, 1986 to January 22, 1987. Service medical records show that on enlistment examination in December 1985, the veteran was found to be qualified for active service. On enlistment examination in August 1986 the veteran was again found qualified for service. Only asymptomatic pes planus was noted. In her report of medical history completed in August 1986, the veteran related that she had been treated for childhood diseases. She also had sinusitis with sudden weather changes. On December 26, 1986, she was seen for complaints of wheezing, coughing and having a choking feeling for the past hour after the third lap of a PC run. She related that she had similar symptoms four years ago when she was running track. She quit and had no further problems until now. She also related that she had never been able to run longer than a half mile at any time; she was a sprinter in high school. On consultation on December 31, 1986, she reported complaints of wheezing, coughing and shortness of breath with running, with an onset at approximately two laps, which lasted one hour. She had had similar problems since age 14. There were no other problems with asthma without running and she never took medication for the condition. Mild asthma which existed prior to service was diagnosed. Proventil was prescribed. A January 12, 1987 Medical Board Report indicates that the veteran's previous examinations were reviewed. It was noted that on enlistment she reported being in good health and that she was not taking any medications. She also marked "no" to shortness of breath or chronic cough. Asthma was diagnosed. The physician concluded that the medical condition existed prior to service and was not aggravated by service beyond the normal progression of the disease. Discharge was recommended. Private medical records from the Meyer Medical Group dated from October 1993 to October 1996 show that the veteran was seen for asthma. She was given Azmacort and an inhaler. A November 1996 statement from V. Mather, M.D. reported that the veteran had been under his/her care since April 1996 for bronchial asthma which was under good control with Azmacort and Maxair inhaler. Dr. Mather did not recall the veteran being in the hospital for an exacerbation of her condition. On VA examination in December 1996, the veteran complained of asthma. She related that during basic training in January 1987, she started wheezing and coughing. She was told she had asthma and was given an inhaler. Subsequently, she was discharged. Since discharge, she has been followed by different doctors and treated with Azmacort and Proventil. She typically had asthma attacks with extreme temperature and weather changes. She had a more severe attack two to three times per year, but has not had any hospital admissions, intubations, or steroid use. She felt short of breath after one block. She reported that she did not have asthma when she entered service. A chest x-ray was normal. Asthma was diagnosed. At a personal hearing before a traveling member of the Board in October 1998, the veteran was assisted by a VA Benefits Counselor. She testified that she had no signs of asthma on either of her enlistment physicals and was not treated for asthma until her second period of duty in the Air Force. Presently, she took Azmacort and Proventil for the condition. II. Analysis Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1131; 38 C.F.R. § 3.303. A veteran will be considered to have been in sound medical condition upon entrance into service, except as to defects, infirmities, or disorders noted at entrance, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior to service, and was not aggravated during service. 38 U.S.C.A. §§ 1111, 1137; 38 C.F.R. § 3.304. A preexisting disease or injury will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. Clear and unmistakable evidence (obvious or manifest) is required to rebut the presumption of aggravation where the preservice disability underwent an increase in severity during service. This includes medical facts and principles which may be considered to determine whether the increase is due to the natural progress of the condition. Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during and subsequent to service. 38 U.S.C.A. § 1153; 38 C.F.R. § 3.306. Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened. Hunt v. Derwinski, 1 Vet. App. 292 (1991). Furthermore, in Green v. Derwinski, 1 Vet. App. 320 (1991), the Court held that the veteran's psychiatric illness was not aggravated by service, despite his claim that his condition at time of entry into service, which was apparently in remission, should be considered as baseline against which his condition upon discharge should be measured; symptoms described prior to the veteran's service were similar to symptoms described in his service medical records. The veteran's assertion that a disability increased in severity is not competent medical evidence of aggravation. McIntosh v. Brown, 4 Vet. App. 553 (1993). The veteran's enlistment examinations in December 1985 and August 1986 were negative for any findings indicative of asthma; hence, the presumption of soundness applies. However, in December 1986, approximately two weeks into basic training during her second period of service, she presented with complaints of coughing, wheezing and shortness of breath. She reported that she had similar symptoms approximately four years earlier when she ran track. She was never able to run more than a half a mile, but she was not diagnosed with asthma and never took medication for the condition. Based on the evidence of record, a Medical Board noted the similarity in reported symptoms four years prior and concluded that the veteran's asthma existed prior to service. This competent medical evidence constitutes clear and unmistakable evidence that asthma existed prior to service, and is sufficient to rebut the presumption of soundness at time of entrance into service, particularly in light of the veteran's short period of active service. See Bagby v. Derwinski, 1 Vet.App. 225 (1991). Therefore, the issue becomes whether the veteran's asthma was aggravated by her service. The Board notes that it may reasonably be concluded that there was an increase in the veteran's disability during service because she required medication to control her symptoms. she reported that prior to service she had not used medication. Therefore, the presumption of aggravation also applies. However, the Board finds that this presumption has also been rebutted because the Medical Board opined that the increase was due to the natural progress of the disease. The veteran has not provided any competent evidence to the contrary, and as noted above any assertion by her that the disability increased in severity is not competent medical evidence of aggravation. See McIntosh, supra. Therefore, the Board concludes service connection for asthma is not warranted. The Board notes that at an October 1998 hearing, the veteran testified that asthma was not diagnosed prior to service. While this may be so, she reported on several occasions that she experienced similar symptoms four years prior when she ran track. Based on this, the physicians who examined her in service concluded that the condition existed prior to service. Again, she has not presented any medical evidence to the contrary. In a similar case, Harris v. West, 11 Vet. App. 456 (1998), the Court held that a doctor's unequivocal and uncontradicted opinion that, based on the veteran's history, the condition preexisted service and, although it worsened in service, such worsening was due to the natural progression of the disease, was clear evidence of preexistence. Therefore, the Board finds the medical evidence more probative than the veteran's testimony on the issue of preexistence. ORDER Service connection for asthma is denied. GEORGE R. SENYK Member, Board of Veterans' Appeals Department of Veterans Affairs