Citation Nr: 0533892 Decision Date: 12/15/05 Archive Date: 12/30/05 DOCKET NO. 97-03 623A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a left shoulder disorder. 2. Entitlement to service connection for asbestosis as a result of asbestos exposure. 3. Entitlement to service connection for a bilateral wrist disorder. 4. Entitlement to service connection for a bilateral hip disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. Fussell, Counsel INTRODUCTION The veteran had active service from July 1975 until July 1995. This matter comes before the Board of Veterans' Appeals (Board) from a February 1996 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Waco, Texas. The case was remanded in October 2003 and has now been returned for further appellate consideration. The November 2003 VA respiratory examination indicates that the veteran's current respiratory symptoms are related to bronchitis and possibly recurring sinusitis. It is not clear whether the veteran seeks service connection for respiratory disability secondary to his service-connected sinusitis. So, this matter is referred to the RO for clarification. FINDINGS OF FACT 1. The veteran was seen for acute left shoulder symptoms during service but there is no objective clinical evidence of current left shoulder pathology. 2. The veteran was exposed to asbestos during service and had acute and transitory upper respiratory infections during service but asbestosis as a result of asbestos exposure is not shown. 3. During service the veteran had acute and transitory injuries to the fingers and hand but not the wrists and, although there was an inservice notation of chronic wrist pain, a current bilateral wrist disorder is not clinically shown. 4. The veteran was seen for acute hip symptoms during service but there is no objective clinical evidence of current bilateral hip pathology. CONCLUSIONS OF LAW 1. A chronic left shoulder disorder was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2004). 2. Asbestosis as a result of asbestos exposure was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2004). 3. A bilateral wrist disorder was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2004). 4. A bilateral hip disorder was not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 1131, 5107(b) (West 2002); 38 C.F.R. § 3.303 (2004). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act (VCAA) The VCAA became effective on November 9, 2000, and describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2004). Upon receipt of a complete or substantially complete application, VA must inform the claimant of information and medical or lay evidence not of record: (1) necessary to substantiate the claim; (2) that VA will seek to obtain; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2005); 38 C.F.R. § 3.159(b) (2004); Charles v. Principi, 16 Vet. App. 370, 373-74 (2002); Quartuccio v. Principi, 16 Vet. App. 183, 186- 87 (2002). See also Valiao v. Principi, 17 Vet. App. 229, 332 (2003) (implicitly holding that RO decisions and statements of the case may satisfy this requirement). VCAA notice should be provided to a claimant before the initial unfavorable decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004) ("Pelegrini II"); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). Here, however, the rating action appealed was in February 1996 prior to the November 2000 enactment of the VCAA and, thus, it was impossible to provide notice of the VCAA prior to the enactment thereof. However, in Mayfield v. Nicholson, 19 Vet. App. 103 (2005), it was held that, even if there was an error in the timing of the VCAA notice, i.e., it did not precede the initial RO adjudication, it could be cured by affording the claimant a meaningful opportunity to participate in VA's claim processing such that the essential fairness of the adjudication was unaffected. Such is the case here. The veteran was notified of the VCAA in a November 2001 letter. Prior to that his service medical records (SMRs) were received. The veteran's VA treatment records are on file and he underwent VA nexus examinations in February 1997 and more recently following the October 2003 remand by the Board. 38 U.S.C.A. § 5103A(d). Further, although offered, the veteran declined his opportunity for a hearing to provide oral testimony in support of his claim. The more recent statements and correspondence from the veteran and his representative do not make reference to or otherwise mention any additional treatment from other sources (e.g., private or non-VA, etc.). Accordingly, no further development is required to comply with the VCAA or the implementing regulations. And the appellant is not prejudiced by the Board deciding the appeal without first remanding the case to the RO. See Bernard v. Brown, 4 Vet. App. 384 (1993). Law and Regulations For service connection to be granted for any disability, it is required that the facts, as shown by the evidence, establish that a particular injury or disease resulting in chronic disability was incurred in service, or, if pre- existing service, was aggravated therein. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Furthermore, with chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of 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." Id. 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. Id. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id.; See, too, Savage v. Gober, 10 Vet. App. 488, 495 (1997). Service connection is also possible for any disease initially diagnosed after discharge from service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2004). Disability which is proximately due to or the result of a service-connected disorder shall be service-connected. 38 C.F.R. § 3.310(a) (2004). Service connection will also be granted for aggravation of a non-service-connected condition by a service-connected disorder, although compensation is limited to the degree of disability (and only that degree) over and above the degree of disability existing prior to the aggravation. See Allen v. Brown, 7 Vet. App. 439 (1995). Direct service connection may not be granted without medical evidence of a current disability, medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996) (table). Background The November 1974 service enlistment examination revealed a scar on the veteran's left wrist and left thumb. A September 1978 re-enlistment examination noted that the left wrist scar was from a knife wound. In February 1977 the veteran injured his left thumb. After he later injured his right 3rd finger the impression was that he might have early arthritis but X-rays revealed no degenerative changes and were essentially normal. In July 1977 the veteran bruised the ribs on his left side and complained of pain upon inhalation and lifting. No X-ray was taken but the assessment was a rib fracture. In February 1981 the veteran had an upper respiratory infection (URI). In May 1981 he had chest pain of unknown etiology. In December 1981 the veteran injured his right 1st finger and the diagnosis was a soft tissue injury. In February 1982 it was reported that the veteran had had occasional left shoulder pain since having done pushups 3 years earlier. After an examination the assessment was questionable recurrent subluxations of the left shoulder. In June 1982 he complained of occasional left shoulder pain. On examination he had decreased left shoulder strength generally. In November 1982 he had tenderness of the biceps tendon and the assessments included left bicipital tendinitis. In March 1983 the veteran had an URI. In September 1983 he had bronchitis due to a URI. A September 1983 chest X-ray was normal. Paranasal sinus X-rays in October 1983 showed an air-fluid level in the right maxillary sinus; clouding of both maxillary sinuses, the frontal sinuses, the ethmoid air cell; and reduction of the nasal airway, bilaterally. In April 1984 the veteran had a left shoulder sprain. A left shoulder X-ray revealed no fracture or dislocation. In March 1986 the veteran had a soft tissue injury of the left hand with resultant mild edema of the left 4th and 5th fingers. An X-ray in March 1986, taken because of pain and point tenderness in his left hand in the area of the 4th and 5th metacarpals after hitting a car, was negative. A summary of the veteran's hospitalization in April and May 1986 reflects diagnoses which included immature and histrionic personality traits as well as psychological factors affecting physical condition. A summary of the veteran's May 1986 hospitalization reflects that a psychology evaluation revealed that he had an hysteric personality which was responsible for much of his complaints of back pain. An X-ray in April 1989, after the veteran injured his left index finger while playing, disclosed no evidence of fracture or dislocation. In May 1990 the veteran complained of right groin pain which decreased with hip extension but increased on hip flexion. His long history of low back disability seemed unrelated. He complained of occasional left hip pain after running. The assessment was that he might have some form of osteoarthritis of the hips but X-rays and a bone scan of the hips were normal. X-rays of the veteran's pelvis in July 1990 revealed no significant abnormality. An August 1990 limited bone scan revealed the veteran's pelvis and hips were normal. The veteran complained of bilateral hip pain in October 1990. His lumbosacral disability was noted and after an examination the diagnosis was that there was no evidence of true arthritic involvement of the hips but the normal X-rays did not rule out degenerative joint disease (DJD) of the hips. Soft tissue rheumatism secondary to low back pain and altered gait was suspected but it was also possible that he had hip capsule limitation which caused his groin pain. It was doubted that he had referred pain from facet joint radiculopathy. In April 1994 it was noted that while the veteran had removed ceiling tiles a light dropped, bringing down asbestos particles and dust, and that 20 minutes after this he had a cough. After verification that the particles were asbestos he was placed on the Asbestos Medical Surveillance Program (AMSP). An April 1994 pulmonary function test was within normal limits. It was noted that he smoked cigarettes, having begun smoking at the age of 10. A chest X-ray in April 1994 as part of the AMSP disclosed no active disease. An October 1994 medical history questionnaire reflects that the veteran had had a problem with a painful left shoulder that had been documented since 1982 but which was not considered disqualifying. On examination for extension in October 1994 the examiner commented that the veteran had chronic left shoulder pain which was not considered disqualifying. In an adjunct medical history questionnaire the veteran reported having or having had arthritis of the wrists and shoulders. On examination for service retirement in March 1995 the examiner reported that the veteran had chronic shoulder and wrist pain which was not considered disqualifying. In an adjunct medical history questionnaire the veteran reported having had pain in his wrists for 1 1/2 months and right hip pain for 4 years as well as having been diagnosed as having bursitis of each shoulder. On VA general medical examination in February 1997 the veteran reported taking Motrin for back and ankle pain. On examination his lungs were clear to auscultation. He had smoked cigarettes since the age of 9 but now smoked only 7 cigarettes daily. The diagnosis was that the general physical examination was not remarkable. On VA orthopedic examination in February 1997 the veteran reported that he had begun having problems with his left shoulder in the 1980s. It now popped, ached, and cracked. He reported that he was losing range of motion in the shoulder and that it seemed to slip a little bit, but not completely, out of joint. In about 1993 or 1994 he had begun having aching in his hands and wrist, greater on the right side than the left. He had pain in his gluteal region which radiated a little into the anterior aspect of the hip joints which he felt was related to his low back because it had begun around the time he had developed low back disability. On examination the veteran walked with a slight left-side limp. He could walk on his heels and on his toes and could squat. He had no swelling, effusion, crepitus, deformities, contractures, tenderness or palpable abnormalities of the upper extremities. Range of motion of the shoulders and wrists was normal. His hip joints were normal with normal range of motion and no tenderness, crepitus or palpable abnormalities. His biceps, triceps, and brachioradialis reflexes were physiological and equal, bilaterally. There was no atrophy, muscle weakness, paresis or neurosensory deficit of the upper or lower extremities. There was no Tinel's or Phalen signs of either wrist. It was noted that a number of X-rays had been taken. A chest X-ray was normal. The diagnoses were arthralgia of multiple joints without significant objectivity, no evidence of carpal tunnel syndrome (CTS) on clinical evaluation, no evidence of arthritis of the wrists on clinical evaluation, no evidence of intrinsic hip abnormalities on clinical evaluation, and no evidence of intrinsic shoulder abnormalities on clinical evaluation. On VA respiratory examination in November 2003 the veteran reported having been exposed to asbestos during service for about 20 minutes. X-rays and evaluations during service had been negative but he was advised to have assessments every two years. His last chest X-ray 2 years ago was negative. He had a productive cough which had persisted for the last 4 months. He had ill-defined pain in both sides of his chest when he first arose and took a deep breath in the morning. He had no history of pneumonia or asthma but still smoked cigarettes. His symptoms over the last 4 or 5 years were sneezing, copious nasal drainage, and a persistent cough. About 3 times a year he took antibiotics due to URIs related to his sinuses. He had occasional exertional shortness of breath. On examination the veteran's lungs were clear and without rales or wheezes. Tendon reflexes of his extremities were normal. The diagnoses were chronic bronchitis, probably related to his cigarette smoking excess; allergic rhinitis; a history suggestive of intermittent sinusitis but not currently active; and with negative chest X-ray and spirometry there was no basis for a diagnosis of asbestosis or other chronic lung disease. It was noted that his exposure to asbestos by documentation was just that of the episode in 1994 but this asbestos exposure was not felt to be related to his current symptoms which were related to bronchitis, probably from cigarette smoking and possibly to allergic rhinitis and recurring sinusitis. A June 2005 addendum to the VA respiratory examination in November 2003 reflects that the veteran's claim file was reviewed. There was no change in the diagnosis and there was no evidence of asbestosis. The veteran's upper airway symptoms and bronchitis were related to his cigarette use. Analysis Left Shoulder Disorder The veteran was seen in 1982 during service for questionable recurrent subluxations of the left shoulder, tendinitis and decreased strength. He was seen in 1984 for a shoulder sprain. But after 1984 there are no actual clinical findings of left shoulder pathology nor did he receive further treatment. Moreover, X-rays have never revealed any abnormality of the left shoulder and there is no clinical evidence of a diagnosis of bursitis or arthritis of the left shoulder. The veteran has reported having been told that he had bursitis. When the underlying medical nature of evidence has been significantly diluted, as in the connection between a lay account of past medical information, and filtered through layman's sensibilities, such evidence is too attenuated and inherently unreliable to constitute 'medical' evidence. Robinette v. Brown, 8 Vet. App. 69, 77 (1995) (citing Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993) and Warren v. Brown, 6 Vet. App. 4 (1993)). At one time during service the veteran reported having arthritis. While laypersons are competent to attest to subjective symptoms (pain, etc.) and manifestly objective symptoms, they do not have the necessary medical training and/or expertise to actually make a diagnosis or, equally importantly, to provide a competent medical opinion etiologically linking a diagnosed disorder to service in the military that ended many years ago. See Espiritu v. Derwinski, 2 Vet. App. 492, 494, 95 (1992); Layno v. Brown, 6 Vet. App. 465 (1994); The 1997 VA examination found that the veteran had arthralgia of multiple joints. "Arthralgia is defined as pain in a joint." Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). "Arthralgia is pain in a joint. Mykles v. Brown, 7 Vet. App. 372, 373 (1995). However, "[p]ain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted." Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), dismissed in part and vacated in part on other grounds sub nom. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001). Also, the notation during service of the veteran's having had chronic left shoulder pain on examination in 1995 is no more than a recitation of a history which was undoubtedly reported by the veteran and, so, amounts to no more the veteran simply having reported the history himself. This is particularly so because the history was not enhanced by any further information recorded by the examiner and because there was no clinical evidence during service from 1984 to 1994 of left shoulder symptoms. The 1997 VA examination specifically found that there was no intrinsic abnormality on clinical evaluation. Competent medical evidence is required to establish the existence of current disability and a nexus between such current disability and military service. This type of medical nexus evidence is necessary to substantiate lay allegations because laypersons do not have the professional medical training and/or expertise to render competent medical diagnoses or opinions. See, e.g., Espiritu v. Derwinski, 2 Vet. App. 492, 494, 95 (1992); see, too, Layno v. Brown, 6 Vet. App. 465 (1994); Edenfield v. Brown, 8 Vet. App. 384, 388 (1995); Robinette v. Brown, 8 Vet. App. 69, 74 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993); Hasty v. Brown, 13 Vet. App. 230 (1999). Here, because there is no competent clinical evidence of current left shoulder pathology service connection for a left shoulder disorder is not warranted. Asbestos As to asbestos-related diseases, the Board notes there are no laws or regulations specifically dealing with asbestos and service connection. However, the VA Adjudication Procedure Manual, M21-1 (M21-1), and opinions of the United States Court of Appeals for Veterans Claims (Court) and General Counsel provide guidance in adjudicating these claims. In 1988, VA issued a circular on asbestos-related diseases providing guidelines for considering asbestos compensation claims. See Department of Veterans Benefits, Veterans' Administration, DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988). The information and instructions contained in the DVB Circular since have been included in VA Adjudication Procedure Manual, M21-1, part VI, paragraph 7.21 (October 3, 1997). VA must adjudicate the veteran's claim for service connection for lung disorder, as a residual of exposure to asbestos, under these guidelines. See Ennis v. Brown, 4 Vet. App. 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). As to the M21-1, it provides that, when considering these types of claims, VA must determine whether military records demonstrate evidence of asbestos exposure in service (see M21-1, Part III, par. 5.13(b) (October 3, 1997); M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)); determine whether there was pre-service and/or post-service evidence of occupational or other asbestos exposure (Id.); and thereafter determine if there was a relationship between asbestos exposure and the currently claimed disease, keeping in mind the latency and exposure information found at M21-1, Part III, par. 5.13(a) (see M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)). In this regard, the M21-1 provides the following non- exclusive list of asbestos related diseases/abnormalities: asbestosis, interstitial pulmonary fibrosis, effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, bronchial cancer, cancer of the larynx, cancer of the pharynx, cancer of the urogenital system (except the prostate), and cancers of the gastrointestinal tract. See M21-1, Part VI, par. 7.21(a)(1) & (2). The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure: mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. See M21-1, Part VI, par. 7.21(b)(1). Next, the Board notes that the M21-1 provides the following medical guidance: in order for an appellant to have a clinical diagnosis of asbestosis the record must show a history of exposure and radiographic evidence of parenchymal lung disease (see M21-1, Part VI, par. 7.21(c)); the latent period for asbestosis varies from 10 to 45 or more years between first exposure and development of disease (see M21-1, Part VI, par. 7.21(b)(2)); and exposure to asbestos may cause disease later on even when the exposure was brief (as little as a month or two) or indirect (bystander disease) (Id.). The Court has held that the M21-1 does not create a presumption of in-service exposure to asbestos for claimants that worked in one of the occupations that the M21-1 listed as having higher incidents of asbestos exposure. See Dyment v. West, 13 Vet. App. 141, 145 (1999); Also see Ennis v. Brown, 4 Vet. App. 438, vacated at 4 Vet. App. 523, new decision issued at 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993); Ashford v. Brown, 10 Vet. App. 120 (1997). Therefore, in claims for service connection for disability due to asbestos exposure, the appellant must first establish that the disease that caused or contributed to the disability at issue was caused by events in service or an injury or disease incurred therein. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992). In VAOPGCPREC 4-2000 (April 13, 2000), VA's General Counsel held, in relevant part, as follows: M21-1, Part VI, par. 7.21(a), (b), & (c) are not substantive in nature, but nonetheless need to be discussed by the Board in all decisions; the first three sentences of M21-1, Part VI, par. 7.21(d)(1) are substantive in nature and the development criteria it lays out must be followed by the agency of original jurisdiction; and M21-1, Part VI, par. 7.21 does not create a presumption of medical nexus between a current asbestos related disease and military service. Here, there is no evidence of pre-service or post-service asbestos exposure. But even assuming that the veteran was exposed to asbestos during service, the evidence still does not show he ever had any pathological changes of his lung tissue consistent with asbestos exposure. In other words, the M21-1 provides that a clinical diagnosis of asbestosis requires, not only a history of exposure but also radiographic evidence of parenchymal lung disease. And, here, there has never been a diagnosis suggesting the veteran had asbestosis. Also, there is evidence that the veteran has smoked cigarettes which is responsible for his current bronchial and upper airway symptoms. So, service connection for asbestosis is not warranted. Bilateral Wrist Disorder The veteran had several injuries to his fingers and to his left hand during service but an injury of the wrists is not shown. There was a notation at the service retirement examination of the veteran's having chronic wrist pain. At one time during service the veteran reported having arthritis of the wrists. However, this is not competent medical evidence. See Espiritu, Id. Also, the 1997 VA examination diagnosis of arthralgia of multiple joints is not sufficient to establish a diagnosed or identifiable pathology for which service connection may be granted. See Lichtenfels, Id., and Sanchez-Benitez, Id. Also, the notation during service of the veteran's having had chronic wrist pain on an examination in 1995 is no more than a recitation of a history which was undoubtedly reported by the veteran. So, this amounts to no more than the veteran simply having reported the history himself, particularly since the history was not enhanced by any further information recorded by the examiner and because there was no clinical evidence during service of pathology of the veteran's wrists. See Robinette, Id. The 1997 VA examination specifically found that there was no arthritis of the wrists on clinical evaluation. Generally see Espiritu, Id. Here, since there is no competent clinical evidence of current pathology of the veteran's wrists service connection for a disorder of the wrists is not warranted. Bilateral Hip Disorder The veteran complained of hip pain during service in 1990 but repeated X-rays and bone scans were negative. In October 1990 it was noted that X-rays did not rule out the presence of arthritis and other diagnostic possibilities were mentioned, e.g., soft tissue rheumatism and hip capsule limitation. However, none of these have ever been clinically demonstrated to exist. There was a notation at the service retirement examination of the veteran's having hip pain for several years. This was simply a recitation of a history related by the veteran. See Robinette, Id. The 1997 VA examination diagnosis of arthralgia of multiple joints is not sufficient to establish a diagnosed or identifiable pathology for which service connection may be granted. See Lichtenfels, Id., and Sanchez-Benitez, Id. Also, the notation during service of the veteran's having had chronic hip pain on an examination in 1995 is no more than a recitation of a history which was undoubtedly reported by the veteran. This is, in essence, no more than the veteran simply having reported the history himself, particularly since the history was not enhanced by any further information recorded by the examiner and because there was no clinical evidence during service of pathology of the veteran's wrists. The 1997 VA examination specifically found that there was no intrinsic abnormality of the veteran's hips on clinical evaluation. See Espiritu, Id. Here, because there is no competent clinical evidence of current pathology of the veteran's hips service connection for a disorder of the hips is not warranted. This being the case, the claims must be denied because the preponderance of the evidence is unfavorable. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. See also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability.) In the absence of proof of present disability there can be no valid claim. Degmetich v. Brown, 104 F.3d 1328 (1997) (interpreting 38 U.S.C. § 1131 as also requiring the existence of a present disability for VA compensation purposes). See, too, Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). ORDER The claim for a left shoulder disorder is denied. The claim for asbestosis as a result of asbestos exposure denied. The claim for a bilateral wrist disorder is denied. The claim for a bilateral hip disorder is denied. ____________________________________________ WARREN W. RICE, JR. Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs