Citation Nr: 20050488 Decision Date: 07/29/20 Archive Date: 07/29/20 DOCKET NO. 11-05 219 DATE: July 29, 2020 ORDER Entitlement to service connection for residuals of broken or fractured ribs is denied. Entitlement to service connection for residuals of a fractured sternum is denied. FINDINGS OF FACT 1. The evidence is against a finding that the Veteran has or had residuals of broken or fractured ribs at any time during, or proximate to, the period on appeal. 2. The evidence is against a finding that the Veteran has or had residuals of a fractured sternum at any time during, or proximate to, the period on appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for broken ribs have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a fractured sternum have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1999 to September 2002, including service in the Persian Gulf. The Veteran also served in the Pennsylvania Army National Guard. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a November 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2014 and September 2019, the Board remanded the case to the RO for additional development. As the requested development has been completed, no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran’s appeal originally included claims for service connection for a stomach disability and atrial fibrillation. An April 2020 rating decision granted service connection for the stomach disability as gastroesophageal reflux disease and service connection for atrial fibrillation. This is considered a full grant of the benefit sought on the appeal for the claims of service connection for gastroesophageal reflux disease and atrial fibrillation. Holland v. Gober, 10 Vet. App. 433, 436 (1997). The Veteran has perfected appeals on the issues of an earlier effective date for the Veteran’s current rating for posttraumatic stress disorder (PTSD), entitlement to special monthly compensation for aid and attendance, entitlement to temporary total disability, and service connection for traumatic brain injury. The Board’s review of the claims file reveals that the RO is still acting on these issues, notably providing the Veteran with a hearing before the Board. As such, the Board will not accept jurisdiction over them at this time, but these issues will be the subject of a subsequent Board decision, if otherwise in order. Service Connection 1. Entitlement to service connection for broken ribs 2. Entitlement to service connection for a fractured sternum The Board has grouped these two issues together as the Board has determined that the two disabilities involve similar facts and analysis. The Veteran is seeking service connection for residuals of broken ribs and a fractured sternum. Notably, in March 2001, while off base, the Veteran was horrifically assaulted. Then in June 2001, while deployed in the Persian Gulf, a truck accident propelled the Veteran forward and his chest hit his rifle. Service medical providers told him he suffered broken ribs and a fractured sternum. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran’s service records confirm his March 2001 assault. The service treatment records indicate the Veteran was struck only in the face with a pipe by two AWOL soldiers. There is no mention of trauma or injury to the chest area incorporating the ribs and sternum. VA has also obtained the Court Martial documents of the main assailant which includes the Veteran’s testimony. Those documents and testimony corroborate that the Veteran was hit in the face, but do not show the Veteran was hit or stomped upon his chest or ribs. The service treatment records for the June 2001 truck accident document treatment for lacerations. The records note the Veteran hit his chest against the vehicle and he complained of sternal pain. X-rays taken at the time do not appear in the claims file. In a July 2009 VA examination for a traumatic brain injury, the Veteran described the accident occurring when the truck hit a tank divot. The Veteran hit the roof of the truck with his head and his chest hit his rifle. At that time, he was told that his sternum and ribs were fractured. In October 2009, the Veteran received a VA examination regarding his sternum and rib fracture claims. The Veteran reported how the truck drove into a 16-foot hole. The Veteran, a passenger, recalled a big bang and then he was lying on the ground. He stated he does not know what had happened. A few days later, when he could seek treatment, he was told he had a sternum fracture and multiple rib fractures. He was also told there was nothing that could be done and given pain pills. Gradually over the next couple of months, the chest area was less sore with training but other (unspecified) trauma caused pain. The Veteran reported current residual soreness with different types of weather or with certain movements such as pushups. X-rays for both the right and left ribs and the sternum were normal. The VA examiner concluded that the Veteran had a chest contusion with no evidence to support any fracture. He stated that seven years later, it was difficult to associate the Veteran’s current symptoms, e.g., pain with damp weather or driving, with the injury in service without resorting to speculation. In June 2010, the Veteran complained of chest pain and a chest x-ray was performed that was within normal limits. At a second VA examination in January 2020, the Veteran reported that the sternum and rib fractures occurred in the assault when the assailant stomped on his chest fracturing his lower right anterior ribs and sternum. The truck accident reinjured the sternum when he landed on his M16 rifle. His pain continued in the sternum area with certain movement such as pushups. The examiner noted however, that an October 2014 chest X-ray demonstrated the Veteran’s osseous structures were unremarkable without any residual deformity. The VA examiner concluded that the Veteran did not suffer sternum and rib fractures in service. Instead, the VA examiner diagnosed costochondral syndrome and stated that it was less likely than not that any current symptoms are related to the truck accident and assault in service. X-rays did not show a fracture of the sternum or a fracture of any rib. The examiner cited to online medical literature to explain that costochondral pain the Veteran experienced after the trauma would typically resolve in 6-12 months. The examiner was unable to attribute his current complaints to his in-service injury given that his pain from those incidents would have resolved by now. The Board notes that the Veteran has reported a sternum fracture to his civilian medical providers on multiple occasions particularly when he has complained of chest pain but other occasions as well such as treatment for PTSD. It does not appear that any chest pain complaints have been attributed to a sternum or rib fracture but instead have been attributed to his other disabilities such as his gastroesophageal reflux disease and atrial fibrillation. Furthermore, the Veteran has had numerous chest X-rays in addition to the ones stated above. In all instances, the radiologists have not reported any evidence of a sternum fracture or rib fracture. Initially, the Board acknowledges that the service treatment records may not be complete. For instance, after the June 2001 truck accident, treatment included an order for chest X-rays, but the X-ray report is not of record. The RO has made multiple attempts to ensure that all his service treatment records have been associated with the file. An April 2020 document from the Department of Defense indicates that all service records available have been provided to VA. VA advised the Veteran that he could submit copies of records in his control or submit alternative forms of evidence to support his claim. To date, he has not responded with any such evidence. Thus, the Board finds that the VA met its duty to assist in developing the claim by exhausting all reasonable efforts to obtain the service records concerning medical treatment. Further efforts to search for records which likely no longer exist would be futile and the Board concludes that all available service records are of record regarding his claims and thus, the Board will proceed to the merits. Although the Board is sympathetic toward the Veteran regarding missing medical records, it is bound by the law, and this decision is dictated by the relevant statutes and regulations. The requirements for service connection are set forth as noted above. Absent any additional evidence of record regarding what happened in service, the Board can only speculate as to whether the Veteran suffered fractures to his sternum and his ribs. In any event, evidence of a current disability and of a nexus between service and a current disability is still required. Wade v. West, 11 Vet. App. 302 (1998). There is no evidence of record reflecting a diagnosed disability such as X-ray findings demonstrating an old fracture to the sternum or ribs or any other abnormality to the sternum or ribs, to include breaks. All radiology reports of the chest have either been silent on the issue or to the extent the radiologist commented on the observable bones and joints, the findings are normal. Further, while the Veteran reported fracturing his sternum in service to his medical providers, it appears all the transcriptions appear to be history provided by the Veteran alone and not a diagnosis made by a medical provider. LeShore v. Brown, 8 Vet. App. 406, 409 (1995) (a bare transcription of a lay history is not transformed into competent medical evidence merely because the transcriber happens to be a medical professional). The Board recognizes that the Veteran recalls his service medical providers telling him he had a fractured sternum and rib fractures. The Veteran's testimony as to what he was told by medical personnel does not constitute competent medical evidence. Robinette v. Brown, 8 Vet. App. 69, 77 (1995) (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); see also Kirwin v. Brown, 8 Vet. App. 148, 153 (1995). As there is no competent evidence of current chronic residuals of a sternum fracture or rib fractures, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The evidence is also against a finding of a disability at any point during the claims period or shortly prior to the claim being filed. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). While pain can constitute a disability in certain circumstances, the Veteran’s pain or other symptoms does not constitute a disability as it does not result in any functional impairment and there is no evidence indicating the Veteran suffers from functional impairment due to his chest pain. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). Furthermore, the medical records indicate that quite often the Veteran’s chest pain results from his other service- connected disabilities such as his gastroesophageal reflux disease and atrial fibrillation. It would violate the rule against pyramiding to grant service connection for the chest pain as a result of the service trauma when this symptom is already part of those disabilities which are also connected to service. 38 C.F.R. § 4.14. As to the costochondral syndrome diagnosed by the January 2020 VA examiner, he interviewed the Veteran and reviewed the pertinent medical history and performed an examination. The examiner concluded that the assault and the truck accident did not result in fractures to the sternum or ribs, but in costochondral pain which is known to resolve in a year or less. The Board notes the Veteran reported in 2009 that the pain gradually subsided after the trauma which is in line with the VA examiner’s opinion. The Board finds this opinion highly probative as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. The Board has considered the Veteran’s statements, to include his assertions that current chest pain symptoms began during service at least after the June 2001 truck accident. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., pain; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. To the extent the Veteran asserts a continuity of symptomatology beginning during service, the Board finds these statements to lack credibility as they are in direct conflict with the Veteran’s November 2005 and January 2007 reports of medical history in the National Guard where he denied any painful bones or joints. He did report a history of a broken bone in the January 2007 history although the report does not indicate what bone was broken. If sternum pain or rib pain was present during service, the Board would expect the Veteran would have responded “yes” when asked if he had recurrent sternum or rib pain at separation because a reasonable person would have interpreted the question to include symptoms of sternum or rib. Moreover, the Veteran responded affirmatively when asked whether he had other conditions and the Board would thus expect the Veteran to have also responded affirmatively to having sternum or rib pain. He also denied any problem or report of injury to the sternum or ribs when asked if he had any other injury or illness not already specifically mentioned. The Board finds the reports of medical history in the National Guard be more reliable than more recent assertions as it was done contemporaneous to service and for the purpose of identifying disability at that time. For the above reasons, the preponderance of the evidence is against the claims and service connection for residuals of broken or fractured ribs and residuals of a fractured sternum must be denied. C.B. Iwanowski Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Russell P. Veldenz, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.