92 Decision Citation: BVA 92-25973 Y92 BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 DOCKET NO. 91-51 335 ) DATE ) ) ) THE ISSUES 1. Entitlement to service connection for hypertension. 2. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. 3. Entitlement to service connection for bronchitis. 4. Entitlement to service connection for a chronic upper respiratory disorder. 5. Entitlement to service connection for jungle rot of the feet. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, his son, and his wife ATTORNEY FOR THE BOARD William J. Jefferson, Associate Counsel INTRODUCTION The veteran had active service from March 1968 to March 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Fargo, North Dakota, Regional Office (RO). In a July 1991 rating decision, the veteran's claims of service connection for hypertension; an acquired psychiatric disorder, to include post-traumatic stress disorder; bronchitis; an upper respiratory infection; and jungle rot of the feet were denied. He was informed of the rating decision in July 1991. A notice of disagreement was received in August 1991. A statement of the case was issued in August 1991. A substantive appeal was received in August 1991. A personal hearing was held at the RO in October 1991. A decision from a hearing officer at the RO was rendered in October 1991, affirming the denials of service connection. A statement from the veteran's accredited representative, dated in December 1991, was associated with the claims folder. The case was received and docketed at the Board in December 1991. An informal brief from the veteran's accredited representative, dated in March 1992, was associated with the claims folder. In June 1971, the Board denied service connection for a skin disorder. At that time, the veteran's skin disorders referred to eczema and acne which had affected the face and upper extremities. A skin disorder affecting the feet, particularly jungle rot, was not claimed, shown, or at issue. We conclude that the veteran's current claim concerning service connection for jungle rot of the feet may be considered here as separate and distinct from the previous claim denied by the Board. Therefore, the Board will review the claim of service connection for jungle rot de novo, as the VA RO has done. CONTENTIONS OF APPELLANT ON APPEAL The veteran argues that during service while in the Republic of Vietnam, he was exposed to stressful and traumatic events, which have resulted in post-traumatic stress disorder. He also argues that his depressive disorder had its onset during active service. It is also maintained that he has bronchitis, upper respiratory infections, and hypertension, and jungle rot of the feet which are related to his active service. He maintains that service connection for the aforementioned disorders is warranted. It is also requested that the case be remanded for development under the appropriate rules of of the Veterans Benefits Manual, M21-1, for post-traumatic stress disorder, and that the veteran be afforded a VA psychiatric examination. DECISION OF THE BOARD In accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), following review and consideration of all evidence and material of record in the veteran's claims file, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claims of entitlement to service connection for hypertension, an acquired psychiatric disorder to include post-traumatic stress disorder, bronchitis, a chronic upper respiratory infection, and jungle rot of the feet. FINDINGS OF FACT 1. Acute elevated blood pressure readings were noted on examination for induction into active service. 2. Chronic hypertension was not shown during service or to a compensable degree within one year after service. 3. A psychoneurosis was not shown during service and was first shown a little more than a year after service. 4. Post-traumatic stress disorder is not shown. 5. An acute upper respiratory infection was treated in 1968 during service. 6. A chronic upper respiratory disorder in service was not shown. 7. Bronchitis and obstructive airways disease were not shown during service or for many years after service. 8. Jungle rot of the feet was not shown during or after service. CONCLUSIONS OF LAW 1. Hypertension was not incurred in or aggravated during active service; nor may service incurrence be presumed thereof. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.303(b), 3.307, 3.309 (1991). 2. An acquired psychiatric disorder, to include post-traumatic stress disorder; bronchitis; a chronic upper respiratory disorder; and jungle rot of the feet were not incurred in or aggravated during active service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303(b), (1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS We note that we have found that the veteran's claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented claims which are not implausible. A review of the claims folder reveals that the veteran's service medical and personnel records have been obtained. In April 1991 a letter was mailed to the veteran requesting specific information concerning his current symptoms, and stressful events that he may have been subjected to during service. Additionally, the veteran has been afforded VA social, psychological, and psychiatric evaluations and examinations recently, to evaluate the nature of his psychiatric disorder. We conclude that the advisory provisions of M21-1 have been complied with, and that the evidence is sufficient to render a decision in this case. Hence, we are satisfied that all relevant facts have been properly developed. 38 U.S.C.A. § 5107(a). I. Hypertension A service pre-induction physical examination, performed in August 1966, reported a blood pressure reading of 120/64, which is within normal. In a March 1968 pre-induction physical examination, the veteran's blood pressure readings were elevated, at 160/98 and 170/98. A cardiovascular evaluation and a chest X-ray revealed no abnormalities. A three day hold was placed on the veteran prior to entry into service, and it was reported that the average blood pressure readings during the period were 138/82, within normal limits. The veteran was accepted into service, and the pre-induction elevated blood pressure readings were not considered disqualifying. The veteran's service medical records are negative for complaints or findings referrable to hypertension or cardiovascular disease. In a separation report of medical history, the veteran made an affirmation that he either had or had had high or low blood pressure. The separation physical examination report is negative for any abnormalities of the heart, including a chest X-ray. The veteran's blood pressure was 128/86 or within normal limits. A VA physical examination was performed in May 1970. No abnormalities of the cardiovascular system were reported, and the veteran's blood pressure was within normal limits at 134/82. An April 1971 clinical entry from a private medical facility reported an impression of anxiety. An elevated blood pressure reading of 180/70 was reported. Another April 1971 private entry revealed a borderline blood pressure reading of 140/84. A March 1974 entry was 180/70. The clinical impression was systolic hypertension. Hypertension was reported in March 1975 when blood pressure was 160/95 and 150/98, and subsequent blood pressure readings through 1978 were borderline. VA clinical records from March 1986 through 1991 revealed treatment for hypertension. In a May 1991 VA physical examination, the veteran reported that he had had hypertension for years, and it was detected within a year after his discharge from service. History of hypertension was the diagnosis. The veteran testified that he had elevated blood pressure at his induction into service, and he was hospitalized until it went down so he could be inducted. Personal hearing transcript, hereinafter T., at 2. He averred that he was not told during basic training or ever again that he had hypertension. T. 3. He reported that almost a year to the day he was discharged, he received treatment for anxiousness, and his blood pressure was elevated. After reviewing the evidentiary data of record, the Board concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for hypertension. While elevated blood pressure readings were reported at induction in March 1968, there is no clear evidence that chronic hypertension existed prior to active service, especially in light of the prior August 1966 induction examination report which had revealed normal blood pressure. The elevated blood pressure at induction examination in March 1968 was seemingly situational or acute. No elevated blood pressure readings or evidence of hypertension was shown during the veteran's active service. At discharge from service, the veteran reported that he had or had had high or low blood pressure. However, no hypertension or cardiovascular disease was shown clinically. It is pertinent to note that one elevated systolic blood pressure reading was reported in April 1971, several weeks after the applicable presumptive period, and was followed by a normal reading in April 1971, and no evidence of or treatment for hypertension for several years. However, and importantly, no chronic hypertension to a compensable degree was shown during the applicable presumptive period and there was no continuity of symptomatology after service for a number of years. In essence, no evidence of manifestations of hypertension are shown during the presumptive period or during service for that matter. The Board has considered the veteran's 1991 testimony from his personal hearing. However, we find that the testimony is outweighed by the evidentiary data of record, including contemporaneous medical records, and does not establish service connection for chronic hypertension or cardiovascular disease. The Board concludes that the preponderance of the evidence indicates that chronic hypertension was shown during the veteran's period of active service and that chronic hypertension was not shown to a compensable degree within one year after service. Also, continuity of symptoms after service is not shown. Therefore, service connection for hypertension is not warranted. II. An Acquired Psychiatric Disorder to Include Post-Traumatic Stress Disorder An August 1966 pre-induction report of medical history was marked affirmatively for bed wetting and nervous trouble of any sort. The 1966 pre-induction physical examination report indicated that there was a history of bed wetting, and there was some doubt if there had been any recurrence. Nervous trouble was indicated as "chews fingernails." A March 1968 pre-induction report of medical history and a physical examination report were negative for any pertinent disabilities. Service records reveal that the veteran served in the Republic of Vietnam from September 1969 to March 1970. His occupational specialty was as a vehicle mechanic. It was reported that he participated in one unnamed campaign. He received no combat medals. His service medical records are negative for any complaints or findings referrable to a psychiatric disorder. A May 1970 VA physical examination was negative for any psychiatric abnormalities. Private clinical records from April 1971 reported that the veteran seemed emotionally used. Anxiety was the impression. A September 1975 clinical entry reported nervousness. Librium was prescribed. VA clinical records from March 1986 reported treatment for anxiety. Treatment for anxiety was also reported in March 1991. He was referred for post-traumatic stress disorder screening. A March 1991 statement from a VA social services worker in a mental health clinic, reported that the veteran identified a number of post-traumatic stress disorder symptoms. It was also reported that he had stress, including familial problems. The veteran reported anxiety and depression. The clinician reported that the veteran did not fit into a depression diagnosis or post-traumatic stress disorder. An assessment by a social worker/counselor was performed at a Vet Center in May 1991. A family history of alcoholism was reported. It was reported that psychological testing results indicated that the veteran felt he experienced a low degree of stress in combat. He described his exposure to combat as quite limited. It was reported that the veteran served with the Combat Engineers during service as a mechanic, and he worked in the Enlisted Men's Club. He stated that he did not associate with Vietnamese people during service. He reported that he drank and got drunk every night while in Vietnam. When questioned concerning significant service marker events, he reported that he witnessed a truck roll over with his buddies in it, and that he lived next door to "Graves Registration." He stated that when he returned home from service, he partied and drank. He stated he lost most of his good jobs due to tardiness or not showing up for work. Upon questioning, the veteran indicated that he frequently had vivid recollections of Vietnam. He stated that he had not had many until the Persian Gulf War problem began. He reported that he did not engage in as many activities as he had in the past. He reported that he felt guilty about surviving the war when others had not. The veteran reported that gunfire, helicopters, and his lake home reminded him of Vietnam. The clinician summarized that even though the veteran was not exposed to very much combat in Vietnam, he did have a negative experience. Further assessment was recommended. A VA psychology assessment, including testing, was performed in May 1991. It was reported that the veteran appeared to have psychological problems which may have predated Vietnam service. The problems centered around family anger and conflict. Passive aggressive personality disorder was the clinical impression. A contemporaneous statement from a counselor in a VA alcohol treatment program indicated that the veteran had a history of alcohol consumption which had progressed to daily drinking in Vietnam, with current periodic drinking. It was reported that the veteran appeared to be depressed, with periodic (alcohol) use for relief of painful thoughts and feelings. A VA psychiatric examination was performed in May 1991. The veteran complained of an explosive temper of two years duration which was progressively worsening, argumentativeness, and tension. The mental status examination revealed that the veteran was tearful, anxious, and that he had a depressed affect and mood. The assessment was major depressive disorder; dysthymia; anxiety disorder, not otherwise specified; and doubt post-traumatic stress disorder. The examiner indicated that after reviewing the contemporaneous clinical records, post-traumatic stress disorder was not diagnosable. In a July 1991 statement form the veteran, he described stressful events to which he was subjected during service in Vietnam. He stated that during his first night with his company the first person he sat with was killed. He stated that his company area was next to Graves Registration, and he witnessed choppers landing and unloading corpses. He also stated that artillery guns would go off every night and one would have to get drunk to be able to sleep. He stated that while welding runways, South Vietnamese planes would attempt to land, requiring him to run for safety, as they laughed when they went by. He stated that he had to weld bullet holes in truck fuel tanks which were still full, which produced anxiety. The veteran reported that once he was subjected to mortar fire. He reported that he witnessed a truck with soldiers overturn, killing two men who he had been partying with the night before. The veteran stated that while transporting goods, his truck was hit by enemy fire. He stated that he received treatment in a field hospital for a skin infection and he was lying with mortally wounded soldiers, which presented overwhelming fear. The veteran testified that the first day that he was in Vietnam a soldier he was talking to was killed, for racial reasons. October 1991 hearing transcript, hereinafter T., at 5. He stated graves registration was right next door to him and it had an effect on him mentally. T. 6. The veteran's son stated that when his family visited a Vietnam memorial, the veteran began to run for no apparent reason, and he cried when he got inside his van and was upset. T. 8. He reported that the veteran began swearing if he saw Vietnamese people in a restaurunt, or he would leave immediately. T. 8. The veteran's wife testified that while sleeping, the veteran assaulted her while dreaming of Vietnam. T. 8. The Board has reviewed the evidence of record and concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder. While nervous trouble, a history of childhood enuresis, and nail biting were reported on preinduction physical examination in 1966, no such findings were reported at induction examination in 1968 or during service. In fact, the veteran's service medical records, including discharge physical examination records, are entirely negative for any complaints or findings referrable to a psychiatric disorder. Treatment for anxiety, which is a psychoneurosis, was first reported in April 1971, more than one year after service. However, there is no evidence which relates the onset of the 1971 treatment for anxiety to the veteran's active service. Based on these findings, most importantly the lack of any complaints or treatment during service, the Board concludes that a chronic psychiatric disorder was not shown during the veteran's period of active service. A chronic psychiatric disorder was first shown too remote in time and is unrelated to the veteran's active service. Regarding post-traumatic stress disorder, the evidence reveals that the veteran served in the Republic of Vietnam, for approximately seven months as a vehicle repairman, and he also apparently worked in the Enlisted Men's Club He received no combat medals. The veteran has reported events to which he was subjected during service in Vietnam, which would be considerd as unusually stressful. While the veteran's reported stressors may be outside the range of usual human experience and distressing, it does not appear that a constellation of symptomatology necessary to support a diagnosis of post-traumatic stress disorder due to Vietnam service has been presented. Clinically, it has been reported that the veteran has identified symptoms of post-traumatic stress disorder. It has been reported that he has stress from other sources. His current complaints consist of explosive temper and tension. Symptoms such as flashbacks, nightmares of truamatic experiences, and avoidance of activities that arouse recollections of trauma were not shown. It was reported that viewed news of the Gulf War. While vivid recollections of Vietnam experiences have been reported, the nature and extent of such recollections is not expressed. Moreover, extensive psychiatric and psychological data recently performed is negative for a diagnosis of post-traumatic stress disorder. A diagnosis of post-traumatic stress disorder is not shown. Dysthymia, major depression, anxiety and passive aggressive personality disorder are the current diagnoses. In fact it has been reported on psychological testing that a post-traumatic stress disorder scale was within normal limits. The preponderance of the evidence demonstrates that the veteran does not have a post-traumatic stress disorder. The Board has considered the testimony from the personal hearing, in which the veteran's Vietnam experiences, claimed stressful events, as well as symptoms are reported. However, the Board finds that the testimony is outweighed by the evidence of record, including clinical findings. Therefore, service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder, is not warranted. III. Bronchitis and a Chronic Upper Respiratory Infection Service medical records reveal that the veteran received treatment in a medical facility in May 1968 for complaints of a sore throat. A chest X-ray was negative. Acute diffuse upper respiratory infection, organism undetermined was the diagnosis. He was discharged to duty two days later. The remainder of the veteran's service medical records, including discharge physical examination, are negative for complaints or findings referrable to an upper respiratory disorder or bronchitis. A May 1970 VA physical examination, and a chest X-ray were negative for any respiratory abnormalities. A private clinical entry from September 1972 reported treatment for complaints of a sore throat of four days duration and a congested chest. It was reported that a chest X-ray was negative. A private clinical entry in November 1974 reported treatment for flu-like symptoms. The veteran was treated conservatively. VA outpatient clinical records in March 1991 reported the veteran's complaints of shortness of breath and wheezing. Cessation of cigarette smoking for 10 months was reported. Probable chronic obstructive pulmonary disease was diagnosed. A VA physical examination was performed in May 1991. The veteran complained of problems breathing. An evaluation of the respiratory system reported a history of bronchitis. Expectoration of brown sputum was reported. The veteran also indicated that he occasionally used antibiotics. The evaluation was essentially within normal limits. It was reported that the veteran's dyspnea was not disproportionate to his obesity. A chest examination was normal. Pulmonary function tests revealed mild to moderate obstructive airway disease. The diagnosis was bronchitis. The veteran testified that he first received treatment for an upper respiratory infection in basic training. T. 9. He stated that the condition had worsened to where it was currently asthma and bronchitis. T. 9. After reviewing the evidentiary data of record, the Board concludes that the preponderance of the evidence is not in favor of the veteran's claim of service connection for bronchitis or residuals of an upper respiratory infection. Service records reveal treatment for what was described as an acute upper respiratory infection, and the veteran was returned to duty. The remainder of the service medical records, including discharge physical examination records, are negative for any complaints or findings referrable to an upper respiratory disorder or bronchitis. Post-service clinical records reveal treatment for upper respiratory symptoms in 1972 and 1974, treated without sequalae. Clinical records many years later, in 1991, revealed bronchitis and obstructive airways disease. The Board finds that the upper respiratory infection treated in 1968 during service was an acute ailment and resolved. A chronic upper respiratory disorder in service is not shown. Also, continuity of symptoms after service is not shown. Additionally, bronchitis, asthma, and/or chronic obstructive airways disease were shown about 1990, many years after the veteran's period of active service. The Board has considered testimony from the veteran at his personal hearing, indicating that the upper respiratory infection shown during service continues today and is manifested by his current asthma and bronchitis. However, the veteran's testimony is outweighed by the evidence of record, including clinical data. The Board concludes that service connection for a chronic upper respiratory disorder or bronchitis is not warranted. IV. Jungle Rot of the Feet The August 1966 pre-induction report of medical history revealed that the veteran had painful feet, subsequent to an automobile accident in 1965, and occasional boils. Service records in 1969 and 1970 revealed treatment for a boil of the buttock and abscesses of the left mandible and wrist. The veteran reported history of foot trouble at discharge. The service medical records, including the discharge physical examination report, are negative for any complaints or treatment for a skin disorder of the feet or jungle rot. A VA dermatology examination was performed in May 1970. The The veteran did not report any complaints or a history of problems concerning his feet. The examination report revealed recurrent furunculosis on the dorsum of the right hand and acne vulgaris of the face, but did not refer to any skin disorder of the feet, specifically jungle rot. A VA physical examination was performed in May 1991. The veteran made no complaints referrable to his feet. The examination revealed normal skin and feet. The veteran testified that his jungle rot of the feet was a disorder that was infrequent. T. 11. He reported that he had been treating the disorder since service. T. 11. The Board has reviewed the evidentiary data of record and concludes that the preponderance of the evidence is against the veteran's claim of entitlement to service connection for jungle rot of the feet. He received treatment for boils and abscesses of the left mandible area and wrist. However, no complaints or findings regarding a skin disorder of the feet are shown. Post-service clinical records are negative for evidence of jungle rot of the feet. In fact, the most recent VA physical examination reported normal skin and feet. The veteran has testified that his skin disorder of the feet, namely jungle rot, occurs infrequently. However, a definitive diagnosis of the jungle rot of the feet is not shown or supported by the evidence of record. Absent any objective evidence, such as clinical findings, revealing a jungle rot of the feet either during or after service, the Board is compelled to find the testimony not credible and conclude that that service connection for jungle rot of the feet is not warranted. ORDER Service connection for hypertension is denied. Service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder is denied. Service connection for bronchitis is denied. Service connection for a chronic upper respiratory infection is denied. Service connection for jungle rot of the feet is denied. BOARD OF VETERANS' APPEALS WASHINGTON, D.C. 20420 * J. E. DAY (MEMBER TEMPORARILY ABSENT) SAMUEL W. WARNER (CONTINUED ON NEXT PAGE) *38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans' Appeals Section, upon direction of the Chairman of the Board, to proceed with the transaction of business without awaiting assignment of an additional Member to the Section when the Section is composed of fewer than three Members due to absence of a Member, vacancy on the Board or inability of the Member assigned to the Section to serve on the panel. The Chairman has directed that the Section proceed with the transaction of business, including the issuance of decisions, without awaiting the assignment of a third Member. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.