Citation Nr: 0306854 Decision Date: 04/09/03 Archive Date: 04/14/03 DOCKET NO. 89-21 946 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for a chronic acquired dermatological disorder, to include chloracne, including as secondary to Agent Orange (AO) exposure. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD David T. Cherry, Counsel INTRODUCTION The veteran served on active duty from October 1967 to December 1970, including service in the Republic of Vietnam. These matter is before the Board of Veterans' Appeals (Board) on appeal from a November 1988 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. The RO denied entitlement to service connection for a skin rash as secondary to AO exposure. In June 1990, the Board did not accept jurisdiction of the issue of entitlement to service connection for a skin rash as secondary to AO exposure pursuant to Nehmer v. United States Veterans Administration, 712 F. Supp. 1404 (N.D. Cal. 1989), and referred the matter to the RO for consideration when new instructions were issued. The veteran provided oral testimony before a Hearing Officer at the RO in January 1994, a transcript of which has been associated with the claims file. In May 1997, the Board remanded the claim to the RO for further development and adjudicative action. In March 2001 the RO most recently affirmed the determination previously entered. The case has been returned to the Board for further appellate review. FINDINGS OF FACT 1. VA has met its duty to notify and assist the veteran. 2. A chronic acquired dermatological disorder including chloracne was not shown in active service. 3. The competent and probative evidence shows that the veteran does not have chloracne or any other acneform disease consistent with chloracne. 4. The competent and probative evidence establishes that the veteran does not a chronic, acquired dermatological disorder which has been linked to active service on any basis, including as secondary to AO exposure. CONCLUSION OF LAW A chronic, acquired dermatological disorder, to include chloracne was not incurred in or aggravated by active service, including as secondary to AO exposure. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307(a)(6)(d), 3.309(e) (2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION Factual Background The veteran's service medical records show that the skin was reported as normal on the July 1967 enlistment examination. In the report of medical history, the veteran did not report having had any skin diseases. On July 20, 1969, the veteran complained of a rash on the skin in the crotch. The impression was dermatitis. Two days later, he reported the same complaint. It was noted that the rash showed improvement. The December 1970 separation examination report shows that the skin was reported as normal. The veteran did not report having had any skin diseases. During a November 1973 VA hospitalization, the veteran reported that he had bad feet from service in Vietnam, which he called "jungle rot." VA medical records reflect that tinea versicolor of the thorax was diagnosed in July 1976. In November 1978, the veteran reported that he had had a rash for two days. Physical examination of the trunk revealed a rash around the belt line, back, chest and arms. The diagnosis was urticaria. VA medical records show that in April 1980 it was indicated that the veteran had a rash that appeared to be tinea versicolor. In July 1980 he reported that he had had a rash on his skin for the past two months, and indicated that it had first started about three years ago. He also noted that he had "sores" on his skin while serving in Vietnam nine years ago, and that his current rash was somewhat similar. Physical examination revealed scabbed over, scaly areas scattered about the legs and trunk. The diagnosis was chronic dermatitis. In September 1980, tinea versicolor and tinea corporis were diagnosed. The veteran underwent a VA fee basis examination in October 1988. The examiner indicated that the veteran had hypopigmented scaling dermatosis of the chest and back, which was clinically consistent with tinea versicolor and was not related to exposure to AO. The examiner also noted that the veteran had scaling of both legs, which was consistent with asteatotic eczema. During a June 1992 VA hospitalization, the veteran underwent a dermatology consultation. He reported that he had a scrotal rash as well as a rash around the neck, which he stated had been present since 1968. The diagnoses were tinea versicolor of the neck and probable contact dermatitis at the waist. During a September 1992 VA hospitalization the veteran was diagnosed with tinea corporis. The veteran underwent another VA fee basis examination in March 1993. He complained of an itchy rash over his "private parts," which he said had recurred since his time in Vietnam. Physical examination revealed that the inguinal region and gluteal cleft were hyperpigmented and lichenified. The differential diagnoses were lichen simplex chronicus, tinea corporis and a mild form of psoriasis. The examiner opined that the condition was not due to AO exposure and was not a subtype of chloracne. At his January 1994 hearing before a Hearing Officer at the RO, the veteran testified that he had chloracne in service and that he continued to have it. He reported that no medical professional had diagnosed his skin disorder as chloracne. He attributed his skin disorder to in-service chemical exposure. Transcript. The veteran was afforded a VA skin disease examination in October 1998. He reported that he had a rash in 1970, which became a serious problem in 1972 or 1973, and that most of the rash was present in the groin. He indicated that he first had a rash around his neck in 1991 or 1992, and that he first had rash on his feet three to four years ago. Following physical examination, the diagnoses included (1) bilateral tinea pedis of the planter surfaces of the feet; (2) tinea versicolor present in the upper chest, back and axillary areas; and (3) tinea cruris, which had been irritated through itching and now had a lichenification secondary to the chronic itching and irritation. The examiner indicated that the tinea cruris did not show any signs of being related to AO exposure or being a chloracne- type rash. The examiner also noted that the tinea versicolor was not associated with AO or any other herbicide. The examiner concluded by stating that the veteran did not have a rash that exhibited an acneform type of disorder associated with exposure to AO or any other herbicide. In an April 1999 addendum, the VA examiner indicated that tinea cruris and tinea versicolor can occur due to humidity, sweating and poor hygiene, and that the tinea cruris cannot be 100 percent related to active service. In a July 1999 addendum, the VA examiner noted the veteran had no signs of any condition that is secondary to exposure to herbicides and no signs of any skin condition that is related to a service-connected activity. The examiner indicated that tinea versicolor is present in children and adults who have never been in Vietnam or in any war activities. The examiner also noted that tinea cruris is a fungal type of rash which can occur at any time during one's life, and that it had nothing to do with any wartime activities or service- related activities. The examiner indicated that tinea cruris can occur in civilian life and at any time. The examiner reported that the rash veteran had in service may have been tinea cruris. The examiner, however, noted that he could not provide a diagnosis with a 100-percent certainty because he did not examine the veteran in service. The examiner stated that a rash which occurred in service is not associated with a rash that occurred in the 1990s, and that tinea cruris can come and go. The examiner opined that there was no specific relationship of the rash in service to the rash that occurred in the 1990s. The examiner reiterated that no rash present now can be associated with a rash in service. During an August to October 1999 VA hospitalization, the veteran underwent a dermatology consultation. He reported that he had had a very itchy, chronic groin eruption since he was in Vietnam. He claimed that since he was in Vietnam, he had broken out extensively under both arms and around the neck and upper trunk. The diagnoses were tinea cruris, tinea corporis, tinea versicolor, lichen simplex chronicus as a secondary manifestation of the groins, and extensive moccasins-type tinea pedis. The veteran underwent a VA general medical examination in February 2000. He reported that he had a rash years ago involving his neck and arms which was usually worse in the summer. Physical examination revealed no sign of a rash. A dermatological disorder was not diagnosed. In an April 2001 statement, a VA social worker noted the veteran had a "rash encountered during Agent Orange (sic)." Criteria To establish service connection for a claimed disability the facts must demonstrate that a disease or injury resulting in current disability was incurred in active military service or, if pre-existing active service, was aggravated therein. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. The United States Court of Appeals for Veterans Claims (CAVC) has held that, in order to prevail on the issue of service connection, there must be medical evidence of a (1) current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may 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). Where there is a chronic disease shown as such in service or within the presumptive period under 38 C.F.R. § 3.307 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) (2002). This rule does not mean that any manifestation in service will permit service connection. To show 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." When the disease identity is established, there is no requirement of evidentiary showing of continuity. 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. To show 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." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). The CAVC has also reiterated that, alternatively, either or both of the second and third elements can be satisfied, under 38 C.F.R. § 3.303(b) (2002), by the submission of (a) evidence that a condition was "noted" during service or during an applicable presumption period; (b) evidence showing post-service continuity of symptomatology; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. McManaway v. West, 13 Vet. App. 60, 65 (1999) (citing Savage v. Gober, 10 Vet. App. 488, 495-97). CAVC has established the following rules with regard to claims addressing the issue of chronicity. The chronicity provision of 38 C.F.R. § 3.303(b) is applicable where evidence, regardless of its date, shows that a veteran had a chronic condition in service and still has such condition. Such evidence must be medical unless it relates to a condition as to which, under the CAVC's case law, lay observation is competent. Savage v. Gober, 10 Vet. App. 488, 498 (1997). A lay person is competent to testify only as to observable symptoms. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). A layperson is not, however, competent to provide evidence that the observable symptoms are manifestations of chronic pathology or diagnosed disability, unless such a relationship is one to which a lay person's observation is competent. See Savage, 10 Vet. App. at 495-97. The CAVC has further determined chronicity was not demonstrated when the sole evidentiary bass for the asserted continuous symptomatology was the sworn testimony of the appellant himself and when "no" medical evidence indicated continuous symptomatology. McManaway, 13 Vet. App. at 66. In Voerth v. West, 13 Vet. App. 117 (1999), the CAVC held that the appellant had not submitted medical evidence providing a nexus between an in-service injury and a current disability. The CAVC held that where a claimant's personal belief, no matter how sincere, was unsupported by medical evidence, the personal belief cannot form the basis of a claim. The CAVC stated that it clearly held in Savage that Section 3.303 does not relieve a claimant of the burden of providing a medical nexus. Rather, a claimant diagnosed with a chronic condition must still provide a medical nexus between the current condition and the putative continuous symptomatology. Until the claimant presents competent medical evidence to provide a relationship between a current disability and either an in-service injury or continuous symptomatology, the claimant cannot succeed on the merits of the claim. Voerth, 13 Vet. App. at 120. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to a herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The last date on which such a veteran shall be presumed to have been exposed to a herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 U.S.C.A. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to a herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 U.S.C.A. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform diseases consistent with chloracne, Hodgkin's disease, multiple myeloma, non-Hodgkin's lymphoma, acute and subacute peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). The term "soft-tissue sarcoma" includes epithelioid sarcoma. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year, and respiratory cancers within thirty years, after the last date on which the veteran was exposed to a herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). Evidence which may be considered in rebuttal of service incurrence of a disease listed in Sec. 3.309 will be any evidence of a nature usually accepted as competent to indicate the time of existence or inception of disease, and medical judgment will be exercised in making determinations relative to the effect of intercurrent injury or disease. The expression "affirmative evidence to the contrary" will not be taken to require a conclusive showing, but such showing as would, in sound medical reasoning and in the consideration of all evidence of record, support a conclusion that the disease was not incurred in service. 38 C.F.R. § 3.307(d). The Secretary of VA has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Diseases Not Associated With Exposure to Certain Herbicide Agents, 67 Fed. Reg. 42,600, 42,604 (June 24, 2002). Notwithstanding the foregoing presumption provisions, which arose out of the Veteran's Dioxin and Radiation Exposure Compensation Standards Act, Public Law No. 98-542, § 5, 98 Stat. 2725, 2727-29 (1984), and the Agent Orange Act of 1991, Public Law No. 102-4, § 2, 105 Stat. 11 (1991), the United States Court of Appeals for the Federal Circuit (CAFC) has determined that a claimant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). In the regulations implementing the Veterans Claims Assistance Act of 2000 (VCAA), competent lay evidence is defined as any evidence not requiring that the proponent have specialized education, training or experience. Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R § 3.159(a)(1). In the regulations implementing the VCAA, competent medical evidence is defined as evidence provided by a person who is qualified through education, training or experience to offer medical diagnoses, statements or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. See 38 C.F.R § 3.159(a)(2). See also Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. §§ 3.102, 4.3 (2002). The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When, after consideration of all of the evidence and material of record in an appropriate case before VA, there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107 (West Supp. 2002); Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Analysis Preliminary Matter: Duty to Assist At the outset, it should be noted that on November 9, 2000, the President signed into law the VCAA, Pub. L. No. 106-475, 114 Stat. 2096 (2000). The law eliminates the concept of a well-grounded claim, redefines the obligations of VA with respect to the duty to assist, and supercedes the decision of the CAVC in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom. Morton v. Gober, 14 Vet. App. 174 (2000) (per curiam order) (holding that VA cannot assist in the development of a claim that is not well grounded). This law also includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. The VCAA is applicable to all claims filed on or after the date of enactment, November 9, 2000, or filed before the date of enactment and not yet final as of that date. VCAA of 2000, Pub. L. No. 106-475, § 7(a), 114 Stat. 2096, 2099 (2000). See also Karnas v. Derwinski, 1 Vet. App. 308 (1991). VA has issued final rules to amend adjudication regulations to implement the provisions of the VCAA of 2000. See 38 C.F.R § 3.159 (2002). The regulations pertaining to these claims merely implement the VCAA and do not provide any rights other than those provided by the VCAA. See 66 Fed. Reg. 45,620, 45,629 (Aug. 29, 2001). In that regard, the RO provided the veteran notice of the VCAA and adjudicated his claim with this law in mind in a May 2001 supplemental statement of the case. Through rating decisions, statements of the case, supplemental statements of the case, an October 1988 letter, a March 1993 letter, a June 1997 letter, and a May 2001 letter accompanying the May 2001 supplemental statement of the case, the RO informed the veteran of the information and evidence necessary to substantiate his claim and his responsibilities for providing evidence. He was advised of evidence he could submit himself or to sufficiently identify evidence and if private in nature to complete authorization or medical releases so that VA could obtain the evidence for him. Such notice sufficiently placed the veteran on notice of what evidence could be obtained by whom and advised him of his responsibilities if he wanted such evidence to be obtained by VA. See 38 U.S.C.A. § 5103 (West Supp. 2002); Quartuccio v. Principi, 16 Vet. App. 183 (2002); 38 C.F.R. § 3.159 (2002). Copies of the above-mentioned documents were sent to or made available for review by the representative prior to the submission of written argument in March 2003. In regard to providing evidence, the RO in the June 1997 letter asked the veteran to identify all medical providers who had treated him for a skin disorder. In that letter, the RO enclosed copies of the VA Form 21-4142 (authorization for release of information), and asked the veteran to complete those forms. The veteran responded later that month and indicated that his only treatment was at a VA medical center. The RO obtained all treatment records from that VA medical center. Additionally, in the May 2001 letter, the RO asked the veteran to identify any additional evidence that would substantiate his claim, offered to assist him in obtaining such evidence, and enclosed copies of the VA Form 21-4142. The veteran did not respond. As for the duty to assist, the service medical records are of record. The RO asked the National Personnel Records Center (NPRC) for any additional records in July 1997, and NPRC provided additional copies of the veteran's enlistment and separation examinations. The RO obtained VA medical records, and as noted above, the veteran indicated that he only received treatment at one particular VA medical center. In light of the above, VA has fulfilled its duty to assist in obtaining relevant records. See 38 U.S.C.A. § 5103A (West Supp. 2002); 38 C.F.R § 3.159 (2002). Pursuant to the May 1997 Board remand, VA provided the veteran with a third medical examination since he filed his claim and obtained a medical opinion regarding the natures and etiologies of his current skin disorders. Accordingly, VA has satisfied its duty to assist by providing a medical examination and obtaining a medical opinion. See 38 U.S.C.A. § 5103A; 38 C.F.R § 3.159(c)(4). In light of the above, the RO complied with the directives of the May 1997 remand. See Stegall v. West, 11 Vet. App. 268 (1998). In light of the foregoing, the Board is satisfied that all relevant facts have been adequately developed to the extent necessary; no further assistance to the veteran in developing the facts pertinent to his claim is required to comply with the duties to notify and to assist under both the former law and the new VCAA. 38 U.S.C.A. §§ 5107(a), 5103, 5103A; 38 C.F.R. § 3.159. Additionally, the Board finds that the duty to notify has been satisfied. 38 U.S.C.A. § 5103; 38 C.F.R. § 3.159(b). As for the hearing officer's duty to assist, for the same reasons as noted above with regard to the VCAA, the hearing officer's duty under 38 C.F.R. § 3.103(c)(2) has been satisfied. See Stuckey v. West, 13 Vet. App. 163 (1999); Costantino v. West, 12 Vet. App. 517 (1999). Having determined that the duties to notify and to assist have been satisfied, the Board turns to an evaluation of the veteran's claims on the merits. Service Connection Service medical records reflect that the veteran had a groin rash in July 1969. However, on separation examination, he denied having had any skin diseases and the skin was noted to be normal. Therefore, the probative evidence shows that the veteran did not have a chronic acquired dermatological disorder to include chloracne in active service. See 38 C.F.R. § 3.303. Additionally, neither chloracne nor another acneform disease consistent with chloracne has been diagnosed. The March 1993 VA fee basis examiner and the October 1998 VA examiner both noted that the veteran did not have such a disorder. As for the veteran's testimony at his hearing that he has chloracne, his belief as to the nature of his dermatological disorder is not probative inasmuch as he is a lay person and not competent to make a medical diagnosis muchless opine as to etiology. See 38 C.F.R § 3.159(a). See also Espiritu, 2 Vet. App. at 494-95. Accordingly, the probative evidence reflects that the veteran does not have chloracne or any acneform disease consistent with chloracne. See 38 C.F.R. §§ 3.307, 3.309. The next matter is whether any current dermatological disorder is otherwise related to active service. In regard to exposure to AO or other herbicides, the October 1988 and March 1993 VA fee basis examiners and the October 1998 VA examiner all addressed whether a current dermatological disorder was related to such exposure. None of them opined that any current disorder was related to exposure to AO or other herbicides. As for the April 2001 opinion of the VA social worker intimating that the veteran had a rash due to exposure to AO, it has not been shown the social worker has any medical expertise in dermatology to render a medical opinion either as to diagnosis or as to etiology referable to the matter at hand. See Black v. Brown, 10 Vet. App. 279, 284 (1997); 38 C.F.R. § 3.3159. Therefore, her opinion is not competent medical evidence. As for the veteran's assertion, made at various times, that he has a skin disorder related to exposure to AO, the veteran's belief as to the etiology of his dermatological disorder is not probative inasmuch as he is a lay person and not competent to render a medical opinion. See 38 C.F.R § 3.159(a). See also Espiritu, 2 Vet. App. at 494-95. In light of the above, the probative evidence shows that the veteran does not have a chronic, acquired dermatological disorder that is related to exposure to Agent Orange or other herbicide agents. As to the veteran's assertions of continuity of symptomatology, no medical professional has provided a nexus between the veteran's current disability and his in-service symptomatology. Savage v. Gober, 10 Vet. App. 488 (1997). In that regard, the October 1998 VA examiner noted that while the veteran may have had tinea cruris in service when he was treated for a groin rash, tinea cruris can come and go, and that there was no specific relationship of the rash in service to the rash that occurred in the 1990s. Accordingly, the probative evidence reveals that the veteran does not have a chronic, acquired dermatological disorder that is otherwise related to active service, including the in-service groin rash, including on the basis of continuity of symptomatology. See McManaway, Voerth, supra. In short, the competent, probative evidence establishes that the veteran does not have a chronic acquired dermatological disorder, including chloracne, which has been linked to active service on any basis, including AO exposure, thereby precluding a grant of entitlement to service connection. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 5107 ; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. Although the veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). ORDER Entitlement to service connection for a chronic, acquired dermatological disorder, to include chloracne, including as secondary to AO exposure, is denied. ____________________________________________ RONALD R. BOSCH Veterans Law Judge, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.