Citation Nr: 0303576 Decision Date: 03/03/03 Archive Date: 03/18/03 DOCKET NO. 95-27 671 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to an initial disability evaluation in excess of 30 percent for scalp folliculitis, acne keloidalis nuchae, and hidradenitis suppurativa. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant, Appellant's husband ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Associate Counsel INTRODUCTION The veteran had active service from May 1989 to August 1992. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office in Seattle, Washington and Muskogee, Oklahoma (RO). The Seattle, Washington RO granted service connection for the veteran's skin disorder and assigned a 10 percent disability evaluation effective May 1994. The veteran's claims file was subsequently transferred to the Muskogee, Oklahoma RO, wherein she was granted a 30 percent disability evaluation for her skin disorder, also effective May 1994. In a December 2000 decision, the Board denied the veteran's claim for an initial disability evaluation in excess of 30 percent for her skin disorder. The veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In January 2002, the Court vacated the December 2000 Board decision with respect to the issue presently on appeal, and remanded the matter back to the Board for development consistent with the Joint Motion for Remand and to Stay Proceedings (Motion). The veteran's appeal was returned to the Board for additional development, consideration of the Veterans Claims Assistance Act of 2000, and readjudication. The Board observes that the December 2000 Board decision also remanded the issues of service connection for anemia and entitlement to an increased disability evaluation for cholelithiasis. These issues were not addressed by the Court and are not presently before the Board. As such, these issues are still pending before the RO. FINDINGS OF FACT 1. The veteran was notified of the evidence needed to substantiate her claim, and all relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. From May 16, 1994 to August 29, 2002, the veteran's skin disorder was manifested by repeated ulceration and exceptional repugnancy. 3. Since August 30, 2002, the veteran's skin disorder required near constant systemic therapy of corticosteroids and immunosuppressants, as it had for the previous year. CONCLUSION OF LAW 1. The criteria for an initial disability evaluation of 50 percent for scalp folliculitis, acne keloidalis nuchae, and hidradenitis, for the period from May 16, 1994 to August 29, 2002, have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107(b) (West 1991 & Supp. 2001); 66 Fed. Reg. 45,620, 45,630-32 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. §§ 3.102, 3.159); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118, Diagnostic Code 7806 (2001); 67 Fed. Reg. 49,590, 49,596 (July 31, 2002). 2. The criteria for a disability evaluation of 60 percent for scalp folliculitis, acne keloidalis nuchae, and hidradenitis, for the period from August 30, 2002, have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107(b) (West 1991 & Supp. 2001); 66 Fed. Reg. 45,620, 45,630-32 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R. §§ 3.102, 3.159); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.118, Diagnostic Code 7806 (2001); 67 Fed. Reg. 49,590, 49,596 (July 31, 2002). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran essentially contends that the current disability evaluation assigned for her skin disorder does not accurately reflect the severity of that disability. Specifically, the veteran asserts that her disorder should be assigned an increased disability evaluation because she experiences recurrent cysts and lesions, drainage, and scarring. As a preliminary matter, in November 2000, the Veterans Claims Assistance Act of 2000 (VCAA) became law. The VCAA applies to all claims for VA benefits and provides, among other things, that the VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim for benefits under laws administered by the VA. The VCAA also requires the VA to assist a claimant in obtaining that evidence. See 38 U.S.C.A. §§ 5103, 5103A (West Supp. 2001); 66 Fed. Reg. 45, 630 (Aug. 29, 2001) (to be codified at 38 C.F.R. § 3.159). First, the VA has a duty under the VCAA to notify the veteran and her representative of any information and evidence needed to substantiate and complete her claim. The rating decisions, the statement of the case, and the supplemental statements of the case issued in connection with the veteran's appeal, as well as additional correspondence to the veteran, have notified her of the evidence considered, the pertinent laws and regulations, and the reason that her claim was denied. The RO indicated that they would review the information of record and determine what additional information is needed to process the veteran's claim. The RO also informed the veteran of what the evidence must show in order to warrant entitlement to an increased disability evaluation and provided a detailed explanation of why an increased rating was not granted. In addition, the statement of the case and the supplemental statements of the case included the criteria for granting an increased rating for her skin disorder, as well as other regulations pertaining to her claim for an increased evaluation. Letters to the veteran, from the RO, notified the veteran as to what kind of information they needed from her, and what she could do to help her claim. Likewise, a December 2002 letter from the Board apprised the veteran of a change in the regulations regarding skin disorders and notified her that she could submit additional evidence regarding her claim. The veteran was also provided a copy of the revised regulations. See Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002) (requiring VA to notify the veteran of what evidence he was required to provide and what evidence the VA would attempt to obtain). Under the circumstances, the Board finds that the notification requirements of the VCAA have been satisfied. Second, the VA has a duty to assist the veteran in obtaining evidence necessary to substantiate her claim. In this regard, the veteran's service medical records, military medical records, and VA medical records have been obtained. In addition, the veteran was afforded several VA examinations and a hearing before the RO. The veteran and her representative have not made the Board aware of any additional evidence that should be obtained prior to appellate review, and the Board is satisfied that the requirements under the VCAA have been met. As such, the Board finds that the duty to assist was satisfied and the case is ready for appellate review. See Bernard v. Brown, 4 Vet. App. 384, 392-394 (1993). See also VAOPGCPREC 16-92. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Furthermore, a disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. In addition, where an award of service connection for a disability has been granted and the assignment of an initial evaluation for that disability is disputed, separate evaluations may be assigned for separate periods of time based on the facts found. In other words, evaluations may be "staged." See Fenderson v. West, 12 Vet. App. 119, 126 (1999). In this case, the issue of an increased evaluation for dermatitis stems from an initial grant of service connection and the assignment of a 30 percent disability evaluation. Historically, a September 1994 rating decision granted the veteran service connection for multiple cysts, and assigned a noncompensable disability evaluation effective May 16, 1994. The veteran submitted a notice of disagreement in May 1995, the RO issued a statement of the case in June 1995, and the veteran perfected her appeal. Following the submission of additional medical evidence, the RO, in a January 1997 rating decision, increased the veteran's disability evaluation to 10 percent disabling, also effective May 1994. The veteran filed a notice of disagreement with the 10 percent disability evaluation in November 1997 and, after the submission of additional medical evidence, the RO increased the disability evaluation for the veteran's skin disorder to 30 percent, again effective May 1994. As discussed in the Introduction, the Board denied the veteran's claim for an increased disability evaluation in a December 2000 decision, which was vacated and remanded with regard to that issue by the Court in January 2002. Following additional development, the veteran's claim is again before the Board. According to the September 1994 rating decision, service connection was granted on the basis that the veteran's service medical records showed treatment for a right thigh abscess in October 1989, an infected right thigh cyst in November 1989, a fistula in ano in May 1990, and folliculitis of the scalp in January 1991; a VA examination which showed cysts on the scalp, right axillary area, right groin, and perivaginal area; and a two year history of recurrent cysts on various body parts. An August 1992 military medical record (when the veteran was a dependent of a member of the military), states that the veteran complained of crusting sores on her scalp and sores on the right inguinal area. The assessment was seborrheic dermatitis/folliculitis. Keflex and Selsun shampoo were prescribed. In October 1993 she was treated for a cyst in the right axilla with moderate purulent exudate. A December 1993 VA medical record states that the veteran had moderate to severe acne of the face, multiple areas of folliculitis (scalp, mons pubis, and right axilla), and spontaneous, purulent drainage of the right axilla folliculitis. A fever was suspected to be secondary to the veteran's folliculitis. Keflex was increased. In March 1994, the veteran had an aspiration of yellow puss from an inguinal lesion. She was also treated for folliculitis of the scalp and acne. At the time, examination showed multiple pustular lesions around the hair shafts. Rimantadine was prescribed. In May 1994, the veteran was noted as having hidradenitis, requiring use of dicloxacillin. In June 1994, the veteran was treated for draining cysts of the left groin and right axilla with healed hidradenitis. Dicloxacillin was prescribed. Another June 1994 VA medical record shows that a right thigh abscess was aspirated. According to the aforementioned June 1994 VA examination, the veteran reported that she had recurrent cysts throughout her body, extending from the scalp area to the perivaginal rectal area and thighs. She also reported that these cysts have "come and gone" and required multiple incisions and drainage. Examination showed cysts throughout the back of her scalp, a chronic cyst of the right axillary area, and a tender cyst in the right groin. The veteran also had a cyst in the perivaginal area. The diagnosis was recurrent large cysts involving the scalp, axillary areas, and inguinal areas. An August 1995, the veteran was noted as having Grade III cystic acne, without response to erythromycin or retin-a. In November 1995, the veteran was treated for facial acne and lesions of buttocks and vaginal area. Tetracycline and retin-a were noted as helping, but were discontinued. An undated treatment note shows that the veteran had papular lesions of the rectal area, multiple hyperpigmented areas of the face, and a cystic inflammation on each buttock. The assessment was acne/folliculitis. Retin-a and doxycycline were prescribed. In March 1996, examination showed greasy, moderately thick scaling of the scalp, with pustules along the hairline, and hyperpigmented macules of the cheek and forehead. The assessment was acne/folliculitis, improved, and seborrheic dermatitis. A July 1996 VA treatment note shows that the veteran's acne improved with the doxycycline and retin-a. Examination showed that the veteran did not have any pustules, but did have some healing papular lesions and small areas of hyperpigmentation. Her scalp had decreased thick scaling. The assessment was improved acne and seborrheic dermatitis. In May 1997, the veteran was treated for chronic, painful sores on the back of her head and small pustules on her face. Doxycycline and Nizoral shampoo were prescribed. A November 1997 VA medical record shows that the veteran complained that the sores on her head had been bleeding. Examination showed folliculitis of the scalp, with a possible infection. A December 1997 VA treatment record indicates that the veteran was diagnosed with folliculitis of the scalp following complaints of lesions and cysts on the scalp. Keflex was prescribed as the veteran was unable to take erythromycin or dicloxacillin. Another record states that she had a chronic subcutaneous cyst in the right upper thigh, which was not spontaneously draining. Warm compresses and treatment of her symptoms was recommended. The veteran was afforded another VA examination in January 1998. According to the report, the veteran complained of chronic sores on her scalp and occasional flare-up of sores in her pubic area. The veteran reported that she had been treated with multiple courses of antibiotics, with temporary relief, and shampoos, which have not helped. The examination showed scattered follicular papules and pustules of the central scalp, scattered scars similar to follicular papules on the posterior scalp and neck, and scattered comedones, papules, and macules of hyperpigmentation on the face. She also had follicular papules and subcutaneous small nodules on the medial thighs and labia majora, as well as scarring on the medial thighs in a follicular pattern. The assessment was chronic scalp folliculitis, acne keloidalis nuchae of the posterior scalp and neck, moderate inflammatory facial acne, and hidradenitis suppurativa of the medial thighs. The examiner noted that these problems were chronic and could only be partially controlled. The examiner prescribed a topical Cleocin solution, topical flucinanite, and oral antibiotics. A March 1998 VA medical record states that an examination of the veteran showed follicular papules and crusting on the veteran's occipital scalp. The assessment was acne keloidal nuchae. Several medications were prescribed, including betamethasone ointment. The veteran was afforded a hearing before the RO in June 1998. According to the transcript, the veteran testified that she had cysts on her buttocks, vaginal area, and on her head. She stated that the cysts on her head bleed and cause headaches, and that the shampoos used to treat her disorder caused hair loss. She also stated that the cysts itch, but that she did not have daily itching. She also testified that she had some of her cysts surgically removed and others were surgically aspirated. In addition, the veteran reported that she had taken antibiotics for her cysts, but that the doctors preferred not to do so anymore, as it was causing her stomach upset. She also reported that she used steroids for treatment, and that the surgical removal and aspiration of her cysts had left many scars. The veteran also related that her skin disorder was chronic. An October 1998 VA medical record listed the veteran's medications as: betamethasone ointment, selenium sulfide lotion/shampoo, fluocinolone topical solution, clindamycin topical solution, famotidine tablet, and tretinoin cream. A treatment addendum indicates that the veteran had lesions on her labia, which were open, but not draining. A March 2000 VA treatment record states that the veteran had hyperpigmented macular lesions of the left arm. A July 2000 VA medical record notes a history of seborrheic dermatitis and acne. She was treated for a small excoriation of the perianal area. A March 2001 VA treatment note states that the veteran had severe inflammatory acne lesions on her face, with scarring. Another March 2001 treatment note indicates that the veteran had lesions on her scalp, and that she was to restart her shampoo and steroid cream. A February 2002 VA medical record shows that the veteran had acne vulgaris and seborrheic dermatitis. In addition, she was treated for a rectal lesion with surrounding erythema and white discharge. There were no ulcerations. Medications included: benzoyl peroxide 5/erythmomycin gel; betamethasone valerate aerosol; clindamycin phosphate topical solution; fluocinolone acetonide topical solution; hydroquinone cream; minocycline capsules; salicylic acid/sulfur shampoo; selenium sulfide lotion/shampoo; tretinoin cream; and triamcinolone acetonide cream. A July 2002 VA treatment note indicates that the veteran had a pilonidal cyst on the left superior gluteal fold with excoriation and discharge. Another July 2002 treatment note indicates that the veteran complained that her medications were not working. An August 2002 VA "order summary" indicates that the veteran had been prescribed various creams, ointments, tablets, shampoos since July 1996 for her skin disorder, most with instructions to use daily. The veteran was most recently afforded a VA examination in September 2002. The report indicates that the veteran reported a long history of "breaking out" on her scalp, axilla, groin, and perianal area. She also reported that she had been treated with numerous medications, but only had minimal relief. Upon examination, she had hyperkeratotic papules and nodules in the posterior scalp; hyperpigmentation and nodules on the forehead, cheeks, and neck; and scarring and sinus tracts in the axilla. There was no evidence of drainage in these areas. Her buttocks and gluteal cleft had numerous, tender firm nodules. She also had a fissure in the gluteal cleft, with purulent discharge and erythema. There was extensive scarring of the vaginal area, with sinus tracts, hyperpigmentation, and nodules. There were also numerous sinus tracts and ulcerations in the gluteal cleft. There were many fissures and tracts in the veteran's groin and buttock areas, with scarring and tenderness. The examiner characterized the scarring on the veteran's posterior scalp, axilla, and groin as "exceptionally repugnant" and noted that the scars on the veteran's axilla and groin were tender. There were color irregularities noted on the veteran's face and neck. The impression was acne keloidalis, under fair control and hidrosadenitis suppurativa, active in the groin and buttock areas. The examiner also noted that the veteran's axilla was not actively involved at that time. The examiner stated that the veteran's hidrosadenitis suppurativa was a systemic disease, which will "wax and wane" in severity for the veteran's lifetime, requiring continuous treatment. The examiner also stated that alopecia and pigment changes were a part of her acne and pseudofolliculitis, "which have systemic and nervous manifestations." A January 2003 VA medical record noted that the veteran was prescribed nine medications for her skin disorder. The record also indicated that the veteran was treated for a right buttock lesion and a lesion on the left gluteal cheek with a small draining fistula. The assessment was pilonidal cyst. Antibiotics were prescribed. The RO assigned a 30 percent disability evaluation for the veteran's skin disorder by analogy to 38 C.F.R. § 4.118, Diagnostic Code 7806. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but also the anatomical localization and symptomatology are closely analogous. See 38 C.F.R. § 4.20 (2002). The Board notes that after the veteran initiated this appeal, the regulations pertaining to the evaluation of skin disorders were amended, effective August 30, 2002. See 67 Fed. Reg. 49,590 (2002). "[W]here the law or regulation changes after a claim has been filed or reopened but before . . . the appeal process has been concluded, the version most favorable to the appellant should and . . . will apply unless Congress provided otherwise or permitted the Secretary of Veterans Affairs (Secretary) to do otherwise and the Secretary did so." Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). However, where the amended regulations expressly provide an effective date and do not allow for retroactive application, the veteran is not entitled to consideration of the amended regulations prior to the established effective date. See Green v. Brown, 10 Vet. App. 111, 116-119 (1997); see also 38 U.S.C.A. § 5110(g) (West 1991 & Supp. 2001). Therefore, the Board must evaluate the appellant's claim for an increased rating under both the old criteria in the VA Schedule for Rating Disabilities and the current regulations in order to ascertain which version is most favorable to his claim, if indeed one is more favorable than the other. For any date prior to August 30, 2002, the Board cannot apply the revised regulations. Under the former version of Diagnostic Code 7806, a 30 percent disability evaluation was assigned under this Code for eczema with constant exudation or itching, extensive lesions, or marked disfigurement. See 38 C.F.R. § 4.118, Diagnostic Code 7806. A 50 percent disability evaluation was warranted for eczema with ulceration or extensive exfoliation or crusting, and systemic or nervous manifestations, or for exceptionally repugnant eczema. Id. The Board observes that there is no higher disability evaluation under this Code. According to the current regulations, effective August 30, 2002, the veteran's disorder continues to be evaluated under 38 C.F.R. § 4.118, Diagnostic Code 7806, which is now used for rating dermatitis in addition to eczema. A 30 percent disability evaluation is assigned for dermatitis or eczema over 20 to 40 percent of the body or 20 to 40 percent of the affected exposed areas, or systemic therapy, such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly during the past year. See 67 Fed. Reg. At 49,596 (2002). For the next higher 60 percent disability evaluation, there must be dermatitis or eczema over more than 40 percent of the entire body or more than 40 percent of the exposed areas affected, or; constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs for the past 12 month period. Id. There is no higher disability evaluation available under this Code. The Board has carefully reviewed the evidence of record, as summarized above, and finds that for the reasons and bases set forth below, the veteran's skin disorder most closely approximates the criteria for a 50 percent disability rating from May 16, 1994 to August 29, 2002 under the former criteria and a 60 percent disability rating from August 30, 2002 under the current criteria. See 38 C.F.R. § 4.118, Diagnostic Code 7806 (2001); 67 Fed. Reg. 49,590, 49,596 (2002). Upon reviewing the former rating criteria in relation to the evidence for consideration, the Board finds that the veteran's disability picture is more severe than was evaluated, and that an increased disability evaluation is warranted. The objective medical evidence of record clearly shows that the veteran's symptomatology has met at least some of the criteria for a 50 percent disability evaluation from May 16, 1994 to August 29, 2002. The veteran experienced ulcerations and crusting, as well as hyperpigmentation, purulent discharge, and exudation. Furthermore, the most recent VA examiner clarified the nature of the veteran's skin disorder, stating that the hyperpigmentation and alopecia were systemic manifestations of the veteran's acne and folliculitis. Likewise, the veteran had infected cysts and scarring from cysts. In addition, the veteran had required the near continuous use of medication, since at least 1992, as her skin disorder was chronic, with worsening symptoms with flare-ups. Most significantly, the VA examiner in September 2002 stated that the veteran's scars from the fissures and sinus tracts of her skin disorder were exceptionally repugnant. Therefore, the Board finds that reasonable doubt should be resolved in the veteran's favor and concludes that the veteran's skin disorder from May 16, 1994 through August 29, 2002 more closely approximated a 50 percent disability evaluation under Diagnostic Code 7806. Additionally, the Board finds that the veteran's dermatitis is most consistent with a 60 percent disability evaluation and that an increased disability evaluation is warranted upon reviewing the current rating criteria in relation to the veteran's symptomatology demonstrated after August 30, 2002. The objective clinical evidence of record clearly shows that the veteran requires near-constant systemic therapy for her skin disorder, since at least 1996. In this regard, the Board notes that the veteran uses steroid topical treatments as well as antibiotics to alleviate the symptoms of her skin disorder, without complete control. Moreover, the Board notes that the veteran's skin disorder, during flare-ups, encompasses a significant portion of the affected areas, causing discomfort. Likewise, the Board notes that the veteran had hyperpigmentation and nodules on her forehead, cheeks, and neck, and papules and nodules on her scalp, as well as cysts and scars on her thighs and in her vaginal and rectal areas. As such, the Board finds that the veteran's skin disorder from August 30, 2002 more closely approximated a 60 percent disability evaluation under Diagnostic Code 7806. The Board acknowledges that the veteran and her representative requested an additional disability evaluation for her scars. However, the Board points out that the veteran's scarring from the cysts, ulcerations, and other manifestations of her skin disorder were contemplated by the aforementioned increased disability evaluations, and that an additional disability evaluation for her scarring is not warranted. In this regard, the Board notes that the nature, extent, and severity of the veteran's scarring was contemplated when granting an increased disability evaluation for her skin disorder on the basis of exceptional repugnancy and the need for near constant systemic therapy to treat her skin disorder. As such, the veteran is not entitled to an additional disability evaluation for her scars. See 38 C.F.R. § 4.14 (the evaluation of the same "disability" or the same "manifestations" under various diagnoses is prohibited). See also Brady v. Brown, 4 Vet. App. 203, 206 (1993) (a claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity."). Finally, the Board has considered whether the veteran is entitled to an increased disability evaluation on an extra- schedular basis. However, the Board concludes that the record does not present such "an exceptional or unusual disability picture as to render impractical the application of the regular rating schedule standards." 38 C.F.R. § 3.321(b)(1). In this regard, the Board finds that there has been no showing by the veteran that her skin disorder, standing alone, resulted in marked interference with employment or necessitated frequent periods of hospitalization so as to render impractical the application of normal rating schedule standards. Rather, it appears that the veteran has been treated on an outpatient basis for her skin disorder and that the veteran's unemployment is due to the veteran's choice, as she is a homemaker who cares for her young son. Accordingly, the Board finds that the criteria for submission for assignment of an extra-schedular rating pursuant to 38 C.F.R. § 3.321(b)(1) have not been met. ORDER Subject to the laws and regulations governing awards of monetary benefits, a 50 percent disability evaluation for scalp folliculitis, acne keloidalis nuchae, and hidradenitis, is granted for the period from May 16, 1994 to August 29, 2002, and a 60 percent disability evaluation is assigned from August 30, 2002. WARREN W. RICE, JR. Member, 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.