Citation Nr: 0410177 Decision Date: 04/20/04 Archive Date: 04/29/04 DOCKET NO. 03-01 939 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUE 1. Entitlement to an effective date earlier than August 9, 1999, for the grant of compensation under 38 U.S.C.A. § 1151 for ataxia with hearing loss, right ear (evaluated as 100 percent disabling); right fifth cranial nerve palsy (evaluated as 30 percent disabling); right seventh cranial nerve palsy (evaluated as 20 percent disabling); left ulnar neuropathy with history of left cubital tunnel syndrome, postoperative, and left carpal tunnel syndrome, postoperative (evaluated as 20 percent disabling); and aggravation of bipolar disorder with depression and irritable behavior (evaluated as 20 percent disabling); and for the grant of special monthly compensation at the housebound rate. 2. Entitlement to an effective date earlier than July 19, 2001, for the grant of pension benefits. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Veteran, his spouse, and A.F. ATTORNEY FOR THE BOARD Michelle L. Kane, Senior Counsel INTRODUCTION The veteran had active military service from September 1952 to August 1954. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama, which granted compensation under 38 U.S.C.A. § 1151 for ataxia with hearing loss, right ear (evaluated as 100 percent disabling); right fifth cranial nerve palsy (evaluated as 30 percent disabling); right seventh cranial nerve palsy (evaluated as 20 percent disabling); left ulnar neuropathy with history of left cubital tunnel syndrome, postoperative, and left carpal tunnel syndrome, postoperative (evaluated as 20 percent disabling); and aggravation of bipolar disorder with depression and irritable behavior (evaluated as 20 percent disabling); and granted special monthly compensation at the housebound rate. These awards were initially effective from June 21, 2001; however, an August 2002 rating decision amended the effective date to August 9, 1999. The veteran continues to maintain an earlier effective date is warranted. As discussed in more detail below, the Board finds that the veteran filed a notice of disagreement with the effective date assigned by the RO for the grant of nonservice-connected pension benefits in a July 2001 rating decision, thereby initiating, but not perfecting, an appeal. This issue is being REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the veteran if further action is required on his part. FINDINGS OF FACT 1. The veteran underwent surgery for an acoustic neuroma at a VA facility on March 5, 1996. 2. The veteran's original claim for compensation under the provisions of 38 U.S.C.A. § 1151 for residuals of resection of an acoustic neuroma was received on April 1, 1996. CONCLUSION OF LAW The veteran is entitled to an effective date of March 5, 1996, for the grant of compensation under 38 U.S.C.A. § 1151 for ataxia with hearing loss, right ear (evaluated as 100 percent disabling); right fifth cranial nerve palsy (evaluated as 30 percent disabling); right seventh cranial nerve palsy (evaluated as 20 percent disabling); left ulnar neuropathy with history of left cubital tunnel syndrome, postoperative, and left carpal tunnel syndrome, postoperative (evaluated as 20 percent disabling); and aggravation of bipolar disorder with depression and irritable behavior (evaluated as 20 percent disabling); and for the grant of special monthly compensation at the housebound rate. 38 U.S.C.A. § 5110(a), (c) (West 2002); 38 C.F.R. §§ 3.154, 3.400(i) (2003). REASONS AND BASES FOR FINDING AND CONCLUSION VA has a duty to assist the veteran in the development of facts pertinent to his claim. On November 9, 2000, the President signed into law the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). This law redefines the obligations of VA with respect to the duty to assist a claimant in obtaining evidence necessary to substantiate the claim and includes an enhanced duty to notify a claimant and his or her representative, if any, as to the information and evidence necessary to substantiate and complete a claim for VA benefits. 38 U.S.C.A. §§ 5102, 5103, 5103A (West 2002); 38 C.F.R. § 3.159(b) and (c) (2003). In light of the favorable resolution herein, it is clear sufficient evidence was developed, and no further action is needed to comply with the VCAA. To summarize the relevant procedural history in this case, the veteran has been granted compensation under 38 U.S.C.A. § 1151 for the residuals of excision of an acoustic neuroma, which was conducted at a VA medical facility on March 5, 1996. Those residuals consist of ataxia with hearing loss, right ear (evaluated as 100 percent disabling); right fifth cranial nerve palsy (evaluated as 30 percent disabling); right seventh cranial nerve palsy (evaluated as 20 percent disabling); left ulnar neuropathy with history of left cubital tunnel syndrome, postoperative, and left carpal tunnel syndrome, postoperative (evaluated as 20 percent disabling); and aggravation of bipolar disorder with depression and irritable behavior (evaluated as 20 percent disabling). He has also been granted special monthly compensation at the housebound rate under 38 C.F.R. § 3.350(i). All awards have been assigned an effective date of August 9, 1999. That is the date as of which VA received a statement signed by the veteran indicating that he wanted "to file a 1151 claim." As an aside, the Board notes some issues -- such as the finality of a February 2000 rating decision that denied the 1999 claim, and the filing of a subsequent July 2001 claim - that were previously discussed by the RO. In light of the RO's assignment of an effective date of August 9, 1999 for the grant of compensation benefits under 38 U.S.C.A. § 1151, it is not necessary for the Board to elaborate on these points. The assignment of effective dates of awards is generally governed by 38 U.S.C.A. § 5110 and 38 C.F.R. § 3.400. Unless specifically provided otherwise, the effective date of an award based on an original claim for service connection "shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor." 38 U.S.C.A. § 5110(a). The implementing regulation clarifies this to mean that the effective date of an evaluation and an award of compensation based on an original claim "will be the date of receipt of the claim or the date entitlement arose, whichever is the later." 38 C.F.R. § 3.400. With section 1151 claims, such as this one, the effective date of an award will be (1) the date such injury was suffered if the claim for compensation is received within one year of that date, or (2) date of receipt of claim. 38 U.S.C.A. § 5110(c); 38 C.F.R. § 3.400(i)(1). As noted above, an effective date of August 9, 1999, has been assigned for the grant of compensation under section 1151, and the accompanying special monthly compensation benefits. The pertinent question in this case is whether there was a formal or informal claim at an earlier date, such that would warrant assigning an earlier effective date. A "claim" is defined in the VA regulations as "a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit." 38 C.F.R. § 3.1(p). An informal claim is "[a]ny communication or action indicating an intent to apply for one or more benefits." 38 C.F.R. § 3.155(a). VA must look to all communications from a claimant that may be interpreted as applications or claims - formal and informal - for benefits and is required to identify and act on informal claims for benefits. Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). The veteran argues an earlier effective date is warranted, pointing to a claim he filed on April 1, 1996. He maintains that his spouse sought the advice of VA employees on proper claim filing and completed the application in accordance with their instructions. He argues his spouse was either misled or intentionally not told how to file a section 1151 claim. In the alternative, he argues that the April 1996 claim did, in fact, encompass his 1151 claim and either that such a claim was obvious from the face of the document or should have been inferred and developed by VA. He maintains VA failed in its duty to assist him in developing the 1151 claim. On the formal claim received in April 1996 on VA Form 21-526, Veterans Application for Compensation or Pension, the veteran indicated in the block # 17, "nature of sickness, disease, or injuries for which this claim is made and date each began", bipolar disorder and "3/5/96 Brain surgery (tumor) VA Med. Ctr Birmingham, AL." In item #19, the veteran identified in-service treatment for acute sinusitis and manic-depression. He also completed the sections of the application identified as the sections to complete if he was claiming he was totally disabled. He submitted a statement from a private physician indicating that he had had surgery for resection of an acoustic neuroma on March 5, 1996, and that the resulting disabilities rendered him unable to return to gainful employment. An April 1996 rating decision denied service connection for manic depression and acute sinusitis, and the notification letter also informed the veteran that his claim for nonservice-connected pension benefits had been denied based on excessive income. The veteran argues an April 1996 claim for compensation for disability resulting from the March 1996 brain surgery performed by VA remained pending after the April 1996 rating decision that adjudicated the other claims filed in April 1996. The Board agrees. 38 C.F.R. § 3.154, concerning claims for injury due to hospital treatment, etc., provides: A formal claim for pension, compensation, dependency and indemnity compensation or any statement in a communication showing an intent to file a claim for disability or for death benefits resulting from the pursuit of a course of vocational rehabilitation, hospitalization, medical or surgical treatment, or examination under Department of Veterans Affairs laws may be accepted as a claim. The regulatory history of 38 C.F.R. § 3.154 shows that the regulation became effective on May 29, 1959 (in language derived from former VA Regulation 1026). The initial version required that a claim for § 1151 compensation (then found under section 351) include a statement showing an intent to file an application for additional disability or death benefits due to training, hospitalization or medical or surgical treatment. 38 C.F.R. § 3.154 (1959). Effective July 20, 1961, 38 C.F.R. § 3.154 was amended to permit acceptance of "a formal claim" for compensation, pension or dependency and indemnity compensation as a claim under § 1151. Under the revised regulation, where a formal claim for compensation did not make specific reference to additional disability as a result of hospitalization, a claim under § 1151 would be assumed. See Compensation and Pension- -Transmittal Sheet 217 (July 20, 1961). The regulatory history makes it clear that no reference to § 1151 or to an intent to file a claim for benefits for disability due to VA treatment was required in order to accept the formal claim as a claim under § 1151. The language of this regulation is, at best, ambiguous. It is not clear whether the phrase "showing an intent to file a claim for disability . . . resulting from . . . hospitalization, medical or surgical treatment, or examination" only modifies the prior clause concerning "any statement in a communication," or whether it is also meant to modify "[a] formal claim for . . . compensation." In other words, the regulation implies that either a formal claim for benefits or a statement showing intent to file a claim for benefits for a disability due to VA treatment is required for the claim to be considered a claim for benefits pursuant to section 1151. Current guidance from the Veterans Benefits Administration (VBA) resolves this regulatory ambiguity in the veteran's favor by stating that, although there is no requirement for submission of VA Form 21-526, a formal claim for compensation or pension is a claim for compensation under 38 U.S.C. 1151. VBA's Adjudication Procedure Manual, M21-1, Part IV, para. 22.02(a) (emphasis added). There is a further note to that manual provision indicating that if a formal claim for compensation or pension is received and entitlement under 38 U.S.C. 1151 is ultimately established, that formal claim ordinarily must be accepted as the claim for 38 U.S.C. 1151 benefits. Id. The Board also notes that a claim for compensation under section 1151 claim is a claim for VA disability compensation. The Board is not aware of any VA form that is specifically designed to serve as an application for benefits under section 1151. The Board also notes that the veteran has submitted a copy of a VA brochure on how to claim disability compensation benefits, including "veterans disabled from VA health care"; this instructs claimants to apply by filling out VA Form 21-526, the same form completed by the veteran in April 1996. The Board also concludes that the veteran's 1996 claim can reasonably be read as evidencing an intent to apply for compensation benefits for the residuals of the March 1996 surgery. It is relevant that he listed brain surgery performed on March 5, 1996 at a VA medical facility in the space provided for describing the disorders for which this claim was made. Also, in the accompanying medical certificate, he provided a medical statement as to the consequences of that VA surgery, including the fact that he was disabled. Although he did not specifically refer to 38 U.S.C.A. § 1151 or argue that the treatment was negligent, the medical problems he cited were precisely those for which he was ultimately granted compensation benefits. There is no requirement in the law that a veteran must specify with precision the statutory provision or corresponding regulation under which he is seeking benefits. Akles v. Derwinski, 1 Vet. App. 118, 121 (1990). In various precedential decisions from the United States Court of Appeals for the Federal Circuit and the United States Court of Appeals for Veterans Claims, VA's adjudication system has been called "non-adversarial," "paternalistic," and "uniquely pro- claimant." These courts have repeatedly held that there is an expectation that VA will "fully and sympathetically develop the veteran's claim to the optimum..." See, e.g., Manio v. Derwinski, 1 Vet. App. 140, 145 (1991) (quoting from H.R.Rep. No. 963, 100th Cong., 2nd Sess. 13). Moreover, by regulation, it is the obligation of VA to assist a claimant in developing the facts pertinent to a claim and to render a decision which grants every benefit that can be supported in law. 38 C.F.R. § 3.103(a) (1996). The fact that the veteran referenced the March 1996 VA surgery as a reason for his belief that he was entitled to compensation reasonably implies that the veteran had an underlying belief in his own mind that he should be compensated for the medical problems that resulted from this surgery and that were enumerated on the supporting doctor's statement. At this point, the Board also recognizes the sworn testimony of the veteran and his wife to the effect that they believed the veteran was submitting a claim for compensation based on VA medical treatment when he completed the VA Form 21-526. There is certainly no reason to doubt their testimony. When the April 1996 VA Form 21-526 is read in light of the particular facts of this case and with a view toward the special role of VA as expressed by Congress and the courts, the Board believes that, with all reasonable doubt resolved in the veteran's favor, that communication can be said to have raised a claim for entitlement to compensation under 38 U.S.C.A. § 1151 for the residuals of removal of an acoustic neuroma at a VA facility. It was clear that the veteran was seeking some type of VA benefit based on the residuals of that surgery. The fact that he did not cite the correct law or regulation or use particular terms of art did not negate the fact that he was seeking VA benefits, in part, for the residuals of this surgery. In the specific circumstances of this case and for the reasons detailed above, the Board finds that the formal claim for compensation and pension received from the veteran on April 1, 1996, also constituted a claim for section 1151 compensation benefits. Since this claim was not adjudicated by the April 1996 rating action, no finality attaches to that rating action for the purpose of determining the proper effective date for benefits under section 1151 and 38 C.F.R. § 3.350. Therefore, the 1996 claim remained pending at the time of the February 2000 rating decision that initially considered this claim. The claim was denied as not well grounded. The veteran's notice of disagreement (NOD) was received in November 2000. As noted by the RO's Decision Review Officer (DRO) in an August 2002 rating decision, the RO should have reconsidered the veteran's claim pursuant to the VCAA when the NOD was received. Since it did not, the claim remained pending until it was ultimately granted by the April 2002 rating decision on appeal. The VA records show that the surgery at issue took place on March 5, 1996. Since his claim was filed within one year of that date, the proper effective date is the date the injury was suffered - or, March 5, 1996. 38 U.S.C.A. § 5110(c); 38 C.F.R. § 3.400(i)(1). ORDER An effective date of March 5, 1996, is assigned for the grant of compensation under 38 U.S.C.A. § 1151 for ataxia with hearing loss, right ear (evaluated as 100 percent disabling); right fifth cranial nerve palsy (evaluated as 30 percent disabling); right seventh cranial nerve palsy (evaluated as 20 percent disabling); left ulnar neuropathy with history of left cubital tunnel syndrome, postoperative, and left carpal tunnel syndrome, postoperative (evaluated as 20 percent disabling); and aggravation of bipolar disorder with depression and irritable behavior (evaluated as 20 percent disabling); and for the grant of special monthly compensation at the housebound rate. REMAND The Board must consider all documents submitted prior to its decision and review all issues reasonably raised from a liberal reading of these documents. Suttmann v. Brown, 5 Vet. App. 127, 132 (1993) (citations omitted). Where such review reasonably reveals that the claimant is seeking a particular benefit, the Board is required to adjudicate the issue or, if appropriate, remand the issue to the RO for development and adjudication; however, the Board may not ignore an issue so raised. Id. In a July 2001 rating decision, the RO granted entitlement to nonservice-connected pension benefits effective from July 2001. In October 2001, the veteran stated he disagreed with the effective date. It is clear that the veteran's statement was a notice of disagreement (NOD) with the effective date assigned by the RO for the pension benefits; however, this remains pending. A statement of the case (SOC) was never issued on this claim. Manlincon v. West, 12 Vet. App. 238, 240-41 (1999); see also Godfrey v. Brown, 7 Vet. App. 398, 408-410 (1995); Archbold v. Brown, 9 Vet. App. 124, 130 (1996); VAOPGCPREC 16-92 (O.G.C. Prec. 16-92). However, this issue will be returned to the Board after issuance of the SOC only if perfected by the filing of a timely substantive appeal. See Smallwood v. Brown, 10 Vet. App. 93, 97 (1997); Archbold, 9 Vet. App. at 130. Accordingly, this claim is REMANDED for the following: Provide the veteran a statement of the case as to the issue of entitlement to an earlier effective date for the grant of nonservice-connected pension benefits. The veteran should be informed that he must file a timely and adequate substantive appeal in order to perfect an appeal of this issue to the Board. See 38 C.F.R. §§ 20.200, 20.202, and 20.302(b). If a timely substantive appeal is not filed, the claim should not be certified to the Board. If so, subject to current appellate procedures, the case should be returned to the Board for further appellate consideration, if appropriate. The veteran need take no further action until he is so informed. He has the right to submit additional evidence and argument on the matter that the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. ____________________________________________ MARY GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs YOUR RIGHTS TO APPEAL OUR DECISION The attached decision by the Board of Veterans' Appeals (BVA or Board) is the final decision for all issues addressed in the "Order" section of the decision. The Board may also choose to remand an issue or issues to the local VA office for additional development. If the Board did this in your case, then a "Remand" section follows the "Order." However, you cannot appeal an issue remanded to the local VA office because a remand is not a final decision. The advice below on how to appeal a claim applies only to issues that were allowed, denied, or dismissed in the "Order." If you are satisfied with the outcome of your appeal, you do not need to do anything. We will return your file to your local VA office to implement the BVA's decision. However, if you are not satisfied with the Board's decision on any or all of the issues allowed, denied, or dismissed, you have the following options, which are listed in no particular order of importance: * Appeal to the United States Court of Appeals for Veterans Claims (Court) * File with the Board a motion for reconsideration of this decision * File with the Board a motion to vacate this decision * File with the Board a motion for revision of this decision based on clear and unmistakable error. Although it would not affect this BVA decision, you may choose to also: * Reopen your claim at the local VA office by submitting new and material evidence. There is no time limit for filing a motion for reconsideration, a motion to vacate, or a motion for revision based on clear and unmistakable error with the Board, or a claim to reopen at the local VA office. None of these things is mutually exclusive - you can do all five things at the same time if you wish. However, if you file a Notice of Appeal with the Court and a motion with the Board at the same time, this may delay your case because of jurisdictional conflicts. If you file a Notice of Appeal with the Court before you file a motion with the BVA, the BVA will not be able to consider your motion without the Court's permission. How long do I have to start my appeal to the Court? You have 120 days from the date this decision was mailed to you (as shown on the first page of this decision) to file a Notice of Appeal with the United States Court of Appeals for Veterans Claims. If you also want to file a motion for reconsideration or a motion to vacate, you will still have time to appeal to the Court. As long as you file your motion(s) with the Board within 120 days of the date this decision was mailed to you, you will then have another 120 days from the date the BVA decides the motion for reconsideration or the motion to vacate to appeal to the Court. You should know that even if you have a representative, as discussed below, it is your responsibility to make sure that your appeal to Court is filed on time. How do I appeal to the United States Court of Appeals for Veterans Claims? Send your Notice of Appeal to the Court at: Clerk, U.S. Court of Appeals for Veterans Claims 625 Indiana Avenue, NW, Suite 900 Washington, DC 20004-2950 You can get information about the Notice of Appeal, the procedure for filing a Notice of Appeal, the filing fee (or a motion to waive the filing fee if payment would cause financial hardship), and other matters covered by the Court's rules directly from the Court. You can also get this information from the Court's web site on the Internet at www.vetapp.uscourts.gov, and you can download forms directly from that website. The Court's facsimile number is (202) 501-5848. To ensure full protection of your right of appeal to the Court, you must file your Notice of Appeal with the Court, not with the Board, or any other VA office. How do I file a motion for reconsideration? You can file a motion asking the BVA to reconsider any part of this decision by writing a letter to the BVA stating why you believe that the BVA committed an obvious error of fact or law in this decision, or stating that new and material military service records have been discovered that apply to your appeal. If the BVA has decided more than one issue, be sure to tell us which issue(s) you want reconsidered. Send your letter to: Director, Management and Administration (014) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 VA FORM JUN 2003 (RS) 4597 Page 1 CONTINUED Remember, the Board places no time limit on filing a motion for reconsideration, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to vacate? You can file a motion asking the BVA to vacate any part of this decision by writing a letter to the BVA stating why you believe you were denied due process of law during your appeal. For example, you were denied your right to representation through action or inaction by VA personnel, you were not provided a Statement of the Case or Supplemental Statement of the Case, or you did not get a personal hearing that you requested. You can also file a motion to vacate any part of this decision on the basis that the Board allowed benefits based on false or fraudulent evidence. Send this motion to the address above for the Director, Management and Administration, at the Board. Remember, the Board places no time limit on filing a motion to vacate, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to revise the Board's decision on the basis of clear and unmistakable error? You can file a motion asking that the Board revise this decision if you believe that the decision is based on "clear and unmistakable error" (CUE). Send this motion to the address above for the Director, Management and Administration, at the Board. You should be careful when preparing such a motion because it must meet specific requirements, and the Board will not review a final decision on this basis more than once. You should carefully review the Board's Rules of Practice on CUE, 38 C.F.R. 20.1400 -- 20.1411, and seek help from a qualified representative before filing such a motion. See discussion on representation below. Remember, the Board places no time limit on filing a CUE review motion, and you can do this at any time. How do I reopen my claim? You can ask your local VA office to reopen your claim by simply sending them a statement indicating that you want to reopen your claim. However, to be successful in reopening your claim, you must submit new and material evidence to that office. See 38 C.F.R. 3.156(a). Can someone represent me in my appeal? Yes. You can always represent yourself in any claim before VA, including the BVA, but you can also appoint someone to represent you. An accredited representative of a recognized service organization may represent you free of charge. VA approves these organizations to help veterans, service members, and dependents prepare their claims and present them to VA. An accredited representative works for the service organization and knows how to prepare and present claims. You can find a listing of these organizations on the Internet at: www.va.gov/vso. You can also choose to be represented by a private attorney or by an "agent." (An agent is a person who is not a lawyer, but is specially accredited by VA.) If you want someone to represent you before the Court, rather than before VA, then you can get information on how to do so by writing directly to the Court. Upon request, the Court will provide you with a state-by-state listing of persons admitted to practice before the Court who have indicated their availability to represent appellants. This information is also provided on the Court's website at www.vetapp.uscourts.gov. Do I have to pay an attorney or agent to represent me? Except for a claim involving a home or small business VA loan under Chapter 37 of title 38, United States Code, attorneys or agents cannot charge you a fee or accept payment for services they provide before the date BVA makes a final decision on your appeal. If you hire an attorney or accredited agent within 1 year of a final BVA decision, then the attorney or agent is allowed to charge you a fee for representing you before VA in most situations. An attorney can also charge you for representing you before the Court. VA cannot pay fees of attorneys or agents. Fee for VA home and small business loan cases: An attorney or agent may charge you a reasonable fee for services involving a VA home loan or small business loan. For more information, read section 5904, title 38, United States Code. In all cases, a copy of any fee agreement between you and an attorney or accredited agent must be sent to: Office of the Senior Deputy Vice Chairman (012) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 The Board may decide, on its own, to review a fee agreement for reasonableness, or you or your attorney or agent can file a motion asking the Board to do so. Send such a motion to the address above for the Office of the Senior Deputy Vice Chairman at the Board. VA FORM JUN 2003 (RS) 4597 Page 2