Citation Nr: 0410750 Decision Date: 04/26/04 Archive Date: 05/06/04 DOCKET NO. 03-04 969 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma THE ISSUE Whether new and material evidence has been received to reopen a claim of entitlement to service connection for multiple sclerosis, and if so, whether service connection is warranted. REPRESENTATION Veteran represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD Debbie A. Riffe, Counsel INTRODUCTION The veteran served on active duty in the Army from July 1970 to March 1972, with subsequent service in the Army Reserve. This case comes to the Board of Veterans' Appeals (Board) on appeal from a February 2002 RO decision, which determined that new and material evidence had been received to reopen a claim of service connection for multiple sclerosis and denied the claim on the merits. The Board notes that, notwithstanding the RO's determination to reopen the multiple sclerosis claim, the Board must make an independent assessment as to whether new and material evidence sufficient to reopen the veteran's claim has been received under 38 U.S.C.A. § 5108. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). The issue on appeal is phrased accordingly. In May 2003, the veteran notified the RO that he wished to withdraw his request for a personal hearing at the RO. FINDINGS OF FACT 1. In an unappealed October 1999 rating decision, the RO denied the veteran's claim of entitlement to service connection for multiple sclerosis. 2. The evidence received since the October 1999 RO decision includes evidence that is not cumulative or redundant of evidence previously considered and that is so significant that it must be considered in order to fairly decide the merits of the claim. 3. Currently diagnosed multiple sclerosis is shown to have initially manifested during the veteran's active military service. CONCLUSIONS OF LAW 1. New and material evidence has been submitted to reopen the claim of entitlement to service connection for multiple sclerosis. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2001). 2. Multiple sclerosis was incurred in active service. 38 U.S.C.A. §§ 1110, 5107 (West 2002); 38 C.F.R. § 3.303 (2003). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. New and Material Evidence Initially, the Board notes that prior to receipt of the veteran's application to reopen the claim of entitlement to service connection for multiple sclerosis, the Veterans Claims Assistance Act of 2000 (VCAA), codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002), was signed into law. Regulations implementing the VCAA were published at 66 Fed. Reg. 45,620, 45,630-32 (August 29, 2001) and codified at 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326 (2003). The regulations included amendments concerning the timing and scope of assistance VA will provide to a claimant who attempts to reopen a previously-denied claim. 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326 (2003). The amended definition of new and material evidence, codified at 38 C.F.R. § 3.156(a), is not liberalizing, but applies only to an application to reopen a finally-decided claim received on or after August 29, 2001. 66 Fed. Reg. 45,620, 45,629. It does not apply to this veteran's claim, which was received prior to August 2001. In any event, as explained herein below, the Board is of the opinion that new and material evidence has been presented to reopen the veteran's claim. Therefore, no additional evidence or information is required to substantiate his application to reopen. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service incurrence will be presumed for certain chronic diseases, including multiple sclerosis, if manifest to a compensable degree within seven years from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 2002); 38 C.F.R. §§ 3.307 (2003). In the present case, the RO denied the veteran's claim of entitlement to service connection for multiple sclerosis in rating decisions dated in December 1993 and October 1999, on the basis that multiple sclerosis was neither diagnosed during military service nor found to be manifested within the seven-year presumptive period following discharge from active service. The veteran did not perfect an appeal with regard to these decisions, and they became final. 38 U.S.C.A. § 7105(c) (West 1991); 38 C.F.R. §§ 3.104, 20.302, 20.1103 (1993, 1999). A claim may be reopened if new and material evidence is submitted. 38 U.S.C.A. §§ 5108, 7105 (West 2002); Evans v. Brown, 9 Vet. App. 273 (1996); Manio v. Derwinski, 1 Vet. App. 140 (1991). "New and material evidence" means evidence not previously submitted to VA decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). The last final disallowance of the veteran's claim in this case is the October 1999 RO decision. As such, the Board will consider evidence submitted since this determination in order to ascertain whether that evidence is new and material to reopen the veteran's service connection claim. When the RO denied the claim of service connection for multiple sclerosis in October 1999, it had considered the veteran's service records, which did not show a diagnosis of multiple sclerosis; VA examinations completed in February 1976 and May 1991, which did not show any neurological symptoms; reports from a private physician dated in July 1993 and July 1999, which reflect that the veteran was suffering from neurological symptoms including quadraparesis of the legs and arms secondary to multiple sclerosis; statements of the veteran describing his multiple sclerosis symptoms since 1974; and, statements of servicemen and a doctor, dated in 1974 and 1999, which reflect knowledge of the veteran's hospitalization in 1974 for a fever of undetermined origin after returning from service in Panama. The evidence received since the October 1999 decision includes private medical reports, as well as statements of the veteran, a fellow serviceman, and a friend. The non-medical statements indicate, among other things, that the veteran was very sensitive to heat during a military operation to Panama in 1974 and that upon returning was hospitalized for a high fever of unknown origin. A friend of the veteran also described his frequent contacts with the veteran between 1977 and 1985 when they jogged regularly together, noting the veteran's problems tolerating heat and his repeated loss of footing without any apparent cause. Additional private medical records include those from W. Dean Shipley, M.D., dated in February 2000 and January 2003; Helen Lutsch, M.D., dated in January 2003; and Craig Bash, M.D., dated in January 2004. Dr. Shipley and Dr. Lutsch indicated that the veteran suffered symptoms consistent with multiple sclerosis as far back as the mid 1970s, or 1974. Dr. Bash opined that certain symptoms of the veteran during his periods of service were manifestations of multiple sclerosis. It is noted that for the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In Kutscherousky v. West, 12 Vet. App. 369 (1999), the United States Court of Appeals for Veterans Claims (Court) held that the prior holdings in Justus and Evans that the credibility of the evidence is to be presumed was not altered by the Federal Circuit decision in Hodge. The statements of the veteran's private physicians, a fellow serviceman, and a friend were not previously before the RO in October 1999. Moreover, in light of the fact that such support the veteran's contention that multiple sclerosis was first manifested during active service, the Board finds that the additionally-received evidence is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156. The evidence is certainly new, as it was not of record at the time of the October 1999 RO decision, or cumulative or duplicative of the evidence previously of record. Also, the additional medical evidence shows that the veteran currently has a diagnosis of multiple sclerosis, which appears to have been incurred in active service or manifested within the applicable presumptive period following discharge from service. Of particular significance are the opinions of Dr. Shipley, Dr. Lutsch, and Dr. Bash, who all appear to agree that the onset of the veteran's multiple sclerosis occurred during the veteran's periods of service. Thus, the Board finds that new and material evidence has been submitted since the October 1999 RO decision that denied service connection for multiple sclerosis, and that the claim is reopened. II. Merits of Claim of Service Connection As new and material evidence has been received to reopen the veteran's claim of entitlement to service connection for multiple sclerosis, the Board now proceeds to adjudicate the issue on the merits. The VCAA, discussed above, redefined VA's duties to notify and to assist a claimant in the development of a claim. In view of the Board's completely favorable decision as to service connection, however, further notification and assistance is unnecessary. The veteran contends that symptoms of his multiple sclerosis initially manifested during his active service. In particular, he describes that, during a Special Forces operation in Panama in 1974, he experienced flu-like symptoms and was especially sensitive to heat, easily fatigued, and clumsy. He states that he was admitted to the hospital upon his return from Panama but that tests for typhoid fever came back negative. He indicates that his final diagnosis was fever of unknown origin. He claims that following his release from the hospital he continued to experience unexplained symptoms that were eventually diagnosed as multiple sclerosis. He contends that multiple sclerosis is a difficult disease to diagnose, with symptoms waxing and waning over time. A review of the service medical records show that the veteran, on a June 1969 Report of Medical History for purposes of attending a summer camp as a Reserve Officer Training Corps cadet, reported that he had color blindness and wore glasses for nearsightedness. On a Report of Medical History in July 1970 at enlistment, the veteran indicated that he had had partial color blindness for four years and had worn glasses. On a May 1972 physical examination for separation purposes, he was evaluated as normal; there was no indication that vision screening was performed. On a February 1973 military physical examination for airborne training or "ranger school," he was noted to have problems with vision and color blindness. On a February 1976 VA examination, no neurological symptoms were noted and there was no diagnosis of multiple sclerosis. Military physical profile reports are divided into six categories (P, U, L, H, E, S). The "E" stands for "eyes". Para. 9-3(b)(1)- (6), Army Regulation (AR) 40-501, Change 35 (Feb. 9, 1987). See also Odiorne v. Principi, 3 Vet. App. 456, 457 (1992); Hanson v. Derwinski, 1 Vet. App. 512, 514 (1991). On an August 1977 bi- annual military physical examination, the veteran was noted to have problems with vision and color blindness. His physical profile, or "PULHES," which reflects his overall physical and psychiatric condition on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service), was indicated to be "1" in all aspects except for his eyes, which were indicated to be "2." On a June 1983 physical examination for Reserves, the veteran was noted to have problems with vision and color blindness and his physical profile was "2" for eyes. Private medical records dated from 1988 to 1993 reflect that, as a result of numerous falls, the veteran received treatment for various injuries, to include a fracture of the left hand, right rib fracture, left knee strain with closed head trauma, right elbow injury, and sprain of the right second metatarsophalangeal joint. He was also seen for complaints of "flu" with joint aches, malaise, and low-grade fever. On a May 1991 VA examination, the veteran denied having any symptoms of neurological loss, and he was clinically evaluated as normal neurologically. The impression did not include multiple sclerosis. Reports from Garrett Watts, M.D., and William Hale, M.D., dated in July 1993 and September 1993, respectively, referred to the veteran's recent onset of multiple sclerosis. Such diagnosis was also noted on VA examinations in September 1994 and August 1996. In a statement received in September 1998, Rodney Miles, M.D., noted that the veteran's multiple sclerosis primarily affected his coordination. On an April 1999 VA examination, it was noted that the veteran's multiple sclerosis was diagnosed in 1990 and that his symptoms were reported to have included episodes of falling, poor coordination, and dizziness. In a July 1999 medical statement, a private doctor indicated that the veteran was suffering from neurological symptoms including quadraparesis of the legs and arms secondary to multiple sclerosis. In a statement dated in September 1974 and received in September 1999, a military doctor indicated that the veteran was a patient in the Tinker Air Force Base (AFB) Hospital from August 20-29, 1974, due to fever. He indicated that the veteran was released with instructions to remain on light duty for one month. In another statement received in September 1999, a retired member of the Special Forces indicated that during the veteran's period of hospitalization in August 1974, he was responsible for the personnel and medical records of the veteran and for communications with Tinker AFB Hospital regarding the veteran. He stated that because the veteran had deployed to Panama for annual training prior to his hospitalization, the doctors initially suspected that he may have had typhoid fever but finally diagnosed his flu-like symptoms as "fever of unknown origin." It was his observation that the veteran never fully recovered from such symptoms as general loss of coordination and balance, inability to think and communicate clearly, and extreme fatigue. In a statement received in March 2001, a fellow serviceman of the veteran indicated that he was the veteran's immediate commander during their military operation to Panama in 1974. He stated that the veteran was stricken with a high fever and subsequently hospitalized at Tinker AFB Hospital, which was first believed to be typhoid but later found to be a fever of unknown origin. He also related that during the Panama operation the veteran was so sensitive to heat that he did not wear underwear or socks and that he seemed clumsy. He also noted that the veteran once complained of double vision and appeared to need to go to the bathroom frequently. In a statement received in February 2003, a friend of the veteran related his memories of experiences involving the veteran, most notably his almost daily contacts with the veteran between 1977 and 1985 when they jogged regularly together. He stated that during that period the veteran tripped repeatedly without any apparent cause and had problems tolerating the heat. In support of his claim, the veteran also sought and submitted statements from his private physicians as well as from a private consultant, who furnished opinions in regard to the etiology of his multiple sclerosis. Specifically, W. Dean Shipley, M.D., in February 2000, May 2002, and January 2003, stated that the veteran had quadraparesis with ataxia of both upper extremities and complete loss of use of both legs. He opined with "reasonable medical certainty" that the veteran suffered from multiple sclerosis as far back as the mid 1970s (in one statement he indicated in the 1960s and 1970s) when he experienced symptoms of intermittent diplopia, balance and coordination problems, and weakness associated with fevers. Dr. Shipley confirmed that the veteran's reported symptoms of coordination problems and dizziness early in his military career were indications of multiple sclerosis despite the fact that it was not diagnosed by a neurologist until much later. Helen Lutsch, M.D., in January 2003, stated that multiple sclerosis was a disease with an insidious onset, and she described the symptoms (weakness or clumsiness of a leg or hand, fatigability of a limb, gait disturbances) that often occurred months or years before the disease was recognized. She also noted that the course of the disease was highly varied and unpredictable, that months or years may separate episodes, and that remissions have lasted for more than 25 years. As regards the veteran, she noted his report of symptoms from 1974 and opined that the evidence appeared consistent with the diagnosis of multiple sclerosis for the symptoms and signs presented by him in connection with his tour of duty in Panama in 1974. Finally, Craig Bash, M.D., in January 2004, noted that he had reviewed the veteran's claims file and medical records for the express purpose of furnishing a medical opinion concerning his multiple sclerosis. He noted his expertise in having diagnosed thousands of patients with multiple sclerosis. Dr. Bash opined that the veteran's auditory and color vision changes during his periods of service were his first symptoms of multiple sclerosis, and the doctor stated that his opinion was consistent with the medical opinions of Dr. Shipley and Dr. Lutsch regarding the probable date of onset of the veteran's multiple sclerosis. For his opinion, Dr. Bash cited to the facts as presented in the record and discussed these facts in relation to cited medical precepts. Dr. Bash specifically cited to test results in 1972, 1973, 1977 and 1983, as indicative in a "waxing and waning" of the veteran's auditory function, color and vision function and visual acuity, and indicated such were "classic" for early symptoms of multiple sclerosis. Dr. Bash noted that the conclusion was consistent with medical literature and with the lay testimony from the veteran and others. The Board also notes that in the March 2004 presentation, the veteran's representative cited to treatise evidence supporting the veteran's claim. First, the representative cited to the MERCK MANUAL, for the propositions that the age of onset of multiple sclerosis is usually between 20 and 40, and, that heat exacerbates symptoms. The representative then noted that the veteran was 23 years of age in 1970 and that he had served in Panama, a tropical climate, and that during such period he evidenced symptoms later attributed to multiple sclerosis. The representative also noted that one treatise pointed to febrile illnesses, such as the veteran's fever upon returning from panama, as a "provocative event" for multiple sclerosis, see MULTIPLE SCLEROSIS: NEW APPROACHES TO IMMUNOTHERAPY, Vollmer (1996). Such treatise evidence is informative as to accepted medical theories and conclusions and may be considered in support of the veteran's claim. Sacks v. West, 11 Vet. App. 314 (1998); cf. Wallin v. West, 11 Vet. App. 509 (1998). The Board has considered the veteran's contentions as well as his medical history. Of note is the absence of the veteran's complete Reserve medical record, particularly the records of his 1974 hospitalization at Tinker AFB. As such, consideration has been given to the narrative statements submitted relevant to such hospitalization. The Board also notes that there is no evidence of a medical diagnosis of multiple sclerosis until the 1990s. Furthermore, although cited as an in-service change/manifestation, the veteran evidently had had color vision and visual acuity problems upon entering service in July 1970, a fact that was not discussed by Dr. Bash. The veteran's representative notes that there was no entrance examination; however, the medical history report at entrance into active service is consistent with a prior history given by the veteran in connection with Reserve duty. In any case, the Board has not herein taken the position that the veteran's had multiple sclerosis prior to service or otherwise that the veteran is not entitled to the presumption of soundness at service entrance. Instead, the Board has considered the nature and onset of objective manifestations claimed by the veteran and noted by the physicians who have provided opinions in this record. Based on such, the Board finds that there is convincing evidence to show that the veteran's currently diagnosed multiple sclerosis was initially manifest during his period of service. First, the Board finds that, although neither the veteran nor other lay individuals who have come forward on his behalf are competent to identify a diagnosis or to provide an opinion as to etiology, these individuals are competent to relate symptoms objectively manifested by the veteran during and subsequent to service. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). These individuals report changes with vision and gait, later noted by medical professionals to be associated with multiple sclerosis. Referenced treatise evidence also supports such association. There is no evidence showing that such report of symptoms by the veteran or other lay individuals is inconsistent with the veteran's medical history or otherwise lacks credibility. Moreover, although the opinions of Dr. Shipley, Dr. Lutsch, and Dr. Bash, do not necessarily account for the manifestation of certain symptoms prior to active service, and although such opinions are not set out as definitive, such opinions are offered by competent medical professionals based on a credible symptom history reported by the veteran and other lay individuals and based on review of the file. These opinions relate the onset of the veteran's multiple sclerosis to symptoms shown initially during service and within several years after discharge. The etiological conclusions drawn, to include as considering the significance of the veteran's in-service treatment for a fever and the changes in his vision and extremity complaints, as noted by Dr. Bash from a review of in-service examination reports, are consistent with medical treatises cited by the veteran's representative and by the physicians themselves. Finally, the etiologic conclusion that multiple sclerosis was first manifested by symptoms shown during active service is not refuted by other competent medical opinions of record. In view of the foregoing, and resolving any doubt in the veteran's favor, the Board concludes that the evidence demonstrates that the veteran's multiple sclerosis was initially manifest during active service. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303. ORDER As new and material evidence has been received, the claim of entitlement to service connection for multiple sclerosis is reopened. Service connection for multiple sclerosis is granted. ____________________________________________ J. M. Daley 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