Citation Nr: 0603593 Decision Date: 02/08/06 Archive Date: 02/22/06 DOCKET NO. 04-24 616A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to a disability rating in excess of 10 percent for depression from January 15, 2002 to April 2, 2003. 2. Entitlement to a disability rating in excess of 50 percent for depression from April 3, 2003 to April 20, 2004. 3. Entitlement to a disability rating in excess of 10 percent for depression from April 21, 2004. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD Carole R. Kammel, Counsel INTRODUCTION The veteran served on active duty from June 1965 to December 1976, and from December 1980 to September 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2003 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona, wherein the RO continued a 10 percent disability evaluation for service-connected depression. The RO also assigned a 10 percent evaluation to the service- connected urethritis and continued a noncompensable evaluation for service-connected nephrosclerosis. In this case, the RO issued notice of the adverse determination on May 29, 2003. In September 2003, the RO received the veteran's notice of disagreement with respect to the May 1993 rating action. In December 2003, the RO issued a statement of the case (SOC), which addressed the increased evaluation claims for service-connected non-specific urethritis, ephrosclerosis and depression. On July 13, 2004, the RO received the veteran's substantive appeal, wherein the appellant indicated that he was only seeking appellate consideration of his claim for an increased evaluation for depression. Under the pertinent law and regulations, following the issuance of a statement of the case, the claimant must file a substantive appeal within 60 days from the date the SOC is mailed or within the remainder of the one-year time period from the date of mailing of notice of the initial determination being appealed, whichever ends later. 38 U.S.C.A. § 7105(d)(3) (West 2002); 38 C.F.R. § 20.302(b) (2005). Nevertheless, where a claimant submits additional evidence within 1 year of the date of mailing of the notification of the determination being appealed, and that evidence requires, in accordance with 38 C.F.R. § 19.31, that the claimant be furnished a Supplemental Statement of the Case, then the time to submit a Substantive Appeal shall end not sooner than 60 days after such Supplemental Statement of the Case is mailed to the appellant, even if the 60-day period extends beyond the expiration of the 1-year appeal period. 62 Fed. Reg. 50318, 50319 (Oct. 3, 2001); 38 C.F.R. § 20.302(b) (2005). In this case, in April 2004, the RO received VA outpatient reports, dating from April 2003 to January 2004, that were pertinent to the veteran's claim for increase for his service-connected depression. Thereafter, on July 13, 2004, the RO received the veteran's substantive appeal, wherein the appellant indicated that he was only seeking appellate consideration of his claim for an increased evaluation for depression. In April 2005, the RO issued a supplemental statement of the case (SSOC), which was limited to addressing the claim of entitlement to an increased evaluation for depression. In effect, the SSOC can be regarded as an original SOC. With consideration of all the foregoing, the Board considers that the appeal is timely vis-à-vis the claim of entitlement to an increased evaluation for depression. There is no prejudice to the veteran in light of the Board's favorable consideration of the timeliness of the appeal of the claim for an increased evaluation for service-connected depression. See Bernard v. Brown, 4 Vet. App. 384 (1993). By a March 2005 rating action, the RO determined that the veteran's service-connected depression was 50 percent disabling from April 3, 2003 to April 20, 2004, and 10 percent disabling from April 21, 2004. Thus, the issues have been framed as those listed on the title page. In September 2005, the veteran testified before the undersigned Veterans Law Judge at the RO in Phoenix, Arizona. A copy of the hearing transcript has been associated with the claims files. The issue of entitlement to a disability rating in excess of 10 percent for depression from April 21, 2004, is REMANDED to the RO, via the Appeals Management Center (AMC), in Washington, DC. FINDINGS OF FACT 1. For the period from January 15, 2002 to April 2, 2003, the veteran's depression was manifested in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. 2. From April 3, 2003 to April 20, 2004, the veteran's depression has been manifested by occupational and social impairment with reduced reliability and productivity due to depressed mood, a dysphoric and blunted affect, anhedonia, disturbances in motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. CONCLUSIONS OF LAW 1. For the period from January 15, 2002 to April 2, 2003, the criteria for a disability rating in excess of 10 percent for depression have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9434 (2005). 2. For the period from April 3, 2003 to April 20, 2004, the criteria for a disability rating in excess of 50 percent for depression have not been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107(b) (West 2002); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9434 (2005). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2005). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002 & Supp. 2005); 38 C.F.R. § 3.159(b) (2005); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA notice must inform the claimant of any information and evidence (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in his possession that pertains to the claim in accordance with 38 C.F.R. § 3.159(b)(1). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). The Board notes that the veteran was apprised of VA's duties to both notify and assist in correspondence, dated in September 2004, a December 2003 statement of the case, and April and June 2005 supplemental statement of the cases. In particular, the September 2004 letter informed the veteran that to substantiate his increased evaluation claim(s), the evidence must show that his service-connected depression had increased in severity since he was last examined by VA in August 2002. In the September 2004 letter, the RO instructed the veteran that the evidence included a statement from a doctor, private or VA. The letter advised the veteran that VA must make reasonable efforts to assist him in getting evidence, including service/personnel medical records, VA out-patient treatment records and examination reports, or relevant records held by any government agencies. The veteran was told that it was his responsibility to submit all records not in the possession of a Federal agency, which includes records in his possession. Thus, the RO has satisfied the requirement to notify the claimant of which portion of the information and evidence, if any, was to be provided by the claimant and which portion, if any, would be obtained by VA on behalf of the claimant. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2005); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Although the September 2004 notice provided by the RO was generally not provided until after the RO adjudicated the veteran's claim in May 2003, this sequence of events does not amount to error on the part of the RO, because the notice satisfies the content requirements of the VCAA and afforded the veteran a meaningful opportunity to participate in the adjudication process. Mayfield and Pelegrini, both supra. Consequently, the Board does not find that the late notice under the VCAA requires remand to the RO. Nothing about the evidence or the appellant's response to the RO's notifications suggests that the case must be re-adjudicated ab initio to satisfy the requirements of the VCAA. Regarding VA's duty to assist, extensive post-service VA treatment and examination reports and statements, submitted from the veteran and his representative, and hearing testimony of the appellant and his spouse are of record. Taken together, the Board is persuaded that there is no reasonable possibility that further development would unearth any additional evidence helpful to the veteran. This is especially so given that the veteran testified in support of his claim before the undersigned Veterans Law Judge at the RO in Phoenix, Arizona in September 2005. Consequently, given the standard of the new regulation, the Board finds that VA did not have a duty to assist that was unmet. II. Relevant Laws and Regulations Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. See 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2005). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7 (2005). The veteran's entire history is reviewed when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1995). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3 (2005). The RO has evaluated the veteran's depression under 38 C.F.R. § 4.130, Diagnostic Code 9434 (2005). A 10 percent evaluation is warranted when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent evaluation is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted when there is occupational and social impairment, with reduced reliability and productivity, due to such symptoms as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more frequently than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 evaluation is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and an inability to establish and maintain effective relationships. A 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. III. Factual Background VA outpatient reports, dating from September 2000 to January 2002, reflect that the veteran received treatment for unrelated disabilities. An August 2002 VA mental examination report reflects that the veteran experienced depressive symptomatology after recurrence of his Hodgkin's lymphoma in the year 2000. The veteran related that he had been employed until 1992, when he was diagnosed with cancer and needed to undergo chemotherapy. After his treatment, he returned to work until January 2002, when he resumed chemotherapy. He stated that, "I couldn't deal with the people no more." He indicated that during a typical day, he watched television or "piddle around" the house. He reported that he golfed twice a week. The veteran related that he had been married for thirty-"some" years, and described the status of the marriage as "fine." The veteran reported having two adult daughters, and reported having no problems with either one of them. He described having a decreased appetite (his weight had remained stable at 172 pounds), irritability, sleep disturbance (he reported that he slept five to six nights a week), and hopelessness. He denied any suicidal ideation. The veteran reported having rare episodes of crying. He described his energy level as, "Okay." The veteran related that he had diminished interest in activities that he used to enjoy, such as camping. Upon mental status evaluation in August 2002, the veteran's immediate, recent and remote memories were good. He was oriented in all spheres (the veteran did not know that he was going to be evaluated). His speech was normal but vague on occasion. The veteran was emotional and tearful when he discussed the rating process. His thought process production was that he generally spoke in response to the examiner's question. His responses were abundant in nature. His continuity of thought was goal-directed and relevant. There was no evidence of any suicidal or homicidal ideation. "There were feelings of unreality, ideas of reference, or delusions." The veteran's abstractability and concentration were good. The veteran described his mood as "okay." He was alert, responsive and cooperative. His judgment and insight were described as good and fair, respectively. The examiner entered a diagnosis of depressive disorder secondary to lymphoma. A Global Assessment of Functioning Score (GAF) of 70 was recorded. VA outpatient reports, dating from August 2002 to January 2004, pertinently reflect that on April 3, 2003, the veteran was seen for depression. At that time, he also complained of having a poor appetite with weight loss, decreased energy and motivation and anhedonia for the previous two to three months. The veteran denied having any suicidal thoughts. Upon mental status evaluation, the veteran was well groomed and made occasional eye contact. He was cooperative and pleasant, but became easily frustrated when he discussed his illness (i.e., lymphoma) and problems with VA. His mood was depressed with a blunted affect. His thought process was linear and tight. His thought content was negative for any suicidal or homicidal ideations or psychotic symptoms. His insight and judgment were intact. An assessment of major depressive disorder, recurrent and severe, without psychosis secondary to medical condition (lymphoma) was entered. When seen in early July 2003, a mental status examination was essentially normal with the exception of the veteran demonstrating a frustrated mood and dysphoric affect. In late July 2003, he reported having an increased depressed mood, anhedonia, low energy, poor sleep (three hours a night), and loss of appetite (he had lost five pounds). The veteran denied having any suicidal, manic or psychotic symptoms. He thought that his medication might be helping him. Upon mental status evaluation, the veteran described his mood as "hangin' in there." His affect was slightly depressed. His thought process and content were coherent and linear, respectively. The veteran denied having any suicidal or homicidal ideations, anxiety or "AVH." His insight and judgement were found to have been adequate for treatment. Upon mental status evaluation in mid-December 2003, the veteran continued to reveal a "low" mood and a dysphoric affect with restricted range. A GAF score of 45 was assigned. In mid-to-late January 2004, the examining physician noted that the veteran had a long history of a "low" mood, poor energy, sleep disturbance, and feelings of hopelessness after being diagnosed with Non-Hodgkins lymphoma in 1992. The examiner noted that there was no history of any suicidal or homicidal ideation, manic, hypomanic, psychotic, obsessive compulsive, or somatoform symptoms. It was noted that the veteran had been married for over thirty years, had two children and had fairly good relationships. Upon mental status evaluation, the veteran was oriented in all spheres. His thought process was rational; there was no evidence of any paranoia, delusions or hallucinations. There was no suicidal ideation. His cognition was intact. Insight and judgment were found to have been fair. A diagnosis of mood disorder due to lymphoma, with depressive features was entered. A GAF score of 50 was recorded. IV. Analysis A. Depression from January 15, 2002 to April 2, 2003 The veteran's depression is evaluated as 10 percent disabling from January 15, 2002 to April 3, 2003, under 38 C.F.R. § 4.130, Diagnostic Code 9434. After a careful review of the record, the Board finds that the preponderance of the evidence does not support a disability rating in excess of 10 percent for the veteran's depression from January 15, 2002 to April 2, 2003. The Board notes that during an August 2002 VA examination, the veteran indicated that he had become easily frustrated and stressed since the recurrence of his lymphoma. The veteran also reported having sleep disturbance and a decreased appetite. However, a mental status evaluation in August 2002 was essentially within normal limits with the exception of some vague and tearful speech when the veteran discussed his frustration with the rating process. Although the veteran reported being depressed, his mood was euthymic on evaluation. In addition, although the veteran reported that he had experienced sleep disturbance, he also indicated that he slept five to six nights a week. In addition, while the VA examiner noted that there were "feelings of unreality, ideas of reference, or delusions," this does not correspond with other objective findings such as, goal- directed and relevant continuity of thought, an intact memory, and an absence of any panic attacks and suicidal or homicidal ideation, criteria that correspond with higher evaluations. The Board also notes that the August 2002 VA examination report reflects that the veteran was assigned a GAF score of 70. In this regard, the Board observes that, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM- IV), a GAF score between 61 and 70 indicates that there are some mild (italics added) symptoms, (e.g., depressed mood and mild insomnia); or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. With regards to social relationships, the veteran has been married for over thirty years and has described his marriage as "fine." He also has a relationship with his two adult daughters, and has continued to play golf twice a week. Regarding industrial impairment, the veteran most recently worked as a real estate agent until the year 2000, when he ceased work primarily because he had to resume chemotherapy treatment for his lymphoma. In sum, the Board finds that the veteran's depression more closely approximates the criteria for a 10 percent disability rating for the period from January 15, 2002 to April 2, 2003. B. Depression from April 3, 2003 to April 20, 2004 The veteran's depression is evaluated as 50 percent disabling from April 3, 2003 to April 20, 2004, under 38 C.F.R. § 4.130, Diagnostic Code 9434. Applying the foregoing criteria to the facts of the present case, the Board finds that the preponderance of the evidence is against an initial evaluation greater than 50 percent for service-connected depression from April 3, 2003 to April 20, 2004. In support of the foregoing conclusion, the Board notes that a review of the VA medical evidence of record during this period does not reflect that the veteran has symptomatology typical of a higher rating of 70 percent. In this regard, he has not demonstrated any of the symptomatology required by the 70 percent rating. In this regard, the clinical evidence of record reflects that upon mental status evaluations by VA in late July 2003 and January 2004, there was no evidence of neglect of personal appearance or hygiene, obsessional rituals which interfered with routine activities, illogical or obscure speech. Indeed, those same examination reports also reflect that the veteran's thought process was linear and goal directed without flight of ideas. In any event, it is the criteria for the 50 percent rating that specifically refers to symptoms experienced by the veteran--problems such as disturbances of motivation and mood, flattened affect, and difficulty in establishing and maintaining effective relationships, etc. As noted previously, despite the veteran's depressive symptomatology, he most recently maintain employment as a real estate agent until the year 2000, when he had to resume chemotherapy treatment for his lymphoma. Furthermore, the veteran has maintained a relationship with his wife for over thirty years and has a good relationship with his two children. Consequently, the Board finds that his depression is best represented by the criteria for a 50 percent rating, not those for the 70 percent rating for the period for the period from April 3, 2003 to April 20, 2004. 38 C.F.R. § 4.130 (Diagnostic Code 9434) (2005). V. Conclusion As the preponderance of the evidence is against the instant claims, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Finally, in evaluating these claims, the Board notes that there is no evidence of an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b) (2005). As noted previously, the veteran most recently worked as a real estate agent until the year 2000, when he ceased work primarily because he had to resume chemotherapy treatment for his lymphoma. Therefore, the Board will not consider the question of entitlement to extraschedular evaluations with respect to the instant claims on appeal. ORDER A disability rating in excess of 10 percent for depression for the period from January 15, 2002 to April 2, 2003, is denied. A disability rating in excess of 50 percent for depression for the period from April 3, 2003 to April 20, 2004, is denied. REMAND The veteran's depression is evaluated as 10 percent disabling from April 21, 2004 under 38 C.F.R. § 4.130, Diagnostic Code 9434. The veteran contends that his depression is more severely disabling than that reflected by the current 10 percent evaluation. In this regard, he maintains that he has crying spells associated with his depression, social isolation, low energy, hopelessness, and sleep disturbance. Pertinent VA outpatient reports, dating from April 2003 to March 2005, reflect that when seen on April 21, 2004, the veteran indicated that he was doing fairly well. He reported that he was sad as a result of his older sister's death, which had occurred a few months previously. A mental status examination of the veteran was essentially unremarkable. A diagnosis of mood disorder due to lymphoma, with depressive features was recorded. A GAF score of 55 was entered. In a September 2004 letter, the RO informed the veteran that they were ordering a VA examination in order to determine the current level of his depression. The RO instructed the veteran that the his local VA Medical Center (VAMC) would inform him of the time, date and place of the examination. The RO stated that if the veteran failed to report for the scheduled VA examination in connection with his claim for increase, that it would be denied in accordance with 38 C.F.R. § 3.655 (2005). The veteran was instructed to inform the VAMC if he was unable to attend the examination. Thereafter, in October 2004, the veteran failed to report for a VA examination scheduled in connection with his claim for increase. However, a review of the claims files does not include the letter from the VAMC notifying the appellant of his scheduled October 2004 VA examination. The veteran testified before the undersigned Veterans Law Judge in September 2005 that he was willing to report for another VA examination in support of his claim for increase for his service-connected depression. (Transcript (T.) at page (pg.) 5). Given that much time has passed since the August 2002 VA examination, when the veteran was assigned a GAF score of 70 and a mental status examination was essentially unremarkable with the exception of some vague and tearful speech, the Board finds that one more attempt to examine the veteran should be undertaken. Accordingly, this case is REMANDED to the RO for the following actions: 1. The RO should contact the appellant and request that he identify the names, address, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his depression at any time since April 21, 2004. With any necessary authorization from the appellant, the RO should attempt to obtain copies of pertinent treatment records identified by the appellant in response to this request, which have not been previously secured. 2. Thereafter, the RO should schedule the veteran for a VA psychiatric examination to determine the current severity of the service-connected depression. The psychiatrist should assign a GAF score and explain the significance of the score in terms of social and industrial impairment. The RO also should provide the examiner with copy of the psychiatric rating criteria, and findings should be made that are responsive to the rating criteria with respect to the service-connected depression only. The examiner should explain the rationale for all opinions given. The claims folders, with any evidence obtained pursuant to the request above, must be reviewed by the examiner in conjunction with the examination. Prior to scheduling the examination, the RO should advise the veteran of the date, time, and location of the scheduled examination. The RO should also advise the appellant that failure to report for the examination can result in a denial of his claim under 38 C.F.R. § 3.655(b). All notices to and communications (or efforts at communication) with the veteran must be documented in the claims folders. 3. In the event that the veteran does not report for the examination, documentation should be obtained which shows that notice scheduling the examination was sent to the veteran's last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. After undertaking any other development deemed appropriate, the RO should adjudicate the issue of entitlement to a rating greater than 10 percent for depression from April 21, 2004. 5. If any benefit sought is not granted, the veteran and his representative should be furnished with a supplemental statement of the case and afforded an opportunity to respond before the record is returned to the Board for further review. If the veteran has not reported for the scheduled examination, the supplemental statement of the case should include the provisions of 38 C.F.R. § 3.655 and an explanation of the regulation's application in this case. Thereafter, the case should be returned to the Board for further appellate review, if in order. By this remand, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until he is notified by the RO. The veteran has the right to submit additional evidence and argument on the matter the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). This case must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2005). ______________________________________________ DEBORAH W. SINGLETON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs