Citation Nr: 0213205 Decision Date: 09/30/02 Archive Date: 10/03/02 DOCKET NO. 97-13 525A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Oakland, California THE ISSUE Entitlement to service connection for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Alice A. Booher, Counsel INTRODUCTION The veteran had active service from September 1984 to January 1987. Service connection is in effect for acne of the face, back and shoulders; and bilateral pes planus. This appeal to the Board of Veterans Appeals (the Board) is from action taken by the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, CA. In July 2001, the Board remanded the case for development. The RO has completed that to the extent possible, and the case has been returned to the Board. FINDINGS OF FACT 1. All evidence necessary for review of the issue on appeal has been obtained, and the VA has satisfied the duty to notify the veteran of the law and regulations applicable to her claim and the evidence necessary to substantiate her claim. 2. The existence of an in-service stressor precipitating PTSD has not been corroborated by service records or other satisfactory evidence including credible, alternative sources. 3. Medical experts opine that the veteran does not have a diagnosis of PTSD. CONCLUSION OF LAW PTSD was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131, 1154, 5102, 5103 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304(f), 4.125 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duty to Assist During the pendency of this appeal, 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). The Act is applicable to all claims filed on or after the date of enactment, November 9, 2000, or filed before the date of enactment and not yet final as of that date. See Karnas v. Derwinski, 1 Vet. App. 308 (1991). The new law eliminates the concept of a well-grounded claim, and redefines the obligations of the VA with respect to the duty to assist claimants in the development of their claims. First, the VA has a duty to notify the claimant and her representative, of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102 and 5103 (West Supp. 2002). Second, the VA has a duty to assist the claimant in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A (West Supp. 2002). The VA has promulgated revised regulations to implement these changes in the law. See 66 Fed. Reg. 45,620 (Aug. 29, 2001) (to be codified as amended at 38 C.F.R §§ 3.102, 3.156(a), 3.159 and 3.326(a)). The intended effect of the new regulations is to establish clear guidelines consistent with the intent of Congress regarding the timing and the scope of assistance the VA will provide to a claimant who files a substantially complete application for VA benefits, or who attempts to reopen a previously denied claim. The Board finds that the VA's duties under the law and recently revised implementing regulations have been fulfilled. The veteran was provided adequate notice as to the evidence needed to substantiate her claim. The Board concludes the discussions in the rating decisions, the statement of the case (SOC), the supplemental statements of the case (SSOCs), and letters sent to the veteran informed her of the information and evidence needed to substantiate the claim and complied with the VA's notification requirements. The RO also supplied the veteran with the applicable regulations in the SOC and SSOCs. The VA has no outstanding duty to inform the appellant that any additional information or evidence is needed. The Board also finds that all relevant facts have been properly developed, and that all evidence necessary for equitable resolution of the issue on appeal has been obtained. To the extent that she provided guidance, all relevant evidence identified by the veteran was obtained and considered. The claims file contains the veteran's service and post-service medical and personnel records. The post- service treatment records have also been obtained. The veteran has been afforded disability evaluation examinations by the VA to assess the nature of her disabilities. With regard to the adequacy of the examinations, the Board notes that the examination reports reflect that the examiners recorded the past medical history, noted the veteran's current complaints, conducted examinations, and offered appropriate assessments and diagnoses. The RO has also made repeated efforts to verify the veteran's claimed stressors. For the foregoing reasons, the Board concludes that all reasonable efforts were made by the VA to obtain evidence necessary to substantiate the veteran's claim. The Board is unaware of any additional evidence which exists but has not been obtained. Therefore, no further assistance to the veteran with the development of evidence is required. In the circumstances of this case, another remand to have the RO take additional action under the new Act and implementing regulations would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the veteran are to be avoided). The VA has satisfied its obligation to notify and assist the veteran in this case. Further development and further expending of the VA's resources is not warranted. Taking these factors into consideration, there is no prejudice to the veteran in proceeding to consider the claim on the merits. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993). II. Criteria Service connection may be granted for disability due to disease or injury incurred in or aggravated by service. See 38 U.S.C.A. §§ 1110, 1131 (West 1991 & Supp. 2002). If a chronic disease such as a psychosis is manifest to a compensable degree within one year after separation from service, the disorder may be presumed to have been incurred in service. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991 & Supp. 2002); 38 C.F.R. §§ 3.307, 3.309 (2001). Establishing service connection for PTSD requires (1) a current medical diagnosis of PTSD; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor. See 38 C.F.R. § 3.304(f); Anglin v. West, 11 Vet. App. 361, 367 (1998); Cohen v Brown, 10 Vet. App. 128, 138 (1997). The Board notes that the regulation pertaining to claims for service connection for PTSD was revised during the course of this appeal. See 64 Fed. Reg. 32807-32808 (1999). Pursuant to Karnas v. Derwinski, 1 Vet. App. 308 (1991), where a law or regulation changes after the claim has been filed or reopened and before administrative or judicial review has been concluded, the version most favorable to the veteran applies unless Congress provided otherwise or permitted the VA Secretary to do otherwise and the Secretary did so. Prior to March 7, 1997, governing regulations provided that service connection for PTSD required medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in- service stressor. If the claimed stressor was related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f). VA is required to evaluate the supporting evidence in light of the places, types, and circumstances of service, as evidenced by service records, the official history of each organization in which the veteran served, the veteran's military records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(b); 38 C.F.R. §§ 3.303(a), 3.304; see Hayes v. Brown, 5 Vet. App. 60, 66 (1993). However, on June 18, 1999, and retroactive to March 7, 1997, that regulation was amended to read as follows: Service connection for PTSD requires medical evidence diagnosing the condition in accordance with Sec. 4.125(a) of this chapter, a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor actually occurred. If the evidence establishes that the veteran engaged in combat with the enemy and the claimed stressor is consistent with the circumstances, conditions, and hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. If the evidence establishes that the veteran was a prisoner- of-war under the provisions of Sec. 3.1(y) of this part and the claimed stressor is related to that prisoner-of-war experience, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions and hardships of the veteran's service, the veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f) (effective March 7, 1997). If the diagnosis of a mental disorder does not conform with American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) or is not supported by the findings on the examination report, the rating agency shall return the report to the examiner to substantiate the diagnosis. 38 C.F.R. § 4.125(a). Where the claimed stressor is not related to combat, "credible supporting evidence" is required and "the appellant's testimony, by itself, cannot as a matter of law, establish the occurrence of a noncombat stressor." See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996). The requisite additional evidence may be obtained from sources other than the veteran's service records. See Moreau v. Brown, 9 Vet. App. 389, 395 (1996), aff'd, 124 F.3d 228 (Fed. Cir. 1997) (table). In Cohen v. Brown, 10 Vet. App. 128 (1997), the Court clarified the analysis to be followed in adjudicating a claim for service connection for PTSD. The Court pointed out that the VA has adopted the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) in amending 38 C.F.R. §§ 4.125 and 4.126. See 61 Fed. Reg. 52695-52702 (1996). Therefore, the Court took judicial notice of the effect of the shift in diagnostic criteria. The major effect is that the criteria have changed from an objective ("would evoke ... in almost anyone") standard in assessing whether a stressor is sufficient to trigger PTSD, to a subjective standard. The criteria now require exposure to a traumatic event and response involving intense fear, helplessness, or horror. The question of whether a claimed stressor was severe enough to cause PTSD in a particular individual is now a clinical determination for the examining mental health professional. See Cohen, supra. Nothing in Cohen, however, negates the need for a noncombat veteran to produce credible corroborating and supporting evidence of any claimed stressor used in supporting a diagnosis of PTSD. Id.; Moreau v. Brown, 9 Vet. App. 389, 395 (1996). The corroboration may be by service records or other satisfactory evidence. See Doran v. Brown, 6 Vet. App. 283, 289 (1994). [In Doran, a veteran's service records had been lost due to fire; however, his account of in-service stressors was corroborated by statements from fellow servicemen.] Particularly important to cases such as the one at hand, the Court has stressed the necessity of complete development of the evidence if a PTSD claim is based on an alleged personal assault. See Patton v. West, 12 Vet. App. 272, 276 (1999). In Patton, the Court pointed out that there are special evidentiary development procedures for PTSD claims based on personal assault contained in VA ADJUDICATION PROCEDURE MANUAL M21-1, Part III, 5.14(c) (Feb. 20, 1996), and former MANUAL M21-1, Part III, 7.46(c)(2) (Oct. 11, 1995). The general M21-1 provisions on PTSD claims in 5.14 require that in cases where available records do not provide objective or supportive evidence of the alleged in-service stressor, it is necessary to develop for this evidence. MANUAL M21-1, Part III, 5.14(b)(2). As to personal-assault PTSD claims, more particularized requirements are established regarding the development of "alternative sources" of information as service records may be devoid of evidence because many victims of personal assault, especially sexual assault and domestic violence, do not file official reports either with military or civilian authorities. MANUAL M21-1, Part III, 5.14(c). Further, the provisions of subparagraphs (7) and (8) indicate that "[b]ehavior changes that occurred at the time of the incident may indicate the occurrence of an in-service stressor", and that "secondary evidence may need interpretation by a clinician, especially if it involves behavior changes" and that "[e]vidence that documents such behavior changes may require interpretation in relationship to the medical diagnosis by a VA neuropsychiatric physician." When read together, the Court states that the subparagraphs show that in personal-assault cases the Secretary has undertaken a special obligation to assist a claimant in producing corroborating evidence of an in-service stressor. Also in Patton, the Court qualified prior statements contained in other Court decisions indicating that "something more than medical nexus evidence is required to fulfill the requirement for 'credible supporting evidence'," and that "[a]n opinion by a mental health professional based on a post-service examination of the veteran cannot be used to establish the occurrence of the stressor." The Court stated that these quoted categorical statements were made in the context of discussing PTSD diagnoses other than those arising from personal assault. See Cohen, supra; Moreau v. Brown, 9 Vet. App. 389 (1996). To that extent, the Court found that the above categorical statements in Cohen and Moreau, and other cases where that may have been in accordance, are not operative. In addition, the Court noted that in two places MANUAL M21-1, Part III, 5.14, appeared improperly to require that the existence of an in-service stressor be shown by "the preponderance of the evidence." The Court clearly stated that any such requirement would be inconsistent with the benefit of the doubt doctrine which is applicable where the evidence is in equipoise. Patton, 12 Vet. App. at 280. III. Background Service records show no direct or collateral evidence of an assault of any kind. Gynecological records show routine check-ups and testing, all of which were negative and did not reflect sexual assault. VA post-service clinical reports show that the veteran had nasal treatment in 1990. In November 1990, she complained of having worsening stress urinary incontinence over several years. She had had infections over the years but urinary testing had been reportedly negative. In November 1990, she was noted on examination to have a cystocele and some pannus in her abdomen. She underwent a culpocystourethropexy. There was no notation of residuals of sexual or other trauma in any of the associated clinical records. On her initial claim for VA compensation filed in 1991, the veteran made no mention of inservice trauma or psychiatric problems. On VA admission in January 1991, the veteran was seen for ongoing urinary stress incontinence. It was noted that she had previously delivered twins and had had back pain for several years. She had also had numerous urinary tract infections. She underwent culpocystourethropexy and abdominal advancement flap procedures. In her history, she made no mention of having been assaulted. A VA hospital summary from March 1991 notes that the veteran exhibited a hypoplastic jaw and a deformed nose for which she underwent surgery. The source for such deformities was not identified. In January 1992, she was described as having asymmetry involving the middle and inferior nasal turbinate. She did not reference having been assaulted or having experienced trauma to the nose or elsewhere in or since service. On VA evaluation in February 1992, the veteran complained of vulvar irritation and abdominal pain. She said she had born twins, one of whom died. The diagnosis was desquamans dermatitis and various sources were suggested. She made no reference to assault. On other occasions during that month she was felt to have a yeast vaginitis for which treatment was given, and acne. On neurological evaluation in March 1992, the veteran reported that she had had scoliosis since she was age 3 with associated back problems. She also had periodic numbness into one or both legs. She said she had injured her left wrist in October 1984 and now had poor grip therein with some numbness and tingling and constant pain. She said notwithstanding prior surgery, she still had urinary incontinence. The examiner described her as being somewhat paranoid when she described her experiences as an adopted child. She also described some sort of "spells" although the examiner did not find an organic basis and felt that there was a possible psychosomatic overlay involved. VA clinical report from August 1994 showed that the veteran had right arm pain and tingling in her fingers. There were some fading bruises on her arm but no notation was made as to whether these were from trauma or some other cause. Right carpal tunnel syndrome was diagnosed, in pertinent part. The veteran filed a VA Form 21-4138 in 1995 claiming that she had had PTSD since 1987 and service. The RO requested that she document and/or provide alternative sources for alleged stressors, in detail. VA clinical reports from April 1995 show X-ray evidence of prior, "old" trauma to the distal tibia above the ankle joint. In June 1995, the veteran reported having sustained injuries to her ankle in 1986 and 1988 and said she had since turned the ankle again. In October 1995, the veteran provided another VA Form 21-4138 in which she reported that she was sexually harassed by several military enlisted men from 1985-1987 while a personnel records specialist at HQ, Army Garrison at the Presidio in San Francisco; that she was falsely accused by others; that she had been blackballed in service, and that the impact of this had followed her into the Reserves. She detailed these incidents and said they had prevented her from getting a federal job until 1990, and from which she still had memories. She alleged that she had been fingerprinted, and had even undergone mug-shots (was photographed) as a criminal, but that she was not one. In 1988, as a civilian, she said she was again accused of various untruths, and this had employment impact as well, all of which continued in her memory In September 1995, the RO again requested that she provide more specific details so that the allegations of assault and similar treatment could be pursued via alternative sources. The veteran's service personnel file was secured and filed in the claims folder, confirming that she was a personnel specialist, among other things, but not reflecting any trauma or incidents as identified above either directly or indirectly. VA treatment records show that the veteran was seen on an ongoing basis for various care including for recurrent vaginitis and frequent vaginal irritation. One notation in 1994 was that she had a slightly strange (paranoid) affect with regard to why her children had been taken from her. Throughout 1994 visits she was noted to have legal difficulties and was said to be willing to go to counseling for a custody hearing. There were other notations such as that she had ear pain which on occasion was diagnosed as otitis externa, but she alleged that the ear pain was due to a co-worker deliberately opening the window. In early 1995, she was noted to have a list of prior experiences when she felt she had been treated unfairly, in and out of the military, and including involving her marriage and losing her kids. She exhibited anxiety. The RO endeavored on several occasions to obtain any CID records; it was reported that there were none available. Several copies of her personnel files were received and filed in the claims file. Private and VA facilities reported that no further records were available for the veteran. The RO denied her claim for PTSD on several occasions noting that she had not provided additional identifying information relating to alleged stressors so that additional RO development could be undertaken. Her representative noted that she had identified three separate incidents of having been sexually assaulted in service. Further information was not provided by her in that regard. Extensive documentation was received relating to problems the veteran had at work. In May 1996, a statement was submitted for the file after examination by two psychiatric specialists. It was noted that they had been requested to make a clinical assessment of the veteran's situation as it related to her VA employment. They concluded that she primarily suffered from a personality disorder which was manifest in the work environment, details of which were provided. It was noted that attempts were being made to treat the chronic disorder with psychopharmacological approaches but that there had been no significant improvements. It was concluded that she was unable to perform her assigned job duties; and that it was unlikely that she would be able to do such duties because for her to work satisfactorily within her needs would require almost complete autonomy and lack of supervision. In July 1997, a report of VA psychiatric evaluation showed that the veteran had filed numerous complaints as to her treatment within and without the VA facility; that she was under great financial stress; that she was about to lose her hotel room; and that she had been evicted before on several occasions, etc. After extensive examination and review of her records, the examiners concluded that under Axis I, the veteran had generalized anxiety disorder and delusional disorder, persecutory type and episodic alcohol abuse; Axis II was a personality disorder, cluster B with borderline and paranoid traits. Her Global Assessment of Functioning (GAF) score was estimated to be 35. A psychological assessment was undertaken in July 1999 at which time the veteran reported a number of incidents in and since service. The psychological examiner noted, in summary, that she had had a difficult childhood and that she alleged a series of sexual harassment incidents in service and Reserves. She was said to have been referred to the VA facility for medication to manage her anxiety, homelessness and joblessness. Diagnosis was generalized anxiety; PTSD was to be ruled out. Clinical reports from later in July 1999 show that the veteran was treated on an ongoing basis for residuals of a recent assault by her boyfriend with lacerations, abrasions, bruises, edema, etc., which had involved blows to her face and jaw. Reports of care in 1999 and thereafter show that she has also been seen for various orthopedic complaints and reports of having fallen and injured her ankle, etc. In December 1999, diagnoses were shown as Axis I, of general anxiety disorder as well as depressive disorder, and Axis II, personality disorder (cluster, borderline and paranoid). During such care, including in January 2000, the veteran reported that she was a victim of recent domestic violence at which time she had been thrown to the ground and again injured her ankle and feet. Subsequent VA clinical reports show that the veteran continued to have problems with being evicted and in other settings. She had provided various scenarios of how abuse and deprivation had taken place in the past and how she had developed her various behaviors including hoarding which was causing greater problems in her several serial residences. In October 2000, psychiatric evaluation again assessed a general anxiety or depressive disorder along with borderline personality and binge drinking. In October 2001, she was reevaluated. She was then living in another state because she needed to get away from her ex- boyfriend who had just gotten out of jail. The prospect of her being evicted from her then residence was discussed in detail. IV. Analysis In essence, the veteran claims that she developed PTSD as a result of a sexual assault in service. In this regard, and in order to be assured that all possible development had been undertaken, the case was remanded by the Board, and both before and since, the RO has undertaken extensive development of the available evidence. The Board is satisfied that all evidence that is reasonably available is now in the file. From the outset, it should be noted that the Board is well aware of the special problems which may be faced in questions of proof involving alleged sexual assault cases. In fact, these difficulties have been forthrightly addressed in relatively recent regulatory changes (cited above) which permit some variations from the norm of proof and encourage alternative manner and means of development of the evidence for PTSD which is claimed to have resulted from other such alleged stressors. In this instance, the RO has endeavored diligently on repeated occasions to obtain additional evidence to corroborate and illuminate her stories. However, allegations of sexual assault are by their very nature, intensely personal. As a result, they are acutely driven as a primary source of evidence, in such a case as this, by information which is solely possessed by the veteran herself. In this case, the veteran has been repeatedly requested to provide such data so that further development might be undertaken. To the minimal extent that she had identified incidents, the RO has undertaken to pursue and obtain collateral information to support her contentions. However, her cooperation in that regard has been sorely limited and no productive information has been forthcoming in or outside service records. And other than saying that she was assaulted on three occasions in service, she has not provided additional information which might assist in the development of collateral evidence to support that contention. It is noted that because of the special nature of cases such as this, the regulations provide a variety of alternative sources which may be used to be corroborative of an alleged stressor. But since the veteran has not provided adequate resources, these alternatives could not be appropriately and adequately pursued by the RO. In sum, the total absence of service evidence, of official or unofficial nature, provides utterly no credible support for the alleged stressors. That is not to say that she did or did not have problems in service, but merely that the evidence does not support that argument. In any event, the mere presence of stressors is not sufficient, in and of itself, if the stressors cannot be connected in a causal manner to a diagnosis of PTSD, and if the other criteria set forth above are not met. Parenthetically, there is also a recent clear pattern that the veteran has had any number of incidents since service, some of which apparently involve assaults on her by one or another persons, all of which are unrelated to service. She has also experienced, by her own admission, a litany of nonassaultive-type problems in and outside employment which seem to have somewhat escalated in recent years. The Board is not unsympathetic to her apparent widespread difficulties, whether they are or are not caused by herself or others. But while the Board need not address the cause and effect relationship between her current or more recent difficulties in her work and social environments, it must be noted that these may be as stress-causative as any alleged inservice factor absent proof to the contrary. However, in this case, there is a much more pivotal problem which cannot be overcome and resolved to her satisfaction, and that is the lack of a PTSD diagnosis. Given that the veteran has had ongoing manifestations of some sort of mental health problems, exhaustive psychiatric evaluations have taken place over the years since separation from service. Throughout, the diagnosis most prevalent has been personality disorder although there have been elements of depression and anxiety. Virtually the only person to suggest that the veteran has PTSD is the veteran. One psychologist suggested that PTSD might be an alternative diagnosis based on the veteran's allegations of inservice sexual harassment or assault, but subsequent evaluation by mental health physicians definitely and unequivocally negated that hypothesis. In Cohen v. Brown, op. cit., the Court clarified the analysis to be followed in adjudicating a claim for service connection for PTSD. As noted above, the DSM-IV, in amending 38 C.F.R. §§ 4.125 and 4.126, clearly requires that for the purposes of establishing service connection for PTSD, there must be an unequivocal current diagnosis of PTSD, and proceeds to set forth the detailed criteria for such a diagnosis. The veteran does not fulfill that criteria and she does not have a current diagnosis of PTSD. Similarly, the Court held in Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) that a service-connection claim must be accompanied by evidence which establishes that the claimant currently has the claimed disability. Absent that diagnosis in this case, accordingly, the Board concludes that PTSD was not incurred in or aggravated by service. ORDER Service connection for PTSD is denied. JEFF MARTIN Member, Board of Veterans' Appeals IMPORTANT NOTICE: We have attached a VA Form 4597 that tells you what steps you can take if you disagree with our decision. We are in the process of updating the form to reflect changes in the law effective on December 27, 2001. See the Veterans Education and Benefits Expansion Act of 2001, Pub. L. No. 107-103, 115 Stat. 976 (2001). In the meanwhile, please note these important corrections to the advice in the form: ? These changes apply to the section entitled "Appeal to the United States Court of Appeals for Veterans Claims." (1) A "Notice of Disagreement filed on or after November 18, 1988" is no longer required to appeal to the Court. (2) You are no longer required to file a copy of your Notice of Appeal with VA's General Counsel. ? In the section entitled "Representation before VA," filing a "Notice of Disagreement with respect to the claim on or after November 18, 1988" is no longer a condition for an attorney-at-law or a VA accredited agent to charge you a fee for representing you.