Citation Nr: 0402538 Decision Date: 01/27/04 Archive Date: 02/05/04 DOCKET NO. 02-20 427 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia THE ISSUES 1. Entitlement to an initial rating in excess of 20 percent for the service-connected diabetes mellitus. 2. Entitlement to service connection for paraganglioma excision claimed as secondary to herbicide exposure. 3. Entitlement to service connection for coronary artery disease, post-operative coronary artery bypass graft, claimed as secondary to the service-connected diabetes mellitus. REPRESENTATION Appellant represented by: Military Order of the Purple Heart of the U.S.A. ATTORNEY FOR THE BOARD L. Cryan, Counsel INTRODUCTION The veteran had active service from June 1962 to May 1966. This case is before the Board of Veterans' Appeals (Board) on appeal from a January 2002 rating decision by the RO. The Board notes that, during the pendency of this appeal, a March 2003 rating decision granted service connection for chronic renal insufficiency with an evaluation of 60 percent and that a July 2003 rating decision assigned a total compensation rating based on individual unemployability. (The issues of secondary service connection for coronary artery disease and paraganglioma excision are being REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the veteran and his representative if further action is required on his part.) FINDING OF FACT The veteran's diabetes mellitus is shown to be productive of a disability picture that has more nearly approximated that of the required use of insulin, restricted diet and regulation of his activities since the date of the grant of service connection. CONCLUSION OF LAW The criteria for the assignment of a 40 percent rating, but not higher, for the service-connected diabetes mellitus have been met since the effective date of the grant of service connection. 38 U.S.C.A. §§ 1155, 5107, 7104 (West 2002); 38 C.F.R. §§ 4.7, 4.119 including Diagnostic Code 7913 (2003). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection for diabetes mellitus was granted in a January 2002 rating decision with an initial 20 percent rating assigned effective on March 21, 2001. The veteran timely appealed that determination, asserting that his diabetes mellitus was severe enough to warrant a rating in excess of 20 percent. At a VA examination in November 2001, the veteran reported that he was first diagnosed with diabetes in 1981 and that he was placed on insulin 30 units, then increased to 35 units. He denied hypoglycemic reactions requiring hospitalization and was on a no sugar, low cholesterol, no fat, no salt diet. He was previously on Minoxidil, but had weight gain of 10 pounds and the medicine was discontinued. He reported no restrictions of activities related to diabetes, but it was noted that the veteran suffered a stroke which had caused other significant medical problems. Current symptoms and disabilities included double vision in the left eye, blurry vision, vascular condition, high blood pressure, coronary bypass grafting, coronary artery disease and status post CVA which affected his right side. He also had involuntary jerking motions of the hand and leg. Also, the veteran reported that he continued to have swelling of the feet with bluish black discoloration at various intervals. The veteran reported that his hypertension was diagnosed in 1970. Laboratory work revealed findings of WBC/RBC 7.7/4.1, H&H 13.1/38.4, MCV 93.6, HGB A1C 7/01 8.4, electrolytes 11/01 sodium 142, potassium 3.8, chloride 106, glucose 118, BUN 24, creatinine 1.8, calcium 9. Urinalysis revealed negative protein, glucose 250, negative ketones, acid for bacteria, occasional WBC's RBC's negative nitrites and leukocytes. The impression was that of diabetes mellitus type II secondary to Agent Orange exposure, with current insulin therapy for management, patient has poor control as documented elevated HGB A1C. In a March 2002 statement, the veteran reported that he was first diagnosed with diabetes and high blood pressure in 1978. The veteran further stated that he had no idea that he had vascular problems or heart problems until 1990. VA outpatient treatment reports from February 2002 to August 2002 show continued treatment for uncontrolled diabetes mellitus. The veteran was afforded another VA examination in October 2002. The examiner noted that the veteran was first diagnosed with the diabetes mellitus in 1977-1978. The veteran denied any ketoacidosis or hypoglycemic reactions. He indicated that he was on a diabetic diet, low cholesterol. The veteran denied any weight loss and stated that he had a little weight gain since his last examination. The veteran reported restrictions of his activities included inability to ambulate, loss of strength secondary to having a stroke. The veteran also reported diabetic retinopathy. The veteran reported right-sided numbness since his stroke. He also noted that he had follow-up every three months. On physical examination, the veteran presented in a wheel chair. His blood pressure sitting was 180/84. Cardiovascular showed normal S1 and S2. Skin was intact with noted thickened discolored nails of bilateral feet 1 through 5 with noted erythema of the right foot. There was increased sensitivity to the right lower extremity. It was painful to touch. The veteran did have on bilateral support hose which were removed for examination. The veteran was noted to have spasms of the right lower extremity during examination. Laboratory work from May 2002 revealed findings of wbc count 5.9, rbc count 3.92, hemoglobin 12.9, hematocrit 37.1, MCV 94.6, MCH 32.8. Hemoglobin A1C 7.2. Sodium 139, potassium 5.1, chloride 103, C02 25, glucose 157, BUN 43, creatinine 2.4, calcium 8.6. On 10/15/02, urinalysis showed negative protein, glucose and ketones. Diagnosis was as follows: (1) Diabetes type II diagnosed approximately 1977-1978; (2) Diabetes mellitus Type II, veteran currently with end organ damage with nephrologic, cardiovascular and neurologic complications reported; (3) Diabetes mellitus with a history of hypertensive vascular disease; (4) Coronary artery disease, status post coronary artery bypass grafting x 5; also cerebrovascular accident in September 2001 with residual hemiparesis of the right; (5) Diabetes type II with renal failure, elevated BUN and creatinine levels on assessment; (6) Elevated glucose level on 10/15/02; (7) Diabetes type II. Renal condition could be attributed to the dm as well as his hypertensive vascular disease which did target the renal system. It is more likely than not that the type II diabetes had contributed to his renal failure. The veteran was afforded another VA examination in January 2003 to evaluate his chronic renal insufficiency. He reported lethargy, significant weakness, no anorexia; rather, he gained 10-20 pounds over the past four to six months. He denied frequency in urination. Laboratory results revealed findings of PT, INR 2.2 secondary to Coumadin. WBC count 5.6, hgb 13, hct 37.7, platelets 180,000. Sodium 139, potassium 4.2. Chloride 103, bicarb 28, BUN 29, creatinine 2.4 Glucose 108. Urinalysis showed no evidence of any proteins, ketones, glucose or nitrites in the urine. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. In general, disability evaluations are assigned by applying a schedule of ratings that represent, as far as can practicably be determined, the average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 2002). The Board attempts to determine the extent to which the veteran's disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.1, 4.2, 4.10 (2003). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2003). The veteran is currently evaluated under the criteria listed at 38 C.F.R. § 4.119, Diagnostic Code 7913 for rating diabetes mellitus. A 100 percent disability rating will be assigned when diabetes mellitus requires more than one daily injection of insulin, restricted diet, and regulation of activities, (avoidance of strenuous occupational and recreational activities) with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated. A 60 percent disability rating will be assigned when diabetes mellitus requires insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 40 percent disability rating is for assignment when diabetes requires insulin, restricted diet, and regulation of activities. A 20 percent evaluation is assignable where the diabetes requires insulin and a restricted diet; or oral hypoglycemic agents and restricted diet. When the diabetes mellitus is managed by a restricted diet only, a 10 percent evaluation is warranted. Compensable complications of diabetes are separately evaluated unless they are part of the criteria used to support a 100 percent evaluation. Noncompensable complications are considered part of the diabetic process under Diagnostic Code 7913. 38 C.F.R. § 4.119; Diagnostic Code 7913, Note (1) (2003). In this case, the evidence of record shows that the veteran's diabetes mellitus has been insulin-dependent since the effective date of service connection.. In addition, the evidence shows that the veteran must maintain a restricted diet and has significant impairment due to the service- connected diabetes mellitus. The Board is mindful that the veteran suffered a stroke in September 2001, however, the Board finds, given the extent of its manifestations, that the service-connected diabetes mellitus is productive of some restriction of activity. . Based on the evidence of record as outlined hereinabove, the Board finds that the veteran's service-connected diabetes mellitus results in a disability picture that more nearly approximates the criteria for the assignment of an initial rating of 40 percent. However, absent findings of episodes of ketoacidosis or hypoglycemic reactions requiring treatment or progressive loss of weight or strength, the Board finds that a higher rating is not for application for the service-connected connected diabetes mellitus at this time. The Board points out that at the time of an initial rating, separate ratings can be assigned for separate periods of time based on the facts found-a practice known as "staged" ratings. Fenderson v. Brown, 12 Vet. App. 119 (1999). The Board finds that, at no time since service, has the service- connected disability been more disabling than as currently rated. Finally, the Board points out that on November 9, 2000, the President signed into law the Veterans Claims Assistance Act (VCAA) of 2000, which has since been codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002). Among other things, this law eliminated the concept of a well-grounded claim, redefined the obligations of VA with respect to the duty to assist, and superseded the decision of the United States Court of Appeals for Veterans Claims in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom. Morton v. Gober, No. 96-1517 (U.S. Vet. App. Nov. 6, 2000) (per curiam order), which had held that VA cannot assist in the development of a claim that is not well grounded. This change in the law is applicable to all claims filed on or after the date of enactment of the Veterans Claims Assistance Act of 2000, or filed before the date of enactment and not yet final as of that date. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107. The regulations implementing the VCAA are codified at 38 C.F.R. § § 3.102, 3.156(a), 3.159 and 3.326. Except as specifically noted, the new regulations are effective on November 9, 2000. Because of the change in the law brought about by the Veterans Claims Assistance Act of 2000, compliance with the notice and duty to assist provisions contained in the new law is now required. See 38 U.S.C. §§ 5102, 5103, 5103A, and 5107). The RO has had an opportunity to address this new legislation with regard to the veteran's claim for increase. The veteran has been informed of what information was needed to support his claim in rating decisions, Statements of the Case, and letters sent to his by the RO as noted hereinabove. Moreover, the veteran was afforded several examinations at which he reported as to the severity of the service-connected disability. Most importantly, the Board finds that the veteran is not prejudiced thereby and no further assistance in developing the facts pertinent to his claim is required. In this case, the Board finds that there is sufficient evidence of record to decide his claim properly. ORDER An initial 40 percent rating, but not higher, for the service-connected diabetes mellitus is granted, subject to the regulations controlling to disbursement of VA monetary benefits. REMAND The veteran asserts that service connection is warranted for coronary artery disease and for paraganglioma excision on a secondary basis. At the outset, the Board again notes that the statutes governing assistance to claimants and the benefit of the doubt were recently amended. More specifically, the Board noted that there had been a significant change in the law with the enactment of the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000), now codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002). This change in the law is applicable to all claims filed on or after the date of enactment of the Veterans Claims Assistance Act of 2000, or filed before the date of enactment and not yet final as of that date. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107. The regulations implementing the VCAA are now codified at 38 C.F.R. § § 3.102, 3.156(a), 3.159 and 3.326). Except as specifically noted, the new regulations are effective on November 9, 2000. In Quartuccio v. Principi, 16 Vet. App. 183 (2002), the United States Court of Appeals for Veterans Claims (Court), interpreted the VCAA to require that the VA has a duty to notify the veteran as to the laws and regulations governing his appeal, to provide notice as to the type of evidence necessary to substantiate the claims, to provide notice of the veteran's responsibility to provide evidence, and to provide notice of the actions taken by VA. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). As such, the RO must ensure that the veteran has not been properly notified of the VCAA and that VA has fulfilled its duty to assist the veteran in this case with regard to these issues. A. Service connection for coronary artery disease At the outset, the Board notes that the RO rating decision of January 2001 denied the veteran's claim of service connection for coronary artery disease claimed as secondary to the service-connected diabetes mellitus based on a finding that the veteran's coronary artery disease preceded the diagnosis of diabetes mellitus. More specifically, the RO noted that the evidence of record showed that the veteran was initially diagnosed with hypertension, a well-established cause of coronary artery disease, in approximately 1970, some 11 years prior to his diabetes diagnosis. The Board is mindful that hypertension and coronary artery disease might very well be related, but the evidence of record does not confirm that assumption in this case. Rather, the veteran has asserted that his heart problems began several years after the diagnosis of diabetes mellitus. Specifically, the veteran asserts that his diabetes and hypertension were diagnosed in 1981, but that his heart and vascular conditions were not noticed until he had the paraganglioma removed in 1987. Moreover, VA doctors have suggested that the veteran's heart and vascular problems could be complications of the diabetes mellitus. As such, the veteran should be afforded another VA examination to determine the likely etiology of the veteran's cardiovascular disease and if it likely a complication of the service-connected diabetes mellitus. B. Service connection for paraganglioma excision The veteran asserts that his paraganglioma excision was secondary to agent orange exposure. In an October 2001 statement, the veteran indicated that Dr. Roger Giordano of Richmond Virginia had submitted an expert medical opinion advancing the veteran's current disability of paraganglioma as related to Agent Orange exposure. It does not appear that any such opinion is currently associated with the claims file. The issue should therefore be remanded to the RO to afford the veteran another opportunity to submit the aforementioned opinion in support of his claim of service connection. In light of the need for another VA examination, the examiner should opine as to the likelihood that the veteran's paraganglioma is related to exposure to herbicides. Moreover, the veteran has asserted that his paraganglioma is a soft tissue sarcoma. On examination, the examiner should confirm or deny this assertion. If the paraganglioma is in fact a soft tissue sarcoma, additional development will be necessary to determine if service connection is warranted on a presumptive basis under 38 C.F.R. § 3.307, 3.309 (2003). Accordingly, these matters are remanded for the following action: 1. The RO should take appropriate action to contact the veteran in order to request that he identify the names, addresses, and approximate dates of treatment for any VA and non-VA health care providers who treated him for coronary artery disease and residuals of paraganglioma, not previously identified. After obtaining any necessary authorization from the veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the veteran in response to this request, which have not been previously secured. Once obtained, all records must be associated with the claims folder. In particular, any opinion as to the etiology of the paraganglioma from Dr. Roger Giordano (5700 Fitzhugh Avenue, Richmond, VA 23226) should be obtained and associated with the claims file. 2. The veteran should be afforded a VA examination to determine the current severity of the veteran's diabetes mellitus, including all complications stemming from the diabetes mellitus. All indicated x-ray studies and laboratory tests should be completed. The claims file, to include all evidence added to the record pursuant to this REMAND, should be made available to the examiner prior to the examination. Based on his/her review of the case, the examiner should render an opinion as to the likelihood that the veteran has coronary artery disease is likely a complication of the service-connected diabetes mellitus. A complete rationale for all opinions expressed must be provided. 3. The veteran also should be afforded a VA examination in order to ascertain the current nature and likely etiology of the claimed paraganglioma. Detailed clinical findings should be reported in this regard. Based on his/her review of the case, the examiner should offer an opinion as to whether the veteran has current disability due to a paraganglioma that at least as likely as not was caused or aggravated by herbicide exposure in service. The examiner in this regard should say whether the veteran suffered from any form of a soft tissue sarcoma that could be attributed to service. A complete rationale for all opinions expressed must be provided. 4. Following completion of the development requested hereinabove, the RO must undertake to review the veteran's claims. The RO in this regard must ensure that all notification and development action required by the VCAA is completed. In particular, the veteran must be notified that he has up to one year to provide evidence in support of his claims for benefits. If any benefit sought on appeal remains denied, then the veteran and his representative should be provided with a supplemental statement of the case (SSOC). The SSOC must contain notice of all relevant actions taken on the claim for benefits, to include a summary of the evidence and applicable law and regulations considered pertinent to the issue currently on appeal. An appropriate period of time should be allowed for response thereto. Thereafter, the case should be returned to the Board for the purpose of appellate disposition, if indicated. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West 2002) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.43 and 38.02. ______________________________________________ STEPHEN L. WILKINS 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