Citation Nr: 0403557 Decision Date: 02/09/04 Archive Date: 02/23/04 DOCKET NO. 00-24 155A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to an increased evaluation for residuals of idiopathic anaphylaxis with recurrent angioedema, currently rated as 40 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J. D. Deane, Associate Counsel INTRODUCTION The veteran served on periods of active duty from August 1980 to August 1984 and from November 1990 to February 1992. This case comes to the Board of Veterans' Appeals (Board) from a January 2000 rating decision rendered by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The veteran cancelled a scheduled Travel Board hearing with the Judge from the Board at the RO in July 2003. FINDINGS OF FACT 1. All the evidence requisite for an equitable disposition of the veteran's claim has been developed and obtained, and all due process concerns as to the development of his claim have been addressed. 2. Residuals of idiopathic anaphylaxis with recurrent angioedema are manifested by attacks with symptoms of erythema and swelling of the eyes, lips, and tongue as well as throat angioedema and intermittent urticaria. CONCLUSION OF LAW 1. The schedular criteria for an increased rating for residuals of idiopathic anaphylaxis with recurrent angioedema are not met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. Part 4, § 4.104, Diagnostic Code 7199-7118 (2003); 38 C.F.R. Part 4, § 4.118, Diagnostic Code 7825 (2003). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Increased Rating for Idiopathic Anaphylaxis with Recurrent Angioedema The severity of a service-connected disability is ascertained, for VA rating purposes, by the application of rating criteria set forth in VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (2003) (Schedule). To evaluate the severity of a particular disability, it is essential to consider its history. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2 (2003). Where there is a reasonable doubt as to the degree of disability, such doubt will be resolved in favor of the claimant. See 66 Fed. Reg. 45,620, 45,630 (Aug. 29, 2001) (to be codified at 38 C.F.R. § 3.102); 38 C.F.R. §§ 4.3, 4.7 (2003). In addition, where there is a question as to which of two disability evaluations should 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. See 38 C.F.R. § 4.7 (2003). In a July 1992 rating decision, the veteran was granted service connection for idiopathic anaphylaxis and assigned a 10 percent rating under Diagnostic Codes 6399-6304 as well as granted service connection for idiopathic urticaria and assigned a 10 percent rating under Diagnostic Codes 7199- 7118, both effective from February 15, 1992. In a December 1993 rating decision, the RO assigned the veteran a 20 percent rating for recurrent idiopathic angioedema (formally diagnosed idiopathic urticaria) under Diagnostic Codes 7199- 7118, effective from June 28, 1993. In a January 2000 rating decision, the veteran was assigned a 20 percent rating for idiopathic anaphylaxis under Diagnostic Codes 8999-8911 as well as a 40 percent for recurrent idiopathic angioedema under Diagnostic Codes 7199-7118, both effective from August 7, 1998. The veteran filed a Notice of Disagreement in February 2000. In addition, in a February 2001 rating decision, the RO found that the July 1992 rating decision was clearly and unmistakably erroneous in granting service connection for idiopathic urticaria (now shown as idiopathic angioedema) and idiopathic anaphylaxis as two separate disabilities. The RO then noted that the veteran's disabilities would be evaluated as idiopathic anaphylaxis with recurrent angioedema and assigned a 40 percent rating under Diagnostic Codes 7199- 7118, effective from August 7, 1998. The veteran contends that his service-connected disability of idiopathic anaphylaxis with recurrent angioedema is more severe than currently evaluated, and that an increased evaluation should be assigned. After a review of the evidence, the Board finds that the evidence does not support the assignment of an increased rating for the veteran's idiopathic allergic disability. The severity of a service-connected disability is ascertained, for VA rating purposes, by the application of rating criteria set forth in VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (2003) (Schedule). The rating schedule does not specifically provide for rating the veteran's residuals of idiopathic anaphylaxis with recurrent angioedema. It is permissible to evaluate the veteran's service-connected disability under the provisions of the schedule, which pertain to a closely related disease, or injury that is analogous in terms of functions affected, anatomical localization, and symptomatology. See 38 C.F.R. § 4.20 (2003). The veteran's service-connected residuals of idiopathic anaphylaxis with recurrent angioedema are currently evaluated by analogy under 38 C.F.R. § 4.104, Diagnostic Codes 7199-7118 for angioneurotic edema. Under Diagnostic Code 7118, a 10 percent rating is warranted for attacks without laryngeal involvement lasting one to seven days and occurring two to four times a year. A 20 percent rating is warranted for attacks without laryngeal involvement lasting one to seven days and occurring five to eight times a year, or; attacks with laryngeal involvement of any duration occurring once or twice a year. A 40 percent rating is assigned for attacks without laryngeal involvement lasting one to seven days or longer and occurring more than eight times a year, or; attacks with laryngeal involvement of any duration occurring more than once or twice a year. See 38 C.F.R. § 4.104, Diagnostic Code 7118 (2003). As noted above, the veteran's service-connected idiopathic anaphylaxis with recurrent angioedema is currently rated as 40 percent disabling pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7118 for angioneurotic edema. This is the maximum rating under that diagnostic code. However since the veteran's current disability of idiopathic anaphylaxis with recurrent angioedema has some of the same symptoms as urticaria, the Board will also consider whether the veteran's disability would support an increased evaluation under the regulations for skin disabilities. During the pendency of this appeal, the criteria for evaluating skin disorders were changed and the new regulations became effective on August 30, 2002. See 67 Fed. Reg. 49590 - 49599 (July 31, 2002). Prior to August 30, 2002, urticaria did not have its own diagnostic code, so it was rated by analogy to angioedema under Diagnostic Code 7118 as shown above. The criteria for Diagnostic Code 7825 under the new regulations states that a 60 percent rating is assigned for recurrent debilitating episodes of urticaria occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy. See 38 C.F.R. § 4.118, Diagnostic Code 7825 (2003). VA treatment records from February 1996 show that the veteran had an acute anaphylactic attack during that month with symptoms of erythema, swelling of the lips and tongue, and throat angioedema. It was noted that the veteran increased his steroid medication and resolved the flare-up within an hour. An April 1996 treatment record shows that the veteran was unable to taper down steroid therapy secondary to a flare-up of urticaria/angioedema. An additional treatment record dated in June 1996 noted that the veteran had suffered from a flare-up with a few hives on his face, which had lasted about two days. A July 1996 treatment note showed that the veteran stated that he had suffered a flare-up the week before with symptoms of a numb tongue, swollen eyes, and hives all over. The record stated that the veteran suffered from anaphylaxis with frequent relapses on multiple medications. Additional VA treatment records dated in April and July 1997 show that the veteran complained of intermittent redness of the face but noted that the veteran had not suffered from swelling or urticaria recently. Treatment notes from October and December 1997 stated that the veteran had recurrent anaphylaxis with questionable steroid withdrawal symptoms and that steroid use caused his facial flush. The veteran was treated for nasal mucosa edematous and post pharynx erythematous in January 1998. A February 1998 treatment note detailed that the veteran had a recent flare-up of idiopathic anaphylaxis with facial erythema and tongue numbness. The file also contains an undated statement from a VA physician to the veteran's employer which noted that the veteran suffered from systemic anaphylaxis which causes the veteran to rapidly develop swelling of the lips, eyes, lungs, and vocal cords. In a September 1999 VA examination report, the examiner noted that the veteran had been a patient of his since August 1993 and had exhibited "clinical manifestations which included angioedema, anaphylaxis with chronic urticaria and dizziness, chronic allergic rhinitis in conjunction with diffuse fibromyalgia-like syndrome". In addition, the veteran complained of current symptoms of intermittent bouts of erythematous skin rash with pruritus in the September 1999 examination report. The examiner described the veteran's disease activity in detail and stated that the veteran had frequent exacerbations and remissions occurring every few months. It was noted that the veteran usually goes up on the dose of prednisone used for treatment of the symptoms during an allergic flare-up and then tapers down afterward. The examiner also stated that under this regimen the veteran has not suffered any major anaphylactic events. The examiner detailed that the veteran's allergic flare-up usually begins with a sensation of erythema, flushing, and diffuse pruritus and when left untreated becomes angioedema and anaphylaxis. It was noted that the veteran has been intubated a few times in the past for airway maintenance after a flare-up occurred. Finally, the examiner stated that the veteran's "swelling attacks sometimes occur on a periodic basis every three weeks". A diagnosis of "idiopathic anaphylaxis presenting dominantly as angioedema syndrome with some urticaria" was listed in the September 1999 examination report. Additional VA treatment records from December 1999 showed that veteran complained of an idiopathic anaphylactic reaction. A VA treatment note dated in April 2000 showed that the veteran suffered from mild erythema on the oropharynx as well as moderate erythema on his cheeks and neck. A November 2000 VA general medical examination report listed a diagnosis of idiopathic angioedema. An additional May 2001 VA esophagus and hiatal hernia examination report listed the veteran's diagnosis as "history of idiopathic anaphylaxis and angioedema currently chronically steroid dependent". A December 2001 VA treatment note stated that the veteran had successfully tapered down his steroid dosage. It was noted that the veteran had suffered from a rash/eruption a few weeks before and had been able to treat the flare-up with Benadryl. The examiner stated that the veteran had no current anaphylactic events or problems. The Board acknowledges the veteran's multiple statements in the file, which describe the severity of his symptoms as well as the Internet reference materials he submitted. However, the veteran has not demonstrated that he has the medical expertise that would render competent his statements as to the current severity of his service-connected disability of idiopathic anaphylaxis with recurrent angioedema. His opinion alone cannot meet the burden imposed by 38 C.F.R. §§ 4.104, 4.118 with respect to the severity of his service- connected disability. See Moray v. Brown, 2 Vet. App. 211, 214 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). The evidence does not show that an evaluation in excess of 40 percent is warranted. Diagnostic Code 7118 provides a maximum 40 percent disability rating for idiopathic anaphylaxis with recurrent angioedema. See 38 C.F.R. § 4.87 (2003). The veteran also does not fit the "new" criteria for a 60 percent rating for urticaria under Diagnostic Code 7825. The medical evidence discussed at length above does not show that the veteran suffers from recurrent debilitating episodes of urticaria occurring at least four times during the past 12-month period despite continuous immunosuppressive therapy. On the contrary, the evidence shows that the veteran is quickly able to resolve an allergic flare-up, using increased steroid therapy in the past and, more recently, using an over-the-counter allergy medication. In this case, the Board finds no other provision upon which to assign a higher rating. The RO also determined that referral to the Under Secretary for Benefits or the Director of the Compensation for an extraschedular rating was not warranted. Under 38 C.F.R § 3.321(b)(1), in exceptional cases where schedular evaluations are found to be inadequate, consideration of an extra- schedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities may is made. The governing norm in an exceptional case is a finding that the case presents such 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. See 38 C.F.R § 3.321(b)(1) (2003). In this case, the Schedule is not inadequate. The veteran currently receives the maximum benefit allowed under part of the Schedule for his service- connected disability of idiopathic anaphylaxis with recurrent angioedema. The Board also notes that the Schedule does provide for higher ratings for the veteran's disability under the regulations for skin disabilities. However, as discussed above, the schedular criteria for a higher rating under the regulations for skin disabilities has not been shown. In addition, it has not been shown that the veteran's service- connected disability of idiopathic anaphylaxis with recurrent angioedema alone has required frequent periods of hospitalization or has produced marked interference with the veteran's employment. For these reasons, an extraschedular rating is not warranted. II. VCAA A change in the law, on November 9, 2000, redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify the claimant of the information and evidence necessary to substantiate a claim for VA benefits. See Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. §§ 5100 et. seq. (West 2002). Implementing regulations for VCAA have been published. See 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). Except for amendments not applicable, the provisions of the regulations merely implement the VCAA and do not provide any rights other than those provided by the VCAA. The Board has conducted a complete and thorough review of the veteran's claims folder. The Board finds that the RO advised the veteran of the evidence necessary to support his claim for entitlement to an increased evaluation for idiopathic anaphylaxis with recurrent angioedema. The veteran has not indicated the existence of any pertinent evidence that has not already been requested, obtained, or attempted to be obtained. The RO made all reasonable efforts to obtain relevant records adequately identified by the veteran. All evidence identified by the veteran relative to this claim has been obtained and associated with the claims folder. As discussed above, during the pendency of this appeal, the criteria for evaluating skin disorders were changed and the new regulations became effective on August 30, 2002. See 67 Fed. Reg. 49590 - 49599 (July 31, 2002). The veteran was notified of the new rating criteria in a Supplemental Statement of the Case (SSOC) issued by the RO in February 2003. VA also has a duty to assist the appellant in obtaining evidence necessary to substantiate the claim. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c). In this case, the RO sent the veteran a letter dated in June 2003 as well as a SSOC issued in February 2003, which notified the veteran of the type of evidence necessary to substantiate his claim. The documents also informed him that VA would assist in obtaining identified records, but that it was the veteran's duty to give enough information to obtain the additional records and to make sure the records were received by VA. See Quartuccio v. Principi, 16 Vet. App. 183 (2002) (holding that both the statute, 38 U.S.C.A. § 5103(a), and the regulation, 38 C.F.R. § 3.159, clearly require the Secretary to notify a claimant which evidence, if any, will be obtained by the claimant and which evidence, if any, will be retrieved by the Secretary). The June 2003 letter from the RO and the SSOC issued in February 2003 also explicitly informed the veteran about the information and evidence he is expected to provide. For the final requirement for notice consistent with 38 U.S.C. § 5103(a) and 38 C.F.R. § 3.159(b), the AOJ must request or tell the claimant to provide any evidence in the claimant's possession that pertains to the claim. See Pelegrini v. Principi, No. 01-944 (U.S. Vet. App. Jan. 13, 2004). The veteran submitted a statement, which noted that he did not have any additional evidence to submit for his claim in June 2001. In addition, the June 2003 letter from the RO also stated that the veteran should inform the RO of any additional information or evidence that he would want the RO to obtain. In this case, there is no additional development needed. Consequently, any defect in such notice would not prejudice the veteran in this instance. The Board finds that VA's duties to assist the claimant and to notify him of the evidence necessary to substantiate his claim has been satisfied. In a decision promulgated on September 22, 2003, Paralyzed Veterans of America v. Secretary of Veterans Affairs, 345 F.3d 1334 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit invalidated the 30-day response period contained in 38 C.F.R. § 3.159(b)(1) as inconsistent with 38 U.S.C.§ 5103(b)(1). The Court made a conclusion similar to the one reached in Disabled Am. Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339, 1348 (Fed. Cir. 2003) (reviewing a related Board regulation, 38 C.F.R. § 19.9). The Court found that the 30-day period provided in § 3.159(b)(1) to respond to a VCCA duty to notify is misleading and detrimental to claimants whose claims are prematurely denied short of the statutory one-year period provided for response. In this case, the SSOC issued in February 2003 by the RO to the veteran included notice that the appellant had a full year respond to a VCAA notice. It has not been more than one complete calendar year since that notice. However, under the Veterans Benefits Act of 2003, it is now permissible for VA to adjudicate a claim before the expiration of the statutory one-year period provided for response after VCAA notice. This provision is retroactive to the date of the VCAA, November 9, 2000. See Veterans Benefits Act of 2003, Pub.L. 108-183, § 701, 117 Stat. 2651 (Dec. 16, 2003) (to be codified at 38 U.S.C. § 5103(b)). The Board acknowledges that the June 2003 letter was sent to the veteran after the RO's January 2000 decision that is the basis for this appeal. As noted in the recent decision of Pelegrini v. Principi, No. 01-944 (U.S. Vet. App. Jan. 13, 2004), the plain language of 38 U.S.C.A. § 5103(a) requires that this notice be provided relatively soon after VA receives a complete or substantially complete application for benefits; thus, the Court held that under section 5103(a), a service-connection claimant must be given notice before an initial unfavorable RO decision on the claim. In this case, however, the unfavorable RO decision that is the basis of this appeal was already decided, and the notice of disagreement has been filed, by the time the VCAA was enacted. As the case had already proceeded far downstream from the application for benefits under section 1151, providing the section 5103(a) notice then - as the Court noted in Pelegrini - would largely nullify the purpose of the notice. As there could be no useful purpose for providing a section 5103(a) notice under the circumstances of this case - - that is, at a time so far removed from the application for benefits -- the Board concludes that any defect in the section 5103(a) notice in this instance is harmless error. Indeed, the Court seems to state in Pelegrini that providing such notice late in the appellate process would, in fact, prejudice the claimant rather than assist him. ORDER An increased evaluation for residuals of idiopathic anaphylaxis with recurrent angioedema is denied. ______________________________________________ MARY GALLAGHER Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs YOUR RIGHTS TO APPEAL OUR DECISION The attached decision by the Board of Veterans' Appeals (BVA or Board) is the final decision for all issues addressed in the "Order" section of the decision. The Board may also choose to remand an issue or issues to the local VA office for additional development. If the Board did this in your case, then a "Remand" section follows the "Order." However, you cannot appeal an issue remanded to the local VA office because a remand is not a final decision. The advice below on how to appeal a claim applies only to issues that were allowed, denied, or dismissed in the "Order." If you are satisfied with the outcome of your appeal, you do not need to do anything. We will return your file to your local VA office to implement the BVA's decision. However, if you are not satisfied with the Board's decision on any or all of the issues allowed, denied, or dismissed, you have the following options, which are listed in no particular order of importance: ? Appeal to the United States Court of Appeals for Veterans Claims (Court) ? File with the Board a motion for reconsideration of this decision ? File with the Board a motion to vacate this decision ? File with the Board a motion for revision of this decision based on clear and unmistakable error. Although it would not affect this BVA decision, you may choose to also: ? Reopen your claim at the local VA office by submitting new and material evidence. There is no time limit for filing a motion for reconsideration, a motion to vacate, or a motion for revision based on clear and unmistakable error with the Board, or a claim to reopen at the local VA office. None of these things is mutually exclusive - you can do all five things at the same time if you wish. However, if you file a Notice of Appeal with the Court and a motion with the Board at the same time, this may delay your case because of jurisdictional conflicts. If you file a Notice of Appeal with the Court before you file a motion with the BVA, the BVA will not be able to consider your motion without the Court's permission. How long do I have to start my appeal to the Court? You have 120 days from the date this decision was mailed to you (as shown on the first page of this decision) to file a Notice of Appeal with the United States Court of Appeals for Veterans Claims. If you also want to file a motion for reconsideration or a motion to vacate, you will still have time to appeal to the Court. As long as you file your motion(s) with the Board within 120 days of the date this decision was mailed to you, you will then have another 120 days from the date the BVA decides the motion for reconsideration or the motion to vacate to appeal to the Court. You should know that even if you have a representative, as discussed below, it is your responsibility to make sure that your appeal to Court is filed on time. How do I appeal to the United States Court of Appeals for Veterans Claims? Send your Notice of Appeal to the Court at: Clerk, U.S. Court of Appeals for Veterans Claims 625 Indiana Avenue, NW, Suite 900 Washington, DC 20004-2950 You can get information about the Notice of Appeal, the procedure for filing a Notice of Appeal, the filing fee (or a motion to waive the filing fee if payment would cause financial hardship), and other matters covered by the Court's rules directly from the Court. You can also get this information from the Court's web site on the Internet at www.vetapp.uscourts.gov, and you can download forms directly from that website. The Court's facsimile number is (202) 501-5848. To ensure full protection of your right of appeal to the Court, you must file your Notice of Appeal with the Court, not with the Board, or any other VA office. How do I file a motion for reconsideration? You can file a motion asking the BVA to reconsider any part of this decision by writing a letter to the BVA stating why you believe that the BVA committed an obvious error of fact or law in this decision, or stating that new and material military service records have been discovered that apply to your appeal. If the BVA has decided more than one issue, be sure to tell us which issue(s) you want reconsidered. Send your letter to: Director, Management and Administration (014) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 VA FORM JUN 2003 (RS) 4597 Page 1 CONTINUED Remember, the Board places no time limit on filing a motion for reconsideration, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to vacate? You can file a motion asking the BVA to vacate any part of this decision by writing a letter to the BVA stating why you believe you were denied due process of law during your appeal. For example, you were denied your right to representation through action or inaction by VA personnel, you were not provided a Statement of the Case or Supplemental Statement of the Case, or you did not get a personal hearing that you requested. You can also file a motion to vacate any part of this decision on the basis that the Board allowed benefits based on false or fraudulent evidence. Send this motion to the address above for the Director, Management and Administration, at the Board. Remember, the Board places no time limit on filing a motion to vacate, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to revise the Board's decision on the basis of clear and unmistakable error? You can file a motion asking that the Board revise this decision if you believe that the decision is based on "clear and unmistakable error" (CUE). Send this motion to the address above for the Director, Management and Administration, at the Board. You should be careful when preparing such a motion because it must meet specific requirements, and the Board will not review a final decision on this basis more than once. You should carefully review the Board's Rules of Practice on CUE, 38 C.F.R. 20.1400 -- 20.1411, and seek help from a qualified representative before filing such a motion. See discussion on representation below. Remember, the Board places no time limit on filing a CUE review motion, and you can do this at any time. How do I reopen my claim? You can ask your local VA office to reopen your claim by simply sending them a statement indicating that you want to reopen your claim. However, to be successful in reopening your claim, you must submit new and material evidence to that office. See 38 C.F.R. 3.156(a). Can someone represent me in my appeal? Yes. You can always represent yourself in any claim before VA, including the BVA, but you can also appoint someone to represent you. An accredited representative of a recognized service organization may represent you free of charge. VA approves these organizations to help veterans, service members, and dependents prepare their claims and present them to VA. An accredited representative works for the service organization and knows how to prepare and present claims. You can find a listing of these organizations on the Internet at: www.va.gov/vso. You can also choose to be represented by a private attorney or by an "agent." (An agent is a person who is not a lawyer, but is specially accredited by VA.) If you want someone to represent you before the Court, rather than before VA, then you can get information on how to do so by writing directly to the Court. Upon request, the Court will provide you with a state-by-state listing of persons admitted to practice before the Court who have indicated their availability to represent appellants. This information is also provided on the Court's website at www.vetapp.uscourts.gov. Do I have to pay an attorney or agent to represent me? Except for a claim involving a home or small business VA loan under Chapter 37 of title 38, United States Code, attorneys or agents cannot charge you a fee or accept payment for services they provide before the date BVA makes a final decision on your appeal. If you hire an attorney or accredited agent within 1 year of a final BVA decision, then the attorney or agent is allowed to charge you a fee for representing you before VA in most situations. An attorney can also charge you for representing you before the Court. VA cannot pay fees of attorneys or agents. Fee for VA home and small business loan cases: An attorney or agent may charge you a reasonable fee for services involving a VA home loan or small business loan. For more information, read section 5904, title 38, United States Code. In all cases, a copy of any fee agreement between you and an attorney or accredited agent must be sent to: Office of the Senior Deputy Vice Chairman (012) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 The Board may decide, on its own, to review a fee agreement for reasonableness, or you or your attorney or agent can file a motion asking the Board to do so. Send such a motion to the address above for the Office of the Senior Deputy Vice Chairman at the Board. VA FORM JUN 2003 (RS) 4597 Page 2