Citation Nr: 1237694 Decision Date: 11/02/12 Archive Date: 11/09/12 DOCKET NO. 10-29 544 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUES 1. Entitlement to service connection for bilateral hearing loss. 2. Entitlement to service connection for bilateral pes planus. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Fleming, Counsel INTRODUCTION The Veteran had active military service from January 1946 to February 1946, and from February 1951 to June 1951. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota, in which the RO denied the Veteran's claim for service connection for bilateral hearing loss. In that decision, the RO also denied the Veteran's petition to reopen a previously denied claim for service connection for bilateral pes planus, finding that no new and material evidence had been submitted. In September 2011, the Board granted the Veteran's petition to reopen his claim for bilateral pes planus and remanded both issues on their merits for further notification, evidentiary development, and adjudication. The Board instructed the agency of original jurisdiction (AOJ) to provide the Veteran with VCAA-compliant notice, obtain records of his award of benefits from the Social Security Administration (SSA), provide the Veteran with VA examination, and then re-adjudicate the claims. The AOJ provided the requisite notice via a September 2011 letter; attempted to obtain the Veteran's SSA records, which were deemed unavailable; and scheduled the Veteran for VA examinations, which were conducted in October 2011. The Veteran was then provided a supplemental statement of the case (SSOC) in September 2012, in which the AOJ again denied the Veteran's claims. Thus, as to the matter decided herein, there is compliance with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (noting that where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). Please note that this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). The issue of service connection for bilateral pes planus is addressed in the Remand portion of the decision below and is remanded to the RO via the Appeals Management Center (AMC), in Washington, D.C. FINDING OF FACT A chronic bilateral hearing loss disability was first diagnosed many years after the Veteran's active duty and is not causally or etiologically related to such service. CONCLUSION OF LAW Bilateral hearing loss was not incurred or aggravated in service. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION I. The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial unfavorable AOJ decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). Here, a pre-decisional letter dated in January 2010 complied with VA's duty to notify the Veteran with regard to the issue of entitlement to service connection for bilateral hearing loss. Specifically, this letter apprised the Veteran of what the evidence must show to establish entitlement to the benefit, what evidence and/or information was already in the RO's possession, what additional evidence and/or information was needed from the Veteran, what evidence VA was responsible for getting, and what information VA would assist in obtaining on the Veteran's behalf. In particular, it notified the Veteran of the criteria for assigning a disability rating and an effective date. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Regarding VA's duty to assist, the AOJ obtained the Veteran's service treatment records (STRs) and post-service medical records and secured an examination in furtherance of his claim. The AOJ attempted to obtain records of the Veteran's award of SSA benefits, but was informed by SSA that the records are unavailable. The Veteran also submitted a statement in January 2012 in which he indicated that he had also contacted SSA but learned that his records had been destroyed. The Veteran has not identified any additional pertinent records which have not been obtained and associated with the claims file. VA has no duty to inform or assist that was unmet. A pertinent VA opinion with respect to bilateral hearing loss was obtained in October 2011. 38 C.F.R. § 3.159(c)(4). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The VA examination obtained in this case is sufficient, as it considered all of the pertinent evidence of record, including the statements of the Veteran, and provided explanations for the opinions stated. Thus, the Board finds that VA's duty to assist with respect to obtaining a VA examination with respect to the issue of entitlement to service connection for bilateral hearing loss has been met. 38 C.F.R. § 3.159(c)(4). II. Analysis Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (1995). Certain chronic diseases, including sensorineural hearing loss, may be presumptively service connected if they become manifest to a degree of 10 percent or more within one year of leaving qualifying military service. 38 C.F.R. §§ 3.307(a)(3); 3.309(a) (2012). Moreover, the absence of evidence of hearing loss in service is not a bar to service connection for hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 160 (1993). For the purposes of applying the laws administered by VA, impaired hearing is considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, and 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of those frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran contends that he has bilateral hearing loss as a result of in-service acoustic trauma, or alternately to a fall he alleges he experienced while on active duty, incurring a head injury. Although the Veteran was only in service for a matter of months, he has testified that he was exposed to noise during rifle training. In the June 2010 rating decision, the RO conceded the Veteran's in-service to acoustic trauma. STRs show no treatment for, or diagnosis of, bilateral hearing loss or a head injury. Although no separation examination from the Veteran's 1946 period of service is of record, report of the separation examination conducted in May 1951 showed bilateral hearing acuity of 15/15 on whispered voice testing. According to post-service medical records, the first complaint of bilateral hearing loss was in April 2005. At that time, a private audiologist conducted audiological evaluation that revealed bilateral hearing loss. No etiological opinion was provided. The Veteran has also submitted multiple statements to VA concerning his claimed hearing loss. He contends that he fell from a rope ladder during a training exercise during his 1946 period of service, hitting his head and causing bilateral hearing loss. The Veteran has alternately claimed that he was exposed to acoustic trauma during rifle training while on active duty, which led to his current hearing loss. In a May 2010 statement, the Veteran contended that he has had hearing loss from his time in service to the present. The Veteran was afforded VA audiological examinations in January 2010 and again in October 2011. The examinations both revealed bilateral hearing loss as defined by VA in accordance with 38 C.F.R. § 3.385. At the January 2010 VA examination, the Veteran reported that his hearing loss began in the 1960s, more than a decade after his separation from service. He also stated that he was not exposed to noise while on active duty. Upon review of the claims file, the examiner issued an opinion later in January 2010 in which she opined that it is less likely than not that the Veteran's hearing loss is related to service. In so finding, the examiner noted the nine-year difference between the Veteran's separation from service and his reported onset of hearing loss. Pursuant to the Board's September 2011 remand, the Veteran again underwent VA examination in October 2011. At that time, he reported that his hearing loss began within six months of his separation from service and had continued to the present. He also stated that he had been given hearing aids in 1949 or 1950. He further stated that he had been exposed to noise during rifle training, as well as post-service noise exposure while working for many years in farm equipment maintenance. The examiner opined that it is less likely than not that the Veteran's current bilateral hearing loss is related to service. In so finding, the examiner considered both the Veteran's claimed head injury and his in-service noise exposure. However, the examiner found that the Veteran's 1951 STRs were silent as to any hearing aids or audiological disorder. Further, the examiner noted that any in-service noise exposure had been minimal, given his commanding officer's statement in March 1951 that the Veteran had not "pulled a detail since he has been in company." Thus, the examiner opined that the Veteran's exposure to in-service acoustic trauma, if any, was not of "sufficient dosage" to cause his current hearing loss. The examiner further found that the etiology of the type of hearing loss the Veteran experienced was not likely caused by a head injury, pointing out that the head injury such as that the Veteran claimed to have experienced would have caused a more unilateral or conductive hearing loss. By contrast, the Veteran experiences a bilateral, sensorineural hearing loss. Thus, the examiner concluded, any etiological relationship between the Veteran's current hearing loss and service is unlikely. Based on a review of the evidence, the Board finds that service connection for bilateral hearing loss is not warranted. The Board acknowledges that the Veteran had in-service acoustic trauma and has a current bilateral hearing loss disability as defined by VA, but the evidence fails to show a nexus between his service and his current disability. The only medical opinions of record, that of the VA examiners, indicate that the Veteran's current bilateral hearing loss is not the result of in-service acoustic trauma or head injury. The examiners based these opinions on the Veteran's case history. There is no indication that any medical professional has provided any opinion indicating that the Veteran's bilateral hearing loss is related to his military service. The VA examiner opinions are uncontradicted. The Board acknowledges that the Veteran contended in a May 2010 statement that he first noticed the onset of bilateral hearing loss in service or shortly thereafter. However, the earliest treatment record shows bilateral hearing loss was first diagnosed in 2005. In addition, report of the January 2010 VA examination reveals that the Veteran reported the onset of his bilateral hearing loss to have been over nine years after his separation from service. Further, although the Veteran claimed to his October 2011 VA examiner that he was given hearing aids in 1949 or 1950, the record does not bear this out; his 1951 entrance examination is silent as to any hearing problems, and he was found to have normal hearing under the whispered voice test at that time. As such, the Board finds that the objective medical evidence of record outweighs the credibility of the Veteran's reported history. Such records are more reliable, in the Board's view, than the Veteran's unsupported assertion of events now over five decades past. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (holding that VA cannot ignore a veteran's testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence); see also Curry v. Brown, 7 Vet. App. 59, 68 (1994) (establishing that contemporaneous evidence has greater probative value than history as reported by the Veteran). Thus, the Board concludes that the Veteran's statements regarding having hearing problems since service are simply not credible evidence and thus, have limited, if any, probative value. There is no indication until 2005 that the Veteran complained of hearing loss. The United States Court of Appeals for Veterans Claims (Court) has indicated that normal medical findings at the time of separation from service, as well as the absence of any medical records of a diagnosis or treatment for many years after service, is probative evidence against the claim. See Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board where it found that veteran failed to account for the lengthy time period after service for which there was no clinical documentation of low back condition); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that a prolonged period without medical complaint can be considered, along with other factors concerning a claimant's health and medical treatment during and after military service, as evidence of whether an injury or a disease was incurred in service which resulted in any chronic or persistent disability). The lack of any evidence of hearing complaints, symptoms, or findings for over five decades between the period of active service and his first complaint is itself evidence which tends to show that bilateral hearing loss did not have its onset in service or for many years thereafter. Thus, the Board finds that the evidence does not support a finding that the onset of the Veteran's current bilateral hearing loss was in service or shortly thereafter. Furthermore, the claims folder contains no competent evidence of bilateral hearing loss associated with the Veteran's active duty. Without continuity of pertinent symptomatology after service or competent evidence of an association between the Veteran's bilateral hearing loss and his active duty, service connection for bilateral hearing loss is not warranted. Additionally, there is no evidence that the Veteran's bilateral hearing loss was manifest to a degree of 10 percent or more within one year of leaving qualifying military service. Thus, service connection on a presumptive basis is not warranted. 38 C.F.R. §§ 3.307(a)(3); 3.309(a). The Board acknowledges the Veteran's belief that he has bilateral hearing loss that is related to his military service. However, there is no evidence of record showing that the Veteran has the specialized medical education, training, and experience necessary to render competent medical opinion as to etiology of a disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Consequently, the Veteran's own assertions as to etiology of a disability have no probative value. Accordingly, and based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran's claim for service connection for bilateral hearing loss. As the preponderance of the evidence is against the Veteran's claim, the benefit-of-the-doubt rule does not apply, and the Veteran's claim of entitlement to service connection for bilateral hearing loss is denied. See 38 U.S.C.A §5107 (West 2002 & Supp. 2012). ORDER Entitlement to service connection for bilateral hearing loss is denied. REMAND Regrettably, a remand is again necessary for further evidentiary development of the Veteran's claim for service connection for bilateral pes planus. The law provides that VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim and requires VA to assist a claimant in obtaining that evidence. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). Such assistance includes providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C.A. §§ 5103, 5103A (West 2002); 38 C.F.R. § 3.159 (2012). In Stegall v. West, the Court held that a remand was necessary because of the RO's failure to follow the Board's directives in a prior remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled in service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. § 1111. History provided by the Veteran of the pre-service existence of conditions recorded at the time of the entrance examination does not, in itself, constitute a notation of a preexisting condition. 38 C.F.R. §§ 3.304(b)(1); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Crowe v. Brown, 7 Vet. App. 238, 246 (1995). To rebut the presumption of sound condition under Section 1111 of the statute for disorders not noted on the entrance or enlistment examination, VA must show by clear and unmistakable evidence both that the disease or injury existed prior to service and that the disease or injury was not aggravated by service. VAOPGCPREC 3-2003 (July 16, 2003). A presumption is an assumption of fact resulting from a rule of law which requires such fact to be assumed from another fact or group of facts found or otherwise established in the action. Black's Law Dictionary 1067 (5th ed. 1979). Therefore, where the presumption of sound condition at entrance to service cannot be rebutted, the fact for which the presumption stands-that is, that the veteran was in sound condition at entry to service as to the disability for which he seeks service connection-must be assumed as a matter of law. Accordingly, service connection may not be granted on the basis of aggravation of a preexisting disease or injury in such a case. Rather, where the government fails to rebut the presumption of soundness under Section 1111, the veteran's claim must be considered one for service incurrence or direct service connection. See Wagner v. Principi, 370 F.3d 1089, 1094, 1096 (Fed. Cir. 2004) (indicating that, in cases where the presumption of soundness cannot be rebutted, the effect is that claims for service connection based on aggravation are converted into claims for service connection based on service incurrence). In the current appeal, the Veteran asserts that his current pes planus was incurred in service. According to the Veteran, he injured his feet when he fell from a rope ladder, landing on his feet on a cement floor, during basic training in 1946. He states that he was evaluated for foot problems and was eventually hospitalized before being medically discharged due to his foot problems. However, although the Veteran asserts that his foot problems originated in service, the medical evidence of record also reflects his contentions that his pes planus began prior to service. The Veteran's STRs reflect that, at his January 1946 enlistment examination, the evaluation of his lower extremities was normal, and no pes planus was noted. However, a February 1946 notation in the record indicates that the Veteran was diagnosed with flat feet that existed prior to service. At that time, the Veteran reported that he had had flat feet all his life but had not had problems with his feet until approximately four years before service; since that time, he had experienced increasing pain in his arches and ankles. He was noted to be unable to walk or stand more than 15 minutes at a time. He was discharged from service one week later due to pes planus. The Veteran's lower extremities were also shown to be normal at the January 1951 entrance examination for his second period of service, with "no particular evidence" of pes planus noted on a February 1951 evaluation. However, in March 1951, the Veteran was put on profile for "severe" flat feet and was found unfit for duty. He was again discharged shortly thereafter. The Veteran was afforded a VA examination in October 2011, at which time he was diagnosed with bilateral pes planus. He stated that he was "unsure" when he was first diagnosed with pes planus, but that he first had trouble with his feet following a fall from a rope ladder during boot camp when he landed on his feet on a cement floor. He stated that he had had pain in his feet from the fall that has continued to the present. Physical examination found no pain or swelling on manipulation or use of the feet, although the examiner noted decreased longitudinal arch height bilaterally. No marked deformity or pronation was found, and no other disorder of the feet was diagnosed, although radiological study revealed arthritis in the feet. The examiner stated that the Veteran's bilateral pes planus clearly and unmistakably existed prior to service but was clearly and unmistakably not aggravated beyond its natural progression during service. In so opining, the examiner offered the rationale that the Veteran's STRs did not document an in-service injury that aggravated the pre-existing pes planus beyond its normal progression. In her reasoning, the examiner pointed primarily to an evaluation of the Veteran written by his commanding officer in March 1951, during his second period of active service, in which the officer found the Veteran not credible in his reports of having foot pain. However, the examiner failed to discuss why she found the evidence clear and unmistakable that the Veteran's pes planus pre-existed his period of active duty, particularly given the January 1946 entrance examination that did not note pes planus, as well as the multiple statements by the Veteran and his friends and family members attesting to the fact that he had no foot trouble prior to active duty. In addition, the Veteran and his friends and family members have submitted multiple statements attesting that the Veteran injured his feet in a fall during basic training in 1946 and has had foot problems since that time. Further, the Veteran's parents submitted a statement in May 1949 in which they contended that the Veteran had not had any problems with his feet prior to his first period of service in 1946, but did have such problems on returning from service. The Board finds the Veteran competent to report continuing symptoms of pain in his feet since service. However, the Board points out that there is also evidence to suggest that the Veteran did in fact have problems with his feet prior to his 1946 period of active duty-namely, an STR dated in February 1946, in which the Veteran reported that he had had flat feet all his life, but had not had pain in the feet until approximately four years prior to entering service. VA has a duty to obtain a medical examination when the record contains competent evidence of a current disability or symptoms of a current disability; evidence establishing that an event, injury, or disease occurred in service; an indication that the disability or persistent or recurrent symptoms of a disability may be associated with service or a service-connected disability; and insufficient evidence to decide the case. 38 U.S.C.A. §5103A; 38 C.F.R. §3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). If the VA undertakes the effort to provide the Veteran with a medical examination, it must ensure that such exam is an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Although the Veteran was afforded a VA examination in October 2011, it does not appear that the examiner provided a medical opinion as to the nature and etiology of the Veteran's bilateral pes planus. In addition, the Board is unable to determine what rationale the examiner relied on in finding that the Veteran's pes planus did in fact clearly and unmistakably pre-exist his time in service. Although there are no pre-service medical records documenting the Veteran's pes planus, the February 1946 notation in his STRs indicates that the Veteran had pes planus all his life, with symptoms manifesting at least four years prior to entering service. However, the Veteran's January 1946 entrance examination is silent as to a diagnosis of pes planus or complaints of any foot disorder. In addition, the Veteran has stated on multiple occasions that he did not have pes planus prior to his 1946 period of active duty. Therefore, the Board finds that a new VA examination, to include a medical opinion, is necessary for determining the nature and etiology of the Veteran's currently diagnosed bilateral pes planus, including whether the evidence clearly and unmistakably shows both that the Veteran's pes planus pre-existed service and was not worsened thereby. As this matter is being remanded for further development, the AOJ should also attempt to obtain any ongoing medical records pertinent to the Veteran's claim. 38 U.S.C.A. § 5103A(c) (West 2002); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (holding that VA medical records are in constructive possession of the agency and must be obtained if pertinent). In view of the foregoing, the case is REMANDED for the following action: Please note that this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2011). Expedited handling is requested. 1. Request relevant records pertaining to treatment the Veteran has received for his feet from the St. Cloud VA Health Care System, dating from February 2012 to the present. All such available documents must be associated with the claims file. 2. Schedule the Veteran for an appropriate VA examination for the purpose of ascertaining the nature and etiology of any pes planus or other foot disorder that he may have. The claims file and a copy of this remand must be made available to the examiner for review, and the examination report must reflect that the claims file was reviewed in conjunction with the examination. All indicated tests must be performed, and the findings must be reported in detail. In rendering the below-requested opinions, the examiner must specifically discuss the January 1946 enlistment examination, the February 1946 service treatment record, the January 1951 pre-induction examination, the March 1951 service treatment records, and the multiple statements of the Veteran and his friends and family members. Following a review of the record and an examination of the Veteran, the examiner must provide a clear, well-reasoned response to each of the following: a. Specify the nature of any current pes planus or other foot disorder and provide diagnoses for all such identified disorders. b. Does the Veteran have bilateral pes planus or any other bilateral foot disorder that clearly and unmistakably existed prior to his enlistment in service in either January 1946 or February 1951? Specify and discuss the evidence used to arrive at this conclusion. c. If so, did such pre-existing disability clearly and unmistakably undergo a permanent increase in severity during the Veteran's active service-and if so, was that permanent increase in severity during service due to the natural progress of the condition? d. If the Veteran's current pes planus did not clearly and unmistakably exist prior to service, then is it at least as likely as not, i.e., a 50 percent probability or greater, that such disability(ies) had its(their) clinical onset in service or is(are) otherwise etiologically related to either period of the Veteran's military service? The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After completing the above, and any other development deemed necessary, re-adjudicate the issue of entitlement to service connection for bilateral pes planus. If the benefit sought on appeal is not granted, the Veteran and his representative must be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response. No action is required of the Veteran until he is notified; however, the Veteran is advised that failure to report for any scheduled examination may result in the denial of his claim. 38 C.F.R. § 3.655 (2012). The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ REBECCA N. POULSON Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs