Citation Nr: 18141580 Decision Date: 10/11/18 Archive Date: 10/10/18 DOCKET NO. 16-10 357 DATE: October 11, 2018 ORDER New and material evidence having not been received, the application to reopen the claim of service connection for mitral regurgitation is denied. New and material evidence having not been received, the application to reopen the claim of service connection for coronary artery disease (CAD) is denied. New and material evidence having not been received, the application to reopen the claim of service connection for bilateral lower extremity peripheral vascular disease is denied. New and material evidence having not been received, the application to reopen the claim of service connection for bladder dysfunction is denied. New and material evidence having not been received, the application to reopen the claim of service connection for pseudofolliculitis barbae (PFB) is denied. New and material evidence having been received, the application to reopen the claim of service connection for hypertension is granted. Service connection for hypertension is granted. A compensable rating for bilateral hearing loss is denied. A compensable rating for erectile dysfunction (ED) is denied. A total disability rating based on individual unemployability (TDIU) due to service connected disabilities is denied. REMANDED A rating in excess of 20 percent for diabetes mellitus (DM) with peripheral neuropathy of the bilateral lower extremities. FINDINGS OF FACT 1. The Veteran had active service from May 1966 to May 1968. 2. In an unappealed June 2004 rating decision, the RO denied service connection for mitral regurgitation, CAD, peripheral vascular disease of the lower extremities, bladder dysfunction, and PFB on the basis that there was no evidence of a current diagnoses. 3. The evidence submitted since the June 2004 rating decision, to the extent that it is new with regard to the issues of CAD, mitral regurgitation, bladder dysfunction, PFB, and peripheral vascular disease of the bilateral lower extremities, is not material. 4. In an unappealed June 2004 rating decision, the regional office (RO) denied an application to reopen a claim of service connection for hypertension on the basis that the Veteran did not submit evidence establishing that hypertension was caused or aggravated by service-connected DM. 5. The evidence submitted since the June 2004 rating decision relates to an unestablished fact necessary to substantiate the claim for service connection for hypertension. 6. Hypertension was aggravated by service-connected DM. 7. For the entire period on appeal, audiometric testing revealed, at worst, an average puretone threshold of 56 decibels (dBs) and 94 percent speech recognition in the left ear, and an average puretone threshold of 68 dBs and 94 percent speech recognition in the right ear. 8. For the entire period on appeal, ED has been manifested by subjective complaints of an inability to perform sexually; objective findings include no internal or external penile deformities or abnormalities. 9. The Veteran’s service-connected disabilities, which include post-traumatic stress disorder (PTSD), DM with peripheral neuropathy, tinnitus, bilateral hearing loss, ED, and hypertension, have not rendered him unable to secure or follow a substantially gainful occupation. CONCLUSIONS OF LAW 1. The June 2004 rating decision, which denied service connection for mitral regurgitation, CAD, peripheral vascular disease of the bilateral lower extremities, bladder dysfunction, PFB, and hypertension is final. 38 C.F.R. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 2. New and material evidence has not been received with respect to the claim of entitlement to service connection for mitral regurgitation and the claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 3. New and material evidence has not been received with respect to the claim of entitlement to service connection for CAD and the claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 4. New and material evidence has not been received with respect to the claim of entitlement to service connection for peripheral vascular disease of the bilateral lower extremities and the claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 5. New and material evidence has not been received with respect to the claim of entitlement to service connection for bladder dysfunction and the claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 6. New and material evidence has not been received with respect to the claim of entitlement to service connection for PFB and the claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 7. The evidence received since the June 2004 rating decision is new and material; the claim of service connection for hypertension is reopened. 38 U.S.C. §§ 1101, 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2017). 8. Resolving reasonable doubt in the Veteran’s favor, hypertension was aggravated by a service-connected disability. 38 U.S.C. §§1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309, 3.310 (2017). 9. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code (DC) 6100 (2017). 10. The criteria for a compensable rating for ED have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115b, DC 7522 (2017). 11. The criteria for the grant of a TDIU have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.340, 3.341, 3.400, 4.16 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS As an initial matter, in a June 2018 letter, the Veteran was made aware of the Rapid Appeals Modernization Program (RAMP) and subsequently elected to participate in RAMP, selecting the option to have his appeals processed as supplemental claims. However, as noted in the June 2018 letter, appeals that have been activated by the Board are not eligible for RAMP processing. The claims at issue were activated by the Board in December 2017, prior to the Veteran’s participation in RAMP. As the issues discussed below have already been activated by the Board, the Board will proceed accordingly. New and Material Evidence to Reopen Previously Denied Claims Prior unappealed rating decisions may not be reopened absent the submission of new and material evidence warranting revision of the previous decision. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. “New” evidence means evidence “not previously submitted to agency decisionmakers.” “Material” evidence means “evidence that, by itself or when considered with previous evidence of record, related to an unestablished fact necessary to substantiate the claim.” 38 C.F.R. § 3.156(a). Material evidence is: (1) evidence on an element where the claimant initially failed to submit any competent evidence; (2) evidence on an element where the previously submitted evidence was found to be insufficient; (3) evidence on an element where the appellant did not have to submit evidence until a decision of the Secretary determined that an evidentiary presumption had been rebutted; or (4) some combination or variation of the above three situations. Kent v. Nicholson, 20 Vet. App. 1 (2006). In order to be “new and material” evidence, the evidence must not be cumulative or redundant, and “must raise a reasonable possibility of substantiating the claim,” which has been found to be enabling, not preclusive. See Shade v. Shinseki, 24 Vet. App. 110 (2010). When determining whether the claim should be reopened, the credibility of the newly submitted evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1991). Mitral Regurgitation, CAD, Vascular Disease, PFB, and Bladder Dysfunction The Veteran was initially denied service connection for these claims in June 2004 on the basis that the evidence did not establish that he had diagnoses of the claimed disorders. The evidence of record at the time of the June 2004 rating decision consisted of service treatment records (STRs), post-service medical treatment records, and private medical treatment records. He did not appeal that decision and the June 2004 rating decision became final. The evidence received subsequent to the June 2004 rating decision includes additional post-service medical treatment records; however, the medical treatment records are not material as they provide no new evidence that the Veteran was either diagnosed with the disorders or that the disorders were caused by a service-connected disability. The medical treatment records therefore fail to raise a reasonable possibility of substantiating the claims and do not support reopening. The evidence also includes a February 2009 VA examination. The examiner opined that there were no findings of secondary complications of the Veteran’s DM related to a heart condition, that the lower extremities were neurologically normal and there were no secondary complications of DM related to the peripheral arteries, that the Veteran did not experience urinary incontinence, fecal leakage, or anal pruritus, that there were no signs of a skin disease, and that there were no findings of secondary complications of DM related to a skin condition. In a June 2014 VA examination, the examiner related that the Veteran’s heart had a normal rate and rhythm, normal S1 and S2, and no evidence of S3 or S4, murmurs or gallops, and heaves or thrills, that a cardiac disorder was less likely than not caused or aggravated by DM, that an examination of the lower extremities was normal and peripheral vascular disease was less likely than not caused or aggravated by DM, and that there was no urinary incontinence or bowel incontinence upon examination, and there was no evidence of rashes or lesions and a skin disorder was less likely than not caused by DM. Similarly, a June 2015 disability benefits questionnaire (DBQ) and a July 2015 VA examination diagnosed ED but found that the Veteran did not have a voiding dysfunction. The February 2009, June 2014, and July 2015 examinations are not material as they reveal no relationship between the disorders on appeal and the Veteran’s DM. This evidence weighs against the claims and fails to raise a reasonable possibility of substantiating the claims. Moreover, the medical evidence does not reflect a current diagnosis of peripheral vascular disease and no relationship between peripheral vascular disease and DM. This evidence also weighs against the claims and fails to raise a reasonable possibility of substantiating the claims. Based on the above, the medical evidence does not support claims to reopen and the appeals are denied to this extent. Hypertension The Veteran was initially denied service connection for hypertension in January 2003 based on a finding that the evidence of record did not establish that hypertension was related to active service. He was again denied service connection for hypertension in June 2004. The RO noted in June 2004 that there was no evidence of record establishing that the Veteran’s hypertension was caused or aggravated by DM. The evidence of record at the time of the decision consisted of STRs, post-service medical treatment records, and private medical treatment records. He did not appeal that decision and the June 2004 rating decision became final. The evidence received subsequent to the June 2004 rating decision includes additional post-service medical records diagnosing hypertension, a February 2009 VA examination opining that hypertension was aggravated by DM, a June 2014 VA examination opining that hypertension was less likely than not caused or permanently aggravated by DM, and June 2015 DBQs opining that hypertension was at least as likely as not permanently aggravated by DM. The evidence is new and material within the meaning of applicable law and regulations because it is probative of the issue. The February 2009 VA examination and June 2015 DBQs assert that a relationship exists between hypertension and DM. This evidence is new as it was not of record prior to the June 2004 rating decision. Moreover, the evidence is material as it relates to the unestablished element of a relationship between his current disability and his service-connected disability. Accordingly, the newly added evidence relates to an unestablished fact necessary to substantiate the claim of service connection for hypertension. As such, the application is granted, the claim is reopened, and the appeal is granted to this extent. Service Connection for Hypertension Having reopened the claim for hypertension, the Board will address it on the merits. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that his hypertension is related to his service-connected DM. Therefore, the Board will address secondary service connection. In this regard, the Veteran has been diagnosed with hypertension. Specifically, April 2004 and February 2009 VA examinations, and a June 2015 DBQ diagnosed hypertension. Therefore, a current disorder has been shown and the first element of service connection has been met. Further, the Veteran has been service connected for DM since January 2003. Therefore, the second element of secondary service connection has been met. Next, the record is in conflict as to whether a link exists between the Veteran’s hypertension and his service connected DM. In a February 2009 VA examination, the examiner diagnosed hypertension and opined that it was aggravated by his diabetes. The examiner explained that diabetes affected the blood vessels through the relationship between elevated sugars. In subsequent June 2015 VA examination, the clinician diagnosed DM and hypertension. The clinician opined that hypertension was at least as likely as not permanently aggravated by DM. This evidence also weighs in favor of the claim. On the other hand, December 2002 and April 2004 VA examinations diagnosed hypertension, but opined that it was not secondary to the Veteran’s service connected DM. In a subsequent June 2014 VA examination, the examiner opined that hypertension was less likely than not caused or permanently aggravated by DM. This evidence also weighs against the claim. Accordingly, the evidence is at least in equipoise on the question of whether the Veteran’s hypertension is caused or aggravated by DM. For this reason, after resolving reasonable doubt in his favor, service connection for hypertension is warranted and the appeal is granted. Because the Board is granting service connection on a secondary basis, all other theories of service connection are rendered moot. Increased Rating Claims Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Hearing Loss With regard to the Veteran’s left ear hearing loss, the Rating Schedule provides rating tables for the evaluation of hearing impairment. Table VI assigns a Roman numeral designation (I through XI) for hearing impairment based on a combination of percent speech discrimination and the puretone threshold average (the sum of the puretone thresholds at 1000, 2000, 3000, and 4000 Hertz (Hz), divided by four). 38 C.F.R. § 4.85. Table VII is used to determine the percentage evaluation by combining the Table VI Roman numeral designations for hearing impairment in each ear. When evaluating service-connected hearing impairment, ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned in audiometric evaluations. Lendenmann v. Principi, 3 Vet. App. 345 (1992). 38 C.F.R. § 4.86 provides for exceptional patterns of hearing impairment. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hz) is 55 dBs or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). Each ear is evaluated separately. When the puretone threshold is 30 dBs or less at 1000 Hz, and 70 dBs or more at 2000 Hz, the rating specialist will determine the Roman numeral designation from either Table VI or Table VIA, whichever results in the higher numeral. That numeral is then elevated to the next highest Roman numeral. 38 C.F.R. § 4.86(b). Each ear is evaluated separately. Turning to the evidence, in May 2014, the Veteran was afforded an audiological examination. The audiometric results were as follows:   Hertz 1000 2000 3000 4000 Average Left Ear 45 40 65 75 56.25 Right Ear 50 55 75 90 67.50 Speech audiometry revealed speech recognition ability of 96 percent in the left ear and 98 percent in the right ear. Applying the findings to Table VI reveals a numeric designation of Level II in the left ear on the basis of 56 dBs puretone threshold average and 96 percent speech discrimination and a numeric designation of Level II in the right ear on the basis of 68 dBs puretone threshold average and 98 percent speech discrimination. The numeric designation for the left ear (Level II) along with the numeric designation for the right ear (Level II) entered into Table VII reflect a noncompensable rating for hearing impairment. In July 2015, the Veteran was afforded another audiological examination. The audiometric results were as follows: Hertz 1000 2000 3000 4000 Average Left Ear 35 45 55 60 48.75 Right Ear 35 35 50 50 42.50 Speech audiometry revealed speech recognition ability of 94 percent in the left ear and 94 percent in the right ear. Applying the findings to Table VI reveals a numeric designation of Level I in the left ear on the basis of 49 dBs puretone threshold average and 94 percent speech discrimination and a numeric designation of Level I in the right ear on the basis of 43 dBs puretone threshold average and 94 percent speech discrimination. The numeric designation for the left ear (Level I) along with the numeric designation for the right ear (Level I) entered into Table VII reflect a noncompensable rating for hearing impairment. Of record are multiple statements from the Veteran describing the impact of his hearing loss on his daily life. In his statements, he explained that he had difficulty understanding speech in noisy environments and group situations, that his hearing had been gradually declining for several years, noted that the hearing loss was more severe in his right ear, and that he required hearing aids. The Board has considered the lay statements submitted by the Veteran, and recognizes his complaints regarding the worsening severity of his hearing loss. He is competent to describe hearing difficulty; however, his description of his service-connected disability must be considered in conjunction with the clinical evidence of record, as well as the pertinent rating criteria. In this regard, ratings are derived by a mechanical application of the rating schedule. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Thus, the Board must predicate its determination on the basis of the results of the audiology studies of record. Based on the results from the examinations discussed above, the criteria for a compensable rating have not been met. Therefore, the appeal is denied. Erectile Dysfunction The Veteran is rated under DC 7522 regarding ED. The Board will also consider all potentially relevant diagnostic codes. In order to warrant a compensable rating, the evidence must show a deformity of the penis with loss of erectile power. In a June 2015 examination, the Veteran reported that he first experienced ED in 2005 and that it had worsened since that time. The clinician revealed that his treatment plan did not include continuous medication for treatment and diagnosed ED. The clinician found that the Veteran was unable to achieve an erection sufficient for penetration and ejaculation with and without medication, and that he did not have a benign or malignant neoplasm or metastases related to his ED. Upon examination, the clinician found that the Veteran’s penis was physically normal. In a subsequent July 2015 VA examination, the Veteran reported that his ED began when he was not able to perform and that it had worsened. The examiner noted that his treatment plan included taking continuous medication and diagnosed ED. The examiner found that the Veteran was unable to achieve an erection sufficient for penetration and ejaculation with and without medication, and that he did not have a benign or malignant neoplasm or metastases related to his ED. The examiner stated that a physical examination was not conducted at the request of the Veteran and that he said that his penis had a normal anatomy with no penile deformity or abnormality. Based on the above, a compensable rating is not warranted for ED. In this regard, the June 2015 and July 2015 VA examination found the Veteran’s penis to be physically normal. There was no indication that there was a physical abnormality either internally or externally. Furthermore, the Veteran stated in his July 2015 VA examination that he had no penile deformity or abnormality. Accordingly, a compensable rating is not warranted and the appeal is denied. TDIU TDIU ratings may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more and there is sufficient additional service-connected disability ratings to bring the combined rating to 70 percent or more. 38 C.F.R §§ 3.340, 3.341, 4.16(a). Substantially gainful employment is defined as work which is more than marginal and which permits the individual to earn a living wage. Moore v. Derwinski, 1 Vet. App. 356 (1991). In evaluating a veteran’s employability, consideration may be given to his or her level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.321(b), 4.16, 4.19. The mere fact that a claimant is unemployed or has difficulty obtaining employment is not sufficient. A high rating in itself is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. 38 C.F.R. § 4.16(a). For the purpose of one 60 percent or one 40 percent disability in combination, disabilities resulting from a common etiology or a single accident will be considered as one disability. 38 C.F.R. § 4.16(a). Even when the percentage requirements are not met, entitlement to a total rating, on an extraschedular basis, may nonetheless be granted in exceptional cases, when the veteran is unable to secure and maintain a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. §§ 3.321(b), 4.16(b). In this case, the Veteran is service-connected for the following - PTSD at 50 percent, DM with peripheral neuropathy at 20 percent, tinnitus at 10 percent, and 0 percent for ED and bilateral hearing loss. The combined rating is 60 percent. Therefore, the schedular criteria for TDIU are not met. Pursuant to 38 C.F.R. § 4.16(b), when a claimant is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities, but fails to meet the percentage requirements for eligibility for a total rating set forth in 38 C.F.R. § 4.16(a), such case shall be submitted for extraschedular consideration in accordance with 38 C.F.R. § 3.321. For a claimant to prevail on a claim for a total compensation rating based on individual unemployability on an extraschedular basis, the record must reflect some factor which takes the case outside the norm. The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the claimant is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose v. Brown, 4 Vet. App. 361 (1993). In this case, while the Veteran is not employed, the evidence does not show that his unemployability is based on his service-connected disabilities. He has reported that he was last able to work full-time in July 2014 at which time he became too disabled to maintain a substantially gainful occupation at a level with his prior experience. A review of the record shows that he served as an oil field supervisor and that he graduated high school. In a March 2009 VA examination, the Veteran related that after separation from service, he worked as an oil field worker for 38 years, had relationships with his co-workers and supervisor that ranged from ok to good, and did not lose any time from work. In a subsequent series of June 2015 and July 2015 VA examinations, clinicians and noted that diabetic peripheral neuropathy, ED, DM, and hypertension did not impact his ability to work. Based on the above, referral for consideration for a TDIU under 38 C.F.R. § 4.16(b) is not warranted. Accordingly, at no time pertinent to this appeal have the criteria for TDIU been met. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable and the appeal is denied. The Board has considered the statements of the Veteran regarding his capacity to work throughout the entire period on appeal. While lay witnesses are competent to report symptoms because this requires only personal knowledge as it comes to them through their senses, Layno v. Brown, 6 Vet. App. 465, 470 (1994), they are not competent to identify a specific level of symptomatology sufficient to satisfy the requirements of 38 C.F.R. § 4.16(a). Such competent evidence concerning the nature and extent of the Veteran’s employability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which his employability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective evidence of complaints of increased symptomatology. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND With regard to the Veteran’s claim for a rating in excess of 20 percent for DM with peripheral neuropathy of the bilateral lower extremities, additional development is required before the claim can be decided. In a February 2016 Form 9, the Veteran reported that his stamina and balance had declined and that his hands and feet were constantly cold. In light of his statement indicating that the symptoms of his DM with peripheral neuropathy had worsened, a remand is necessary to determine the current level of severity of all impairment resulting from his service-connected disability. Finally, current treatment records should be identified and obtained before a decision is made with regard to the current issue on appeal. The matter is REMANDED for the following actions: 1. Identify and obtain any pertinent, outstanding VA and private medical treatment records that are not already of record in the claims file. 2. Schedule the Veteran for an examination by the appropriate clinician to determine the current level of severity of all impairment resulting from his service-connected DM, including peripheral neuropathy. The claims file should be made available to, and reviewed by, the examiner. All indicated tests and studies should be performed. The examiner should provide all information required for rating purposes. 3. Then, readjudicate the claims on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Spigelman, Associate Counsel