Citation Nr: 18143496 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 09-13 071 DATE: October 19, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the regular need for the aid and attendance of another person is granted, subject to controlling regulations governing the payment of monetary awards. REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for gastrointestinal disability other than hiatal hernia with esophageal reflux (including colon polyps), to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for urinary disability (including stress incontinence), to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for kidney disability (including kidney cyst and kidney disease), to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for cardiac disability is remanded. FINDINGS OF FACT 1. The Veteran has been awarded service connection for the following disabilities: posttraumatic stress disorder (PTSD); residuals, compression fracture, T12 and L1; bilateral hearing loss; diabetes mellitus; right lower extremity radiculopathy; left lower extremity peripheral neuropathy; a left foot laceration scar; hiatal hernia with esophageal reflux; and erectile dysfunction. 2. The Veteran requires assistance in accomplishing the activities of daily living and is unable to protect himself from the hazards and dangers of his daily environment on account of service-connected disabilities. CONCLUSION OF LAW The criteria for SMC based on the regular need for the aid and attendance of another person are met. 38 U.S.C. §§ 1114 (l), 5107; 38 C.F.R. §§ 3.350(b), 3.352(a). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from September 1962 to October 1982, which includes service in the Republic of Vietnam. His awards include the Air Medal with “V” Device, Combat Infantryman Badge, and Army Commendation Medal. These matters initially came before the Board of Veterans’ Appeals (Board) from June 2008, July 2009, and March 2010 rating decisions. The Veteran testified before a Decision Review Officer (DRO) and the undersigned Veterans Law Judge (VLJ) at May 2010 and March 2017 hearings, respectively. Transcripts of the hearings have been associated with his claims file. Also, an informal hearing conference with a DRO was conducted in November 2012 in lieu of another formal DRO hearing and a report of that conference has been associated with the Veteran’s claims file. In June 2017, the Board remanded these matters for further development. As for characterization of the issues on appeal, in light of the Veteran’s reported symptoms and contentions and the fact that he has already been awarded service connection for hiatal hernia with esophageal reflux, and in order to encompass all disorders that are reasonably raised by the record, the Board has re-characterized the claims of service connection for colon polyps, stress incontinence, cyst in kidney, and kidney disease as claims of service connection for gastrointestinal disability other than hiatal hernia with esophageal reflux (including colon polyps), urinary disability (including stress incontinence), and kidney disability (including cyst in kidney and kidney disease). See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that, in determining the scope of a claim, the Board must consider the claimant’s description of the claim, the symptoms described, and the information submitted or developed in support of the claim). SMC Entitlement to SMC based on the regular need for the aid and attendance of another person SMC at the aid and attendance rate is payable when a veteran, due to service-connected disability, has suffered the anatomical loss or loss of use of both feet or one hand and one foot, or is blind in both eyes, or is permanently bedridden or so helpless as to be in need of regular aid and attendance. See 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). Pursuant to 38 C.F.R. § 3.350 (b)(3) and (4), the criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance, including a determination that he is permanently bedridden, are contained in 38 C.F.R. § 3.352 (a). That regulation provides that the following will be accorded consideration in determining the need for regular aid and attendance: inability of a claimant to dress or undress himself, or to keep himself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid; inability to feed himself through the loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect him from hazards or dangers incident to his daily environment. “Bedridden” is defined as that condition, which, through its essential character, actually requires that a claimant remain in bed. The fact that a claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. It is not required that all of the above disabling conditions be found to exist before a favorable rating may be made. The particular personal functions that a veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that a veteran is so helpless as to need regular aid and attendance, not that there is a constant need. Determinations that a veteran is so helpless as to be in need of regular aid and attendance will not be based solely upon an opinion that his condition is such as would require him to be in bed. They must be based on the actual requirement of personal assistance from others. See 38 C.F.R. § 3.352 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board finds, for the following reasons, that the preponderance of the evidence indicates that the Veteran requires assistance in accomplishing the activities of daily living and is unable to protect himself from the hazards and dangers of his daily environment on account of service-connected disabilities. The Veteran has been awarded service connection for the following disabilities: PTSD; residuals, compression fracture, T12 and L1; bilateral hearing loss; diabetes mellitus; right lower extremity radiculopathy; left lower extremity peripheral neuropathy; a left foot laceration scar; hiatal hernia with esophageal reflux; and erectile dysfunction. A VA physician reported on an aid and attendance report received in December 2007 that the Veteran was diagnosed as having degenerative joint disease (low back pain), obesity, hyperlipidemia, obstructive sleep apnea, peptic ulcer disease/gastroesophageal reflux disease, PTSD, and diabetes mellitus. He was not able to walk unaided, used a walker and wheelchair for ambulation, required assistance in bathing and tending to other hygiene needs, was only able to travel with an attendant, and was not able to leave home without assistance. He was able to feed himself and care for his needs of nature, was not confined to bed, was able to sit up, was not blind, and did not require nursing home care. Overall, the VA physician concluded that the Veteran had very limited ambulation due to chronic low back pain. In a February 2008 statement, the Veteran and his wife reported, in pertinent part, that the Veteran was unstable due to service-connected disabilities, used an assistive device (leg brace, cane, and/or walker) due to a recent accident that was caused by his instability, and was unable to stand or walk for prolonged periods due to his disabilities. In addition, he required assistance with his medications because he experienced worsening memory loss which caused him to forget to take his medications. In a March 2008 statement, a VA physician reported that the Veteran experienced chronic PTSD, depressive disorder, cognitive disorder not otherwise specified (NOS), short term memory problems, and difficulty with concentration and comprehension. He required the assistance of a caregiver due to his physical challenges and memory problems. The Veteran’s wife reported in a July 2008 statement that the Veteran experienced chronic back pain which caused limitations and difficulty with mobility, ambulation, and bending. He also experienced pain and numbness in his lower extremities, loss of balance, occasional falls, and short-term memory loss which caused him to forget to take medications. The Veteran’s back and neurological disabilities caused severe pain, limited mobility, and instability. He used a right leg brace (partly due to an ankle injury in September 2007 which was caused by a fall from his instability) and a power chair. The reports of VA back, neurological, and psychiatric examinations dated in August 2008 indicate, in pertinent part, that the Veteran reported that he experienced chronic back pain which radiated to his lower extremities and increased in severity during daily flare ups, lower extremity numbness, instability, memory loss, and impaired concentration and attention. He was only able to walk short distances either with the assistance of another person or a cane, he used a wheelchair for ambulation both at home and in public, and he had broken his left leg in September 2007 due to a fall. He wore a long-leg brace on the left leg and a short-leg brace on the right leg. He was able to feed himself, but his wife prepared his meals, he required assistance with bathing, dressing, using the bathroom, and shaving, and he was unable to drive. Examinations revealed that the Veteran was in a motorized wheelchair and was unable to safely stand in order to perform spinal range of motion testing. There was lower back tenderness manifested by groaning and withdrawal, right lower extremity muscle weakness, decreased sensation in both lower extremities, and absent lower extremity reflexes bilaterally. Also, the Veteran exhibited somewhat impaired cognitive functioning. Diagnoses of PTSD, chronic cognitive disorder NOS, and residuals of compression fracture of T12 and L1 were provided. The examiner who conducted the August 2008 back examination noted that the Veteran’s service-connected back disability caused a “significant impairment of his activities of daily living.” Also, the examiner who conducted the August 2008 psychiatric examination concluded that the Veteran was essentially wheelchair bound, that he was dependent upon his wife for his activities of daily living (e.g., his wife helped him with bathing, cleaning, and washing), and that he was unable to take care of himself because of worsening physical problems and cognitive disorder. A physician reported on an October 2008 “Medical Statement for Consideration of Aid & Attendance” form that the Veteran experienced chronic PTSD, cognitive disorder NOS (rule out dementia), lumbosacral spondylosis and disc degeneration, cervical radiculopathy, osteoporosis with history of fractured left ankle, peripheral neuropathy, chronic pain, osteoarthritis, chronic dizziness/vertigo/balance problems, anemia, stress incontinence, restless leg syndrome, hyperglycemia, dyslipidemia, sleep apnea, colon polyps, hearing loss, and epigastric pain. He was not able to walk unaided, used a motorized wheelchair, required daily assistance with bathing, hygiene needs, and putting on and taking off lower extremity prostheses, and had to be reminded to eat on a daily basis. He was able to feed himself, was not confined to bed, and was able to sit up. He was unable to travel or leave his home without assistance because he required assistance getting from his house to the car in a motorized wheelchair and he was unable to drive due to various impairments (including memory problems, sleep apnea, and drowsiness). He did not require nursing home care. The physician concluded that the Veteran needed aid and attendance because his memory problems could create hazards in his environment and he required daily assistance for his protection. The Veteran and his wife reported during the May 2010 DRO hearing that the Veteran experienced impaired memory. As a result of his impaired memory, he required assistance with meal preparations and bathing because he had left the stove on during previous occasions and had forgotten to bathe. Also, he required assistance with dressing, shaving, and putting on his lower extremity braces. The Board acknowledges, at the outset, that the Veteran has not suffered the anatomical loss or loss of use of both feet or one hand and one foot, and is not service-connected for blindness in both eyes. Also, there are non service-connected disabilities that contribute to his functional impairments. For instance, he has been diagnosed as having cognitive disorder NOS. However, where an examiner is unable to distinguish the symptoms of a service-connected disability from non-service connected manifestations, all the manifestations will be considered part of the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996)). In this case, the Board finds that the symptoms of the Veteran’s service-connected PTSD cannot be clearly distinguished from the symptoms associated with his nonservice-connected cognitive disorder NOS. Therefore, the Board will attribute all of the Veteran’s psychiatric/cognitive symptoms to PTSD for the purposes of assessing the extent to which that disability affects the Veteran’s ability to perform his activities of daily living. See id. Overall, the Board finds that the preponderance of the evidence reflects that the Veteran’s service-connected disabilities (predominantly PTSD and his service-connected back and lower extremity neurological disabilities) are of sufficient severity to require the need for assistance in order to perform daily activities and protect himself from the hazards and dangers of his daily environment. In particular, the above evidence indicates that he experiences some cognitive impairment (including memory loss and impaired concentration). As a result, he requires assistance with medication use/management, daily hygiene, and food preparation because he sometimes forgets to take his medications and bathe due to his memory loss, and he has forgotten to turn off the stove. In addition, he is unable to ambulate without the assistance of others or an assistive device due to his service-connected back and lower extremity neurological disabilities, he experiences significant balance problems and has fallen due to his disabilities, and he requires assistance with dressing and bathing due to his disabilities. In sum, the evidence (including the Veteran’s medical records and the medical opinions noted above) supports a finding that the Veteran is so helpless as to be in need of regular aid and attendance of another person due to the manifestations of his service-connected disabilities, which require care or assistance on a regular basis to perform daily activities and to protect him from the hazards or dangers inherent in his daily environment. Hence, entitlement to SMC based on the regular need for the aid and attendance of another person is granted. REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as secondary to service-connected disease or injury, is remanded. The Veteran contends that he has hypertension related to his presumed exposure to herbicide agents in Vietnam. In the alternative, he contends that the hypertension is associated with his service-connected disabilities (e.g., PTSD, back disability, and diabetes mellitus) and/or the medications taken for these disabilities. In the June 2017 remand, the Board instructed the agency of original jurisdiction (AOJ) to obtain a medical opinion as to the etiology of the Veteran’s hypertension. In September 2017, a VA physician reviewed the Veteran’s claims file and opined that his hypertension was not likely caused by service, caused by service-connected diabetes or pain, or aggravated by service-connected disability (including PTSD, diabetes mellitus, and pain). The physician reasoned, in pertinent part, that hypertension is not a disease recognized by VA as being caused by herbicide exposure and that hypertension developed “well prior” to the onset of diabetes. The September 2017 opinion that the Veteran’s hypertension is not related to herbicide exposure in service is insufficient because the sole rationale for this opinion is that hypertension is not a disease recognized by VA as being caused by herbicide exposure. The Board points out, however, that the fact a disability is not on the list of disabilities presumed to be associated with exposure to herbicide agents (including Agent Orange) cannot be the sole basis for finding a lack of nexus between the disability and herbicide agent exposure. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). The Board also notes that the National Academy of Sciences (NAS) has indicated that there is limited or suggestive evidence of an association between hypertension and Agent Orange exposure. See Health Outcomes Not Associated With Exposure to Certain Herbicide Agents; Veterans and Agent Orange: Update 2008, 75 Fed. Reg. 81,332-01 (Dec. 27, 2010)). Moreover, the United States Court of Appeals for Veterans Claims (Court) has held in multiple memorandum decisions that VA’s acknowledgment in the Federal Register that there is “limited or suggestive evidence,” see 79 Fed. Reg. 20308, 20310 (Apr. 11, 2014), of an association between Agent Orange exposure and hypertension was relevant to the question of whether the failure to discuss the Federal Register NAS findings rendered the Board’s reasons or bases inadequate, warranting vacatur and remand. The September 2017 opinion that the Veteran’s hypertension is not caused by diabetes is also insufficient because the physician reasoned that hypertension developed “well prior” to the onset of diabetes. The physician noted that the hypertension was diagnosed in 2000. A July 2009 VA diabetes examination report indicates that the Veteran was diagnosed as having borderline diabetes around the early 2000s. Thus, it appears that the September 2017 opinion may be based upon an inaccurate history. Moreover, the September 2017 physician did not provide any specific opinion as to whether the Veteran’s hypertension was caused by his service-connected PTSD. In this regard, there is evidence showing a possible association between the Veteran’s PTSD and his hypertension, as the VA’s own regulatory documents have indicated a possible association between psychiatric disorders and cardiovascular disease. See Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 70 Fed. Reg. 37040 (June 28, 2005); Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 69 Fed. Reg. 60083 (Oct. 7, 2004) (association between PTSD and cardiovascular disease in prisoners of war). See also VA National Center for PTSD, Kay Jankowski, PTSD and Physical Health (“A number of studies have found an association between PTSD and poor cardiovascular health”). The Board cannot make a fully-informed decision on the issue of entitlement to service connection for hypertension because no VA examiner has adequately opined as to the etiology of the Veteran’s hypertension. Hence, an appropriate medical opinion should be obtained upon remand. Also, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the VA Medical Center (VAMC) in Jackson Mississippi and are dated to May 2018. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the remaining issues on appeal. A remand is required to allow VA to obtain them. 2. Entitlement to service connection for gastrointestinal disability other than hiatal hernia with esophageal reflux (including colon polyps), to include as secondary to service-connected disabilities, is remanded. The Veteran contends that he has current gastrointestinal disability other than hiatal hernia with esophageal reflux and that this disability is related to his presumed exposure to herbicide agents in service. In the alternative, he contends that the disability is associated with his service-connected disabilities and/or the medications taken for these disabilities. A VA intestinal conditions examination was conducted in December 2013 and the Veteran was diagnosed as having constipation. The physician who conducted the examination opined that the Veteran’s constipation was not likely caused or aggravated by service or service-connected disabilities. This opinion is inadequate because the examiner did not provide any specific rationale for why the Veteran’s constipation was not related to service (to include presumed herbicide exposure). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). Moreover, the Veteran has been diagnosed as having colon polyps and no opinion has been provided as to whether the polyps are related to service (to include herbicide exposure in service). The Board cannot make a fully-informed decision on the issue of entitlement to service connetion for gastrointestinal disability other than hiatal hernia with esophageal reflux because no VA examiner has adequately opined as to the etiology of the Veteran’s gastrointestinal disability. Hence, an appropriate medical opinion should be obtained upon remand. Also, all outstanding VA treatment records should be secured upon remand. 3. Entitlement to service connection for urinary disability (including stress incontinence), to include as secondary to service-connected disabilities, is remanded. The Veteran contends that he has current urinary disability and that this disability is related to his presumed exposure to herbicide agents in service. In the alternative, he contends that the disability is associated with his service-connected disabilities and/or the medications taken for these disabilities. In the June 2017 remand, the Board instructed the AOJ to obtain a medical opinion as to the etiology of the Veteran’s urinary disability. In September 2017, a VA physician reviewed the Veteran’s claims file and opined, in pertinent part, that the Veteran’s urinary incontinence was not related to service. This opinion is inadequate because it is partly based upon an inaccurate history. Specifically, the physician reasoned that the Veteran “only reported symptoms starting in 1999.” The report of a March 1983 VA examination, however, indicates that the Veteran reported that he experienced some bladder problems in service at the time of his in-service back injuries. Also, a June 1984 letter from L.R. Hodges, M.D. indicates that the Veteran experienced “some bladder difficulties.” The Board cannot make a fully-informed decision on the issue of entitlement to service connection for urinary disability because no VA examiner has adequately opined as to the etiology of the Veteran’s urinary disability. Hence, an appropriate medical opinion should be obtained upon remand. Also, all outstanding VA treatment records should be secured upon remand. 4. Entitlement to service connection for kidney disability (including kidney cyst and kidney disease), to include as secondary to service-connected disabilities, is remanded. The Veteran contends that he has current kidney disability and that this disability is related to his presumed exposure to herbicide agents in service. In the alternative, he contends that the disability is associated with his service-connected disabilities and/or the medications taken for these disabilities. A VA kidney examination was conducted in April 2012 and the Veteran was diagnosed as having acute pyelonephritis. The physician who conducted the examination did not provide any opinion as to the etiology of this disability. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for kidney disability because no VA examiner has opined as to etiology of the Veteran’s kidney disability. Also, all outstanding VA treatment records should be secured upon remand. 5. Entitlement to service connection for cardiac disability is remanded. As the record currently stands, there is no evidence of current cardiac disability. As additional treatment records are being sought upon remand which may document evidence of cardiac disability, the claim of service connection for cardiac disability is also being remanded. The matters are REMANDED for the following action: 1. Ask the Veteran to identify the location and name of any VA or private medical facility where he has received treatment for cardiac disability, hypertension, kidney disability, urinary disability, and gastrointestinal disability, to include the dates of any such treatment. Ask the Veteran to complete a VA Form 21-4142 for all records of his treatment for cardiac disability, hypertension, kidney disability, urinary disability, and gastrointestinal disability from any sufficiently identified private treatment provider from whom records have not already been obtained. Make two requests for any authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records from the VAMC in Jackson, Mississippi for the period since May 2018; and all such relevant records from any other sufficiently identified VA facility. 3. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an opinion from an appropriate clinician regarding whether the Veteran’s hypertension at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service; (3) is related to an in-service injury, event, or disease, including the Veteran’s presumed exposure to herbicide agents (including Agent Orange); (4) is caused by service-connected disability(ies) (including, but not limited to, back disability, PTSD, and/or diabetes mellitus, as well as any medications taken for these disabilities); or (5) is aggravated by service-connected disability(ies) (including, but not limited to, back disability, PTSD, and/or diabetes mellitus, as well as any medications taken for these disabilities) The clinician must provide reasons for each opinion given. In this regard, the clinician should address the limited or suggestive evidence of a relationship between hypertension and Agent Orange exposure. The fact that hypertension is not on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. The clinician should also specifically comment on the VA documents indicating an association between PTSD and heart disease. See Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 70 Fed. Reg. 37040 (June 28, 2005); Presumptions of Service Connection for Diseases Associated With Service Involving Detention or Internment as a Prisoner of War, 69 Fed. Reg. 60083 (Oct. 7, 2004) (association between PTSD and cardiovascular disease in prisoners of war). See also VA National Center for PTSD, Kay Jankowski, PTSD and Physical Health (“A number of studies have found an association between PTSD and poor cardiovascular health”). 4. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an addendum opinion from an appropriate clinician regarding whether any gastrointestinal disability other than hiatal hernia with esophageal reflux experienced by the Veteran since approximately February 2009 (including, but not limited to, colon polyps) at least as likely as not (1) began during active service; (2) is related to an in-service injury, event, or disease, including the Veteran’s presumed exposure to herbicide agents (including Agent Orange) and the gastrointestinal problems documented in his service treatment records; (3) is caused by service-connected disability(ies) (to include any medications taken for these disabilities); or (4) is aggravated by service-connected disability(ies) (to include any medications taken for these disabilities. The clinician must provide reasons for each opinion given. In this regard, the fact that a specific gastrointestinal disability is not on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. 5. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an addendum opinion from an appropriate clinician regarding whether any urinary disability experienced by the Veteran since approximately February 2009 (including, but not limited to, stress incontinence) at least as likely as not (1) began during active service; (2) is related to an in-service injury, event, or disease, including the Veteran’s presumed exposure to herbicide agents (including Agent Orange), his back injuries, and his reported urinary symptoms at the time of these back injuries; (3) is caused by service-connected disability(ies) (to include any medications taken for these disabilities); or (4) is aggravated by service-connected disability(ies) (to include any medications taken for these disabilities. The clinician must provide reasons for each opinion given. In this regard, the fact that a specific urinary disability is not on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. 6. After all efforts have been exhausted to obtain and associate with the claims file any additional treatment records, obtain an addendum opinion from an appropriate clinician regarding whether any kidney disability experienced by the Veteran since approximately February 2009 (including, but not limited to, kidney cyst, kidney disease, and pyelonephritis) at least as likely as not (1) began during active service; (2) is related to an in-service injury, event, or disease, including the Veteran’s presumed exposure to herbicide agents (including Agent Orange); (3) is caused by service-connected disability(ies) (to include any medications taken for these disabilities); or (4) is aggravated by service-connected disability(ies) (to include any medications taken for these disabilities. The clinician must provide reasons for each opinion given. In this regard, the fact that a specific kidney disability is not on the list of diseases presumed to be associated with exposure to Agent Orange should not be the basis for a negative opinion. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Elwood, Counsel