Citation Nr: 18143655 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 05-05 690 DATE: October 19, 2018 ORDER Entitlement to service connection for a cervical or lumbar spine disability is denied. Entitlement to an initial rating in excess of 30 percent for adjustment disorder is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that any cervical or lumbar disabilities were incurred or are related to service, to include as secondary to service-connected left shoulder disability. 2. Symptoms of adjustment disorder prior to August 1, 2016, including depressed mood, and chronic sleep impairment, have caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 3. As of August 1, 2016, mental disorder symptoms also included cognitive disorders and aphasia, due to a service-connected stroke, that were not otherwise compensated, and combined to result in occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical or lumbar spine disability are not met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria for a rating in excess of 30 percent for adjustment disorder, prior to August 1, 2016, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.130, Diagnostic Code 9440. 3. The criteria for a 50 percent rating, but not higher, for adjustment disorder, as of August 1, 2016, but not earlier, have been met. 38 U.S.C. §§ 1155, 5103, 5103A; 38 C.F.R. §§ 3.159, 4.1, 4.7, 4.130, Diagnostic Code 9440. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1974 to November 1978. The Board denied the claim for entitlement to service connection for a back disability in June 2007. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims. Pursuant to a Joint Motion for Remand filed by the parties, the Court remanded the matter to the Board in September 2008 for action consistent with the terms of the Joint Motion. The Board remanded the claim in June 2009, and August 2017 for further development consistent with the terms of the Joint Motion. In light of the medical opinions obtained, and the further adjudicatory actions taken by the RO, the Board finds that there has been substantial compliance with the remand requests. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). 1. Entitlement to service connection for a cervical or lumbar spine disability Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a service connection for a disability, a Veteran must show: (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 or aggravated during service. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Similarly, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service-connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the non-service-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. In cases of aggravation of a non-service-connected disability by a service-connected disability, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.322. A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 519 (1996). The Veteran contends that current cervical or lumbar spine disabilities are related to a fall in service. In the alternative, the Veteran contends that cervical or lumbar spine disabilities were caused or aggravated by a service-connected left shoulder disability. Specifically, at an April 2017 hearing, the Veteran testified that he initially injured his left shoulder in service in 1974 or 1975 after being tackled to the ground by three men while playing football. The Veteran reported that at the time that he fell on his left shoulder, he was thrown on his back. The Veteran testified that he now has degenerative arthritis and constant pain in the back. In service medical records dated July 1977, the Veteran reported complaints of back pain for approximately three days. The pain was assessed as a pulled muscle. The service medical records contain no other complaints, treatment, or diagnoses related to the neck or back. A February 1986 x-ray of the cervical spine found mild degenerative changes at C3 and C4, with minimal encroachment upon the neuro-foramena bilaterally. At a November 2003 VA examination, the Veteran reported the onset of back pain when he dislocated his shoulder. The Veteran reported pain in the lower back and in the neck which was described as intermittent, and dull with twisting. The Veteran reported the pain as a 0 out of 10 that day, but stated he experienced flare-ups that lasted from 20 minutes to several days. The Veteran also reported neck pain, and stated that he felt a relief of pressure when he cracked the neck. The Veteran reported pain in the back that radiated up and down the back, with tightening in the upper back. On examination, the Veteran ambulated unassisted. He stated he was able to walk approximately three miles. Any falls experienced were related to an Achilles tendon rupture. There was no gross atrophy, spasm, or gross deformity in the spine. No tenderness was noted in the cervical or lumbar spine. X-rays found age-related degenerative changes. The examiner diagnosed mechanical low back pain syndrome with age-related degenerative changes of the cervical and lumbar spines. The examiner opined that the claimed conditions were less likely than not related to service, including the left shoulder disability, as the service medical records did not indicate any spine-related complaints or treatment during service, and the Veteran had not sought treatment for the neck or back. The examiner noted that the Veteran’s job required repetitive lifting, carrying, pushing, and pulling, which were all mechanical stressors to the spine. The examiner also noted that the Veteran was a volunteer fire fighter for the past 23 years. February and April 2016 VA medical records found no complaints of significant stiffness, pain or joint swelling on examination of the musculoskeletal system. Full range of motion was noted in both the neck and spine, and both were non-tender. In November 2016 VA medical records, the Veteran complained of worsening lower back pain, rated an 8 out of 10. The medical records noted a history of neck and lower back osteoarthritis. At a September 2017 VA examination of the cervical spine, the Veteran reported a history of neck pain from a shoulder injury. He reported that the pain radiated to the head, and was throbbing in nature. X-rays of the cervical spine found degenerative changes at C3-C4, and C5-C6. The examiner diagnosed degenerative arthritis of the cervical spine. The examiner opined that it was less likely than not that the cervical spine condition had its onset during or was related to service, including a July 1977 complaint of back pain because there were no complaints related to the neck in service or for many years after service. The examiner also opined that service-connected residuals status post left shoulder dislocation did not cause degenerative arthritis of the cervical spine. The examiner opined that it was as likely as not that the service-connected residuals status post left shoulder dislocation aggravated the cervical degenerative arthritis. At a contemporaneous VA examination of the lumbar spine, the Veteran reported that he hurt his back during a 1975 maneuver with a fox hole jump. He reported he went to sick call, and that the injury had bothered him for many years. The Veteran reported that the pain was chronic, and sharp in nature. He rated the pain a 7 out of 10. X-rays of the lumbar spine found degenerative changes in the lumbar spine, specifically moderate degenerative spondylosis at L2-3 and L4-5. The examiner diagnosed degenerative arthritis of the lumbar spine. The examiner opined that it was less likely than not that the lumbar spine condition had its onset during or was related to service, including a July 1977 complaint of back pain. The examiner also opined that service-connected residuals status post left shoulder dislocation did not cause degenerative arthritis of the lumbar spine. The examiner opined that it was as likely as not that the service-connected residuals status post left shoulder dislocation aggravated the lumbar degenerative arthritis. The examiner stated that there was a service treatment record along with several more current medical treatment records suggesting a back condition existed since service. The examiner stated that sequelae from the back and shoulder injury in service could aggravate the cervical and lumbar conditions. In a February 2018 addendum medical opinion, the examiner opined that it was less likely than not that any identified cervical or lumbar spine disability had been aggravated by service connected residuals of a left shoulder dislocation. The examiner reviewed all of the Veteran’s medical records in making that opinion. The examiner reasoned that the medical records did not indicate any complaints of neck pain related to a shoulder condition. Further, the examiner stated that the pathology of the neck condition was bone in nature, with diagnostics showing age-related degenerative changes. The examiner stated that the neck joint and shoulder joint entities had no pathophysiological relationship with each other. Further, the examiner stated that there was limited competent medical or objective evidence substantiating any likely aggravation of the cervical spine by the left shoulder as there were no records showing a worsening of the neck shoulder or suggesting that the Veteran needed any adjunct treatment to control neck symptoms. Regarding the lumbar spine, the February 2018 examiner stated that while anatomically, the back and shoulder had commonality in muscles, the Veteran’s lumbar condition was bone in pathology, and that the shoulder condition was less likely than not related pathophysiologically related to the lumbar condition. The Board finds that service connection for a cervical or lumbar spine disability is not warranted. While the record shows current degenerative arthritis of the cervical and lumbar spine, the preponderance of the evidence is against a finding of a nexus between the disabilities and qualifying active service or a service-connected disability. Degmetich v. Brown, 104 F.3d 1328 (Fed. Cir. 1997); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). The evidence does not support the contention that a 1977 in-service back complaint assessed as a pulled muscle was an early manifestation of or related to current cervical or lumbar spine disabilities. Multiple VA examiners explicitly opined that the records did not support a relation between service and current cervical or lumbar spine disabilities. In the alternative, the examiners also opined that the evidence does not support the contention that current cervical or lumbar spine disabilities were caused or aggravated by a service-connected left shoulder disability. While a November 2003 VA examiner did not address an in-service complaint of back pain, a subsequent VA examiner in September 2017 and in February 2018 explicitly opined that the in-service complaint was not related to current cervical and lumbar spine disabilities. Regarding a secondary relationship, the September 2017 VA examiner opined that the service-connected left shoulder residuals at least as likely as not aggravated cervical or lumbar conditions, but in reasoning, stated that sequelae from the shoulder injury could aggravate the cervical or spine condition. That is speculative in nature. The February 2018 VA examiner explicitly stated that the cervical and lumbar disabilities were less likely than not related to the service-connected left shoulder disability. The February 2018 VA examiner reviewed the entire medical record, including the statements of the Veteran regarding the onset of neck and back symptomology, and the September 2017 VA examiner’s opinion, in coming to that opinion. However, those statements did not provide objective evidence that the Veteran’s cervical or lumbar spine disabilities were related to a back complaint in service, or a service-connected left shoulder disability. The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). The Board acknowledges the statements of the Veteran regarding the onset of cervical or lumbar spine disabilities, and finds the Veteran competent to report symptoms, such as pain, as that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994); Kahana v. Shinseki, 24 Vet. App. 428 (2011). However, the issue in this case is outside the realm of common knowledge of a lay person, as a nexus is not obvious merely through observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board finds the VA examination opinions to be the most probative and persuasive evidence of record. The VA examiners have medical training, and reviewed all the available medical records, including the Veteran’s statements about the onset of the shoulder disabilities. The Veteran has not submitted any contrary objective evidence suggesting that the cervical or lumbar disabilities were caused or aggravated by service, or by other service-connected disabilities. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a cervical or lumbar spine disability, to include as secondary to a service-connected left shoulder disability, and the claim must be denied. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to an initial rating in excess of 30 percent for adjustment disorder Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4 (2017). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321(a), 4.1 (2017). Psychiatric disabilities are rated using the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders (2017). A 30 percent rating is warranted for a mental disorder when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130 (2017). A 50 percent rating is warranted for a mental disorder when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130 (2017). A 70 percent rating is warranted for a mental disorder when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. 38 C.F.R. § 4.130 (2017). A 100 percent rating is warranted for a mental disorder when there is total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130 (2017). The symptoms listed in the General Rating Formula are examples, not an exhaustive list, and it is not required to find the presence of all, most, or even some of the enumerated symptoms. Mauerhan v. Principi, 16 Vet. App. 436 (2002). When determining the appropriate rating to be assigned for a service-connected mental disorder, the focus is on how the frequency, severity, and duration of the symptoms affect the Veteran’s occupational and social impairment, rather than on the presence or absence of particular symptoms listed in the schedular criteria. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Relevant to a rating of the level of impairment caused by mental disorders is the score on a Veteran’s Global Assessment of Functioning (GAF) Scale. That scale is found in the American Psychiatric Associations’ Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and indicates the examiner’s opinion on the psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. The assigned GAF scores increase or decrease as the Veteran’s level of psychiatric impairment improves or declines. A GAF score of 61 to 70 indicates some mild symptoms, or some difficulty in social, occupational, or school functioning. In such cases, however, the Veteran is generally functioning pretty well, with some meaningful interpersonal relationships. A GAF score of 51 to 60 indicates moderate symptoms, or moderate difficulty in social, occupational, or school functioning. Richard v. Brown, 9 Vet. App. 266 (1996). The nomenclature in DSM IV has been specifically adopted by VA in the rating of mental disorders. 38 C.F.R. § 4.125, 4.130 (2017). While important in assessing the level of impairment caused by psychiatric illness, the GAF score is not dispositive of the level of impairment cause by such illness. Rather, it is considered in light of all of the evidence of record. Brambley v. Principi, 17 Vet. App. 20 (2003); Bowling v. Principi, 15 Vet. App. 1 (2001). Effective March 19, 2015, VA revised the Schedule for Rating Disabilities with respect to the rating criteria for mental disorders. The revisions replaced references in earlier editions of the DSM with revisions in the recently updated Fifth Edition (DSM-5). Those revisions apply to all applications for benefits that are received by VA or that are pending before the agency of original jurisdiction (AOJ) on or after August 4, 2014. Because this case was certified to the Board prior to August 4, 2014, the revised regulations do not apply. The Veteran contends that the disability ratings assigned for adjustment disorder do not accurately compensate the severity of the disability. The present claim for an increased rating arises from service connection for adjustment disorder that was originally granted in a September 2010 rating decision, effective June 16, 2009. May 2009 VA medical records show a diagnosis of adjustment disorder and personality disorder, not otherwise specified. On examination, the Veteran was well-groomed, friendly, and cooperative. The Veteran was alert and oriented to person, place, and time. His mood was dysphoric. Affect was appropriate, but somewhat constricted. No motor abnormalities were noted. Speech was of average speed and intensity. The Veteran denied suicidal or homicidal ideation. Thought processes were logical, and there was no evidence of hallucinations or delusions. The examiner assigned a GAF of 60. At an August 2010 VA examination, the Veteran reported symptoms including irritability, loss of interesting in activities, difficulty concentrating and focusing on tasks, depressed mood, and sleep impairment. The Veteran stated that he obsessed over current events related to the wars in Afghanistan and Iraq. He reported that he had feelings of guilt and worthlessness regarding his inability to continue his military career due to medical issues. The Veteran lived with his wife, with whom he had been married 38 years. He stated that he and his wife got along for the most part, but that he lost his temper at times. Regarding work, the Veteran stated that he had done well in his line of work over the years but that he was recently let go from a job due to political differences with coworkers. The Veteran was able to secure full-time employment after that. On examination, the Veteran was casually dressed and well-groomed. He was cooperative, with appropriate behavior. The Veteran had no impairment of communication, and motor functioning was unremarkable. He was alert and oriented to person, place, and time. The Veteran’s mood was dysphoric, with constricted affect. Speech was within normal limits, and thought process was organized and goal-directed. Recent memory and remote memory were both grossly intact. The Veteran’s thought content was notable for preoccupation with the wars in Afghanistan and Iraq, and worries related to his health. The Veteran denied past or present suicidal or homicidal ideation. There was no evidence of hallucinations or paranoia. The examiner diagnosed adjustment disorder with mixed anxiety and depressed mood, and assigned a GAF of 61. The examiner opined that overall the Veteran’s psychiatric symptoms were mild, and that while he had some impairment in the ability to relate to others, he had maintained steady employment for many years and has been able to function with minimal psychiatric treatment. VA psychiatric treatment records from July 2015 through February 2017 show consistent complaints of depressed mood, anxiety, and sleep impairment. On examination, the Veteran was consistently alert and oriented to person, place, and time. The Veteran was well-groomed, friendly and cooperative. was often anxious or depressed, with congruent affect. The Veteran consistently denied suicidal or homicidal ideation. There was no evidence of hallucinations or delusions. Thought processes were logical, and speech was generally within normal limits. In July 2015, the Veteran complained of worsening memory, attention, and concentration. The Veteran reported feeling helpless and depressed that he had to retire from work due to his physical health after suffering a stroke. At an April 2017 hearing, the Veteran reported continued bouts of depression caused by his inability to work due to physical medical conditions. The Veteran reported trouble falling asleep. He reported he no longer had hobbies. The Veteran attended events at a local fire department and Veterans organization approximately once a month. At an October 2017 VA examination, the Veteran reported symptoms including depressed mood, sleep impairment, rumination, anxiety, anger, disturbances of mood and motivation, reduced libido, erectile dysfunction, memory impairment, and aphasia. The examiner noted that the Veteran stopped working in January 2016 after suffering a stroke. The Veteran lived with his wife and adult daughter. He and his wife watched their grandchildren. The Veteran did all the driving and split chores with his wife. The Veteran stated that he volunteered at the fire department in an administrative capacity, and still participated at a local Veterans organization. On examination, the Veteran was well-groomed and cooperative. His mood was dysphoric with a range of affect. Speech was within normal rate and volume. Thought processes appeared intact, with mild tangential speech. The examiner noted aphasia was evidenced, and that the Veteran was visibly frustrated with it. The examiner diagnosed adjustment disorder with mixed anxiety and depressed mood, and opined that the Veteran had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to psychiatric symptoms. The examiner noted that generally the Veteran was functioning satisfactorily, with normal routine behavior, self-care, and conversation. A January 2018 VA medial psychiatric record noted ongoing cognitive dysfunction, specifically short-term memory problems, due to a stroke. Based upon VA medical records, outpatient therapy notes, and the VA examination reports, the Board finds that the preponderance of the evidence is against the assignment of a rating in excess of 30 percent for adjustment disorder with anxiety and depressed mood. The Veteran’s psychiatric symptoms largely consist of depressed mood, anxiety, and sleep impairment. Other symptoms, including cognitive dysfunctions as aphasia, were connected to the service-connected stroke. However, the Board finds that those symptoms were not rated under the rating assigned for the stroke as of August 1, 2016, when the rating for stroke changed from 100 percent to 10 percent. Therefore, those symptoms may be considered as of August 1, 2016. Multiple VA examiners explicitly opined that the Veteran’s symptoms were mild and did not prevent the Veteran from fully functioning. The Veteran maintained good relationships with his wife and daughters, and performed well at work. The record indicates any inability to work was largely due to physical ailments, and not due to depressed mood. Therefore, the Board finds that impairments with reduced reliability and productivity, or deficiencies in most areas due to psychiatric symptoms have not been shown prior to August 1, 2016. The evidence also does not show total occupational and social impairment as the Veteran maintains a social relationship with his significant other and family. Therefore, the Board finds that the preponderance of the evidence is against the assignment of any rating higher than 30 percent prior to August 1, 2016. However, the Board finds that as of August 1, 2016, the cognitive and mental symptoms due to the stroke that are not considered in the rating for the service-connected stroke must be considered in rating the overall mental disorder because they are components of service-connected disability that is not otherwise rated. 38 C.F.R. § 4.14. Those cognitive symptoms, including memory loss and aphasia resulted in occupational and social impairment with reduced reliability and productivity. However, those symptoms did not result in deficiencies in most areas and total occupation and social impairment has not been shown as the Veteran maintains relationships with a spouse and others. In making a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which are found to be persuasive or unpersuasive, and provide the reasons for the rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36 (1994); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran is competent to report symptoms, such as depressed mood, because that requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). However, the Board finds that the objective evidence does not demonstrate symptoms that more nearly approximate a higher rating under the General Rating Formula for Mental Disorders. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of a rating greater than 30 percent for adjustment disorder with anxiety and depressed mood prior to August 1, 2016, and the claim must be denied. However, the evidence supports the assignment of a 50 percent rating, but not greater, as of August 1, 2016, including consideration of mental disorder symptoms not otherwise rated following the stroke rating changing to 10 percent. The preponderance of the evidence is against the assignment of any higher ratings. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C.§ 5107 (2012); 38 C.F.R. § 3.102 (2017). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Ahmad, Associate Counsel