Citation Nr: 18145136 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 15-44 711 DATE: October 26, 2018 ORDER Entitlement to an initial rating higher than 30 percent for bilateral hearing loss is denied. Entitlement to an initial rating higher than 10 percent for tinnitus is denied. Entitlement to an effective date earlier than May 25, 2012 for the award of service connection for bilateral hearing loss is denied. Entitlement to an effective date earlier than May 25, 2012 for the award of service connection for bilateral hearing loss is denied. REMANDED Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder, anxiety disorder, and depression, is remanded. Entitlement to a rating higher than 10 percent for eczema/dermatitis on the hands, forearms, and thighs is remanded.   FINDINGS OF FACT 1. Since November 2014, the Veteran’s bilateral hearing loss has not been manifested by worse than a bilateral Level VI loss, and there is no evidence indicating he met the criteria for an evaluation higher than 30 percent. 2. The Veteran is in receipt of the maximum schedular evaluation assignable for tinnitus. 3. The Veteran’s claim of entitlement to service connection for defective hearing was denied in a June 1978 rating decision. The Veteran did not submit a timely notice of disagreement with the decision, and it is final. 4. The Veteran submitted a claim to reopen the issue of entitlement to service connection for bilateral hearing loss on May 25, 2012. There is no communication received after June 1978 and prior to May 25, 2012 which could be interpreted as an informal or formal claim of entitlement to service connection for hearing loss or tinnitus. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 30 percent for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.10, 4.85, Diagnostic Code 6100. 2. The criteria for a rating higher than 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.321, 4.87, Diagnostic Code 6260. 3. The criteria for entitlement to an effective date for the grant of service connection for bilateral hearing loss prior to May 25, 2012 have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.158, 3.400. 4. The criteria for entitlement to an effective date for the grant of service connection for tinnitus prior to May 25, 2012 have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.151, 3.155, 3.158, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1975 to December 1977. Increased Rating for Hearing Loss The Veteran’s hearing loss has been assigned a 30 percent evaluation, effective May 25, 2012. Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by puretone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85. To evaluate the degree of disability from defective hearing, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. §§ 4.85, Tables VI and VII, Diagnostic Code 6100. An exceptional pattern of hearing impairment occurs when the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, 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. Further, when the average puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, 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, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b). The Veteran attended a VA examination in February 2013. He reported having to ask people to repeat themselves because he had trouble hearing them and feeling that he was perceived as inattentive because he could not hear well. Puretone threshold testing showed the following results, in decibels: HERTZ 1000 2000 3000 4000 RIGHT 35 40 40 50 LEFT 30 35 40 50 The average puretone thresholds were 41 in the right ear and 39 decibels in the left ear. Speech audiometry revealed speech recognition ability of 52 percent in the right ear, and 56 percent in the left ear. Applying the findings to Table VI in 38 C.F.R. § 4.85 yields a finding of Level VI in both ears. Where hearing loss is at Level VI in both ears, a 30 percent rating is assigned. Id. The examiner noted that the use of speech discrimination score was not appropriate for this Veteran, because the claimant would not attempt to guess at each word despite re-instruction to do so. The Board notes that applying Table VIA for rating hearing impairment based only on puretone threshold average would result in Level III and Level IV, and a lower rating of 10 percent would be assigned. At a July 2015 VA examination, the examiner noted that the claimant’s hearing loss did impact the ordinary conditions of the Veteran’s daily life, and the appellant reported that he often had to ask people to repeat themselves. Puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT 50 50 40 50 LEFT 40 45 50 60 The average puretone thresholds were 47.5 decibels in the right ear and 48.75 decibels in the left ear. Speech audiometry revealed speech recognition ability of 56 percent bilaterally. Applying the findings to Table VI in 38 C.F.R. § 4.85 also results in a finding of Level VI hearing loss in both ears, which, when applied to table VII, allows for a rating of 30 percent. Id. The functional effects of hearing loss on the Veteran’s daily life activities and occupational functioning have been discussed by the Veteran at his VA examinations and in his written statements, and have been taken into consideration by VA. See 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447, 455-56 (2007). The Veteran has reported having trouble hearing people or understanding what they are saying; this is reflective of the types of functional difficulty that would be expected to be caused by his recorded levels of hearing loss, and is adequately compensated by the 30 percent the Veteran has already been assigned. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (Manifestations such as difficulty hearing speech are the types of difficulties contemplated by the schedular criteria for hearing loss.). Accordingly, the VA examinations of record are sufficiently in compliance with the provisions of VA regulations, and they are assigned great probative value in determining the Veteran’s level of hearing impairment. The most probative medical evidence as to the nature of the appellant’s hearing loss are the audiometric findings, and those discussed above reveal that the Veteran’s hearing loss does not warrant a rating any higher than the 30 percent already assigned. In reaching this conclusion, the Board has considered the applicability of the benefit of the doubt doctrine; the preponderance of the evidence is against the Veteran’s claim, and the doctrine is not applicable. 38 U.S.C. § 5107(b). Lastly, the Board notes that the question of entitlement to referral for consideration of an extraschedular rating is neither an issue argued by the claimant nor reasonably raised by the record through evidence of the collective impact of the claimant’s service-connected disabilities, and will not be discussed at this time. Yancy v. McDonald, 27 Vet. App. 484, 494 (2016). Increased Rating for Tinnitus The Veteran has also requested an increased rating for tinnitus. At the February 2013 and July 2015 VA examinations, the Veteran reported having constant tinnitus which began in 1976 or 1978. He reported that it made sleeping difficult at times. Tinnitus is evaluated under the criteria of 38 C.F.R. § 4.87, Diagnostic Code 6260, which provides that a single 10 percent rating is assigned for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, Diagnostic Code 6260, Note 2. The Veteran is already assigned a 10 percent evaluation, which is the maximum scheduler evaluation for tinnitus. As such, he is not entitled to any higher schedular rating for his tinnitus. The symptoms of the claimant’s tinnitus are manifested by frequent or constant ringing in the ears, and these symptoms are accurately reflected by the schedular criteria. The Veteran has not indicated that he has any other symptoms associated with tinnitus other than ringing in the ears, and his assertion that the ringing keeps him up at night is consistent with a functional impact of having constant ringing in the ears. There is no medical evidence or written assertions of any other symptoms which would fall outside of the expected symptomatology associated with tinnitus, which is ringing in the ears. Without any evidence reflecting that the Veteran’s disability picture is not sufficiently contemplated by the rating schedule, referral for a determination of whether his disability picture requires the assignment of an extraschedular rating is not warranted. See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008). The record before the Board does not suggest that tinnitus requires frequent hospitalization or causes a marked interference with employment or otherwise suggests that referral for an extraschedular consideration under 38 C.F.R. 3.321 is indicated. The claim is denied. Earlier Effective Date for Hearing Loss and Tinnitus The Veteran asserts that because he initially submitted a claim of entitlement to service connection for hearing loss in 1978, he should be assigned an effective date back to 1978. In a November 2017 Appellant’s Brief, the representative argued that the effective date should go back to the day the Veteran left service, because he has had these conditions since he was in service. In January 1978, the Veteran wrote to VA stating that he had a problem with defective hearing which originated in service. At a May 1978 VA examination, the Veteran reported that he sometimes heard a clicking sound in the right ear when he opened his jaws, that he sometimes had trouble understanding people, and that he had occasional blockage in his ears. Audiometric testing found hearing thresholds of 10 to 20 decibels in both ears, and speech discrimination ability was 98 percent in the right ear and 100 percent in the left year. He was diagnosed with “no deafness” bilaterally. The examiner attributed the clicking sound to slight malocclusion of the jaws which was a congenital or developmental abnormality The claim of entitlement to service connection for defective hearing was denied in a June 1978 rating decision. The decision stated that the audiology examination had found no “deafness” in either ear, and there were no objective findings of tinnitus. The claim was denied because the evidence of record was negative for any diagnosis of a chronic ear disability or loss of hearing developing. The only correspondence received from the Veteran in the year following the June 1978 decision was a June 1978 letter he submitted explaining why he was unable to attend all of his college classes, and the letter made no mention of any disagreement with the June 1978 rating decision. The Veteran did not submit any notice of disagreement or new and material evidence within one year of the June 1978 rating decision, and it is final. See 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 20.204, 20.302, 20.1103. A final and binding agency decision shall not be subject to revision on the same factual basis, unless clear and unmistakable evidence is found in that decision. 38 C.F.R. § 3.105. In the absence of any clear and unmistakable error in the June 1978 rating decision, it is not revisable on the merits of the claim. The Veteran has not alleged that there is any clear and unmistakable error in the June 1978 rating decision, and there is no indication in the record that a clear and unmistakable error exists in the June 1978 decision. The decision was based on competent medical evidence which indicated that the Veteran had no current bilateral hearing loss or other ear disability. The Veteran next submitted a new claim of entitlement to service connection for a bilateral hearing loss on May 25, 2012. The claim was accepted by VA as including an inferred claim of entitlement to service connection for tinnitus. At a February 2013 VA examination, the Veteran was found to have a bilateral hearing loss disability, and he reported symptoms of tinnitus. Thereafter, entitlement to service connection for bilateral hearing loss and tinnitus was granted in a July 2013 rating decision, effective May 25, 2012. The effective date for direct service connection is the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, it will be the date of receipt of claim, or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400(b)(2)(i). In this case, the Board finds that the earliest date that the Veteran can be assigned an effective date for the award of service connection for tinnitus and hearing loss is May 25, 2012, the date that his claim to reopen was received by VA. The prior June 1978 denial is final, and since that date, there is no record of any correspondence received from the Veteran which indicates a desire to submit a new claim of entitlement to service connection for tinnitus or hearing loss, nor has the Veteran alleged that he sent such correspondence. In the absence of any additional claims submitted prior to May 25, 2012, there is no basis upon which the Board can grant entitlement to an earlier effective date. To the extent that the Veteran has argued that he has had tinnitus and hearing problems since his separation from service or at least for some time prior to submitting his claim in May 2012, and consequently deserves to be compensated for this time regardless of not having filed any other claims prior to 2012, the Board is bound by the laws and regulations that apply to veterans’ claims. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 19.5, 20.101. While acknowledging the Veteran’s contentions, the applicable statutory and regulatory provisions cited above are binding and the Board has no option but to deny entitlement to an effective date prior to May 25, 2012. The Board will not grant the Veteran’s claim on an equitable basis, and it is required to follow the specific provisions of the controlling law and regulations. 38 U.S.C. § 7104; Harvey v. Brown, 6 Vet. App. 416, 425 (1994). In sum, there is no document or record that might be construed, even in the broadest sense, as a claim of entitlement to service connection for bilateral hearing loss or tinnitus after the final June 1978 decision and prior to the May 25, 2012 claim. Therefore, there is no basis for granting an earlier effective date prior to May 25, 2012, and the claims of entitlement to earlier effective dates for the award of service connection for bilateral hearing loss and tinnitus are denied. REASONS FOR REMAND Bilateral Foot Disability In May 2012, the Veteran submitted a claim of entitlement to service connection for a bilateral foot tissue condition with osteoarthritis. He wrote in November 2015 that in service he ran three miles a day barefoot for martial arts training to toughen his feet and that he now has problems with balance and gait. He also writes that service connection is warranted for a rash on his feet and that he has experienced continued problems with his feet ever since service. The Veteran’s service treatment records show that he was treated on several occasions for plantar warts, and in March 1977 he reported pain on the ball of his left foot. In June 1976 he was treated for tinea pedis/athlete’s foot. The Veteran’s December 1977 separation examination noted a foot rash. A February 2013 VA examiner noted that the Veteran had tinea pedis in service which resolved without residuals, and found that the claimant’s currently claimed condition was less likely than not incurred in or caused by service. The examiner also wrote that the Veteran’s osteoarthritis of the feet was not related to his foot skin condition which was resolved tinea pedis. The VA examiner’s opinion is inadequate to decide the issue. The examiner stated that the Veteran’s tinea pedis had resolved in service, but did not properly address the claimant’s assertions that he had continuing problems with foot rashes from the time of service to the present, and did not consider the Veteran’s assertion that the extensive physical training in service caused serious foot pain which he believes eventually developed into his current osteoarthritis of the feet. The issue is therefore remanded so that a more comprehensive examination and opinion can be obtained prior to readjudication. Additionally, there are indications in the VA treatment records that the Veteran attended podiatry consultations in April and October 2011, but the actual reports are not included in the VA treatment records that have been uploaded to VBMS. These records should be obtained, if possible, and associated with the record. Acquired Psychiatric Disorder The Veteran also claims entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder. The Veteran wrote in June 2013 that he had been unfairly arrested in service and tried for marijuana possession, but was found innocent. He wrote that this trauma has never left him and that he still has flashbacks to the incident. The Veteran’s VA treatment records show psychotherapy for various psychiatric diagnoses, a chronic pain syndrome, and insomnia. In April 2010, the Veteran was diagnosed with depression and chronic pain. In November 2016, he was diagnosed with mixed anxiety and depression, which was opined to be most consistent with a chronic adjustment disorder. In June 2016, his diagnoses were noted to be depression and posttraumatic stress disorder. A psychiatrist diagnosed the Veteran with depression, anxiety best typified as chronic dysthymia and anxiety (rule out childhood posttraumatic stress disorder versus narcissistic personality traits) in September 2016. He was noted to have depression, rage, and reactivity bordering on paranoia similar to what is seen in posttraumatic stress disorder. In May 2017, he was found to have symptoms of depression, anxiety, character and developmentally based rigidity, suspiciousness, and rage reaction. In addition, the Veteran’s treatment records also indicate that his psychiatric symptoms may be caused or aggravated by his chronic pain. Because the question of entitlement to a bilateral foot disorder is still on appeal, an examiner should provide a medical opinion addressing whether any diagnosed psychiatric disorders are caused and/or aggravated by chronic pain from a bilateral foot disorder or other service-connected disorder. Given that the Veteran has not yet been afforded a VA psychiatric examination, the Board remands this case so that an appropriate evaluation can be made to assess his current diagnoses and their etiologies. Increased Rating for Eczema The Veteran is service connected for eczema/dermatitis of the hands, forearms, and thighs since December 16, 1977. The disorder is rated as 10 percent disabling. In May 2012, the Veteran submitted a claim for an increased rating for his skin disorder. At a February 2013 VA examination, the examiner discussed the Veteran’s history of eczematoid dermatitis on the arms and thighs since service, as well as facial rash and tinea pedis in service. The examiner wrote that the conditions did not cause any scarring or disfigurement of the head, face, or neck and that it was treated with Lubriderm cream, a topical medication, for 6 weeks or more in the past 12 months, but not constantly. The examiner wrote that the Veteran’s eczema affected less than 5 percent of the total body area and exposed area. The Veteran wrote in June 2014 that he had a new outbreak of eczema across his body and face. He wrote that it was disfiguring and caused him negative emotional feelings and loss of confidence, and that he believed it affected more than 10 percent of his body. A November 2013 letter from physician R.S. at a dermatology clinic stated that the Veteran had seborrheic dermatitis on his face which “previously involved 20 to 30 percent of his face” and was under control as of October 2013. The Veteran’s treatment records from private dermatologist R.S. show notations of dermatitis on the face, ears, chest, abdomen, upper arms, and feet. The Veteran was afforded a new VA examination in July 2015. The Veteran diagnosed the Veteran with eczema/seborrheic dermatitis. She noted that the Veteran was using Elidel cream on his face, tar shampoo on his scalp and ears, and Lubriderm on the arms, thighs, and hands, and that the use of topical medications was constant/near-constant. The Veteran did not have any other treatments. The examiner found that the Veteran’s skin conditions did not cause scarring or disfigurement of the head, face, or neck. The total body area and exposed area affected was less than 5 percent. The Veteran’s eczema dermatitis is rated under onychomycosis/toenail tinea unguium is rated under Diagnostic Code 7806, for dermatitis or eczema. Diagnostic Code 7806 assigns a 10 percent rating when the skin condition covers at least 5 percent, but less than 20 percent of the entire body or exposed areas; or requires intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs for a total duration of less than 6 weeks during the past 12-month period. A 30 percent rating is assigned when the skin condition covers 20 to 40 percent of the entire body or exposed areas, or systemic therapy drugs were required for a total duration of 6 weeks or more during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806. In September 2018, the United States Court of Appeals for Veterans Claims issued the panel decision Burton v. Wilkie, Vet. App. No. 16-2037 (September 28, 2018), which held that when determining whether topical treatment for a skin disorder constitutes systemic therapy such as corticosteroids or other immunosuppressive drugs, it must be determined whether the topical treatment operates by affecting the body as a whole and whether the given treatment is “like” a corticosteroid or other immunosuppressive drug. Because the Veteran has been prescribed Elidel and Lubriderm creams for treatment of his service-connected skin disorder, the Board finds that an addendum medical opinion is required to establish whether the Veteran’s topical medication could constitute the equivalent of a systemic therapy. The matters are REMANDED for the following action: 1. Obtain all available records from the VA Pacific Islands Health Care System in Honolulu, Hawaii, and its affiliated facility, the VA Hilo Community Based Outpatient Clinic, since November 2017, including any podiatry consultation records which are not included in the records currently uploaded into VBMS, such as the April and October 2011 podiatry consultations. If any such records cannot be located, specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. Then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Provide the Veteran with another opportunity to submit a completed release form (VA Form 21-4142) authorizing VA to request any additional, relevant private treatment records, including any treatment through the VA Choice program or through his private dermatologist. The Veteran should be advised that he can also submit those records himself, including any private evaluations he has attended. If the Veteran provides a completed release form, then request the identified treatment records. At least two attempts should be made to obtain any records, and all attempts to secure those records must be documented in the Veteran’s claims file. He and his representative should be notified of any unsuccessful efforts. 3. After completing directives one and two, schedule the Veteran for a VA podiatry examination to address the nature and etiology of any current foot disorder, including osteoarthritis and tinea pedis. The examiner must be provided access to all files in Veteran’s VBMS and Virtual VA/Legacy files, and must specify in the report that these files have been reviewed. Following a review of the files, please address the following: What are the Veteran’s current diagnoses pertaining to the feet? Please discuss the treatment records showing diagnoses of osteoarthritis, tinea pedis, and dermatitis. For each and every disorder diagnosed at any time since 2012, is it at least as likely as not (is there a 50/50 chance) that the disorder had its onset during or was otherwise related to his service? Please discuss the Veteran’s assertions that he had continuing problems with skin infections on his feet ever since service and that he ran many miles in service barefoot, which he argues caused severe foot pain which has been ongoing since service. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed. 4. Schedule the Veteran for a VA psychiatric examination with a psychiatrist or psychologist to determine the nature and etiology of any diagnosed acquired psychiatric disorder. The examiner must be provided access to all files in Veteran’s VBMS and Virtual VA/Legacy files, and must specify in the report that these files have been reviewed. The examiner is to provide a detailed review of the Veteran’s pertinent medical history, current complaints, and the nature and etiology of any diagnosed psychiatric disability. The examiner should then address: a. What are the Veteran’s current psychiatric diagnoses? Please discuss the Veteran’s diagnoses in his VA treatment records, including posttraumatic stress disorder, anxiety disorder, depressive disorder, adjustment disorder, and narcissistic personality disorder. b. For each and every psychiatric disorder found, address whether it is at least as likely as not that the disorder is related to the Veteran’s active military service. Please specifically address the Veteran’s assertions that he experienced a trauma in service when he was unfairly arrested and tried for marijuana possession and has had nightmares and other psychiatric problems ever since. c. For each and every psychiatric disorder diagnosed, address whether it is at least as likely as not that the disorder was (i) caused or (ii) is aggravated (worsened beyond the natural progression) by the Veteran’s service-connected disabilities or by a bilateral foot disorder. Please discuss the Veteran’s assertions that his skin disorder causes him shame and embarrassment and the medical evidence indicating that his symptoms are worsened by chronic pain disorder. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed 5. Obtain an addendum medical opinion to address the nature of the Veteran’s treatment for service-connected eczema dermatitis on the hands, forearms, and thighs. The examiner must be provided access to all files in Veteran’s VBMS and Virtual VA/Legacy files, and must specify in the report that these files have been reviewed. The examiner should then discuss all of the medications that the Veteran has taken for treatment of his eczema dermatitis, including, but not limited to, Elidel cream, tar shampoo, and Lubriderm, and state whether any of these topical treatments a) operate by affecting the body as a whole in treating his skin condition and b) are “like” a corticosteroid or other immunosuppressive drug. Please also discuss whether the Veteran uses these medications on a large enough scale that the use of this treatment could be considered “systemic.” A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary E. Rude, Counsel