Citation Nr: 18147977 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 16-41 306 DATE: November 7, 2018 ORDER Prior to February 1, 2016, an initial disability rating greater than 30 percent for migraines is denied. Beginning February 1, 2016, a 50 percent rating, but no higher, for migraines is granted. Service connection for a right ankle disorder is denied. Service connection for post-traumatic stress disorder (PTSD) is granted. REMANDED An initial compensable disability rating for allergic rhinitis is remanded. Service connection for folliculitis, claimed as skin condition, is remanded. Service connection for vision problems due to fuel spillage is remanded. Service connection for asthma is remanded. FINDINGS OF FACT 1. Prior to February 1, 2016, the Veteran’s migraines resulted in characteristic prostrating attacks occurring on an average once a month. 2. Beginning February 1, 2016, the Veteran’s migraines have resulted in very frequent completely prostrating attacks productive of severe economic inadaptability. 3. The preponderance of the evidence establishes that residuals of a right ankle injury occurred during a period of dishonorable service. 4. The Veteran has been diagnosed with PTSD, there is credible supporting evidence corroborating his alleged in-service stressor, and medical evidence of record found his condition etiologically related to his active honorable service. CONCLUSIONS OF LAW 1. The criteria for a disability rating greater than 30 percent, prior to February 1, 2016, for migraines have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.14, 4.124a, Diagnostic Code (DC) 8100. 2. The criteria for a 50 percent rating, but no higher, beginning February 1, 2016, for migraines have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.14, 4.124a, DC 8100. 3. The criteria for service connection for a right ankle injury have not been met. 38 C.F.R. §§ 1110, 1131, 5103, 5103a, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 4. The criteria for service connection for PTSD have been met. 38 C.F.R. §§ 1110, 1131, 5103, 5103a, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304(f). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 2000 to December 2006. The Veteran’s service from November 2000 to November 2004 is considered honorable for VA purposes. The period of service from November 2004 to December 2006 is dishonorable for VA purposes. These matters come before the Board of Veterans’ Appeals (Board) from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Increased Rating Service connection for migraines was granted at a 30 percent disabling rate, effective March 29, 2012. Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. 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 military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where, as here, the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of “staged rating” is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board will also consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Migraine headaches are evaluated under 38 C.F.R. § 4.124a, DC 8100. Under this code, a 30 percent rating is assigned for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. Migraine headaches with very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability warrant a 50 percent evaluation, which is also the maximum evaluation available under this diagnostic code. The Veteran underwent a VA examination in August 2013 at which he reported experiencing characteristic prostrating attacks of migraine headache pain once every month to once every two months. He described that the majority of his headaches were incapacitating, he had difficulty concentrating, and he required bedrest in a dark room. He further stated that only medication took the edge off of his headaches. He noted that they had progressively worsened over time, increasing in frequency, intensity, and duration. He endorsed symptoms of constant head pain, pulsating or throbbing head pain, pain on both sides of the head, nausea, and sensitivity to light and sound. He indicated that his head pain lasted less than one day. The examiner determined that his migraines could interfere with his ability to maintain attention and concentration, which could interfere with the ability to obtain and maintain employment that required complex mental tasks. His condition could also result in increased absenteeism. There are few post-service treatment records in the claims file and they do not describe any ongoing clinical treatment, but do note headaches as a chronic condition. The Veteran also reported daily migraines to his mental health treatment providers. The Veteran submitted a log of his migraines, beginning February 1, 2016, which listed daily headache symptoms over a two-month period, noting their severity, time of day the headaches occurred, and the triggers for the headaches. He stated that they were preceded by an aura, worse with movement, and accompanied with throbbing pain, nausea, and sensitivity to light and sound. Later, he submitted another log covering March through May 2017 which listed daily headaches, detailing their duration, severity, triggers, and symptoms which were the same as those endorsed in the earlier logs. In both logs, he reported that he only used over-the-counter medication to treat his headaches and he did not detail any further treatment. In August 2016, a letter from the Veteran’s former employer was submitted which stated that the Veteran could not be employed full-time at their business because his headaches prevented him from working a stable work schedule. The Board finds that prior to February 1, 2016, the Veteran’s migraine condition manifested in characteristic prostrating attacks occurring on an average once a month. He reported as much to the VA examiner and there is no contradictory evidence in the claims file suggesting his headaches were more severe or frequent. Further, the Board finds that from February 1, 2016, the Veteran’s migraine condition manifested in very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability. The headache logs indicated that his condition had worsened appreciably in frequency and duration. The letter from his employer reported that he was inadaptable to a full-time schedule, given his frequent headaches. Accordingly, from the first date of entry of the headache logs, the Veteran’s migraines warrant a 50 percent evaluation. The extent and severity of the Veteran’s migraines are encompassed in the 50 percent rating afforded under 38 C.F.R. § 4.124a, DC 8100, and as noted above, this is the maximum schedular rating for this disability. Service Connection VA benefits are not payable unless the period of service upon which the claim is based was terminated by discharge or release under conditions other than dishonorable. 38 U.S.C. § 5303; 38 C.F.R. § 3.12(a). To establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Right Ankle Disorder The Veteran has contended that a right ankle disability had its onset during a period of honorable service. There are no service treatment records (STRs) from the Veteran’s period of honorable service that discuss any complaints, symptoms, treatment, or diagnosis of a right ankle disorder. During the period of dishonorable service, a May 2005 STR describes that the Veteran stepped off of a curb and inverted his ankle, resulting in an ankle sprain with pain and tenderness to his anterior talo tibial ligament. There are several records detailing follow-up appointments directly following the original report of injury and several prescribed periods of light duty with limitation on certain movements. A follow-up evaluation of the Veteran’s right ankle in June 2005 detailed the initial date of injury as May 2005. An x-ray examination was ordered in June 2005 which stated the reason as “S/p ankle injury May 2004. Not improving.” The July 2005 x-ray revealed a small lucent area in the subarticular region of the tibio-talar joint medially. Another follow-up in August 2005 listed the original injury as occurring in May 2005. Conservative treatment of the ankle injury continued until October 2005, when he was sent to an orthopedic surgeon to discuss his “six-month history of a right ankle sprain.” In January 2006, he underwent an arthroscopic assessment of his right ankle, medial malleolar osteotomy with fixation, and abrasion/microfracture technique for an osteochondral defect of the right talus. Following the surgery, he subsequently was monitored by clinicians and on light duty. A March 2006 Medical Evaluation Board report determined that the Veteran initially injured his right ankle in April 2005. The Board finds that the Veteran’s right ankle injury occurred during a period of service that is dishonorable for VA purposes and he is therefore legally estopped from his claim. There is absolutely no evidence of any injury or complaint regarding the right ankle during his period of honorable service, to include in May 2004, when the Veteran sought treatment for other complaints. Nor are there any profiles recommending light duty or limiting movement. There is clear evidence of a right ankle injury occurring in May 2005, continuing symptomatology, lack of improvement, changes in treatment approaches, and finally worsening to the point that surgery was needed in January 2006. Numerous records subsequent to the May 2005 injury documented that the original injury was in May 2005. The Veteran has pointed to the one record which included a May 2004 date in its x-ray examination order for the May 2005 injury. However, given the lack of any documentation of anything regarding the right ankle until May 2005 and the plethora of documentation following that date, it is plausible to assume that the May 2004 notation was simply a typographical error. The preponderance of the evidence weighs heavily against a finding that any injury to the right ankle occurred during the period of honorable service. As such, service connection is not warranted. 2. PTSD Service connection for PTSD requires medical evidence establishing a diagnosis of the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between the current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. See 38 C.F.R. §§ 3.304(f), 4.125; see also Cohen v. Brown, 10 Vet. App. 128, 140 (1997). As to medical evidence of a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125(a), this regulation provides that, for VA purposes, all mental disorder diagnoses must conform to the Fifth Edition of the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-V). Concerning the requirement that there be credible supporting evidence that the claimed in-service stressor occurred, section 3.304(f) sets forth circumstances that are exceptions to this rule and allow a claimant’s lay testimony, alone, to establish the occurrence of the alleged stressor. In the first circumstance, if the evidence establishes a diagnosis of PTSD during service and the claimed stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided the stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(1). In the second circumstance, if the evidence establishes that the Veteran engaged in combat with the enemy and the claimed stressor is related to that combat, in the absence of clear and convincing evidence to the contrary, and provided the stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(2). In the third circumstance, if a stressor claimed by a Veteran is related to his “fear of hostile military or terrorist activity” and a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted, confirms the claimed stressor is adequate to support a diagnosis of PTSD and that the Veteran’s symptoms are related to the claimed stressor, in the absence of clear and convincing evidence to the contrary, and provided the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(3). In the fourth circumstance, if the evidence establishes the Veteran was a prisoner-of-war (POW) under the provisions of section 3.1(y) of the regulations, and the claimed stressor is related to that POW experience, in the absence of clear and convincing evidence to the contrary, and provided the stressor is consistent with the circumstances, conditions, or hardships of the Veteran’s service, the Veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor. 38 C.F.R. § 3.304(f)(4). And in the fifth circumstance, if a PTSD claim is based on in-service personal assault, evidence from sources other than the Veteran’s service records may corroborate the Veteran’s account of the stressor incident. 38 C.F.R. § 3.304(f)(5). Here, the Veteran does not claim and there is no evidence otherwise showing that he engaged in combat with the enemy or was a prisoner of war. He has also not identified a stressor related to fear of hostile military or terrorist activity, nor has he alleged occurrence of an in-service personal assault. Finally, the Veteran’s STRs do not show diagnoses of PTSD or a related diagnosis such as anxiety disorder or “shell shock.” Accordingly, none of the above exceptions under section 3.304(f) apply. Therefore, the Veteran’s statements alone are not sufficient to establish an in-service stressor, but must be corroborated by credible supporting evidence. See Dizoglio v. Brown, 9 Vet. App. 163, 166 (1996); accord Moreau v. Brown, 9 Vet. App. 389, 394-95 (1996); see also Cohen, 10 Vet. App. at 146-47. The available evidentiary sources for corroboration of a claimed stressor are not limited to service records (as required prior to the adoption of 38 C.F.R. § 3.304(f)), but may also include other sources of evidence. See Cohen, 10 Vet. App. at 143 (citing to M21-1, Part VI, para 7.46(f) (Sept. 21, 1992); M21-1, Subch. XII, para 50.45(d) (1989)). Corroboration of every detail of the stressor is not required. Pentecost v. Principi, 16 Vet. App. 124, 128 (2002). Moreover, a Veteran’s actual presence during the stressor event need not be specifically corroborated if the evidence shows that he was assigned to and stationed with a unit that was present when a reported event that has otherwise been verified occurred; such evidence strongly suggests actual exposure to the stressor event. Id. In general, “after-the-fact medical nexus evidence,” such as a VA examiner’s finding that a claimant’s PTSD was caused by the alleged in-service stressor, cannot by itself serve as credible supporting evidence of the claimed in-service stressor. See Moreau v. Brown, 9 Vet. App. at 396. The Veteran has contended that his currently-diagnosed PTSD stems from his service, namely several connected incidents. He has stated that during a night of partying, he was a designated driver for his group. One Airman was drinking heavily and the Veteran confronted him and attempted to take him home. They argued, and the Veteran left the Airman. He found out a few hours later that the Airman had killed himself. He also described being distraught over the death of his friend and having trouble concentrating while working on the flight deck. He stated that when an aircraft suddenly turned, the force of the exhaust blew him off of the flight deck, and he fell into a safety net. He reported that if he had been blown a few inches further, he would have fallen completely off of the ship and would have died. There are no military personnel or other service records substantiating the Veteran’s alleged stressor. Additionally, there are no STRs showing any symptoms or treatment for a psychiatric condition. There is evidence that he had behavioral problems during his second period of active duty, leading to its categorization as dishonorable service. The evidence of record does establish that the Veteran has a diagnosis of PTSD and that he entered individual therapy in May 2015. A VA examination was conducted in August 2013 which diagnosed PTSD and found that an approximately similarly-stated stressor (experiencing the death of a friend he was supposed to take care of and being blown into a propeller and almost dying himself) established the basis to determine that his PTSD was at least as likely as not related to service. The examiner reasoned that the Veteran was diagnosed with PTSD and currently in treatment and no post-military stressor was identified. The examiner also noted that the stressor was conceded, which was not an appropriate finding, given that the stressor was based on the death of a friend and the Veteran’s own fear of death following a dangerous incident in the wake of the loss of his friend, which was not a stressor of fear of hostile military or terrorist activity. A May 2014 private psychiatric opinion also found that the Veteran’s PTSD was related to his active service based on numerous described incidents. As such, there is a diagnosis of PTSD and links between his condition and his active service. To establish service connection, credible supporting evidence is needed to substantiate the Veteran’s alleged stressor. In August 2017, the Veteran submitted a record outlining the death in service of the Airman he had identified in his stressor statement. The record confirmed that the man had died during the Veteran’s period of honorable active service, that the category of death was an accidental fall or jump, and that the cause of death was acute head injuries received upon falling while climbing down a downspout. The Veteran also submitted two statements from fellow servicemembers. They echoed his contentions regarding his reaction to his friend’s death, and described the incident where the Veteran was not concentrating due to his grief and was blown off of the flight deck. Affording him all benefit of the doubt, the Board finds that the evidence submitted substantiates the Veteran’s account of the stressor events. Accordingly, service connection for PTSD is established. REASONS FOR REMAND 1. Allergic Rhinitis The Veteran’s service-connected allergic rhinitis was last evaluated in August 2013. In an August 2017 statement, the Veteran’s representative wrote that the Veteran’s symptoms have progressively worsened since the August 2013 VA examination and requested a new examination. As such, a new VA examination is needed to evaluate the extent and severity of his disability. Further, in the August 2017 statement, the Veteran’s representative wrote that the Veteran had continued to receive treatment for his allergic rhinitis and the most recent VA treatment records in the claims file date back to June 2016. As such, updated VA treatment records should be sought on appeal. 2. Folliculitis/Skin Condition There is evidence in service that the Veteran was diagnosed with folliculitis and a heat rash with resolving ingrown hairs. He also received a shaving profile. He underwent a VA examination in connection with his claim for folliculitis/skin condition in August 2013. The examiner determined that he had had a diagnosis of folliculitis in service, but that it had resolved and there was no current condition. The Veteran has since stated that his condition is ongoing, that he receives prescribed medication to treat the condition, and that more recent VA medical records contained evidence of treatment. The VA records available do show that he has been prescribed hydrocortisone lotion and ketoconazole shampoo for a “skin condition.” As there is evidence of some sort of current skin disorder requiring treatment, a new VA examination is needed to determine whether any current condition is related to the Veteran’s active honorable service. 3. Vision Problems The Veteran’s STRs demonstrate an April 2001 incident during his active honorable service when he got jet fuel in his eyes, resulting in a scleral abrasion. He also reported in July 2004 that he experienced eye twitching and had difficulty focusing his vision. At an August 2013 VA examination, the Veteran reported blurry vision since the jet fuel incident. The examiner determined that the claimed condition was less likely than not related to service because his visual acuity was correctable to 20/20 in each eye at service entrance, the examination revealed unremarkable anterior and posterior eye health in both eyes without scarring or disfigurement from jet fuel spillage, and he currently had vision correctable to 20/20 in each eye. In a September 2016 private treatment record, the Veteran reported to clinicians that he experienced twitching and stinging in his eyes. As there are new medical records indicating symptomology similar to that experienced in service, a new VA examination is needed to determine whether the Veteran has an ocular condition related to his active honorable service. 4. Asthma The STRs from the Veteran’s period of honorable service contain no treatment for or diagnoses of asthma. During the Veteran’s period of dishonorable service, in October 2005 he was evaluated for possible asthma. He was given a profile due to a positive risk screen. Upon separation, a pulmonary function test (PFT) was performed which revealed normal baseline spirometry, however he had a poor quality methylcholine challenge test, so clinicians were unable to verify a diagnosis of asthma, but determined it was highly likely that he had some reactive airway disease. On his November 2006 service separation report, it was noted that he had asthma, diagnosed in 2005, with environmental triggers, stable with certain medications used to treat his allergic rhinitis. Post-service, a January 2007 VA treatment record noted that the Veteran had possible asthma secondary to environmental triggers. Subsequent VA records listed asthma, unspecified, as an ongoing condition. He has been prescribed Advair, Albuterol, and Singulair. There are several VA treatment records which indicated that the Veteran suffers asthma symptoms during exacerbations of his allergic rhinitis. At the August 2013 VA examination, he reported that when his seasonal allergies worsened, he would get short of breath and wheeze, but this would not happen if his allergies were well-controlled. The examiner did not diagnose asthma as a current condition. Although there is no evidence of asthma during the Veteran’s period of honorable service, subsequent treatment records indicate a possible connection between his service-connected allergic rhinitis and presumed asthma, unspecified. As such, remand is needed to determine whether the Veteran indeed has a diagnosis of asthma, and whether that condition is proximately caused or aggravated by his service-connected allergic rhinitis. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to any outstanding private treatment records pertaining to his claims, specifically to include any outstanding records of eye treatment. He should be asked to authorize the release of any outstanding pertinent non-VA medical records. 2. Obtain all outstanding VA treatment records, to include records since June 2016. 3. After completion of the above, schedule the Veteran for an appropriate VA examination to assess the current severity of his allergic rhinitis. The record should be made available and the examiner’s review of the record should be indicated. All appropriate tests and studies should be conducted, and all clinical findings reported in detail. The report should include all subjective complaints and objective symptoms. In addition to objective test results, the examiner should fully describe the practical effects caused by the disability. The examiner should include a rationale with all opinions. 4. Afford the Veteran a VA examination(s) with respect to his service connection claims. The record should be made available and the examiner’s review of the record should be indicated. The examination report should include discussion of the Veteran’s documented medical history and assertions. All appropriate tests and studies should be conducted, and all clinical findings reported in detail. (a.) Identify any current skin diagnoses. (b.) After reviewing the record and examining the Veteran, offer an opinion as to the following: Whether it is at least as likely as not (50 percent or higher degree of probability) that any diagnosed skin disorder is related to the Veteran’s active honorable service, to include the July 2001 diagnosis of heat rash and resolving ingrown hairs, August 2002 diagnosis of folliculitis, and July 2004 diagnosis of folliculitis with shaving profile. (c.) Identify any current eye diagnoses. (d.) After reviewing the record and examining the Veteran, offer an opinion as to the following: Whether it is at least as likely as not (50 percent or higher degree of probability) that any diagnosed eye disorder is related to the Veteran’s active honorable service, to include the April 2001 jet fuel incident and July 2004 complaint of eye twitching and difficulty focusing his vision. Special attention is directed to the September 2016 private treatment record. (e.) Identify all current respiratory diagnoses. (f.) After reviewing the record and examining the Veteran, offer an opinion as to the following: 1. Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s asthma or any other respiratory condition is related to any in-service disease, event, or injury; 2. Whether it is at least as likely as not (probability of 50 percent or better) that his asthma or other respiratory condition was caused by his service-connected allergic rhinitis; and 3. Whether it is at least as likely as not (probability of 50 percent or better) that his asthma or other respiratory condition was aggravated (i.e., permanently worsened beyond the natural progression) by his service-connected allergic rhinitis. 4. In determining whether the condition is aggravated by the service-connected disability, the clinician must opine upon a baseline level of severity of his asthma or respiratory condition established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the asthma or respiratory condition. 38 C.F.R. § 3.310(b). (g.) Although whether any diagnosed conditions are related to service may be obvious on the current record to one trained in medicine, it is necessary for purposes of VA benefits claims that a qualified person explain the matter to those untrained in medicine. To that end, the clinician is asked to provide a rationale and to explain the reasons behind each opinion expressed and conclusion reached. (Continued on the next page)   5. After completing the requested actions, readjudicate the claims considering all pertinent evidence. If the benefits sought remain denied, furnish to the Veteran and his representative a Supplemental Statement of the Case. APRIL MADDOX Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Rachel E. Jensen, Associate Counsel