Citation Nr: 18149101 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-15 188A DATE: November 8, 2018 ORDER The claim of entitlement to service connection for the residuals of an avulsion fracture of the left acetabulum, claimed as left hip injury, is reopened. Service connection for the residuals of an avulsion fracture of the left acetabulum, claimed as left hip injury, is granted. Compensation under 38 U.S.C. § 1151 for left sciatic nerve injury as a result of a Department of Veterans Affairs (VA) left total hip replacement surgery in April 2012 is granted. REMANDED Entitlement to service connection for right hip arthritis as secondary to avulsion fracture of the left hip is remanded. Entitlement to a disability rating in excess of 20 percent for dislocation of acromioclavicular (AC) joint of the left shoulder with loss of motion is remanded. Entitlement to an initial rating in excess of 20 percent for left upper extremity sensory deficit is remanded. Entitlement to a disability rating in excess of 10 percent for pes planus, bilateral, with arthritis of both calcaneus, by radiological evidence is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. An October 2006 rating decision declined to reopen the Veteran’s claim of entitlement to service connection for the residuals of an avulsion fracture of the left acetabulum; the Veteran did not appeal that decision in a timely manner nor was any new and material evidence submitted within a year of the issuance of the decision. 2. Evidence added to the record since the final October 2006 denial is not cumulative or redundant of the evidence of record at the time of the decision and raises a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for the residuals of an avulsion fracture of the left hip acetabulum. 3. The Veteran’s left hip disability is the result of an in-service avulsion fracture of the left acetabulum. 4. The Veteran’s left sciatic nerve injury is the result of his April 2012 left total hip replacement surgery and is due to an event not reasonably foreseeable. CONCLUSIONS OF LAW 1. The October 2006 rating decision that declined to reopen a claim of entitlement to service connection for the residuals of an avulsion fracture of the left acetabulum, claimed as left hip injury, is final. 38 U.S.C. § 7105(c) (2002), 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2006). 2. New and material evidence having been received, the claim for entitlement of service connection for avulsion fracture of the left acetabulum, claimed as left hip injury, is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. §§ 3.156(a) (2017). 3. The criteria for service connection for the residuals of an avulsion fracture of the left acetabulum, claimed as left hip injury, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for compensation under 38 U.S.C. § 1151 for left sciatic nerve injury as a result of a VA left total hip replacement surgery in April 2012 are met. 38 U.S.C. §§ 1151, 5103A, 5107; 38 C.F.R. §§ 3.358, 3.361, 17.32. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1977 to October 1980 and from January 1981 to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2014 rating decision by the Regional Office (RO) in Winston-Salem, North Carolina. New and Material Evidence 1. The claim of entitlement to service connection for avulsion fracture of the left acetabulum, claimed as left hip injury, is reopened. Pertinent procedural regulations provide that “[n]othing in [38 U.S.C. § 5103A] shall be construed to require [VA] to reopen a claim that has been disallowed except when new and material evidence is presented or secured, as described in [38 U.S.C. § 5108].” 38 U.S.C. § 5103A(f). Reopening a claim for service connection which has been previously and finally disallowed requires that new and material evidence be presented or secured since the last final disallowance of the claim. 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273, 285 (1996); see also Graves v. Brown, 8 Vet. App. 522, 524 (1996). New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). In Elkins v. West, 12 Vet. App. 209 (1999), the Court of Appeals for Veterans Claims (the Court) held the Board must first determine whether the appellant has presented new and material evidence under 38 C.F.R. § 3.156(a) in order to have a finally denied claim reopened under 38 U.S.C. § 5108. Then, if new and material evidence has been submitted, the Board may proceed to evaluate the merits of the claim, but only after ensuring that VA’s duty to assist has been fulfilled. See Vargas-Gonzalez v. West, 12 Vet. App. 321, 328 (1999). The law should be interpreted to enable reopening of a claim, rather than to preclude it. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Even if no appeal is filed, a rating decision is not final if new and material evidence is submitted within the appeal period and has not yet been considered by VA. 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011). In February 1999, the Veteran filed his original claim for service connection for left hip injury. The RO denied the claim in a November 1999 rating decision because the evidence did not link the Veteran’s current left hip complaints to any incidents in service. The Veteran did not submit any evidence within one year of the November 1999 rating decision, nor did he file a timely appeal to the November 1999 rating decision, with regard to this issue. In addition, no new and material evidence was submitted within a year of the decision. Therefore, it is final. 38 U.S.C. § 4005(c) (1988), 38 C.F.R. §§ 3.104, 19.129, 19.192 (1990). The Veteran filed a claim to reopen the issue of service connection for left hip condition in February 2006. In an October 2006 rating decision, the RO continued the denial for avulsion fracture of the left acetabulum, claimed as left hip injury, finding that no new and material evidence was submitted. The Veteran did not submit any evidence within one year of the October 2006 rating decision, nor did he file a timely appeal to the October 2006 rating decision. In addition, no new and material evidence was submitted within a year of the decision. Therefore, it is final. 38 U.S.C. § 7105(c) (2002), 38 C.F.R. §§ 3.104, 20.302, 20.1103 (2006). The Veteran filed a claim to reopen his claim for service connection for left hip injury in June 2012. The March 2014 rating decision on appeal denied the claim to reopen. The bases of the November 1999 and October 2006 prior final denials were the RO’s findings that there was no evidence linking the left hip condition to an incident, event, or disease in service. Thus, in order for the Veteran’s claim to be reopened, evidence must have been added to the record since the October 2006 rating decision that addresses this basis. Evidence submitted and obtained since the October 2006 rating decisions includes VA treatment records and Social Security Administration (SSA) disability claim records, VA examination reports, and lay evidence. In particular, in a May 2012 VA orthopedic surgery note, the Veteran’s orthopedic surgeon opined that if the Veteran was treated in service for his left hip problem, he certainly had it at that time. Without addressing the merits of this evidence, the Board finds that the additional evidence addresses whether the Veteran’s current left hip disability is related to his military service, and is presumed credible for the limited purpose of reopening the claim. Justus, 3 Vet. App. at 512-13. Thus, this evidence is both “new,” as it has not previously been considered by VA, and “material,” as it raises the reasonable possibility of substantiating the Veteran’s claim. The Board thus finds that new and material evidence has been submitted to reopen the issue of entitlement to service connection for avulsion fracture of the left acetabulum, claimed as left hip injury, since the October 2006 rating decision. On this basis, the issue of entitlement to service connection for the residuals of an avulsion fracture of the left acetabulum is reopened. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Generally, in order to establish service connection for the claimed disorders, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). In certain circumstances, lay evidence may also be competent to establish a medical diagnosis or medical etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). 2. Entitlement to service connection for the residuals of an avulsion fracture of the left acetabulum, claimed as left hip injury. The Veteran contends that his current left hip disability was incurred in service as a result of a left hip injury. The Board concludes that the Veteran has a current diagnosis of an avulsion fracture of the left acetabulum that occurred during active service and that he has current residuals related to the in-service injury. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). VA treatment records and the October 2006 VA examination report show the Veteran has a current diagnoses of avulsion fracture of the left acetabulum with residuals and left hip osteoarthritis, and the May 2012 VA orthopedic physician, Dr. W.O., opined that the Veteran’s left hip disability certainly began in service. The Veteran has reported that he complained about his left hip condition in service and his service treatment records reflect this. Dr. O. stated that “As far as I am concerned, if [the Veteran] was treated in the service for this particular problem, he certainly had it at that time. I feel this is certainly longstanding, and [the Veteran] says as far back as 1981, he complained about this when he was in the service.” Indeed, the Veteran’s service treatment records include multiple left hip complaints. He complained of injury to left hip, left hip pain and stiffness in July 1984 and July 1987. After separation from service, in May 1994, he complained of intermittent left hip pain and stated he sprained his hip in service. He continued to seek treatments for left hip pain in September 1999 and November 2000, and in January 2001 he reported a history of chronic left hip pain which began after a fall while performing a training exercise in the Army in 1987. X-ray of the left hip showed marked degenerative joint disease and degenerative disc disease in July 2001. The Veteran has made competent statements that he sustained a left hip injury in service and his left hip condition had its onset in service following the claimed injury. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent to report in-service and post-service symptoms such as dizziness, loss of balance, hearing trouble, stumbling and falling, and tinnitus that were later diagnosed as Meniere’s disease). The Board also finds his statements to be credible as they are consistent with his service and post-service treatment records showing ongoing left hip complaints. The October 2006 VA examiner stated that although it is well documented in the military record that the Veteran had a problem with his left hip, the failure to document at the time of his discharge and following his discharge, and up until 1995 makes it difficult to connect the service injury to the present injury without resorting to unfounded speculation. Both Dr. O. and the October 2006 VA examiner are medical professionals and equally competent to render an opinion regarding the etiology of the Veteran’s left hip disability. Although Dr. O. did not indicate that he had the opportunity to review the Veteran’s entire claims file, Dr. O. had been treating the Veteran as his orthopedic attending physician, to include the total left hip replacement surgery in April 2012. Thus, he was knowledgeable about the Veteran’s past medical history and the Veteran’s current diagnosis based on ongoing clinical experience with the Veteran. The Board therefore finds Dr. O.’s opinion highly probative of a nexus between the Veteran’s current left hip disability and his service. As such, resolving reasonable doubt in the Veteran’s favor, the Board finds that left hip injury was incurred in active service; thus, the criteria for service connection for avulsion fracture of the left acetabulum have been met. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1151 Eligibility The Veteran contends that benefits are warranted under the provisions of 38 U.S.C. § 1151 for additional disability involving severe left sciatic nerve injury resulting from a surgery performed at a VA Medical Center (VAMC) in April 2012. Specifically, the Veteran claims that he underwent a left total hip replacement surgery at the VAMC in Salisbury, North Carolina, and following the surgery, he experienced left leg pain and weakness. He asserts that he sustained left sciatic nerve injury during the left hip surgery. Under 38 U.S.C. § 1151, if VA hospitalization or medical or surgical treatment results in additional disability or death that is not the result of the claimant’s own willful misconduct or failure to follow instructions, compensation may be awarded in the same manner as if the additional disability or death were service connected. See 38 C.F.R. §§ 3.361. Then, in order to constitute a qualifying additional disability, the proximate cause of the additional disability must have been (1) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the facility furnishing the care, treatment, or examination, or (2) an event not reasonably foreseeable. 38 C.F.R. § 3.361(a). To establish causation, the evidence must show that the hospital care or medical or surgical treatment resulted in the veteran’s additional disability. Merely showing that a veteran received care or treatment and that the veteran has an additional disability does not establish cause. 38 C.F.R. § 3.361(c)(1). Hospital care or medical or surgical treatment cannot cause the continuance or natural progress of a disease or injury for which the care or treatment was furnished unless VA’s failure to timely diagnose and properly treat the disease or injury proximately caused the continuance or natural progress. 38 C.F.R. § 3.361(c)(2). To establish that carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on VA’s part in furnishing hospital care, medical or surgical treatment, or examination proximately caused a veteran’s additional disability, it must be shown that the hospital care or medical or surgical treatment caused that disability; and (1) VA failed to exercise the degree of care that would be expected of a reasonable health care provider; or (2) VA furnished the hospital care or medical or surgical treatment without the veteran’s informed consent. In evaluating the Veteran’s claim, the Board first must consider whether the evidentiary record shows that he has additional disability that was caused by negligent VA medical treatment. See 38 U.S.C. § 1151(a)(1). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is entitled to compensation under 38 U.S.C. § 1151 for left sciatic nerve injury claimed to be the result of surgical treatment at the VAMC in Salisbury, North Carolina. 3. Entitlement to compensation under 38 U.S.C. § 1151 for left sciatic nerve injury as a result of a VA left total hip replacement surgery in April 2012. On April 10, 2012, the Veteran underwent surgery at VA, which included left total hip arthroplasty. Two days following that surgery, the record shows that the Veteran appeared to have partial sciatic palsy on April 12, 2012. On his first postoperative visit, two weeks later, it was noted that the Veteran had had continued decreased sensation in his superficial and deep peroneal nerve distributions, and continued difficulty with ankle and toe dorsiflexion. EMG/NCV studies conducted in June and October 2012 revealed a severe left incomplete sciatic nerve injury, with greater involvement of the peroneal division. He continued to experience left leg pain, numbness, inability to dorsiflex his foot and foot drop. The Veteran seeks compensation for his left sciatic nerve injury under the provisions of 38 U.S.C. § 1151. The Veteran’s VA operating surgeon stated on an April 2012 surgical orthopedic note that the postoperative peroneal nerve palsy was likely a stretch injury which occurred intraoperatively. On a July 2012 surgical orthopedic note, the attending physician stated that the Veteran certainly did not have a foot drop before the surgery, and this just came afterwards because of primarily the severity of the reduction of this particular problem. In October 2013 and June 2014, the attending again indicated that the sciatic nerve injury was a complication of surgery, the nerve being stretched, and that “there is no question that the sciatic nerve was injured during his operation on his hip.” Additionally, in a March 2014 VA primary care note, the Veteran’s primary care physician noted a history of total hip surgery in April 2012, which was done fine, but the Veteran had left sciatic nerve injury with predominant peroneal damage and resultant left leg weakness and foot drop. As part of the adjudication of the Veteran’s claim, the entire record was reviewed by an orthopedic surgeon in February 2014 and an opinion was obtained. The VA examiner, however, offered an opinion that the Veteran’s signs and symptoms were clearly not the result of an intraoperative action as he had normal neurologic function and ambulation on the first day post operation, and appeared to have developed the clinical signs and symptoms on the second day post operation. The examiner determined that the cause of the neuropathy was therefore unknown and may be the result of occult spinal pathology, peripheral swelling or compression or some combination thereof. Based on foregoing, the February 2014 VA medical opinion appears to be at odds with the findings of the Veteran’s VA orthopedic surgeon and attending physician who performed the surgery at issue. The Board finds that the evidence is at the very least in equipoise regarding whether the Veteran has a left sciatic nerve injury as a result of his April 2012 left hip surgery. As such, resolving any reasonable doubt in the Veteran’s favor, the Board finds that both the evidence of additional disability prong and proximate cause prong of the criteria for entitlement to benefits under 38 U.S.C. § 1151 are met. The February 2014 VA examiner’s opinion is adamantly against any finding of carelessness, negligence, lack of proper skill, error of judgment, or any other instance of fault by the VA in furnishing hospital care, and there is no evidence to the contrary. As such, the focus here must be on the question of whether it was reasonably foreseeable that the Veteran would develop left sciatic nerve injury as a result of his left total hip replacement surgery. The February 2014 VA examiner stated that the Veteran has concomitant severe spinal stenosis which may be the sole cause, proximate cause or contributing factor to the Veteran’s signs and symptoms. However, the examiner also indicated that an event not reasonably foreseeable (i.e. not a normally expected and discussed potential risk associated with the treatment, procedure or condition) contributed to or resulted in the Veteran’s claimed injury or illness, even though there was no evidence indicating that there was failure on the part of VA to properly treat the claimed disease or disability. 38 U.S.C. § 1151 fully contemplates compensation in cases where there is a medical finding that the disability in question was caused by an event not reasonably foreseeable, and the evidence of record does not include any competent opinions suggesting the contrary. In view of this, the Board finds that the appropriate disposition is to grant compensation for left sciatic nerve injury as due to an event that was not reasonably foreseeable. See 38 U.S.C. §§ 1151(a)(1)(B); 5107. REASONS FOR REMAND Review of the record reveals that a remand is necessary to ensure that there is a complete record upon which to decide the Veteran’s remaining claims. Upon review, the Veteran’s claims file includes no VA treatment records between March 2014 and August 2015. Therefore, the RO should obtain any outstanding VA treatment records. Updated VA treatment records dated from April 2016 should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). 4. Entitlement to service connection for right hip arthritis as secondary to avulsion fracture of the left acetabulum is remanded. The Veteran is seeking service connection for right hip arthritis as secondary to his left hip disability. In light of the grant of service connection for avulsion fracture of the left acetabulum herein, the Board finds that a medical opinion addressing the claimed secondary relationship between the right and left hips is warranted to adequately decide the merits of this claim. 5. Entitlement to a disability rating in excess of 20 percent for dislocation of AC joint of the left shoulder with loss of motion is remanded. VA’s duty to assist includes the conduct of a thorough and comprehensive medical examination. Robinette v. Brown, 8 Vet. App. 69, 76 (1995). This includes providing a new medical examination when a veteran asserts or provides evidence that a disability has worsened and the available evidence is too old for an adequate evaluation of the current condition. Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (finding that VA should have ordered a contemporaneous examination of veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating). The Veteran last underwent a VA examination for his service-connected left shoulder disability in March 2014, over four years ago. Since then, he underwent a left shoulder rotator cuff repair surgery in April 2016. The Veteran is entitled to new VA examinations where there is evidence that his service-connected disability has worsened since the last examination. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); Caffrey, 6 Vet. App. at 381. Accordingly, a more contemporaneous VA examination is required to provide a current picture of the Veteran’s service-connected left shoulder disability. 38 C.F.R. §§ 3.326, 3.327 (2017). 6. Entitlement to an initial rating in excess of 20 percent for left upper extremity sensory deficit is remanded. A separate rating of 20 percent for left upper extremity sensory deficit was granted effective December 10, 2012, in the March 2014 rating decision. In this case, the Board finds that the Veteran must be afforded a VA neurologic examination to determine the existence and severity of any neurologic manifestations of the Veteran’s service-connected left shoulder disability. 38 C.F.R. § 3.159(c)(4)(i); see Littke v. Derwinski, 1 Vet. App. 90, 93 (1990) (noting that remand may be required if record before the Board contains insufficient medical information). 7. Entitlement to a disability rating in excess of 10 percent for pes planus, bilateral, with arthritis of both calcaneus, by radiological evidence is remanded. 8. Entitlement to a TDIU is remanded. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding records from the Ashville VA Medical Center in Salisbury, North Carolina from April 2016 to the present. All records and/or responses received should be associated with the claims file. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any current right hip arthritis. The claims folder must be made available to the examiner and reviewed in conjunction with the examination. All indicated tests, if any, should be conducted. The examiner must provide an opinion, in light of the examination findings, the service and post service medical evidence of record, and the lay statements of record, whether it is at least as likely as not (50 percent probability or more) that the Veteran has any current right hip disability that had its onset in service or is otherwise causally or etiologically related to his active service. The examiner must also provide an opinion as to the whether it is at least as likely as not that any currently diagnosed right hip disorder was proximately caused by, or aggravated beyond its natural progression by the Veteran’s service-connected left hip injury. The examiner must provide all findings, along with a complete rationale for his or her opinion(s), in the examination report. 3. The Veteran should be scheduled for an appropriate VA examination so as to determine the current the nature and extent of all impairment due to the service-connected left shoulder disability. The claims file must be reviewed in conjunction with the examination. All indicated tests should be performed and all findings should be reported in detail. The examiner should describe the nature and severity of all manifestations of the Veteran’s left shoulder disability. The examiner must test and record the range of motion for BOTH shoulders in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. The extent of any weakened movement, excess fatigability, and incoordination on use should also be described by the examiner. The examiner should assess the additional functional impairment due to weakened movement, excess fatigability, or incoordination in terms of the degree of additional range of motion loss. The examiner is reminded that he should specify the degree of additional functional loss/motion due to pain, to include during flare-ups, or state why it was not feasible to provide such information, as required for an adequate examination. Additionally, the examiner should determine whether the Veteran has ankylosis of the shoulders; loss of head (flail shoulder), nonunion, fibrous union, recurrent dislocation at the scapulohumeral joint, nonunion of the humerus; or dislocation, nonunion, malunion, of the clavicle or scapula. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 4. Schedule the Veteran for a VA neurological examination to ascertain the current nature and etiology of the Veteran’s left upper extremity sensory deficit. The claims file should be made available to the examiner for review. The examiner should undertake any evaluation and/or testing deemed necessary, including electromyography (EMG) and nerve conduction studies. The examiner must specifically state whether any neurologic manifestation found results in complete or incomplete paralysis of any nerve. The specific nerves involved must be identified. If incomplete paralysis is found, the examiner must state whether the incomplete paralysis is best characterized as mild, moderate, or severe; with the provision that wholly sensory involvement should be characterized as mild, or at most, moderate. A clear rationale for all opinions and findings and a discussion of the facts and medical principles involved should be provided. 5. After completing the above, readjudicate the claims on appeal. If any benefit sought on appeal remains denied, provide an additional supplemental statement of the case to the Veteran, and return the appeal to the Board for appellate review, after the Veteran and his representative have had an adequate opportunity to respond. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. J. In, Counsel