Citation Nr: 18151284 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 15-18 963 DATE: November 16, 2018 ORDER Service connection for fibrocystic breast disease is denied. A compensable rating for dry eye syndrome is denied. A compensable rating for anemia is denied. A compensable rating for surgical scar of abdomen is denied. A compensable rating for Hashimoto’s thyroiditis is denied. REMANDED Entitlement to service connection for Raynaud’s syndrome is remanded. Entitlement to service connection for right and left hand and forearm numbness is remanded. Entitlement to service connection for Marfanoid habitus is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for fatigue is remanded. Entitlement to service connection for seborrheic dermatitis is remanded. Entitlement to service connection for a headache disability is remanded. Entitlement to service connection for bilateral toenail fungus is remanded. Entitlement to service connection for corns on feet is remanded. FINDINGS OF FACT 1. The Veteran has no current pathologies associated with her fibrocystic breast disease. 2. The Veteran’s dry eye syndrome, treated with eye drops and artificial tears, results in no objective symptomatology and causes no visual impairment. 3. During the period applicable to the appeal, the Veteran’s hemoglobin has been tested to be no less than 13.1 gm/100 ml. 4. The Veteran’s hysterectomy scar is no more than 14 centimeters by 1 centimeter, is linear and superficial, and is not unstable or painful, nor does it cause any functional limitation. 5. The Veteran is not on continuous medication to treat her Hashimoto’s thyroiditis, which does not cause fatigability or other symptomatology. CONCLUSIONS OF LAW 1. The criteria for service connection for fibrocystic breast disease have not been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.304 (2017). 2. The criteria for a compensable evaluation for dry eye syndrome have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.79, Diagnostic Code 6018. 3. The criteria for a compensable rating for anemia have not been met. 38 U.S.C. §§ 1155, 5103, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.117, Diagnostic Code 7700 (2017). 4. The criteria for a compensable evaluation for surgical scar of abdomen have not been met. 38 U.S.C. §§ 1155, 5103, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.118, Diagnostic Code 7804 (2017). 5. The criteria for a compensable evaluation for Hashimoto’s thyroiditis have not been met. 38 U.S.C. §§ 1155, 5103, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.119, Diagnostic Code 7903 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Army from March 1983 to August 1989, from February 1992 to July 1992 and active service in the Air Force from August 1992 to June 1993 and from March 1995 to August 2010. Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2017). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). 1. Entitlement to service connection for fibrocystic breast disease The Veteran was diagnosed with fibrocystic breast disease in service, but has had no pathologies related to the finding or residuals such as scars during the period on appeal. The Veteran argues that she should be granted service connection for fibrocystic breast disease as it was diagnosed while she was in service. A review of the Veteran’s service treatment records shows a January 1994 service medical examination listing a diagnosis of fibrocystic breast disease. Although fibrocystic breast disease is termed a “disease” it is actually a physiologic finding that is generally acute and transient; service connection is not routinely awarded for fibrocystic breast disease. However, service connection for fibrocystic breast disease may be awarded for associated pathologies, such as persistent lumps or thickening requiring surgical excision or fibrocystic breast changes with associated atypical hyperplasia. If service treatment records show fibrocystic breasts and medical evidence shows continuous symptoms and/or nexus to subsequent post-service excision of persistent lumps or thickening, then service connection may be granted. At her February 2010 service retirement examination, the Veteran was noted not to have any breast lumps or pain. On VA examination in October 2010 the Veteran is noted to have no symptoms and to be receiving no treatment related to fibrocystic breast disease. A breast examination showed no masses, scars, nipple discharge, skin abnormality, or surgery. The examiner found no pathology to render a diagnosis. A January 2016 private treatment record notes no breast swelling, tenderness, discharge, or bleeding. A review of the Veterans claims file does not show any statements made by the Veteran herself reporting any symptoms of her fibrocystic breast disease diagnosed in 1994, to include lumps or thickening. Physical examination of the breasts during the period on appeal note no breast pathologies, to include lumps or thickening. Thus, the Board acknowledges the 1994 diagnosis of fibrocystic breast disease in service but finds that a preponderance of the evidence is against finding that she has any current pathologies associated with the condition such that it qualifies as a disability for service connection purposes. Therefore, the claim is denied. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2017). 2. Entitlement to an initial compensable rating for dry eye syndrome The Veteran’s dry eye syndrome is rated noncompensable under Diagnostic Code 6099-6018 for chronic conjunctivitis. The rating criteria do not provide specific criteria for dry eye syndrome, therefore the disability must be rated by analogy. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27 (2017). During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Both the former and revised criteria for Diagnostic Code 6018 distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. 38 C.F.R. § 4.79 (2017). Here, the Board finds that the Veteran’s dry eye syndrome is not an active disease process with objective findings. On VA examination in October 2010 she reported burning and dryness in her eyes but no pain, redness, watering, or discharge. External ocular examination was unremarkable with normal appearing lids, lashes, lacrimal apparatus, and orbits. The conjunctiva, cornea, anterior chamber and iris were also noted to be unremarkable. She was diagnosed with dry eye syndrome, treated with Restasis. On VA examination in December 2016 her corneal health was noted to be good with no signs of devitalized conjunctival or corneal areas. Schirmer's test showed normal strip wetting in both eyes. The examiner explained that a measurement over 15 mm is considered normal, and the Veteran showed over 25mm bilaterally, an increase from her “borderline normal” tear film wetting of 13 to 15 mm in 2010. Lissamine green staining showed no signs of devitalized corneal or conjunctival areas in either eye. Fluorescein staining showed good tear film coverage and normal tear break up time both eyes. The examiner concluded the condition was stable, if not improved. Although the Veteran has reported some subjective symptoms for which she uses eye drops and artificial tears, objective examination and testing has not indicated any dry eye syndrome symptoms. Therefore, the Board finds that a rating for an active disease process under Diagnostic Code 6018 is not warranted. For an inactive disease process, both the former and revised Diagnostic Code 6018 criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement. The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Here, the evidence does not reflect that the Veteran has experienced any incapacitating episodes due to her dry eye syndrome. Thus, a compensable rating is not warranted on that basis. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a) (2017). Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1) (2017). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. 38 C.F.R. § 4.76(c) (2017). Here, on VA examination in October 2010 the Veteran’s visual acuity was measured to be 20/25 in the right eye and 20/20 in the left eye. On VA examination in December 2016 Visual acuity was measured to be 20/40 or better in both eyes. Thus, a compensable rating is not warranted on the basis of visual acuity. Evaluation of visual field is based on the remaining field of vision in each eye. 38 C.F.R. § 4.77 (2017). On VA examination in October 2010 and December 2016, the Veteran’s visual field was noted to be grossly intact. Therefore, a compensable rating is not warranted on the basis of loss of visual field. Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78(a) (2017). There is no evidence here that the Veteran has diplopia as a result of her dry eye syndrome, therefore, a compensable evaluation for impairment of muscle function is not warranted. Finally, there is no evidence that the Veteran’s dry eye syndrome results in any characteristics of disfigurement such that a rating would be warranted under Diagnostic Code 7800. The Board notes that it also considered whether it would be more appropriate to rate the Veteran’s dry eye syndrome under Diagnostic Code 6025, for disorders of the lacrimal apparatus (epiphora, dacryocystitis, etc.). However, on VA examination in 2010 the Veteran was noted to have a normal appearing lacrimal apparatus and no other evidence suggests that the Veteran’s dry eye syndrome is a disorder of the lacrimal apparatus. The Board finds that Diagnostic Code 6018 reasonably contemplates the Veteran’s dry eye syndrome based on functions affected, the anatomical localization, and symptomatology. Based on the forgoing, the Board finds that a compensable rating for dry eye syndrome is not warranted. 3. Entitlement to an initial compensable rating for anemia The Veteran’s current noncompensable rating for anemia is assigned under Diagnostic Code 7700. Diagnostic Code 7700 provides ratings for hypochromic-microcytic and megaloblastic anemia, such as iron deficiency and pernicious anemia. Anemia with hemoglobin 10 gm/100 ml or less, asymptomatic, is rated as noncompensable. Anemia with hemoglobin 10 gm/100 ml (i.e., 10 gm/1 dL) or less with findings such as weakness, easy fatigability or headaches, is rated 10 percent disabling. Anemia with hemoglobin 8 gm/100 ml (i.e., 8 gm/1 dL) or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath, is rated 30 percent disabling. Anemia with hemoglobin 7 gm/100 ml (i.e., 7 gm/1 dL) or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months), is rated 70 percent disabling. Anemia with hemoglobin 5 gm/100 ml (i.e., 5 gm/1 dL) or less, with findings such as high output congestive heart failure or dyspnea at rest, is rated 100 percent disabling. 38 C.F.R. § 4.117 (2017). On VA examination in October 2010, testing showed the Veteran’s hemogloblin level to be at 13.6 gm/100ml. On VA examination in April 2016, testing showed the Veteran’s hemogloblin level to be at 13.1 gm/100ml. The examiner noted that the Veteran reported symptoms of fatigue, tachycardia, and shortness of breath that she attributed to her anemia; however, the examiner opined that such symptoms are not related to her anemia as her hematocrit is normal. In December 2016 the Veteran’s hemoglobin was tested to be 13.3 gm/100 ml. The examiner stated that the Veteran’s B12 injections have corrected her anemia and she has no current symptoms related to the anemia. The Board acknowledges the Veteran’s contention that she experiences symptoms of anemia. However, laboratory testing has not shown a hemoglobin reading of less than 13.1 at any point during the appeal. VA examiners in 2016 explained that the Veteran’s B12 injections have corrected her anemia. For a compensable rating under Diagnostic Code 7700, a veteran’s anemia must result in hemoglobin 10 gm/100 ml or less. As the objective medical evidence does not show a hemoglobin reading of 10 gm/100 ml or less, the Board finds that a preponderance of the evidence is against entitlement to a compensable rating for anemia. 4. Entitlement to a compensable rating for surgical scar of the abdomen The Veteran’s current noncompensable rating for surgical scar of the abdomen is assigned under Diagnostic Code 7805. Diagnostic Code 7805 states that scars and other effects of scars should be evaluated under diagnostic codes 7800, 7801, 7802, or 7804. 38 C.F.R. § 4.118 (2017). Diagnostic Code 7800 evaluates scars of the head, face, and neck, and is thus not applicable here as the scars at question are on the Veteran’s knee. Diagnostic Code 7801 evaluates scars, not of the head, face, or neck that are deep and nonlinear, and is also not applicable. On VA examination in October 2010 the Veteran’s hysterectomy scar was noted to be a linear, superficial scar of 14 centimeter by 1 centimeter. On VA examination in December 2016 the scar was noted not to be deep and non-linear and to be 12.7 centimeters in length. Superficial and nonlinear scars not of the head, face, or neck are evaluated under Diagnostic Code 7802. Under this diagnostic code, a 10 percent rating is assigned for scars that cover an area or areas of at least 144 square inches (929 square cm). Note 2 provides that a superficial scar is one not associated with underlying soft tissue damage. Here, the evidence does not reflect that an area of at least 144 square inches is covered by scar. Finally, Diagnostic Code 7804 assigns ratings for scars that are unstable or painful. This diagnostic code assigns a 10 percent rating for one or two qualifying scars, a 20 percent rating for three or four qualifying scars, and a 30 percent rating for five or more qualifying scars. Note 1 under the diagnostic code provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. On VA examination in both 2010 and 2016 the scar was noted not to be painful or unstable, thus Diagnostic Code 7804 does not apply. Any disabling effects not considered in a rating provided under diagnostic codes 7800-7804 should be evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.118 (2017). There is no indication here that the Veteran’s hysterectomy scar causes any disabling effects. Both the 2010 and 2016 VA examinations noted no limitation of function due to the scar. Based on the forgoing, the Board finds that a compensable rating is not warranted for the Veteran’s abdominal scar. 5. Entitlement to a compensable rating for Hashimoto's thyroiditis The Veteran’s Hashimoto’s thyroiditis is currently rated as noncompensable under Diagnostic Code 7903 for hypothyroidism. Under Diagnostic Code 7903, a 10 percent disability rating is warranted for fatigability or where continuous medication is required for control. A 30 percent disability rating is warranted for fatigability, constipation, and mental sluggishness. A 60 percent disability rating is warranted for muscular weakness, mental disturbance, and weight gain. A 100 percent disability rating is warranted for cold intolerance, muscular weakness, cardiovascular involvement, mental disturbance (dementia, slowing of thought, depression), bradycardia (less than 60 heart beats per minute), and sleepiness. 38 C.F.R. § 4.119 (2017). At her October 2010 VA examination, the Veteran attributed feelings of fatigability, poor memory, and cold intolerance to her thyroid condition. She denied sleepiness, tremor, emotional instability, depression, slowing of thought, difficulty breathing, and difficulty swallowing. She also reported that the condition does not affect her body weight and has not resulted in any heart or gastrointestinal complications. She reported she is currently not receiving any medical treatment for a thyroid condition. The examiner opined there was insufficient evidence to diagnose her with a thyroid condition. A January 2016 private treatment record notes a diagnosis of unspecified hypothyroidism and that her levels should be rechecked. Although the treatment record mentions fatigue, it indicates that she is receiving B12 injections to treat the fatigue and magnesium to help with muscle fatigue, which does not suggest a relationship to her thyroid condition. Lab testing showed Free T4 and Tsh within the reference range. On VA examination in December 2016 the examiner noted that the Veteran has an enlarged thyroid/goiter but her thyroid function studies are all normal, she is not on thyroid replacement medication, and has no symptoms related to her goiter. She was noted not to have any treatment for a thyroid or parathyroid condition. The evidence does not reflect that the Veteran is on continuous medication to treat her thyroid condition. Further, although the Veteran has subjectively reported experiencing fatigability, the most probative medical evidence, particularly the opinion of the December 2016 VA examiner. does not support that the symptom is related to her Hashimoto’s thyroiditis. The Board acknowledges the Veteran’s own opinion, but finds that as a lay person she does not have the education, training, or experience to attribute her subjectively observable symptom of fatigability, which is a symptom of many conditions, specifically to her service-connected thyroid condition. See 38 C.F.R. § 3.159(a)(1); Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011). As a preponderance of the evidence is against finding that the Veteran is on continuous medication for treatment of her service-connected thyroid condition or that she has any symptoms, including fatigability, of that conditions, a compensable rating is not warranted. Based on the forgoing, the Board finds a preponderance of the evidence is against a compensable rating for Hashimoto’s thyroiditis, the benefit of the doubt doctrine does not apply, and the claim must be denied. REASONS FOR REMAND 1. Entitlement to service connection for Raynaud's syndrome, right and left hand and forearm numbness, Marfanoid habitus, a neck disability, and fatigue is remanded. A March 2003 service treatment record reflects that the Veteran reported numbness in both hands that started in her fingertips and had moved into her forearms in the past two months. A treatment note also indicates complaints of neck and muscle pain. It was noted that Raynaud’s phenomenon was suspected and a rheumatology consult was placed. In April 2003 she was diagnosed with Raynaud’s syndrome and Marfanoid habitus. At the time of the examination she complained of paresthesias, pain, aches, fatigue, and sleep loss. The VA examiner who conducted the Veteran’s October 2010 compensation and pension examination opined there is no pathology to render a diagnosis of Raynaud’s disease, right and left hand numbness, Marfanoid habitus, a neck muscle condition, or fatigue. The Veteran has argued that the conditions manifest intermittently and were not in an active phase at the time of the examination. The Veteran requested that she be scheduled for a new VA examination during an active phase of the conditions. Given the in-service diagnoses and the Veteran’s contentions, the Board finds that she should be afforded a new VA examination, if possible when the Veteran reports the conditions are active, to determine what current diagnoses are warranted. 2. Entitlement to service connection for seborrheic dermatitis is remanded. Service treatment records include a January 1994 report of the Veteran seeking treatment for dry skin on the scalp and eyebrows. She was diagnosed with seborrheic dermatitis. In April 1996 she sought additional treatment for the condition and was prescribed shampoo and cream. She returned again in December 1997, continuing to report flakiness on the scalp and around the ears and eyebrows. She sought treatment again in May 2001 with the same complaints and a continuing diagnosis of seborrheic dermatitis was noted. A March 2009 medical record note indicates that the Veteran requested a referral to dermatology for a flaky scalp. On VA examination in October 2010 the Veteran reported she has itching and crusting primarily on her scalp and in her eyebrows since June 1996. The examiner found no skin pathology to render a diagnosis. The Veteran has reported that the condition is intermittent and has requested a new VA examination be scheduled when the condition is active. The Board notes that the Veteran is competent to report a symptom such as a dry scalp, which is readily observable to a lay person. On remand, the Veteran should be scheduled for a new VA examination, if possible during a period when the Veteran identifies her skin condition as being active. 3. Entitlement to service connection for a headache disability is remanded. An April 2005 service treatment record reflects that the Veteran sought treatment for a headache that had persisted for five days. She was noted not to have a history of similar headaches. She was diagnosed with a tension headache. At her October 2010 VA examination, the Veteran reported she has two headaches a month. The examiner did not make a diagnosis, stating that there was no pathology to do so. At her December 2016 VA examination, the Veteran reported that she has had recurrent headaches since 1998. The examiner noted the Veteran’s 2005 in-service diagnosis of tension headaches. The examiner opined that the Veteran’s headache condition was less likely than not incurred in or caused by service. The examiner explained that the Veteran’s service treatment records do not document a diagnosis of migraine headache or recurrent treatment for headaches and medical records do not document ongoing treatment for headaches. The Board notes that the Veteran is competent to report having headaches and to describe the symptoms of those headaches. The current VA examiner opinions are unclear as to whether they are opining, based on clinical examination and interview of the Veteran, that the Veteran does not currently have a headache condition, or if the opinion being rendered is that the Veteran does currently have a headache condition but it did not onset in and is not related to service. On remand, the Veteran should be afforded a new VA examination of her claimed headaches. The VA examiner should consider the Veteran’s lay statements and opine whether the Veteran has a current headache condition, and if so, whether that condition onset in or is related to service. 4. Entitlement to service connection for bilateral toenail fungus and corns on feet is remanded. On VA compensation and pension examination in October 2010 the Veteran reported that she had toenail fungus in both feet beginning in 1987. She also reported an onset of right foot pain in August 2008 that was not related to an injury. The examination report does not indicate whether the examiner saw evidence of toenail fungus or corns on physical examination. Although service treatment records do not include any complaints of or treatment for toenail fungus or corns, the Board notes that the Veteran’s October 2010 report of toenail fungus that had begun years prior was made less than three months after her separation from service. Further, the Veteran is competent to report the onset and presence of both corns and toenail fungus. Therefore, the Board finds that the Veteran should be scheduled for a VA examination in connection with her claim. The matters are REMANDED for the following action: 1. Afford the Veteran a new VA examination with respect to her claims for service connection for Raynaud’s syndrome, right and left hand and forearm numbness, Marfanoid habitus (claimed as muscle pain), a neck disability, and fatigue. If possible, the examination should be scheduled for a time when the Veteran identifies the condition as being active. For each of her claims, the examiner should opine whether she has or has had at any time during the period on appeal, the conditions claimed. The examiner must discuss all applicable symptoms. For each diagnosed condition, the examiner should opine whether it at least as likely as not onset in service or was otherwise caused by service. A full rationale should be provided for all opinions expressed. 2. Afford the Veteran a new VA skin examination. The examiner should opine whether the Veteran currently has, or has had at any time during the period on appeal, a skin condition manifest with dry skin, particularly on the scalp, to include seborrheic dermatitis. If possible, the examination should be scheduled for a time when the Veteran identifies the condition as being active. A full rationale should be provided for all opinions expressed. 3. Afford the Veteran a new VA headache examination. The VA examiner should consider the Veteran’s lay statements and opine whether the Veteran has a current headache condition, and if so, whether that condition onset in or is related to service. A full rationale should be provided for all opinions expressed. 4. Afford the Veteran a VA foot examination. The VA examiner should opine as to whether she has toenail fungus and corns, and if so, whether those conditions onset during or are related to service. A full rationale should be provided for all opinions expressed. 5. Thereafter, readjudicate the Veteran’s pending claims in light of any additional evidence added to the record. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. Thereafter, the case should be returned to the Board for appellate review. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Christensen