Citation Nr: 18151850 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-22 764A DATE: November 20, 2018 ORDER Service connection for sarcoidosis is denied. An evaluation in excess of 50 percent for migraine headaches is denied. An evaluation in excess of 30 percent for sinusitis is denied. An effective date earlier than April 4, 2012 for a 30 percent evaluation of sinusitis is denied. REMANDED Service connection for obstructive sleep apnea is remanded. Service connection for a dental condition, including TMJ dysfunction and osteomyelitis is remanded. REFERRED A claim of entitlement to service connection for a dental disability is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). In dental claims, the RO adjudicates the claim for service connection and the VA Medical Center (VAMC) adjudicates the claim for outpatient dental treatment. As the current issue of entitlement to service connection for a dental disability stems from an adverse determination by the RO, the dental issue addressed herein must be limited to service connection for compensation purposes only. Accordingly, the claim for VA outpatient dental treatment is referred to the Agency of Original Jurisdiction (AOJ) for further referral to the appropriate VAMC. See 38 C.F.R. §§ 17.161, 19.9(b) (2017). FINDINGS OF FACT 1. In a February 2009 rating decision, the RO denied the claim of service connection for sarcoidosis. The Veteran did not timely appeal this decision nor did he submit new and material evidence within the one-year period. 2. Relevant service treatment records were received since the February 2009 rating decision. 3. Sarcoidosis was not manifest in service or within the one-year presumptive period following service. Sarcoidosis is not attributable to service. 4. The Veteran is currently in receipt of the maximum evaluation for migraine headaches. 5. Sinusitis has been manifested by three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment. Radical surgery with chronic osteomyelitis or near constant sinusitis were not shown. 6. The Veteran’s claim for an increased evaluation for sinusitis was received by VA on May 7, 2012. An increase in severity of the disorder was not ascertainable until January 2013. CONCLUSIONS OF LAW 1. The criteria for reconsideration of the February 2009 rating decision have been met. 38 U.S.C.§§ 7105 (2012); 38 C.F.R. §§ 3.156 (c) (2017). 2. Sarcoidosis was not incurred in or aggravated during service and it may not be presumed to have been incurred in or aggravated by service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. The criteria for an evaluation in excess of 50 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.124a, Diagnostic Code 8100 (2017). 4. The criteria for an evaluation in excess of 30 percent for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.21, 4.97, Diagnostic Code 6513 (2017). 5. The criteria for an effective date earlier than April 4, 2012 for a 30 percent evaluation of sinusitis have not been met. 38 U.S.C. §§ 5110 (2012); 38 C.F.R. §§ 3.102, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1996 to January 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims held that a total disability rating based on individual unemployability (TDIU) claim is part of a claim for a higher rating when such claim is raised by the record or asserted by the Veteran. In this case, a TDIU was awarded as of the day after the Veteran’s last day of full time employment. See August 2016 rating decision. The medical and lay evidence of record does not show that his full-time employment was not substantially gainful. Accordingly, the TDIU claim is not before the Board as a component of his claim for an increased evaluation. Id. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The May 2013 rating decision denied the claim of service connection for a dental condition claimed as temporomandibular joint (TMJ) dysfunction and pain in the jaw. In a June 2013 statement, the Veteran’s representative clarified that evaluating the claim as a dental condition was incorrect, and that it should be evaluated as a TMJ disease. The June 2015 Statement of the Case separated the issue into two: 1) service connection for a dental disorder; and 2) service connection for temporomandibular joint dysfunction (claimed as pain in the jaw). The Board finds that these two issues are more appropriately characterized and analyzed as one issue, that of a dental disorder to include temporomandibular joint dysfunction and osteomyelitis. These disorders are compensable dental disabilities and better reflect the evidence and the Veteran’s claims. The issue of the tooth extraction alone has been referred as noted above. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for sarcoidosis, if the Veteran has established a current disability and it is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of a chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). 1. Service connection for sarcoidosis. Generally, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA shall reopen the claim and review the former disposition of the claim. New and material evidence is defined as evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration; such new and material evidence can be neither cumulative nor redundant of the evidence previously of record, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) However, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed but were not associated with the claims file when VA first decided the claim, VA will reconsider the claim, rather than requiring new and material evidence. See 38 C.F.R. § 3.156(c)(1). However, reconsideration is inapplicable to records that VA could not have obtained when it decided the claim because the claimant failed to provide sufficient information for VA to identify and obtain the records. See 38 C.F.R. § 3.156(c)(2). In February 2009, the RO denied the Veteran’s claim of service connection for sarcoidosis. The Veteran was notified of this denial but did not appeal nor submit evidence within the one-year appeal period. Service treatment records, except for one service examination report, were not available at the time of the rating decision. Since the time of the rating decision, service treatment records were located and associated with the claims file. As these are relevant service department records that existed but were not associated with the claims file when VA first decided the claim, VA will reconsider the original claim, rather than requiring new and material evidence. See 38 C.F.R. § 3.156(c)(1). The Veteran seeks service connection for sarcoidosis. The Veteran has contended that his job as a truck driver and exposure to J.P.8 fuel caused irreparable damage to his body and caused his respiratory disorders. See March 2012 Statement in Support of Claim. Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a). The question for the Board is whether the Veteran’s chronic disease, sarcoidosis, manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service. The Board concludes that sarcoidosis was not chronic in service or manifest to a compensable degree in service or within a presumptive period, and continuity of symptomatology is not established. VA treatment records show the Veteran was not diagnosed with, or treated for, sarcoidosis or its manifestations until May 2006, over three years after his separation from service and two years outside of the applicable presumptive period. The evidence also does not show manifestations of sarcoidosis during service or within the presumptive period. Indeed, there are no lung symptoms shown in the service treatment records, other than associated with bronchitis, rhinitis, or sinusitis. The first indication of lung symptoms occurs in the May 2006 records. The Veteran had an abnormal chest X-ray done for investigating chest pain and dyspnea that the Veteran experienced while running. The record notes that two years prior, the Veteran was able to run 5 miles a day in about forty-five minutes. This report is an indicator that symptoms were not continuous and that something changed to cause him to seek treatment. As to other evidence, the Veteran does not report experiencing continuous symptoms of breathing difficulties that have not been attributed to sinusitis. Service connection for sarcoidosis may still be granted on a direct basis; however, there is no indication that a nexus exists between the Veteran’s sarcoidosis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The May 2002 separation examination showed lungs were normal. The separation examination is highly probative evidence to show that symptoms or manifestations of any lung disorder during service had resolved. While the Veteran believes his sarcoidosis is related to the reported exposure to J.P. 8 fuel in service, he is not competent to provide a nexus opinion in this case. This issue is medically complex, as it requires specialized medical education, knowledge of potential toxins and how they affect the cells of the body, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The record does not show that the Veteran in this case has the training or skills needed to make such a determination. Consequently, the Board cannot consider the Veteran’s contention as evidence. As such, the Board gives more probative weight to the competent medical evidence. The preponderance of the probative evidence of record weighs against the claim of service connection for sarcoidosis. The benefit of the doubt doctrine is not applicable where, as here, there is not an approximate balance of positive and negative evidence. See 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); Alemany v. Brown, 9 Vet. App. 518 (1996). Service connection for sarcoidosis is denied. Increased Rating Disability ratings are determined by applying the criteria established in VA’s Schedule for Rating Disabilities, which is based upon the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.20 (2017). When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher evaluation is assigned if the disability more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the claimant. 38 C.F.R. § 4.3 (2017). Consideration must be given to increased evaluations under other potentially applicable Diagnostic Codes. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). 2. An evaluation in excess of 50 percent for migraine headaches. The Veteran seeks an evaluation higher than 50 percent for migraine headaches. The disability is evaluated under Diagnostic Code 8100. 38 C.F.R. § 4.124a. Under this code, 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. 38 C.F.R. § 4.124a, Diagnostic Code 8100. Here, the Veteran is receiving the maximum evaluation. Accordingly, a higher evaluation is not warranted. 3. Evaluation in excess of 30 percent for sinusitis. The Veteran seeks an evaluation in excess of 30 percent for sinusitis. The Veteran’s sinusitis is rated under Diagnostic Code 6513. The General Rating Formula for Sinusitis is applicable for Diagnostic Codes 6510 through 6514. Under this formula, a 30 percent rating is warranted for three or more incapacitating episodes per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is warranted following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries. 38 C.F.R. § 4.97, Diagnostic Code 6513 (2017). An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97, Diagnostic Code 6513, Note 1 (2017). In this case, the April 2013 VA examination report noted the Veteran endorsed chronic nasal congestion which inhibited his breathing through his nose, chronic headaches associated with ear pressure, and chronic post nasal drip which wakes him at night with coughing and choking. The Veteran had pain and tenderness, but no discharge or crusting. Five non-incapacitating episodes of sinusitis were reported. Three or more incapacitating episodes were found. Sinus surgery had not been performed. Near constant sinusitis was not present. Treatment records show the Veteran was treated in January 2013 for sinusitis, which recurred but improved with treatment after two to three weeks. Sinusitis returned in April 2013. In July 2014, the Veteran reported tender sinuses. Until a week prior, his chronic sinusitis was “doing fine.” The treating clinician found antibiotics were not indicated. Later that month, the condition had improved. In August 2014, his sinusitis symptoms had worsened. A note in November 2014 showed the Veteran was doing well, but reported symptoms of acute sinusitis for 10 days. Sinus symptoms continued into December 2014. A January 2015 note shows that symptoms improved after treatment on the last visit, but increased with a decrease in medication. At treatment nine days later, the Veteran reported his symptoms had improved. In February 2015, the Veteran denied sinus pressure and pain. A May 2015 VA treatment visit to followup on the sinus disability revealed the Veteran doing well overall. A September 2015 treatment record noted no recent sinus infections and that the Veteran was not a candidate for surgery. A January 2016 record noted no recent sinus infections. In April 2016, he had crusting. The clinician stated that the nasal symptoms were mild and controlled on daily medication. It was noted that he was not a candidate for surgery. At his July 2016 VA examination, he reported that his symptoms had gotten worse, and that he had month long antibiotic treatments two to three times per year. The examiner noted that the Veteran had episodes of sinusitis with headaches, tenderness, and purulent discharge. He did not have near constant sinusitis. The examiner stated that there were no non-incapacitating episodes of sinusitis in the past year, and that there were three or more incapacitating episodes in the past year. The examiner specified that the Veteran had not had sinus surgery. At the time of the examination, the condition was described as active. The record shows that the Veteran takes medication for his sinusitis, which controls his symptoms to some extent. Generally, “the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria.” Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). In this case, the General Rating Formula for Sinusitis specifically contemplates use of medication. Therefore, the Board does not need to determine the Veteran’s disability picture without the use of medication. On review of the evidence, the sinus disability is not productive of near constant sinusitis. While there was a period of more frequent infections in 2013 and then again in 2014, the presence of lengthy gaps in the frequency of sinusitis prevents a finding that there was near constant sinusitis. Indeed, in 2015 and 2016, records note there were no recent sinus infections. Additionally, the Veteran has not had surgery for his sinusitis. Accordingly, a higher evaluation is not warranted. 4. An effective date earlier than April 4, 2012 for a 30 percent evaluation of sinusitis. In the June 2013 Statement in Support of Claim, which served as the Notice of Disagreement, the Veteran asserted that the 30 percent evaluation should have been awarded as of January 31, 2012. The Veteran contended that this date was the date of his original claim. Generally, the effective date of a claim for an increased evaluation “will be the date of receipt of the claim or the date entitlement arose, whichever is later.” 38 C.F.R. § 3.400(o)(1). The effective date of an award of increased compensation, however, can be the earliest date as of which it was ascertainable that an increase in disability has occurred, if the application is received within one year from such date. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). See Hazan v. Gober, 10 Vet. App. 511 (1997). If the increase in disability occurred more than on year prior, the increase is effective the date of the claim. Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). Consequently, the award of an increased rating should normally be effective either on the date of receipt of the claim or on some date in the preceding year if it was ascertainable that the disorder had increased in severity during that time. Under the version of the regulations in effect in this case prior to March 24, 2015, a “claim” or “application” is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p) (2015). When a claim has been filed which meets the requirements of § 3.151, an informal request for increase will be accepted as a claim. 38 C.F.R. § 3.155 (c). The report of an examination or hospitalization may constitute an informal claim for increase when the report relates to examination or treatment of a disability for which service connection has previously been established. 38 C.F.R. § 3.157 (b)(1). “[E]ntitlement to benefits for a disability or disease does not arise with a medical diagnosis of the condition, but with the manifestation of the condition and the filing of a claim for benefits for the condition." DeLisio v. Shinseki, 25 Vet. App. 45, 56 (2011) (citing to the rule of 38 U.S.C. § 5110(a) that the effective date shall be fixed in accordance with “facts found”). Initially, the RO assigned the 30 percent rating for sinusitis effective May 7, 2012 in its May 2013 rating decision. In an April 2015 Decision Review Officer (DRO) decision, the AOJ granted an effective date of April 4, 2012 based upon a statement received that discussed respiratory symptoms. In this case, the first communication evidencing a belief in entitlement to an increased evaluation is the statement from the Veteran on April 4, 2012. While a claim was received in January 2012, it clearly did not relate to the sinuses. Instead, it was a claim for service connection for sarcoidosis and sleep apnea. Thus, the Board finds the date of claim for an increased rating for sinusitis to be April 4, 2012. With respect to whether it was ascertainable that the disorder had increased in severity during the year prior to April 4, 2012, the first instance of treatment or evaluation of the sinuses after April 4, 2011 is a January 2013 VA treatment report showing an incurrence of sinusitis. Because the evidence does not show that an increase in severity of the sinusitis was factually ascertainable during the one year prior to the April 4, 2012 claim, the correct effective date is April 4, 2012. An effective date prior to April 4, 2012, is denied. REASONS FOR REMAND 1. Service connection for a dental condition, including TMJ dysfunction and osteomyelitis is remanded. The Board cannot make a fully-informed decision on the issue of service connection for TMJ dysfunction because no VA examiner has opined whether it was manifest in service or related to service. The Veteran experienced dental abscesses and a dental extraction in service. He now experiences tremors of the temporomandibular joint and jaw pain. Service treatment records show the Veteran sustained recurrent dental abscesses, experienced trismus (i.e. locked jaw) and tremors, jaw pain, and a swollen left lymph node on the jaw. See January 2002 and March 2002 service treatment records. Service dental treatment records show extraction of tooth #19, with subsequent tear of mucosa, purulent discharge, an apparent muscle spasm, and pain. See January 2002, February 2002, and October 2002 service dental treatment records. An August 2002 pre-service VA examination was conducted. At the examination, the Veteran reported dental tremors to the mandible secondary to the removal of a tooth. On physical examination there was no loss of masticatory motion. Seven teeth were missing. The examiner found the missing teeth could be replaced by either fixed or removable partial dentures. The maximum incisal opening was 46 millimeters. Left and right lateral excursion was 7 to the left and 6 to the right. No bone loss was noted. X-rays revealed no abnormal findings. The examiner opined that a bite guard should improve the pain the Veteran was feeling in the mandible. An October 2003 service department treatment record recounted that dental surgery two years prior involved an abscessed tooth with osteomyelitis of the jaw. Post-service treatment records show the Veteran getting “jaw tremor” and complaining that his “TMJ is acting up.” They also note TMJ disorder in the problem lists during the current appeal period. See February 2012 VA treatment note. Disability compensation and VA outpatient dental treatment may be provided for certain specified types of service-connected dental disorders. For other types of service-connected dental disorders, the claimant may receive treatment only and not compensation. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381, 4.150, 17.161. Under 38 C.F.R. § 3.381, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal diseases are to be considered service-connected only for the purpose of establishing eligibility for outpatient dental treatment as provided in 38 C.F.R. § 17.161. Entitlement to treatment has been referred above. Dental disabilities that may be compensable are set forth in 38 C.F.R. § 4.150. They include chronic osteomyelitis or osteoradionecrosis of the maxilla or mandible, loss of the mandible, nonunion or malunion of the mandible, limited temporomandibular motion, loss of the ramus, loss of the condyloid or coronoid processes, loss of the hard palate, loss of teeth due to the loss of substance of the body of the maxilla or mandible and where the lost masticatory surface cannot be restored by suitable prosthesis, when the bone loss is a result of trauma or disease but not the result of periodontal disease. 38 C.F.R. § 4.150, DCs 9900-9916 (2017). A VA examination is warranted due to evidence of symptomatology that may be consistent with a jaw disorder affecting the temporomandibular joint. The August 2002 VA dental examination did not address TMJ dysfunction. Instead it addressed migraine headaches in conjunction with the mandibular tremor and nerve damage secondary to dental surgery. 2. Service connection for obstructive sleep apnea is remanded. The Veteran contends that he is entitled to service connection for obstructive sleep apnea. Evidence shows that the Veteran sought treatment in October 1999 for being unable to sleep and having morning tiredness. The assessment was jet lag. The Veteran endorsed frequent trouble sleeping in his Report of Medical History at separation. The April 2012 VA medical opinion incorrectly relies, in part, upon a lack of the Veteran’s complaints at separation from service for its negative opinion. Accordingly, remand for an addendum medical opinion is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any temporomandibular joint dysfunction, osteomyelitis, and jaw pain. The examiner must opine as follows: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s disability began during active service, or is related to an incident of service, including the jaw tremors, trismus, tooth extraction, and report of osteomyelitis (see October 2003 treatment record) in service. b. Whether it is at least as likely as not that the Veteran’s symptoms are unrelated to his migraine headache disorder and are a separate disorder, rather than symptoms of the headache disorder. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Obtain an addendum medical opinion regarding the Veteran’s sleep apnea from an appropriate clinician. The examiner must opine whether the current sleep apnea is at least as likely as not related to reports of an in-service injury, event, or disease, including an October 1999 report of daytime sleepiness, and the report of frequent trouble sleeping on the Report of Medical History at separation. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. (Continued on the next page)   3. If upon completion of the above action any benefit sought on appeal remains denied, the case should be returned to the Board after compliance with appellate procedure. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Rocktashel, Counsel