Citation Nr: 18152168 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-37 556 DATE: November 21, 2018 ORDER As new and material evidence sufficient to reopen the previously denied claim for service connection for esophageal carcinoma has been received, the application to reopen is granted. Entitlement to service connection for esophageal carcinoma is granted. Entitlement to service connection for asbestosis is denied. Entitlement to a rating in excess of 10 percent for surgical chest scar, status post coronary artery bypass graft, is denied. FINDINGS OF FACT 1. In a rating decision dated in July 2008, the RO denied service connection for esophageal carcinoma on the basis that there was no evidence that the Veteran’s esophageal carcinoma was related to service on a direct or presumptive basis; the Veteran did not appeal this decision or submit new evidence within one year of the denial. 2. Evidence submitted subsequent to the July 2008 rating decision bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and in connection with evidence previously assembled raises a reasonable possibility of substantiating the claim of entitlement to service connection for esophageal carcinoma. 3. The Veteran’s esophageal carcinoma is likely related to active military service. 4. Asbestosis is not due to or caused by the Veteran’s active service, to include asbestos exposure. 5. The Veteran has one painful, stable surgical scar associated with coronary artery bypass graft, which is linear and measures 20 cm at worst, without signs of skin breakdown, inflammation, edema, keloid formation, or other disabling effects. CONCLUSIONS OF LAW 1. The July 2008 rating decision denying service connection for esophageal carcinoma is final. 38 U.S.C. § 7105 (2014); 38 C.F.R. §§ 3.104(a), 20.1103 (2018). 2. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for esophageal carcinoma has been submitted; the claim is reopened. 38 U.S.C. § 5108 (2014); 38 C.F.R. § 3.156(a) (2018). 3. The criteria for service connection are met for esophageal carcinoma. U.S.C. §§ 1110, 1116 (2014); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018). 4. The criteria for service connection have not been met for asbestosis. 38 U.S.C. § 1110 (2014); 38 C.F.R. § 3.303 (2018). 5. The criteria for a rating in excess of 10 percent for surgical chest scar, status post coronary artery bypass graft, have not been met. 38 U.S.C. §§ 1155, 5107 (2014); 38 C.F.R. §§ 4.118, Diagnostic Code 7804 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1966 to June 1968. During his period of service, the Veteran earned the National Defense Service Medal, Vietnam Campaign Medal, Vietnam Service Medal, Good Conduct Medal, and Marksman Badge (Rifle). New and Material Evidence Where service connection for a disability has been denied in a final decision, a subsequent claim for service connection for that disability may be considered on the merits only if new and material evidence has been received since the time of the prior adjudication. New evidence means evidence not previously submitted to agency decision makers. 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). According to the United States Court of Appeals for Veterans Claims (Court), the pertinent VA law requires that in order to reopen a previously and finally disallowed claim, there must be new and material evidence presented or secured since the time that the claim was finally disallowed on any basis. See Evans v. Brown, 9 Vet. App. 273 (1996). When determining whether the submitted evidence meets the definition of new and material evidence, VA must consider whether the new evidence could, if the claim were reopened, raise a reasonable possibility of substantiating the claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The newly presented evidence need not be probative of all the elements required to award the claim, just probative of each element (or at least one element) that was a specified basis for the last disallowance of the claim. See Evans, 9 Vet. App. at 283; see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998) (noting that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant’s injury or disability, even where it would not be enough to convince the Board to grant the claim). The credibility of the newly submitted evidence is presumed for purposes of reopening the claim. See Justus v. Principi, 3 Vet. App. 510 (1992). The Veteran’s claim for service connection for esophageal carcinoma was initially denied in a July 2008 rating decision. The RO determined that there was there was no evidence that the Veteran’s esophageal carcinoma was related to service on a direct or presumptive basis. The Veteran did not appeal this decision or submit new evidence within one year of the denial. The July 2008 decision thereby became final. In December 2011, the RO reopened but ultimately denied the claim of service connection for esophageal carcinoma. Despite this, the Board has the responsibility of adjudicating the issue of whether new and material evidence has been submitted in the first instance. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Subsequent to the July 2008 rating decision, new and material evidence has been received that relates to unestablished facts that are necessary to substantiate the Veteran’s claim for service connection for esophageal carcinoma, to include a November 2011 VA examination and a December 2017 private opinion, as well as VA and private treatment records. This evidence satisfies the low threshold requirement for new and material evidence and these claims are reopened. See Shade v. Shinseki, 24 Vet. App. 110 (2010). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for a disease initially 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). 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). In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The absence of any one element will result in denial of service connection. Service connection for certain chronic diseases may be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1112, 1137 (2012); 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (2017). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a) (2017); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For the showing of 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. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). A Veteran can establish continuity of symptomatology with competent evidence showing: (1) that a condition was noted during service; (2) post-service continuity of the same symptomatology; and (3) a nexus between a current disability and the post-service symptomatology. Id. Esophageal Carcinoma Additionally, a Veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. If a Veteran was exposed to an herbicide agent during active service, certain enumerated diseases shall be presumptively service-connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. The Veteran contends that he is entitled to service connection for esophageal carcinoma, to include as due to in-service exposure to herbicides. After reviewing the evidence of record, the Board finds that the criteria for establishing service connection for esophageal carcinoma have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). There is no dispute that the Veteran has a current diagnosis of esophageal carcinoma based on the evidence. Further, the Veteran has verified service in the Republic of Vietnam during the Vietnam era. Thus, his exposure to herbicides is conceded. See 38 C.F.R. § 3.307(a)(6). However, esophageal carcinoma is not one of the enumerated disabilities listed under 38 C.F.R. § 3.309(e). Therefore, presumptive service connection for esophageal carcinoma is not applicable. Notwithstanding the foregoing, the Veteran is not precluded from seeking service connection on a direct theory of entitlement. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran appeared for a VA esophageal conditions examination in November 2011. The examiner opined that it was less likely as not that the Veteran’s carcinoma in situ of the esophagus was due to asbestosis. In support of her opinion, the examiner indicated that medical literature did not support a finding that asbestosis caused esophageal cancer. The examiner further indicated that having precancerous changes in the cells of the esophagus (Barrett’s esophagus) was well documented as the cause of esophageal cancer as was the case with this Veteran. A private opinion was submitted by Dr. V. C. in December 2017. Based on a review of the Veteran’s service treatment records, post-service VA and private treatment records, the Veteran’s lay statements, and medical literature, the physician opined that it was at least as likely as not that the Veteran’s adenocarcinoma of the esophagus was caused by his exposure to herbicides while servicing in Vietnam. The Board finds that service connection for esophageal carcinoma is warranted. The Board acknowledges the negative nexus opinion provided by the November 2011 VA examiner; however, the examiner did not adequately consider the Veteran’s presumed exposure to herbicides during service in Vietnam, and therefore such opinion is entitled to significantly less probative value. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (“An opinion based upon an inaccurate factual premise has no probative value.”); see also Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (deeming a medical opinion inadequate because the examiner failed to render an opinion consistent with the Board’s credibility findings). The Board does, however, find the December 2017 private opinion to be of more probative value, as the physician was fully informed of the Veteran’s medical history, provided a fully articulated rationale, and the opinion was supported by a reasoned analysis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-04 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”) As such, the bene his claim for service connection for esophageal carcinoma is granted. See 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Asbestosis As to asbestos-related diseases, the Board notes there are no laws or regulations specifically dealing with asbestos and service connection. However, VA’s Adjudication Procedure Manual provides guidance in adjudicating these claims. See M21-1, Part IV, Subpart ii, Chapter 1, Section I, 3 (August 17, 2017). The M21-1 provides that, when considering these types of claims, VA must determine whether military records demonstrate evidence of asbestos exposure in service VA must also determine whether there was pre-service and/or post-service evidence of occupational or other asbestos exposure; and thereafter determine if there was a relationship between asbestos exposure and the currently claimed disease, taking into consideration the applicable latency and exposure information. The following is a non-exclusive list of asbestos-related diseases/abnormalities: asbestosis, interstitial pulmonary fibrosis, tumors, effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, bronchial cancer, cancer of the larynx, cancer of the pharynx, cancer of the urogenital system (except the prostate), and cancers of the gastrointestinal tract. The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure: mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. In addition, during World War II, several million people employed in U.S. shipyards and U.S. Navy personnel were exposed to asbestos. The M21-1 also provides that a clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Symptoms and signs include dyspnea on exertion, end-respiratory rales over the lower lobes, compensatory emphysema, clubbing of the fingers at late stages, and pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods. Meanwhile, the Court has held that the M21-1 Adjudication Procedure Manual does not create a presumption of in-service exposure to asbestos for claimants that worked in one of the occupations that the manual listed as having higher incidents of asbestos exposure. See Dyment v. West, 13 Vet. App. 141, 145 (1999); Ashford v. Brown, 10 Vet. App. 120 (1997). The Veteran contends that he is entitled to service connection for asbestosis, to include as due to in-service exposure to asbestos. The Veteran underwent a VA respiratory conditions examination in November 2011. The examiner documented a 2006 diagnosis of asbestosis. Thus, the current-disability criterion for service connection is met. See Shedden, supra. Next, the Board must consider whether the Veteran sustained a disease or injury in service. A review of the Veteran’s service treatment records does not reveal any complaints or diagnosis of any pulmonary disabilities during his military service. However, the Veteran’s DD-214 shows that his military occupational specialty (MOS) was electrician during service. As such, probable asbestos exposure is conceded. Therefore, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, it must be determined whether the Veteran’s asbestos is related to service. The Board finds that the burden has not been met. The Veteran submitted to a VA examination in November 2011. The examiner opined that “[i]t is at least as likely as not that [the veteran] has asbestosis, as documented by pleural plaquing on CT scan, due to asbestos exposure, during and out of service.” The examiner further noted that the Veteran’s pulmonary function test (PFT) in 2006 was normal and that he was not being treated for any disability related to asbestosis at the time of examination. The examiner did not provide a nexus opinion with respect to the asbestosis diagnosis. In December 2011, a nexus opinion was obtained from a different VA examiner. The physician agreed that the Veteran had asbestosis. He noted that the Veteran had short-term exposure to asbestos in-service; however, he had significant exposure to asbestos after service. Thus, the physician opined that it was less likely than not that the Veteran’s minimal exposure in service materially contributed to his current asbestosis. The Board finds this opinion to be the most probative evidence of record regarding the nexus element. Consideration has been given to the Veteran’s contentions that his asbestosis is related to his active service. Although laypersons are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a layperson, as it involves making definitive clinical diagnoses based on knowledge of pulmonology. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the Veteran is certainly competent to report that he experiences breathing difficulties, he is not competent to link those complaints to a particular etiology. His assertions are therefore not competent evidence of a medical nexus. The Board has also considered the assertions of the Veteran’s representative, which challenged the December 2011 opinion based on the examiner’s area of specialty. All VA examiners are presumed to be competent—and their medical opinions, in turn, are assumed to be adequate—absent specific evidence to the contrary. See Nohr v. McDonald, 27 Vet. App. 124, 131-32 (2014) (quoting Parks v. Shinseki, 716 F.3d 581, 585 (Fed. Cir. 2013) (“It is now well settled that ‘VA benefits from a [rebuttable] presumption that it has chosen a person who is qualified to provide a medical opinion in a particular case.’”). See also Bastien v. Shinseki, 599 F.3d 1301, 1307 (Fed. Cir. 2010) (“[A]ny challenge ‘to the expertise of a VA expert’ must set forth the specific reasons why the litigant concludes that the expert is not qualified to give an opinion.”); Rizzo v. Shinseki, 580 F.3d 1288, 1290-91 (Fed. Cir. 2009) (holding that the Board is entitled to assume the competency of a VA examiner); accord Sickels v. Shinseki, 643 F.3d 1362, 1365-66 (Fed. Cir. 2011) (holding that, under the presumption of regularity in the administrative process, the Board is entitled to assume the adequacy of VA examinations and opinions absent specific evidence to the contrary). It is not necessary that VA examinations be conducted by a specialist in the particular field of the Veteran’s claimed disability. Here, the Veteran’s representative has not set forth any specific reason why the VA clinician is not qualified to give a competent opinion. On the face of the VA December 2011 opinion, there is nothing to indicate that the examiner is not qualified to perform the necessary review and give an adequate opinion, as there was in Nohr, which required remand for clarification. The examiner did not profess an inability to conduct the evidence review or to provide an adequate opinion. He is designated as a Compensation and Pension physician, and as such, has the requisite medical knowledge to conduct VA examinations. The December 2011 VA examiner provided a clear opinion and there is no competent evidence that contradicts him. The Board finds the December 2011 opinion adequate given the examiner’s review of the claims file, which included a personal interview and physical examination of the Veteran, and rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran’s own assertions have also been considered; he is clearly competent to state observable events and symptoms. However, in this case, his opinion regarding the cause of his asbestosis is not competent and probative. This case is medically complex, transpired over several years, and required a medical in light of the outside factors in the medical history as contributing long-term to the overall disability picture. The Veteran has not been shown to have the training, skills, or experience needed to provide a probative opinion in a case this complex. Although the Board is sympathetic to the Veteran’s claim, the preponderance of the evidence is against the Veteran’s claim of service connection for asbestosis. Accordingly, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). Increased Rating Disability ratings 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. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Consideration must be given to increased evaluations under other potentially applicable Diagnostic Codes. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1. If, as here, there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based upon the facts found. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). See also AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original rating remains in controversy when less than the maximum available benefit is awarded); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s surgical chest scar, status post coronary artery bypass graft, is currently evaluated under DC 7804. Diagnostic Code 7801 provides ratings for scars, other than the head, face, or neck, that are deep or that cause limited motion. Scars that are deep or that cause limited motion in an area or areas exceeding 6 square inches (39 sq. cm.) are rated 10 percent disabling. Scars in an area or areas exceeding 12 square inches (77 sq. cm.) are rated 20 percent disabling. Scars in an area or areas exceeding 72 square inches (465 sq. cm.) are rated 30 percent disabling. Scars in an area or areas exceeding 144 square inches (929 sq.cm.) are rated 40 percent disabling. Note (1) to Diagnostic Code 7801 provides that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Note (2) provides that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under 38 C.F.R. § 4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck. 38 C.F.R. § 4.118. Diagnostic Code 7802 provides ratings for scars, other than the head, face, or neck, that are superficial or that do not cause limited motion. Superficial scars that do not cause limited motion, in an area or areas of 144 square inches (929 sq. cm.) or greater, are rated 10 percent disabling. Note (1) to Diagnostic Code 7802 provides that a superficial scar is one not associated with underlying soft tissue damage. Note (2) provides that if multiple qualifying scars are present, or if a single qualifying scar affects more than one extremity, or a single qualifying scar affects one or more extremities and either the anterior portion or posterior portion of the trunk, or both, or a single qualifying scar affects both the anterior portion and the posterior portion of the trunk, assign a separate evaluation for each affected extremity based on the total area of the qualifying scars that affect that extremity, assign a separate evaluation based on the total area of the qualifying scars that affect the anterior portion of the trunk, and assign a separate evaluation based on the total area of the qualifying scars that affect the posterior portion of the trunk. The midaxillary line on each side separates the anterior and posterior portions of the trunk. Combine the separate evaluations under 38 C.F.R. § 4.25. Qualifying scars are scars that are nonlinear, deep, and are not located on the head, face, or neck. 38 C.F.R. § 4.118. Diagnostic Code 7804 provides a 10 percent evaluation for one or two scars that are unstable or painful. A 20 percent evaluation is warranted for three or four scars that are unstable or painful. A 30 percent evaluation is warranted for five or more scars that are unstable or painful. Note 1 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note 2 provides that if one or more scars are both unstable and painful, 10 percent should be added to the evaluation that is based on the total number of unstable or painful scars. Note 3 provides that scars evaluated under DC 7800, 7801, 7802, and 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, DC 7804. Diagnostic Code 7805 provides that any other scars (including linear scars) and other disabling effects of scars should be evaluated even if not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118. VA treatment notes from January 2013 indicate that the Veteran’s treating physician observed a red, thickened scar on the Veteran’s chest. The scar was noted to be painful. The physician documented that the Veteran complained of “tenderness.” In February 2013, he again complained of a tender scar. In March 2013, VA treatment records indicate that the Veteran had a mid-sternal, 20-centimeter, hypertrophic linear scar that was tender. The Veteran complained that the scar was sore. Some improvement was noted with Kenalog IL injection. The Veteran underwent a VA scars examination in April 2016. The examiner noted one painful scar. The examiner indicated that the Veteran had a linear, 18.5-centimeter stable scar of the sternum. The superior half was tender to palpation. In consideration of the evidence of record, the Board finds that the weight of the evidence preponderates against entitlement to a rating in excess of 10 percent for surgical chest scar, status post coronary artery bypass graft. The scar is shown to be objectively painful. As such, the criteria for the 10 percent rating currently assigned for the scar are shown to be met. The evidence does not demonstrate that the Veteran has three scars that are unstable or painful or at least one scar that is both painful and unstable. The total skin area affected by the scar is not shown to approach 77 square cm. The Board has reviewed all of the criteria under which a rating for scarring in excess of 10 percent may be appropriate, but finds no basis for a rating in excess of 10 percent. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Joseph, Associate Counsel