Citation Nr: 18152469 Decision Date: 11/27/18 Archive Date: 11/23/18 DOCKET NO. 08-07 799 DATE: November 27, 2018 ORDER Entitlement to service connection for diabetes mellitus, including as secondary to chemical exposure in service, is denied. Entitlement to service connection for breathing problems, including as a result of chemical or asbestos exposure, is denied. Entitlement to service connection for sleep apnea, including as secondary to the service-connected disability of tension headaches, is denied. Entitlement to service connection for an eye disorder, is denied. REMANDED Entitlement to service connection for hypertension, including as secondary to chemical exposure, including as secondary to diabetes mellitus, is remanded. Entitlement to service connection for joint pain, including as due to undiagnosed illness, is remanded. Entitlement to service connection for tendonitis, including as due to undiagnosed illness, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has diabetes mellitus due to a disease or injury in service, to include any exposure to chemicals in service. 2. The preponderance of the evidence is against finding that the Veteran has breathing problems due to a disease or injury in service, to include any exposure to chemicals or asbestos in service. 3. The Veteran’s obstructive sleep apnea is neither proximately due to nor aggravated by his service-connected headaches, and is not otherwise related to an in-service injury, event, or disease. 4. The preponderance of the evidence is against finding that the Veteran has an eye disorder due to a disease or injury in service CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for breathing problems are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310(a). 4. The criteria for service connection for an eye disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1982 to January 1985 and from May 1986 to March 1994. The Veteran testified at a hearing before the undersigned in April 2014. A transcript of the hearing has been associated with the claims file. The case was previously before the Board of Veterans’ Appeals (Board) in April 2015 when it was remanded for additional development. In the prior Board remand, the issue of entitlement to service connection for a foot disorder was remanded for additional development. Thereafter, in November 2016 the Regional Office granted entitlement to service connection for bilateral foot calluses (claimed as foot problems/disorder). As such, the issue of entitlement to service connection for a foot disorder is no longer on appeal before the Board. Service Connection Service connection is granted for disability resulting from an injury sustained or a disease contracted in the line of duty during active military service, or for aggravation during service of a pre-existing condition beyond its natural progression. 38 U.S.C. §§ 1110, 1131, 1153; 38 C.F.R. §§ 3.303(a), 3.306. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247 (1999). In the absence of proof of a present disability there can be no valid claim because there is no existing disability to relate or attribute to the Veteran’s service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Under 38 C.F.R. § 3.310, service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson, 581 F.3d at 1316. When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Reasonable doubt concerning any matter material to the determination is resolved in the Veteran’s favor. 38 C.F.R. § 3.102. In this case one of the Veteran’s DD Form 214s shows that he had 3 years, 9 months, and 6 days of foreign service, and received the Kuwait Liberation Medal. He is, therefore, a ‘Persian Gulf War Veteran’ by regulation (i.e., had active military service in the Southwest Asia theater of operations during this war). 38 C.F.R. § 3.317. For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that the Secretary of VA determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117 and 38 C.F.R. § 3.117, unlike those for ‘direct service connection,’ there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9. Further, lay persons are competent to report objective signs of illness. Id. To determine whether the undiagnosed illness is manifested to a degree of 10 percent or more the condition must be rated by analogy to a disease or an injury in which the functions affected, anatomical location or symptomatology are similar. See 38 C.F.R. § 3.317(a)(5); see also Stankevich v. Nicholson, 19 Vet. App. 470 (2006). Entitlement to service connection for diabetes mellitus, including as secondary to chemical exposure in service, is denied. Service treatment record do not reveal any complaint, diagnosis, or treatment for any diabetes mellitus. Upon a Report of Medical Examination dated in August 1990 the Veteran’s urinalysis revealed sugar normal. In a treatment note dated in December 2009 the Veteran was noted to have diabetes since approximately 2002. The Veteran was afforded a VA examination in March 2012. The Veteran was noted to be diagnosed with diabetes mellitus. The date of diagnosis was 2000/2001. The Veteran was diagnosed with sleep apnea. The examiner reported that diabetes mellitus was not caused by or a result of the Gulf War. Diabetes mellitus is not a condition recognized for presumptive service-connected for Gulf War Syndrome. In an addendum dated in July 2012 it was noted that the Veteran had diabetes mellitus since 2002, eight years after he completed his military service. The diagnosis has known risk factors. The examiner reported that since diabetes mellitus has known causes and risk factors it was less likely than not that the Veteran’s diabetes is due to an undiagnosed Gulf War illness. At the hearing before the undersigned the Veteran reported that he was borderline diabetic in service. In a statement dated in November 2014 the Veteran reported that he was made to drink a lot of water in the military to stay hydrated. He would urinate a lot and that was how he was found to have diabetes. A VA medical opinion was obtained in September 2016. The question posed was whether the Veteran’s diabetes mellitus was due to chemical exposure in Gulf. The examiner rendered the opinion that the Veteran’s condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was that diabetes mellitus was most likely due to obesity and age. Entitlement to service connection for diabetes mellitus is not warranted. The Veteran contends that he was borderline diabetic in service and that his diabetes mellitus is related to exposure to chemicals in service. Review of the service treatment records does not reveal any complaint, diagnosis, or treatment for any diabetes mellitus. Post service treatment records do not reveal any diagnosis of diabetes mellitus until years after separation from service. VA medical examiners have rendered the opinion that the Veteran’s disability has known causes and risks and was, therefore, less likely than not due to an undiagnosed Gulf War illness. In addition, after examination in September 2016, the examiner rendered the opinion that the Veteran’s diabetes mellitus was less likely as not related to service and was most likely due to the Veteran’s obesity and age. As the preponderance of the evidence is against a finding that the Veteran has diabetes mellitus related to his active service, including any exposure to chemicals in service, service connection for diabetes mellitus is denied. Entitlement to service connection for breathing problems, including as a result of chemical or asbestos exposure, is denied. Entitlement to service connection for sleep apnea, including as secondary to the service-connected disability of tension headaches, is denied. Service treatment record do not reveal any complaint, diagnosis, or treatment for any respiratory disability or obstructive sleep apnea. Service treatment records reveal that in June 1984 the Veteran complained of head congestion. In October 1986 the Veteran was assessed with an upper respiratory infection (URI). In November 1986 the Veteran was diagnosed with an URI. In a June 1992 treatment note it was reported that the Veteran was fitted with a respirator for asbestos. In a statement dated in July 1997 it was noted that the Veteran was in an area where he may have been exposed to a very low level of a nerve agent. In a statement dated in May 2009 a private provider reported that the Veteran’s pulmonary cough and shortness of breath may have been caused by chemical exposures and caustic irritation. In an August 2010 treatment note the Veteran was reported to be diagnosed with moderate to severe obstructive sleep apnea. The Veteran was afforded a VA examination in March 2012. The Veteran’s physical and chest X-ray were unremarkable. There was no respiratory problem noted in the claims file other than sleep apnea. The examiner found that sleep apnea was not caused by or a result of the Gulf War. The condition was not a condition recognized for presumptive service-connected for Gulf War Syndrome. In an addendum dated in July 2012 it was noted that from review of the claims file there was evidence that the Veteran was treated for acute URIs while in the military, but no chronic pulmonary condition. From a review of March 2012 pulmonary function tests, the pattern may be seen in restriction, obstruction, obesity, and poor effort. Restriction cannot be diagnosed by spirometry without lung volumes and consider obtaining lung volumes if clinically indicated. The examiner stated that there was no evidence from review of private medical records and CPRS that the Veteran had any chronic respiratory disability. The examiner stated that repeat pulmonary function tests (PFTs) would be requested with lung volumes to help resolve the claim. At that time the examiner could not state that the Veteran had chronic respiratory disability. Therefore, an opinion on whether there was an undiagnosed illness could not be given. Regarding sleep apnea, the examiner stated that this was diagnosed approximately 16 years after military discharge. It has a known cause, which is airway obstruction, which can be caused by several factors, ranging from deviated nasal septum to relaxation of pharyngeal muscles with collapse of airway. It was increased in obese patients, such as the Veteran. It can lead to fatigue and sleep disturbances, which the Veteran has reported. As sleep apnea has known causes, it is less likely than not that the Veteran’s sleep apnea is due to an undiagnosed Gulf War illness. In an addendum dated in August 2012 it was reported that the pulmonary function tests were consistent with possible restrictive condition due to obesity and that it would not be due to an undiagnosed illness. At the hearing before the undersigned the Veteran reported that he snored through his military service. A VA Disability Benefits Questionnaire (DBQ) dated in October 2014 was associated with the claims file. The DBQ reports that the Veteran probably has subclinical interstitial lung disease. In a statement dated in November 2014 the Veteran reported that he was exposed to asbestos and chemicals in service and that he was never issued a respirator or protective clothing. He stated that he snored in service and that it would wake him up. The Veteran was afforded a VA examination in September 2016. The Veteran was diagnosed with dyspnea and pulmonary scars. The Veteran was also diagnosed with obstructive sleep apnea. The examiner rendered the opinion that the Veteran’s respiratory condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale provided was that there were no respiratory issues in service and that the Veterans’ shortness of breath was most likely due to deconditioning and age. The examiner rendered the opinion that the Veteran’s obstructive sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale was that hypertension does not cause obstructive sleep apnea and the Veteran’s age and weight caused the Veteran’s obstructive sleep apnea. A VA medical opinion was obtained in October 2016. The examiner noted that the Veteran’s file was present and reviewed. The examiner commented on the prior examination dated in September 2016 and upon a May 2009 letter submitted by a private provider. The examiner noted that regarding his breathing disorder, it could not be stated without pure speculation that it was due to the military. The Veteran reported that he was exposed to several chemicals in the military. The Veteran was not treated for any type of pulmonary condition while in the military. The examiner noted that the Veteran stated that this began in 2014 after he had been out of the military for many years. The examiner continued to note that the Veteran was able to retire early from the federal prison system despite his chronic shortness of breath with activity. Although an opinion could not be rendered without resort to speculation, the examiner stated that it was believed it was probably most likely due to his obesity and deconditioning. Regarding his obstructive sleep apnea, the examiner reported that it was believed that this was a result of inactivity and the Veteran’s morbid obesity and aging process. The examiner noted that this was a common problem in patient’s that age and that are morbid obese. Another VA medical opinion was obtained in May 2017. The examiner rendered the opinion that it is unlikely the Veteran’s sleep apnea was aggravated beyond its natural progression by his military service-connected tension headaches. The Veteran’s tension headaches do not cause him to have significant obesity and enlarged neck that would cause obstructive sleep apnea. The examiner noted that the Veteran’s chronic tension headaches will continue throughout his entire life and should not cause the patient’s weight gain or the abnormal effect of causing obstructive sleep apnea. Another VA medical opinion was obtained in July 2018. The examiner rendered the opinion that it is less likely than not any current chronic respiratory condition was due to or caused by an event, illness, or injury during service. URI, also known as the “common” cold, is a part of the normal human condition, and typical URI’s do not lead to chronic residuals or chronic sequalae. Service treatment records were silent for any illness that would/could cause chronic lung sequelae. The examiner noted that a September 2016 examination noted a diagnosis (which is a symptom) “dyspnea” and that an October 2014 private DBQ noted a diagnosis of sarcoidosis (which is a restrictive lung disease). However, the examiner stated that part of the DBQ was missing information and x-rays were noted as normal. Additional treatment notes were indicated to reveal sleep apnea but no chronic respiratory diagnosis. A March 2012 VA examination report noted restrictive lung disease due to obesity. Entitlement to service connection for a breathing problem and obstructive sleep apnea is not warranted. Initially, the Board notes that the Veteran’s breathing problems and sleep apnea have been attributed to known clinical diagnoses and are, therefore, not undiagnosed illnesses. As for in-service incurrence of any relevant injury or disease to account for his claimed respiratory disorder, the Board recognizes that the Veteran had multiple treatments for upper respiratory infections while in service. However, in an August 1990 special forces examination report, the examiner noted no abnormalities of the lungs. The first complaints of breathing problems in 2005, at least 10 years after his separation from service. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (ruling that a prolonged period after service without medical complaint can be considered, along with other factors, as evidence of whether an injury or a disease was incurred in service resulting in any chronic or persistent disability). See also Mense v. Derwinski, 1 Vet. App. 354 (1991) (holding that VA did not err in denying service connection when the Veteran had failed to provide evidence demonstrating continuity of symptomatology following the conclusion of his service and had failed to account for the lengthy time period following service during which there was no clinical documentation of the claimed disorder). Moreover, this is not a case in which the record is merely silent regarding whether the Veteran experienced a continuity of breathing problems following his separation from active service. Rather, he expressly denied lung problems at the time of his Special-Forces examination in August 1990, and he denied respiratory problems in a February 2006 treatment record. After examination in March 2012 no respiratory problem was noted other than sleep apnea. After additional testing, including pulmonary function testing with lung volumes, the examiner concluded the Veteran’s possible restrictive condition is due to obesity (being overweight). A medical opinion dated in July 2018 indicates that the Veteran did not have any chronic respiratory condition that was due to service and in rendering the opinion discussed the Veteran’s upper respiratory infections in service. To the extent the Veteran has asserted a breathing disorder due instead to exposure to asbestos during his military service, he has presented no contrary medical evidence relating his current condition to his service or diagnosing asbestosis or other asbestos-exposure-related disease or relating his current respiratory pathology to asbestos exposure. As the preponderance of the evidence is against a finding that the Veteran has a breathing disorder related to his active service, to include any exposure to chemicals and/or asbestos, service connection for a breathing problem is denied. Regarding the Veteran’s sleep apnea, the Board acknowledges that the Veteran has reported that he snored in service. However, the Veteran’s service treatment records do not reveal any diagnosis or treatment for any sleep disability. The Veteran was not diagnosed with obstructive sleep apnea until years after separation from service. After examination in September 2016 it was noted that the Veteran’s sleep apnea was not related to his active service. The rationale, in part indicated that hypertension does not cause sleep apnea and that the Veteran’s age and weight caused his obstructive sleep apnea. Another medical opinion has indicated that the Veteran’s sleep apnea was a result of inactivity and the Veteran’s morbid obesity and aging. Further medical opinions have indicated that the Veterans’ sleep apnea was not aggravated by his service connection headaches because they do not cause the Veteran to have weight gain or cause obstructive sleep apnea. As the preponderance of the evidence is against a finding that the Veteran has sleep apnea related to his active service or due to or aggravated by his service-connected headaches, entitlement to service connection for obstructive sleep apnea is denied. Entitlement to service connection for an eye disorder is denied. Service treatment record reveal that the Veteran underwent vision evaluations and that the Veteran complained of difficulty reading in October 1983. In May 1988 the Veteran was noted to examined regarding amblyope congenital. Upon a Report of Medical Examination dated in August 1990 the Veteran was noted to have amblyope congenital and to be restricted from duties requiring good depth perception or binocular vision. In June 2010 the Veteran was noted to have meridional amblyopia right eye secondary to high unilateral astigmatism. The Veteran was further diagnosed with hyperopic astigmatism with presbyopia, angles narrow but open in both eyes, and no diabetic retinopathy. In November 2013 the Veteran was diagnosed with microaneurysm with ON cup left eye; narrow angles; and status post meridional amblyopia of the right eye secondary to high unilateral asigmatism. In January 2016 and January 2017 the Veteran was diagnosed with diabetes with no retinopathy, meridional amblyopia of the right eye and refractive error. Entitlement to service connection for an eye disability is not warranted. Service treatment records reveal that the Veteran was diagnosed with amblyope congenital and that the Veteran’s vision was evaluated for glasses after a complaint of difficulty reading. It is further noted that the service treatment records reveal that the Veteran was restricted from duties requiring good depth perception or binocular vision. However, service treatment records do not reveal and the Veteran does not argue that he suffered an eye injury in service. The Veteran has argued that he has had loss of vision and is treated due to his diabetes. Post service treatment records reveal diagnoses of meridional amblyopia right eye secondary to high unilateral astigmatism, hyperopic astigmatism with presbyopia, angles narrow but open in both eyes, and no diabetic retinopathy. Refractive error is a congenital or developmental abnormality that is not a disease or injury within the meaning of applicable regulation [i.e., not a compensable disability]. 38 C.F.R. § 3.303 (c), 4.9. However, service connection may be granted for disability due to aggravation of a congenital abnormality from superimposed disease or injury in service. See Carpenter v. Brown, 8 Vet. App. 240 (1995); Monroe v. Brown, 4 Vet. App. 513 (1993). A congenital defect can be subject to superimposed disease or injury, and if superimposed disease or injury occurs during military service, service-connection may be warranted for the resultant disability. VAOPGCPREC 82-90, 55 Fed. Reg. 45, 711 (1990). See also 38 C.F.R. § 3.303 (c). The Veteran’s astigmatism and presbyopia are refractive errors of the eye. In addition, the Veteran’s amblyopia is a congenital abnormality. There has been no indication that the Veteran’s eye condition has been subject to the superimposed disease or injury during military service. In addition, the Veteran is not in receipt of service-connected benefits for diabetes mellitus and has not been found to have diabetic retinopathy. As the preponderance of the evidence is against a finding that the Veteran has an eye disorder related to his active service, service connection is denied. REASONS FOR REMAND Entitlement to service connection for hypertension, including as secondary to chemical exposure, is remanded. The Veteran seeks entitlement to service connection for hypertension. The Veteran argues that he was borderline hypertensive in service. Review of the service treatment records reveal notations of elevated blood pressure and, in August 1983, a notation of borderline hypertension. Multiple VA medical opinions have been obtained; however, they are not sufficient. In September 2016 the opinion was rendered that the Veteran’s hypertension was less likely than not related to his active service. The rationale provided was that the hypertension was related to age and obesity and that it was not treated in service. In October 2016 a VA examiner could not render an opinion without resort to speculation because the Veteran’s hypertension was not treated in service. It was noted that the Veteran’s hypertension most likely occurred as an adult onset due to advanced age and obesity and that the hypertension was essential in nature meaning that it was of unknown etiology. A VA medical opinion was obtained in November 2016 it was opined that the Veteran’s hypertension was not a result of or aggravated by headaches or posttraumatic stress disorder (PTSD). The examiner stated that it was not due to these disabilities because the Veteran did not have a headache disorder or PTSD in service. The examiner thereafter, could not render an opinion regarding aggravation without resort to speculation because the Veteran’s blood pressure was not taken while the Veteran was having a headache. In rendering the opinions, the examiners have not adequately discussed the Veteran’s multiple notations of elevated blood pressure in service or the notation of possible borderline hypertension in the service treatment records in rendering the opinion that the Veteran’s hypertension was not incurred in service. In addition, the examiners have not adequately discussed whether the Veteran’s service-connected headache and PTSD disabilities aggravated the Veteran’s hypertension disability. As such, remand is necessary to afford the Veteran another VA examination. Entitlement to service connection for joint pain, including as due to undiagnosed illness, is remanded. Entitlement to service connection for tendonitis, including as due to undiagnosed illness, is remanded. In January 2015 the Veteran reported fibromyalgia. The Veteran was noted to have chronic pain syndrome. In a VA treatment note to establish care dated in December 2015, the Veteran was noted to be diagnosed with fibromyalgia. However, in the most recent problem list the Veteran is not diagnosed with fibromyalgia. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for joint pain and/or tendonitis because it is unclear whether the Veteran has fibromyalgia and if the claimed disabilities of joint pain and/or tendonitis are manifestations of fibromyalgia. As such, the claims are remanded for the Veteran to be afforded a VA examination. Evidence indicates that there may be outstanding relevant VA treatment records. The Veteran receives consistent treatment from VA. The most recent VA treatment record associated with the claims file is dated in May 2018. As such, on remand attempts must be made to obtain and associate with the claims file all VA treatment records regarding the Veteran dated since May 2018. 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from May 2018 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any hypertension. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including exposure to chemicals. Based on the examination and review of the record, the examiner should address the following: (a) Is it as least as likely as not (50 percent or greater probability) that any currently diagnosed hypertension had its onset in service, manifest within one year of separation from service in March 1994 or is otherwise related to any incident of the Veteran’s active duty service, specifically to include any exposure to chemicals? In providing the opinion, the examiner must specifically address the in-service elevated blood pressure readings and notation of possible borderline hypertension. (b) Is it is at least as likely as not that any hypertension is (1) proximately due to service-connected disability, or (2) aggravated by service-connected disability? A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and likely etiology of his claimed joint pain and/or tendonitis. Forward the claims file and copies of all pertinent records to the examiner. Based on a review of the record and examination of the Veteran, the examiner should address the following: (a) List all, if any, diagnoses for the Veteran’s joint pain and tendonitis. (b) Does the Veteran’s joint pain and tendonitis represent manifestations of fibromyalgia? (c) Is it as least as likely as not that any diagnosed joint pain and tendonitis is causally related to active service? (Continued on the next page)   Any opinion expressed by the VA examiner must be accompanied by a complete rationale. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Robert J. Burriesci, Counsel