Citation Nr: 18158122
Decision Date: 12/18/18	Archive Date: 12/14/18

DOCKET NO. 16-32 284
DATE:	December 18, 2018
ORDER
The claim for an increased rating for posttraumatic stress disorder (PTSD) with unspecified depressive disorder in excess of 50 percent is denied.
REMANDED
The claim for service connection for a lumbar spine disability to include as secondary to service-connected disability is remanded.
FINDING OF FACT
For the appellate period, the Veteran’s PTSD is characterized by occupational and social impairment with reduced reliability and productivity; deficiencies in most areas, such as work, family relations, thinking, and mood are not demonstrated.
CONCLUSION OF LAW
The criteria for an evaluation in excess of 50 percent for PTSD have not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.126, 4.130, Diagnostic Code 9411.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty in the U.S. Army from November 1968 to March 1971, with service in the Republic of Vietnam.
This case comes to the Board of Veterans’ Appeals (Board) on appeal from an Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decision dated October 2014 for increased rating for PTSD, and January 2015 for service connection for degenerative lumbar spine. The claim regarding the lumbar spine condition is discussed below in the “Reasons for Remand” section. Regarding the PTSD claim, the AOJ granted a partial increase from a 30 percent rating to 50 percent, effective April 14, 2014. The Veteran appealed, requesting a 100 percent rating for PTSD.
1. Increased rating for PTSD in excess of 50 percent
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. 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 reviewed when making disability evaluations. See generally, 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).  
The regulations for rating mental disorders are found in 38 C.F.R. §§ 4.125-4.130.  The Board notes that PTSD is evaluated under Diagnostic Code 9411 which is rated according to the General Rating Formula for Mental Disorders. As noted above, the AOJ increased the Veteran’s rating for PTSD to 50 percent, effective April 14, 2014.  
A 50 percent rating is provided for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.
A 70 percent rating is provided for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 
A 100 percent rating is provided for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. §§ 4.125-4.130.
When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant’s capacity for adjustment during periods of remission. VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126(a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment.  38 C.F.R. § 4.126(b).
A veteran may only qualify for a given disability rating under 38 C.F.R. § 4.130 by demonstrating the presence of the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-118 (Fed. Cir. 2013). In addition to requiring the presence of the enumerated symptoms, 38 C.F.R. § 4.130 also requires that those symptoms have caused the specified level of occupational and social impairment. Vazquez-Claudio, supra.
However, the factors listed in the rating schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating, so the determination should not be limited solely to whether a veteran exhibited the symptoms listed in the rating scheme, but should also be based on all of a veteran’s symptoms affecting his level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-443 (2002); 38 C.F.R. § 4.126(a).
It is error where the Board fails to assess adequately evidence of a sign or symptom experienced by the veteran, misrepresents the meaning of a symptom, or fails to consider the impact of the veteran’s symptoms as a whole.  However, the presence or lack of evidence of a specific sign or symptom listed in the evaluation criteria, including suicidal ideation, is not necessarily dispositive of any particular disability level. Bankhead v. Shulkin, 29 Vet. App. 10, 25 (2017).
For instance, the scores assigned under the Global Assessment of Functioning (GAF) scale may be a relevant consideration. See e.g., Bowling v. Principi, 15 Vet. App. 1, 14 (2001). However, the American Psychiatric Association has since determined that the GAF score has limited usefulness in the assessment of the level of disability. Noted problems include lack of conceptual clarity and doubtful value of GAF psychometrics in clinical practice. 79 Fed. Reg. 45093 (Aug. 4, 2014).  The Board notes that, effective August 4, 2014, the regulations governing the rating of mental disorders were updated to replace all references to the DSM-IV with references to the DSM-5, which no longer utilizes the GAF score system. 80 Fed. Reg. 14308 (Mar. 19, 2015). However, this change does not apply to claims that were certified for appeal to the Board prior to August 4, 2014 even if such claims were subsequently remanded. Id. As the Veteran’s claim was certified to the Board in September 2016, the DSM-IV does not apply. Therefore, the Board will apply the DSM-5 in its analysis, and will not consider any GAF scores mentioned in the medical records.
After a review of the evidence, for the reasons set forth below, the Board finds that the symptoms of the Veteran’s service-connected PTSD with depression, nightmares, hypervigilance, irritability, anxiety, and social withdrawal do not meet the criteria for a rating in excess of 50 percent.
The evidence of record consists of the Veteran’s outpatient treatment records, an October 2014 VA examination, and the Veteran’s statements. Each is discussed chronologically below.
For the year prior to the Veteran filing his claim for increased rating, his outpatient records reflect that he experienced mildly depressed mood, interest, and energy. For example, at an appointment in March 2013, the Veteran had thoughts of flashbacks, hypervigilance, avoidance, startle response, numbing, and social withdrawal. However, the Veteran did not have any passive thoughts of death, no suicidal or homicidal ideation, and no psychoses. The Veteran had the following psychosocial problems: limited coping skills, limited insight, and health, social, and financial stressors. The Veteran had good eye contact, was cooperative, coherent, goal-directed, and oriented. The VA outpatient treatment records demonstrate that Veteran experienced the same symptoms, with unchanged frequency, severity, and duration at the following appointments: September 2013; December 2013; and July 2014.
At an appointment in September 2014, the Veteran reported being overwhelmed with anxiety that led to anger. He had concerns about managing his anger on the job and in his home life. The mental health treatment provider noted that the Veteran used marijuana daily. The Veteran also reported that he avoided social interactions, and that he had problems falling asleep due to intrusive racing thoughts. The Veteran reported some relationship problems with his immediate family, but said that, overall, he had a good relationship with them. He did not have other close relationships, and had significantly reduced his participation in activities. The treatment provider noted that the Veteran’s behavior was appropriate during the session, that he was alert and oriented, had no memory loss or impairment, no thought process or communication impairment, his hygiene was adequate, and his speech was generally normal. The Veteran denied delusions, suicidal ideations, or homicidal ideations. The provider found that the Veteran’s symptoms caused clinically significant distress or impairment in social, occupational, or other important area of functioning.
In October 2014, the Veteran underwent a VA examination. The Veteran reported the following symptoms: interpersonal relationship problems; feeling sad and discouraged; intrusive thoughts; nightmares; flashbacks; emotional distress; avoidance; loss of interest in activities; feeling detached from others; difficulty trusting others; difficulty expressing or experiencing positive feelings; irritability; anger outbursts; risk-taking behavior; hypervigilance; increased startle response; difficulty concentrating; waking several times per night; difficulty falling asleep; nightmares several times per week; yelling and screaming during sleep; waking at night in a sweat; low esteem with feelings of worthlessness; mild memory problems; and waking to check the premises twice per night. The Veteran denied the following: acts of violence or physical aggression; suicidal ideation; homicidal ideation; current legal or criminal troubles; delusions; illusions; paranoia; hallucinations; and psychiatric hospitalizations. The Veteran was well-groomed, appropriate, cooperative, alert, and oriented. His speech, attention, focus, and eye contact were found to be within normal limits. The Veteran exhibited slight memory deficits. The examiner found that the Veteran had extreme depression, and very severe anxiety. 
The examiner ultimately concluded that the Veteran’s PTSD caused occupational and social impairment with reduced reliability and productivity. The examiner explained that the symptoms of PTSD, anxiety, and depression overlap, and it is impossible to separate the components of each mental health condition. The Veteran’s symptom intensity appeared to be overall severe with somewhat greater impairment noted in occupational, social, and personal functioning than was seen during previous VA examinations. The Veteran’s occupational impairment was characterized by difficulty getting along with co-workers, supervisors, and independent contractors, as well as low tolerance for frustration, difficulty controlling temper, emotional reactivity, and depressed mood. His social impairment was characterized by avoidance, reclusiveness, marital stress, inability to tolerate crowds, irritability, and poor interpersonal relationships.
At the Veteran’s appointments over the next few months, he received counseling specifically for his anger and aggression. He had visits every other week in the following months: November 2014; December 2014; January 2015; and February 2015. At each appointment, the Veteran was friendly and cooperative. He was alert and oriented. His mood was euthymic or normal, and his eye contact was good. Each time, the Veteran denied delusions, hallucinations, suicidal ideation, and homicidal ideation.
The Veteran had a medication management appointment in February 2015. He reported chronic sleep issues with waking at least twice per night. The Veteran said that there was improvement with his nightmares, but they were still occurring three times per week. The Veteran was still employed, and said that his wife was supportive. He denied feeling depressed, suicidal ideation, and use of illicit drugs. The psychiatrist found the Veteran to be alert, oriented, and cooperative. His mood was not depressed and affect was slightly restricted. There were no delusions or hallucinations noted. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. The only psychosocial stressor noted was “physical health problem.” The psychosocial stressors not indicated were: primary support group problem; social environment problem; school/work problem; housing problem; self-care problem; financial problem; and current abuse.
In March 2015, the Veteran reported having difficulty with anger during the preceding three weeks. He said he resorted to yelling and felt the need to push someone. However, for the two weeks after that, the Veteran reported being able to control his anger. At both March 2015 appointments, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed.
Between April 2015 and May 2015 the Veteran reported improvements in his anger, though he had frustration. During this time frame, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed.
In May 2015, the Veteran stopped having nightmares. However, he was still waking at night and had difficulty returning to sleep. That month, he submitted his Notice of Disagreement with the AOJ’s rating of his PTSD. He noted that he had been in therapy continuously since 2005, with an emphasis on anger management. He said he had a job, but it was difficult and he had a lot of conflict. The Veteran reported that he isolates himself, and had problems in his marriage.
Between June 2015 and August 2015, the Veteran reported doing fairly well with his anger, and having no outbursts. During this time frame, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. His mood was euthymic or neutral.
At a psychiatry appointment in August 2015, the Veteran reported that his mood and sleep had been better and he had no nightmares. His energy was good. He denied suicidal and homicidal ideations. The Veteran was alert and oriented and had good eye contact with the doctor. His speech was clear, relevant, and coherent. The Veteran’s mood was not depressed, and he did not have any delusions or hallucinations. The only psychosocial stressor noted was “primary support group problem.” The psychosocial stressors not indicated were: physical health problem; social environment problem; school/work problem; housing problem; self-care problem; financial problem; and current abuse.
The Veteran continued with therapy in September 2015 and October 2015. The Veteran did not have any episodes of angry outbursts during this time. He reported being able to walk away from negative situations. The Veteran did not yell or become aggressive. During this time frame, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed.
At a psychiatry appointment in November 2015, the Veteran reported that his familial relationships had improved. He said he did get agitated, but was using techniques from therapy to cope. The Veteran also reported that his nightmares were better, but they were still occurring approximately three times per week. The Veteran was not using alcohol or illicit drugs. He was not suicidal, and was future-oriented. He was still employed and had support from his family. Of the psychosocial stressors listed, none was noted: primary support group problem; physical health problem; social environment problem; school/work problem; housing problem; self-care problem; financial problem; or current abuse.
Between November 2015 and January 2016, the Veteran experienced some stressful situations, but attempted to employ coping techniques. He reported being able to control his temper and walk away without getting hostile. During this time frame, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. His mood was euthymic at each appointment during this time frame.
In January 2016, the Veteran reported feeling positive that he could control his temper better. He said he had no negative displays of anger. By March 2016, the Veteran reported improvements in his family, and spending more time with them. Between January 2016 and March 2016, the Veteran denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. During this time period, the Veteran’s mood was euthymic at each appointment.
At a psychiatry appointment in April 2016, the Veteran reported difficulty with sleep. He was waking after five hours of sleep, and was unable to fall back asleep. The Veteran also said he had occasional nightmares with some symptoms of hyperarousal. He said his mood was “OK” and things were going well at work. The Veteran denied use of alcohol or illicit drugs. He was not suicidal and was future-oriented. The psychiatrist found the Veteran to be alert, oriented, and cooperative. His mood was not depressed and affect was full range. There were no delusions or hallucinations noted. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. He was found to have had a primary support group problem.
Finally, in May 2016, the Veteran reported that he had 2 anger outbursts in one week. He denied suicidal ideations, homicidal ideations, delusions, or hallucinations. The Veteran was friendly, cooperative, alert, and oriented. His speech was clear, relevant, and coherent. The Veteran’s thoughts were linear and goal directed. There were no barriers to treatment identified. His mood was euthymic.
The preponderance of the evidence is against the claim for an increased rating in excess of 50 percent for the Veteran’s PTSD. As noted above, a 70 percent rating is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is warranted when there is total occupational and social impairment. Here, the Veteran does not have deficiencies in most areas, nor does he have total social and occupational impairment. Therefore, the Veteran’s claim for an increased rating must denied.
While the evidence of record shows that the Veteran had some deficiencies in work, the evidence also shows that he was able to, and did, maintain employment for the entire appellate period. He was able to adapt to his work setting, as evidence by his reports that he was able to implement coping mechanisms. For example, most of the Veteran’s anger management appointments involved discussing frustrating situations at work and in other social settings. In June 2015, the Veteran reported walking away from two negative encounters at work. In September 2015, the Veteran reported that he was able to develop alternative responses to a negative situation and walk away. In November 2015, he described being assertive, but not hostile in a stressful situation. The Veteran’s records reflect that he has never been violent or physically aggressive during the appellate period. There is no evidence of impaired impulse control relating to violence. There is no evidence that any difficulties he faced at work resulted in adverse employment action, such as suspension or termination. The deficiencies in work that are attributable to the Veteran’s PTSD symptoms are addressed by a 50 percent rating.
In addition, although the evidence shows that the Veteran had some deficiencies in family relations, any deficiency that existed appears to have improved. Despite his avoidance, the Veteran maintained a relationship with his wife, children, and grandchildren. For instance, in May 2015 the Veteran reported that he and his wife did not have a close relationship, however, in January 2016, he reported that they were “fine.” Moreover, in February 2015, the Veteran told his psychiatrist that his wife was supportive. In November 2015, the Veteran reported that his relationship with his adult children had improved since he apologized for his anger. In March 2016, the Veteran reported spending time with his grandchildren. In sum, the Veteran does not have a complete inability to establish and maintain relationships. For the appeal period, the effects of the Veteran’s PTSD on his interpersonal relationships are addressed by a 50 percent rating, which contemplates difficulty in establishing and maintaining effective work and social relationships.
Regarding his mood, while Veteran was diagnosed with depression, the overwhelming majority of his outpatient records demonstrate that his mood was euthymic. For example, he was euthymic at visits in the following months: May 2016; April 2016; March 2016; January 2016; December 2015; November 2015; September 2015; August 2015; July 2015; May 2015; April 2015; March 2015; November 2014; and October 2014. At all his appointments, the Veteran was always friendly and cooperative. Furthermore, the Veteran did not have near-continuous panic or depression that affected his ability to function independently, as evidenced by his abilities to complete activities of daily living, maintain his appointments, and keep a job. The mood-related symptoms caused by the Veteran’s PTSD or depressive disorder are contemplated by a 50 percent rating, which covers disturbances of mood.
The evidence of record also shows that Veteran had no impairment in his judgment or thinking. He always denied suicidal and homicidal ideations. The Veteran never exhibited hallucinations, delusions, or psychoses. He never had speech that was intermittently illogical, obscure, or irrelevant. The Veteran never presented at an appointment with disorientation. There was no evidence of obsessional rituals that interfered with his daily activities. 
Because the preponderance of the evidence shows that the Veteran’s PTSD symptoms most closely approximate a 50 percent rating (occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships), the claim for increased rating above a 50 percent is denied. The preponderance of the evidence is against finding that his PTSD symptoms approximate a 70 percent rating.  
The Veteran’s symptoms also do not meet the criteria for a 100 percent rating for this appeal period. The symptoms as described in the factual background above do not manifest in the frequency, severity, or duration consistent with the symptoms identified by the general rating formula for a 100 percent rating. There is no evidence of total social and occupational impairment. The medical records reflect that there was no gross impairment in communication, no persistent danger of hurting self or others, no disorientation, no grossly inappropriate behavior, and no persistent delusions or hallucinations. The Veteran maintained his hygiene, kept his medical appointments, was cooperative with treatment providers and communicated effectively with them, was always oriented, and remembered recent events. Because the Veteran was not totally impaired in his functioning, a 100 percent rating is not warranted. 
The Board is aware that the symptoms listed under the particular percentage evaluations are essentially examples of the type and degree of symptoms for those evaluations, and that the Veteran need not demonstrate those exact symptoms to warrant higher ratings. See Mauerhan, 16 Vet. App. at 436. In this case, based on the above, the evidence is against finding that the Veteran does exhibit symptoms more nearly indicative of a higher level, in excess of 50 percent. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-55 (1990).
REASONS FOR REMAND
1. The claim for service connection for a lumbar spine disability to include as secondary to service-connected disability is remanded.
Unfortunately, due to reasons that follow, a remand is required. Although the Board sincerely regrets this additional delay, it is necessary to ensure the Veteran is afforded adequate due process and every possible consideration.
The Veteran filed his claim for service connection of his low back condition as being secondary to his service-connected left knee. The Veteran underwent a VA examination for his lumbar spine in November 2014. The examiner concluded that the Veteran has a current diagnosis of sciatic neuritis and arthritis of the thoracolumbar spine. The examiner’s opinion was as follows: “the condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran’s service connected condition.” This opinion is inadequate. Pursuant to 38 U.S.C. § 3.310, a Veteran may be secondarily service-connected for a disability that is either proximately due to or the result of a service-connected disability or aggravated (increased in severity) beyond its natural progress by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). The November 2014 examiner only addressed the question of proximate cause, and did not address aggravation. A remand is necessary to address whether or not the Veteran’s back condition has been aggravated by his service-connected knee condition.
Moreover, a remand is necessary for consideration of additional evidence of record. In order for an examination to be adequate, it must consider all the relevant evidence of record. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Here, it appears that the examiner did not consider the Veteran’s in-service mortar attack, or the Veteran’s service-connected bilateral lower extremity peripheral neuropathy. Finally, the medical opinion did not consider whether the Veteran’s back condition could be service connected on a direct basis. Therefore, the Board finds that another VA examination is warranted to determine the nature and etiology of the Veteran’s back condition. Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board’s duty to return an inadequate examination report “if further evidence or clarification of the evidence...is essential for a proper appellate decision.”).
The matter is REMANDED for the following action:
1. Obtain any updated and current relevant VA treatment records and supplement the claims file.
2. Schedule the Veteran for a VA examination to ascertain the nature and etiology of the Veteran’s lumbar spine condition. All necessary tests should be conducted. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner should address the following:
(a)	Whether it is at least as likely as not (50 percent or greater likelihood) that the Veteran’s current back condition manifested during service, manifested to a compensable degree within one year of service, or is otherwise etiologically related to active service, including an inservice mortar attack; 
(b)	Whether it is at least as likely as not that the Veteran’s back condition is proximately due to, or alternatively, aggravated by, a service-connected disability to include service-connected bilateral peripheral neuropathy or service-connected total left knee replacement.

 
S. L. Kennedy
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Smith, Associate Counsel