Citation Nr: 18161056 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 17-02 957 DATE: December 28, 2018 ORDER Service connection for bilateral hearing loss is denied. Service connection for hypertension is granted. REMANDED The claim for service connection for sleep apnea is remanded. The claim for a higher initial rating for migraine headaches is remanded. The claim for service connection for left carpal tunnel syndrome is remanded. The claim for service connection for right carpal tunnel syndrome is remanded. The claim for service connection for lower limb neuropathy is remanded. The claim for service connection for a psychiatric disability to include posttraumatic stress disorder (PTSD), anxiety disorder, memory loss, and depression is remanded. The claim for an initial increased rating for a cervical spine disability is remanded. The claim for an increased rating for a lumbar spine disability is remanded. FINDINGS OF FACT 1. The Veteran was exposed to hazardous noise in service, but he does not have hearing loss meeting Department of Veterans Affairs (VA) criteria for hearing loss disability in either ear. 2. The Veteran developed hypertension in service. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2018). 2. The criteria for service connection for hypertension have been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.3.03, 3.307, 3.309 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1991 to December 1991, from February 2003 to August 2003, and from July 2009 to June 2010. The Veteran also served in the Puerto Rico Army National Guard. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). Service connection may be presumed for certain chronic diseases, including sensorineural hearing loss and hypertension, that are manifested to a compensable degree within one year after separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. § 3.307, 3.309(a). Generally, in order to establish service connection for the claimed disorders, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). In certain circumstances, lay evidence may also be competent to establish a medical diagnosis or medical etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 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). 1. Claim for service connection for bilateral hearing loss. The threshold for normal hearing is from 0 to 20 decibels (dB) with higher thresholds indicating some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). For the purposes of applying the laws administered by the VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1,000, 2,000, 3,000, 4,000 hertz is 40 decibels (dB) or greater, or where the auditory thresholds for at least three of the frequencies 500, 1,000, 2,000, 3,000, or 4,000 hertz are 26 dB or greater, or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran contends, in effect, that he has bilateral hearing loss that developed in service or is otherwise causally related to service. The Veteran was afforded a VA hearing loss examination in October 2015. The examiner noted the Veteran’s history of normal hearing in 2009 and fluctuating hearing acuity over intervals subsequently, and concluded that current hearing loss was at least as likely as not causally related to military noise exposures, including related to his deployments to Kuwait, Cuba, and Somalia. However, at the October 2015 examination, upon authorized audiological evaluation, pure tone thresholds, in decibels, were as follows: HERTZ 500 1000 2000 3000 4000 Average 1000 - 4000 RIGHT 15 20 25 20 15 20 LEFT 10 15 15 20 20 18 Speech audiometry revealed speech recognition ability of 100 percent in the right ear and of 100 percent in the left ear. While the October 2015 VA examination indicates some degree of hearing loss in the right ear at 2000 hertz, and some degree of hearing loss in both ears above 4000 hertz (which findings are not listed hereinabove), the Veteran nonetheless is not shown by the examination findings to meet the threshold for hearing loss disability in either ear based on the October 2015 examination pure tone threshold readings and speech recognition scores. See 38 C.F.R. § 3.385. In the absence of current disability, the weight of the evidence is against the claim, and it must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board recognizes that it is remanding other service connection claims based on the failure to seek service records from the Veteran’s first period of service in 1991. However, because the hearing loss claim is denied based not on absence of a causal link to service (since a causal link to service has been obtained in the form of the October 2015 VA examiner’s opinion) but based on absence of hearing loss meeting the regulatory criteria for hearing loss disability in either ear, there is no reasonable possibility that additional service records would further the claim. Hence, to avoid undue delay, denial of service connection for hearing loss at this juncture is warranted. It is well-settled that development merely for its own sake, without a reasonable possibility of substantiating a claim, “cause[s] unnecessary delay, waste[s] scarce resources, and [is] harmful to the entire system, including to the Court, VA, and, most importantly, the veteran.” Carter v. Shinseki, 26 Vet. App. 535, 547 (2014). The Veteran may certainly re-apply for this benefit at a later date, and service connection may then be warranted if his hearing increases in severity and meets the regulatory criteria for disability. 2. Claim for service connection for hypertension. 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. As hypertension is considered to be a chronic disease for VA compensation purposes, if chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303 (b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including hypertension, are presumed to have been incurred in service if they manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The Veteran contends, in effect, that he developed hypertension in service. Service connection is warranted, as explained below. The Veteran was afforded a VA examination in October 2015 to address his claimed hypertension. The Veteran then reported that he was found to have arterial hypertension when stationed in Mississippi in 2010. The examiner noted that the Veteran was currently prescribed losartan for hypertension. The examiner failed to address whether an initial diagnosis of hypertension was confirmed. The examiner opined that the Veteran’s hypertension was not at least as likely as not caused by or the result of service based because “there is no evidence on service medical record.” However, a service medical data questionnaire from June 2010 includes a response that the Veteran suffers from “headaches and high pressure,” for which he was taking Fioricet and Diovan. Since Diovan is an anti-hypertensive medication, this record supports the Veteran’s assertion that he has been treated for hypertension beginning in 2010. VA treatment records from June 2014, November 2014 and August 2015 also indicate the Veteran was followed for hypertension, controlled, by a private physician. Thus, the October 2015 VA examiner’s opinion is based on the inaccurate factual premise that there was no service record evidence of hypertension. Rather, the weight of the evidence supports onset of hypertension in service. Service connection is accordingly warranted. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS FOR REMAND Regrettably, additional development is required prior to Board adjudication of claims the subject of this remand. The Veteran had three periods of active service, August 1991 to December 1991, February 2003 to August 2003, and July 2009 to June 2010. Requests for service department records were made in September 2010, April 2011, and May 2011, but it appears that requests were only made for records from periods of service in 2003 and from 2009 to 2010, with no request made for records from the period from August 1991 to December 1991. VA requested records from the Army National Guard of Puerto Rico and these were received in March 2012, but the request was only made for records from 2007 to 2009. The Veteran was contacted in July 2012, whereupon he was asked if he had service treatment records from 1991, and he replied that he did not. Service records contained within the claims file include only an enlistment examination from February 1991 and records related to an episode of acute care for a right foot sprain in October 1991. Record from that service interval thus appear incomplete. Because the claims file does not contain a documented request for records from the 1991 service period and a formal finding of unavailability of records from that period has also not been made, such formal request must still be made, prior to adjudication of the service connection claims the subject of remand. VA’s duty to assist under the VCAA includes helping claimants to obtain service treatment records (STRs) and other pertinent records, including private medical records (PMRs). See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159 (c). Hence, remand is required for formal requests to the NPRC, the service department, and the Army National Guard of Puerto Rico, for any additional service treatment and examination records, including specifically from September 1991 to December 1991. VA made a formal finding in May 2012 that service records from February 14, 2003, to August 25, 2003, were unavailable for review, despite official requests for records from that period. Hence, it does not appear that additional development is required for records from this second period of service. Additional required development is discussed below. 1. Claim for service connection for sleep apnea is remanded. The Veteran was afforded a VA examination in October 2015 to address sleep apnea. He then reported that in 2010 upon his return from service in Somalia, his wife complained of his loud snoring. The Veteran also complained of persistent daytime hypersomnolence. The examiner noted that a sleep study was performed in 2014 at the San Juan VA Medical Center, and that moderate obstructive sleep apnea was then assessed. The examiner opined that the Veteran’s sleep apnea was not at least as likely as not caused by or the result of service because “there is no evidence on service medical record.” It thus appears that the examiner failed to give due consideration to the Veteran’s self-reported history, which is competent lay evidence of symptoms of sleep apnea from service. See Charles v. Principi, 16 Vet. App. 370, 374- 75 (2002). Absent such consideration, the examination cannot be valid. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (medical opinion must be supported by adequate analysis of relevant evidence). Similarly, the October 2015 examiner, without explanation, concluded that sleep apnea did not impact the Veteran’s ability to work, despite the Veteran’s report of peristent daytime hypersomnolence. The examiner’s failure to consider this impact further highlights the deficiency of the examination’s findings and conclusions. A new examination by a different examiner is thus warranted. 2. Claim for higher initial rating for migraine headaches is remanded. The Veteran’s service-connected migraine headaches are currently rated under the criteria of 38 C.F.R. § 4.124a, Diagnostic Code 8100, with an initial noncompensable (zero percent) rating assigned. Under this diagnostic code, migraines with very frequent, completely prostrating, and prolonged attacks productive of severe economic inadaptability warrant a 50 percent rating. Migraines with characteristic prostrating attacks occurring on an average once per month over the last several months warrant a 30 percent rating. Migraines with characteristic prostrating attacks averaging one in two months over the last several months warrant a 10 percent rating. Migraines with less frequent attacks warrant a noncompensable rating. 38 C.F.R. § 4.124a. The Veteran’s prior VA examination in January 2011 noted left temporal headaches associated with nausea but not photophobia or phonophobia, occurring approximately weekly and lasting all day, treated with Excedrin Migraine as needed with good response. The examiner assessed tension-type headaches. However, the examiner found the headaches to have significant effects on functioning on days when present, including moderate effect on performing chores, shopping, or recreation, but severe effects on exercise, sports, and traveling. The examiner further commented, “effects on daily activities described above are only during episodes of prostrating headache.” Thus, the examiner appears to have concluded that at least some of the headaches as described by the Veteran were prostrating in nature. While a compensable rating for the Veteran’s migraine headaches would likely have been warranted in January 2011 based on the January 2011 examination findings, the level of impairment due to service-connected migraine headaches during the claim period is less clear, since the effective date of service connection is May 5, 2015, over four years after that examination, and the more recent VA examination addressing the Veteran’s headaches in October 2015 provided less than adequate information. At the October 2015 examination, the Veteran endorsed the following symptoms: pulsating or throbbing pain, pain localized to left side of head, pain on both sides of head, pain worsened with physical activity, and associated sensitivity to light and sound as well as nausea. The Veteran reported that these headaches were typically less than a day in duration. The examiner assessed that the headaches were not characteristic prostrating attacks of migraine/ non-migraine pain. The Veteran reported that he had to take medications and unscheduled breaks due to the headaches, and approximately twice yearly he had to leave the work premises due to the headaches. The examiner did not explain how or why the headaches were not “characteristic prostrating attacks of migraine / non-migraine headache pain.” The examiner also failed to note the frequency of the less severe headaches which the Veteran reported required that he take breaks and use medication. The examination is thus inadequate for rating purposes. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board accordingly finds that a more thorough examination is warranted, which addresses the nature, duration, and frequency of any headaches, and addresses which of these are prostrating or completely prostrating, together with an explanation of the examiner’s assessment. The examination should be retrospective in nature, addressing these questions for the entire rating interval beginning from the May 5, 2015 date of service connection. 3. – 4. Claims for service connection for left and right carpal tunnel syndrome are remanded. The Veteran was afforded a peripheral nerves examination in October 2015 and a diagnosis of bilateral carpal tunnel syndrome was then noted. At that examination, mild, incomplete paralysis of the median nerve was found bilaterally. However, while the examiner provided an opinion that it was not at least as likely as not that bilateral carpal tunnel syndrome was related to service, the examiner failed to provide any rationale to support the opinion. An adequate examination must support its conclusion with an analysis that can be weighed against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). Once VA provides an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Accordingly, a new examination is required. 5. – 7. Claims for higher ratings for cervical spine disability and lumbar spine disability, and service connection for lower limb neuropathy are remanded. Submitted into the record in July 2017 is a Disability Benefits Questionnaire (DBQ) addressing the Veteran’s back disorder and radiculopathy. This examination indicated that the Veteran had an inability to sit or stand for prolonged periods due to his back. The examiner also indicated that functioning was so diminished that amputation of an extremity with prosthesis would equally serve the Veteran. It is unclear what this assessment means in the context of the Veteran’s low back disorder, as the balance of the record does not appear to reflect a level of impairment equivalent to complete amputation of one or both lower extremities. VA examinations afforded the Veteran in May 2018 included examinations of the cervical spine and the lumbar spine for rating purposes. This was subsequent to the most recent statement of the case (SOC) in November 2016 addressing these issues. While these examinations were obtained to address newer claims for service connection for radiculopathy into the extremities, the examinations nonetheless are new examinations presenting new, pertinent evidence that must be reviewed by the RO with issuance of a supplemental statement of the case (SSOC) prior to the Board’s adjudication of the claims for increased rating for cervical and lumbar spine disabilities. 38 U.S.C. § 7105; 38 C.F.R. § 19.31; cf Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law No. 112-154, 126 Stat. 1165. Additionally, the Board finds that a new VA examination during an interval of flare-up, if possible, is warranted. The May 2018 examiner did not find radicular pathology other than moderate right lower extremity numbness, paresthesia, and pain as reported by the Veteran. The examiner could not assess radicular pathology or scope of localized lumbar spine and cervical disability during flare-ups without speculation because the Veteran was not examined during a flare-up. Thus, upon remand an effort should be made to schedule the Veteran for a new VA examination of his back and cervical spine during an interval of flare-up, and for the examiner to attempt to address the apparent discrepancy in severity of disability between that found by the submitted July 2017 DBQ and that found upon current examination or upon examination in May 2018, including with regard to the July 2017 DBQ examiner’s assessment that the Veteran had no useful residual use of a lower extremity (no better than amputation). It is unclear from the record whether the Veteran is claiming service connection for neuropathy in the lower limbs as related to service-connected low back disability. Clarification from the Veteran should be sought. The VA examiner addressing the Veteran’s low back disability should also address any radiculopathy into the lower extremities. 8. Claim for service connection for a psychiatric disability to include PTSD, anxiety disorder, memory loss, and depression is remanded. By an October 2017 rating action, the RO reconsidered the claim for service connection for an anxiety disorder or depressive disorder, also then considering entitlement to service connection for PTSD, treating all these as a claim for service connection for a psychiatric disorder to include each claimed disorder. The RO then found that new and material evidence was presented sufficient to reopen the claim, but denied the claim on the merits. However, there was then pending the appealed claim for service connection for an anxiety disorder and depressive disorder before the Board. Hence, the RO inappropriately then readjudicated the claim that was already pending on appeal and did not require reopening. Because the claim for PTSD has been combined with the prior claims on appeal, and these have been the subject of further VA examination August 2017, subsequent to the last SOC in November 2016 addressing an anxiety disorder, depression, and a memory disorder, and subsequent to an SOC in December 2016 addressing PTSD, the Veteran must be afforded an SSOC addressing these issues including based on the additional examination and additional VA evidence of record, prior to the Board’s adjudication. 38 U.S.C. § 7105; 38 C.F.R. § 19.31. The psychiatric issues should be considered as a single issue. The Veteran, as a layperson, is not competent to distinguish between competing psychiatric diagnoses, and so a claim of service connection for one is considered a claim for all. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Upon remand the Veteran should be appropriately informed that his PTSD and other psychiatric disorder claims are being considered as a single issue. The matters are REMANDED for the following actions: 1. Ask the Veteran to clarify the nature of his claim for service connection for lower limb neuropathy, including what disability or symptoms he is claiming, and how he believes it is related to service or a service-connected disability. 2. Make formal requests to the National Personnel Records Center (NPRC), the service department, and the Army National Guard of Puerto Rico, for any additional service treatment and examination records, including in particular records from the active service period from September 1991 to December 1991. As these are Federal facilities, all reasonable efforts should be made to obtain these records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. 3. Obtain and associate with the record any outstanding VA medical records. All efforts to obtain additional evidence must be documented in the electronic record. 4. With any necessary assistance from the Veteran, obtain and associate with the record any outstanding private medical records. All efforts to obtain additional evidence must be documented in the electronic record. If VA is unable to secure any of the above records, it must notify the Veteran and (a) identify the specific records it is unable to obtain; (b) briefly explain the efforts that it made to obtain those records; (c) describe any further action to be taken with respect to the claims; and (d) notify the Veteran that he is ultimately responsible for providing the evidence. 5. Thereafter, schedule the Veteran for a VA examination to address the nature and etiology of his diagnosed sleep apnea. The claims file should be provided to and reviewed by the examiner in conjunction with the examination. Any tests or studies deemed necessary should be conducted, and the results reported in detail. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) The examiner is to be advised that the prior VA examination addressing sleep apnea in October 2015 was inadequate because it failed to consider the Veteran’s statements regarding symptoms in service and shortly after service, including his wife’s complaints of loud snoring. (b.) Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the sleep apnea arose during service or is otherwise related to service. The examiner must provide an explanation for this opinion which includes consideration of any lay statements of symptoms of disability in service and following service. 6. Schedule the Veteran for a retrospective VA examination to address the nature and severity of his migraine headaches over the entire claim period from May 5, 2015 to the present. The claims file should be provided to and reviewed by the examiner in conjunction with the examination. Any tests or studies deemed necessary should be conducted, and the results reported in detail. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) The examiner is to be advised that the prior VA examination addressing migraine headaches in October 2015 was inadequate because the examiner did not explain how or why the headaches were not “characteristic prostrating attacks of migraine / non-migraine headache pain,” and the examiner failed to note the frequency of the less severe headaches which the Veteran reported required that he take breaks and use medication. The examiner must therefore conduct a more thorough examination than that conducted in October 2015. It must address the nature, duration, and frequency of any headaches, and addresses which of these are prostrating or are completely prostrating, together with an explanation of the examiner’s assessment. Thus, the approximate frequency, duration, and effects of each level of severity of headaches should be addressed. The examiner should explain how or why the headaches the Veteran experiences are migraine or non-migraine, prostrating or non-prostrating, and completely or partially debilitating or not debilitating. (b.) Discuss the effect of the Veteran’s headaches on any occupational functioning and activities of daily living. (c.) The examination should be retrospective in nature, addressing these questions for the entire rating interval beginning from the May 5, 2015 date of service connection. If possible, the examiner should provide such details for any intervals of greater or lesser severity of headaches. (d.) If it is not possible to provide a specific finding without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 7. Schedule the Veteran for a VA examination to address the nature and etiology of his left and right carpal tunnel syndrome. The claims file should be provided to and reviewed by the examiner in conjunction with the examination. Any tests or studies deemed necessary should be conducted, and the results reported in detail. Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) The examiner is to be advised that the prior VA examination addressing carpal tunnel in October 2015 was inadequate because it failed to provide any rationale to support the opinion provided. (b.) For any carpal tunnel syndrome of each upper extremity present during the claim period, provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disorder arose during service or is otherwise related to service. The examiner must provide an explanation for this opinion which includes consideration of any lay statements of symptoms of disability in service and following service. 8. Schedule the Veteran for a VA examination to address the nature and severity of his service-connected cervical spine disability and lumbar spine disability. To the extent feasible, this examination should be conducted during a period of flare-up of these disabilities. The claims file should be provided to and reviewed by the examiner in conjunction with the examination. Any tests or studies deemed necessary should be conducted, and the results reported in detail. The examiner must consider the Veteran’s self-reported symptoms when assessing the disabilities Following review of the claims file and examination of the Veteran, the examiner should respond to the following: (a.) Separately for the cervical and the thoracolumbar spine, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. Thus, range of motion with and without weightbearing must be provided. These findings must be documented on the examination report. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. (b.) Provide an opinion as to whether the Veteran has had an objective neurological abnormality associated with the lumbar spine disability and/or cervical spine disability at any point during the appeal period. Indicate the nerve roots involved for each objective neurological impairment found at any point, and the severity of the symptoms (e.g., mild, moderate, severe). (c.) To the extent possible, the examiner should identify any symptoms and functional impairments due to cervical spine disability or lumbar spine disability alone and discuss the effect of each of these on any occupational functioning and activities of daily living. (d.) The examiner should attempt to address the apparent discrepancy in severity of disability between that found by the submitted July 2017 DBQ and that found upon current examination or upon VA examination in May 2018, including with regard to the July 2017 DBQ examiner’s assessment that the Veteran effectively had no residual use of the right lower extremity (no better than amputation). (e.) If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 9. Then, readjudicate the issues on appeal. If the determinations remain less than fully favorable, the Veteran and his representative must be furnished a supplemental statement of the case (SSOC) and given the opportunity to respond before the case is returned to the Board. L. Chu Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Schechter