Citation Nr: 21015172 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 18-02 169 DATE: March 16, 2021 ORDER Entitlement to a rating in excess of 50 percent for endometriosis is denied. Entitlement to a compensable rating for scar due to removal of uterus and ovaries is denied. Entitlement to a compensable rating for bilateral hearing loss is denied. REMANDED Entitlement to a compensable rating for osteopenia is remanded. FINDINGS OF FACT 1. The Veteran underwent a complete removal of her uterus and both ovaries due to endometriosis. 2. The Veteran has one scar related to her status post total abdominal hysterectomy with bilateral salpingo-oophorectomy that is neither painful nor unstable. 3. Veteran’s bilateral hearing is manifested by hearing acuity of no worse than Level I bilaterally. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 50 percent for endometriosis status post abdominal hysterectomy with bilateral salpingo-oophorectomy are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.116 , Diagnostic Code 7617. 2. The criteria for a compensable rating for status post total abdominal hysterectomy with bilateral salpingo-oophorectomy scar are not met. 38 U.S.C. §§ 1155 , 5107; 38 C.F.R. §§ 3.102 , 4.118, Diagnostic Code 7804, 7805. 3. The criteria for a compensable rating for bilateral hearing loss are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code (DC) 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1977 to December 1977. In September 2018, the Board remanded the case for further development, which is completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Ratings Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a “staged” rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court since has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 1. Entitlement to a rating in excess of 50 percent for endometriosis The Veteran contends she is entitled to an increased rating for endometriosis. She is currently rated at 50 percent under DC 7629 for endometriosis, status post abdominal hysterectomy and bilateral salpingo-oophorectomy. Under DC 7629, a 30 percent schedular rating is assigned for pelvic pain or heavy or irregular bleeding not controlled by treatment. A maximum schedular 50 percent rating is assigned for lesions involving bowel or bladder confirmed by laparoscopy, pelvic pain, or heavy or irregular bleeding not controlled by treatment, and bowel or bladder symptoms. 38 C.F.R. § 4.116 , DC 7629. The Veteran attended a VA examination in September 2012 and reported undergoing a total abdominal hysterectomy with bilateral removal of the ovaries on May 11, 1977 due to a pelvic mass consistent with endometriosis. She requires chronic estrogen therapy and reported pain on bowel movements. The examiner found no current symptoms or evidence of active endometriosis and no functional impact on her ability to work. In January 2016 the Veteran attended another VA examination and reported no symptoms of pelvic conditions. The examiner noted continued hormone therapy and that the attempt to discontinue treatment resulted in a relapse in menopausal symptoms. The examiner again found no current signs or symptoms of endometriosis and no functional impact on the ability to work. The Veteran attended another VA examination in August 2016 and reported low abdominal pain and discomfort during intercourse. The examiner noted symptoms of constant pain, pain on penetration during intercourse and vaginal dryness and atrophy. The examiner reported that these symptoms are secondary to the removal of her uterus and ovaries at 30 years of age. Review of the medical records reveal continued estrogen therapy. The Board notes that the Veteran is in receipt of the maximum schedular rating under DC 7629 for endometriosis. However, throughout the appeal period the medical evidence does not reveal signs, symptoms or treatment of endometriosis. Rather the Veteran’s reported symptoms and treatment are found to be secondary to her hysterectomy. As such, the Board finds that DC 7617, which specifically completes the complete removal of the uterus and both ovaries is the appropriate diagnostic code to use to rate the symptomology. Under DC 7617 a 100 percent evaluation is assigned for three months following total abdominal hysterectomy. After three months, a 50 percent rating is assigned for complete removal of uterus and both ovaries. 38 C.F.R. § 4.116 , DC 7617. As the Veteran underwent her surgery in 1977, she is well past the three-month period for which a 100 percent rating is warranted. Therefore, the Veteran is not entitled to a rating in excess of 50 percent for endometriosis status post total abdominal hysterectomy with bilateral salpingo-oophorectomy. The claim is denied. The Board notes that the Veteran has already been assigned special monthly compensation for loss of use of creative organ throughout the entire appeal period. 38 C.F.R. § 4.118, Diagnostic Codes 7617-7619. 2. Entitlement to a compensable rating for scar due to removal of uterus and ovaries The Veteran contends she is entitled to a compensable rating for her surgical scar secondary to hysterectomy. For the following reasons, the Board finds a compensable rating is not warranted. Scars, other than of the head, face, or neck, are evaluated under the provisions of 38 C.F.R. § 4.118, Diagnostic Codes 7801, 7802, 7804, and 7805. Under DC 7801, a scar not of the head, face, or neck that is deep and nonlinear is rated as follows: a 10 percent rating is assigned for an area of at least 6 square inches (36 sq. cm.) but less than 12 square inches (77 sq. cm.); a 20 percent rating is assigned for an area of at least 12 square inches but less than 72 square inches (465 sq. cm.); a 30 percent rating is assigned for an area of at least 72 square inches but less than 144 square inches (929 sq. cm.); and a maximum 40 percent rating is assigned for an area of 144 square inches or greater. 38 C.F.R. § 4.118, DC 7801. A deep scar is one associated with underlying soft tissue damage. Id. at Note (1). Under DC 7802, a maximum 10 percent rating is assigned for a superficial and nonlinear scar not of the head, face, or neck if it measures 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118, DC 7802. A superficial scar is one not associated with underlying soft tissue damage. Id. at Note (1). DC 7804 assigns ratings for scars that are unstable or painful. A 10 percent rating is assigned for one or two qualifying scars, a 20 percent rating for three or four qualifying scars, and a 30 percent rating for five or more qualifying scars. Note 1 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. See 38 C.F.R. § 4.118, Diagnostic Code 7804. Under DC 7805, other disabling effects not considered under diagnostic codes 7800-7804 are rated under an appropriate diagnostic code. 38 C.F.R. § 4.118, DC 7805. The Veteran attended a VA examination in July 2013 for her scar at which time she reported no complications. The examiner noted that the scar was neither painful nor unstable and described it as a linear scar with a length of 116 centimeters located on the abdominal region. The examiner concluded that it did not functionally impact the Veteran’s ability to work. In August 2016 the Veteran underwent another VA examination. The examiner described the scar as 16 centimeters by 1.1 centimeters located midline on the abdomen. Again, the scar was neither painful nor unstable and did not impact the Veteran’s ability to work. Review of the medical records did not reveal any complaints or treatments related to the Veteran’s scar. As such, the evidence does not establish the presence of a scar with soft tissue damage, a scar approximating an area of 144 square inches or greater, or a scar that is unstable or painful. 38 C.F.R. § 4.118, DC 7801, 7802, 7804. Moreover, there is no evidence that the Veteran’s scar caused any other impairment. See 38 C.F.R. § 4.118, DC 7805. Accordingly, the Board finds that a compensable rating for surgical scar secondary to hysterectomy is not warranted at any time during the appeal period. 3. Entitlement to a Compensable Rating for Bilateral Hearing Loss The Veteran contends that she is entitled to a higher rating for hearing loss because she has difficulty understanding conversations and hearing when there is background noise. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85. The rating schedule establishes 11 auditory hearing acuity levels based upon average puretone thresholds and speech discrimination. See 38 C.F.R. § 4.85. “Puretone threshold average” as used in Tables VI and VIa is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz and divided by four. This average is used in all cases (including those of § 4.86) to determine a Roman numeral designation from Tables VI and VIa. 38 C.F.R. § 4.85(d). Table VI, “Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). The Roman numeral designation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(b). Table VIa, “Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on puretone threshold average. Table VIa is used when the examiner certifies that the use of the speech discrimination test is not appropriate due to language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85(c). Table VII, “Percentage Evaluations of Hearing Impairment,” is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in each ear. The horizontal rows represent the ear having better hearing and the vertical columns represent the ear having the poorer hearing. The percentage evaluation is located at the point where the row and the column intersect. 38 C.F.R. § 4.85(e). Special provisions apply in instances of exceptional hearing loss. See 38 C.F.R. § 4.86. When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) are all 55 decibels or more, the adjudicator must determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa in 38 C.F.R. § 4.85, whichever results in the higher numeral. 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. Each ear is evaluated separately. 38 C.F.R. § 4.86(b). As the Veteran’s hearing does not establish an exceptional hearing pattern, only Table VI is applicable. The Veteran underwent a VA examination in June 2013 and reported difficulty understanding conversations. Her puretone thresholds, in decibels were as follows: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 20 10 40 50 30 100 LEFT 5 30 55 60 38 96 Based on the findings, under Table VII, the Veteran has a level I hearing acuity bilaterally, which results in a non-compensable rating. In January 2016 the Veteran attended another VA examination and reported difficulty understanding speech and hearing in situations with background noises. Functionally, the examiner concluded the Veteran is able to function adequately in silent environments where background noise should be minimal. Her puretone thresholds, in decibels were as follows: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 20 15 45 45 31 100 LEFT 10 40 65 70 38 96 Based on the findings, under Table VII, the Veteran has a level I hearing acuity bilaterally, resulting in a non-compensable rating. The Veteran underwent another VA examination in August 2016 and reported difficulty understanding conversations. Her puretone thresholds, in decibels were as follows: HERTZ CNC 1000 2000 3000 4000 Avg % RIGHT 15 10 20 45 23 100 LEFT 10 30 65 60 41 100 Based on the findings, under Table VII, the Veteran has a level I hearing acuity bilaterally, which results in a non-compensable rating. Review of the medical records reveals complaints of hearing loss and difficulty understanding speech. In March 2012 an audiological appointment revealed excellent speech recognition bilaterally and mild to moderate sensorineural hearing loss from three to eight kilohertz in the right ear and mild to severe sensorineural hearing loss from two to eight kilohertz. The Veteran also attended an evaluation in November 2018. The audiologist reported moderate sensorineural hearing loss in the higher frequencies for the right ear and mild to severe sensorineural hearing loss for the mid-high and high frequencies of the left ear with word recognition scores at 100 percent. The Board acknowledges the Veteran’s lay statements regarding her symptoms of difficulty understanding conversations and hearing with background noise. While the Boards does not doubt the sincerity of the Veteran’s assertions regarding the severity of her hearing loss, or its functional impact, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). Additionally, the rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The functional impact that the Veteran describes and her main complaint of reduced hearing acuity and clarity, is contemplated by the assigned rating criteria. Doucette v. Shulkin, 28 Vet. App. 366 (2017); Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017). When considering the medical evidence from the VA examinations and medical treatment records the Veteran’s symptoms are consistent with her current rating. Accordingly, the preponderance of the probative evidence is against the claim of entitlement to a compensable rating for hearing loss. In reaching the conclusion above, the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to a compensable rating for osteopenia The Veteran last underwent a VA examination in August 2016 for osteopenia. The medical records contain a bone density scan from 2019 revealing a decrease in bone density. Thereby, the medical evidence indicates that the Veteran’s symptoms have increased since her last VA examination and a new VA examination is necessary to determine the current severity of the Veteran’s osteopenia. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for a VA medical examination to determine the current severity of her service-connected osteopenia. The electronic claims file must be reviewed in conjunction with the examination. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted, and the results included in the examination report. The examiner should consider and address the Veteran’s full medical history, to include her lay statements that her osteopenia causes pain, swelling and stiffness in her joints. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. The examiner must also provide an assessment of the Veteran’s functional limitations due to her osteopenia as it may relate to her ability to function in a work setting and to perform work tasks. However, the examiner should refrain from commenting on the Veteran’s employability. A complete rationale should be given for all opinions and conclusions rendered. (Continued on the next page)   If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303. Department of Veterans Affairs YOUR RIGHTS TO APPEAL OUR DECISION The attached decision by the Board of Veterans' Appeals (Board) is the final decision for all issues addressed in the "Order" section of the decision. The Board may also choose to remand an issue or issues to the local VA office for additional development. If the Board did this in your case, then a "Remand" section follows the "Order." However, you cannot appeal an issue remanded to the local VA office because a remand is not a final decision. The advice below on how to appeal a claim applies only to issues that were allowed, denied, or dismissed in the “Order.” If you are satisfied with the outcome of your appeal, you do not need to do anything. Your local VA office will implement the Board’s decision. However, if you are not satisfied with the Board's decision on any or all of the issues allowed, denied, or dismissed, you have the following options, which are listed in no particular order of importance: • Appeal to the United States Court of Appeals for Veterans Claims (Court) • File with the Board a motion for reconsideration of this decision • File with the Board a motion to vacate this decision • File with the Board a motion for revision of this decision based on clear and unmistakable error. Although it would not affect this BVA decision, you may choose to also: • Reopen your claim at the local VA office by submitting new and material evidence. There is no time limit for filing a motion for reconsideration, a motion to vacate, or a motion for revision based on clear and unmistakable error with the Board, or a claim to reopen at the local VA office. Please note that if you file a Notice of Appeal with the Court and a motion with the Board at the same time, this may delay your appeal at the Court because of jurisdictional conflicts. If you file a Notice of Appeal with the Court before you file a motion with the Board, the Board will not be able to consider your motion without the Court's permission or until your appeal at the Court is resolved. How long do I have to start my appeal to the court? You have 120 days from the date this decision was mailed to you (as shown on the first page of this decision) to file a Notice of Appeal with the Court. If you also want to file a motion for reconsideration or a motion to vacate, you will still have time to appeal to the court. As long as you file your motion(s) with the Board within 120 days of the date this decision was mailed to you, you will have another 120 days from the date the Board decides the motion for reconsideration or the motion to vacate to appeal to the Court. You should know that even if you have a representative, as discussed below, it is your responsibility to make sure that your appeal to the Court is filed on time. Please note that the 120-day time limit to file a Notice of Appeal with the Court does not include a period of active duty. If your active military service materially affects your ability to file a Notice of Appeal (e.g., due to a combat deployment), you may also be entitled to an additional 90 days after active duty service terminates before the 120-day appeal period (or remainder of the appeal period) begins to run. How do I appeal to the United States Court of Appeals for Veterans Claims? Send your Notice of Appeal to the Court at: Clerk, U.S. Court of Appeals for Veterans Claims 625 Indiana Avenue, NW, Suite 900 Washington, DC 20004-2950 You can get information about the Notice of Appeal, the procedure for filing a Notice of Appeal, the filing fee (or a motion to waive the filing fee if payment would cause financial hardship), and other matters covered by the Court's rules directly from the Court. You can also get this information from the Court's website on the Internet at: http://www.uscourts.cavc.gov, and you can download forms directly from that website. The Court's facsimile number is (202) 501-5848. To ensure full protection of your right of appeal to the Court, you must file your Notice of Appeal with the Court, not with the Board, or any other VA office. How do I file a motion for reconsideration? You can file a motion asking the Board to reconsider any part of this decision by writing a letter to the Board clearly explaining why you believe that the Board committed an obvious error of fact or law, or stating that new and material military service records have been discovered that apply to your appeal. It is important that your letter be as specific as possible. A general statement of dissatisfaction with the Board decision or some other aspect of the VA claims adjudication process will not suffice. If the Board has decided more than one issue, be sure to tell us which issue(s) you want reconsidered. Issues not clearly identified will not be considered. Send your letter to: Litigation Support Branch Board of Veterans' Appeals P.O. Box 27063 Washington, DC 20038 VA FORM DEC 2016 4597 Page 1 CONTINUED ON NEXT PAGE Remember, the Board places no time limit on filing a motion for reconsideration, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to vacate? You can file a motion asking the Board to vacate any part of this decision by writing a letter to the Board stating why you believe you were denied due process of law during your appeal. See 38 C.F.R. 20.904. For example, you were denied your right to representation through action or inaction by VA personnel, you were not provided a Statement of the Case or Supplemental Statement of the Case, or you did not get a personal hearing that you requested. You can also file a motion to vacate any part of this decision on the basis that the Board allowed benefits based on false or fraudulent evidence. Send this motion to the address on the previous page for the Litigation Support Branch, at the Board. Remember, the Board places no time limit on filing a motion to vacate, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to revise the Board's decision on the basis of clear and unmistakable error? You can file a motion asking that the Board revise this decision if you believe that the decision is based on "clear and unmistakable error" (CUE). Send this motion to the address on the previous page for the Litigation Support Branch, at the Board. You should be careful when preparing such a motion because it must meet specific requirements, and the Board will not review a final decision on this basis more than once. You should carefully review the Board's Rules of Practice on CUE, 38 C.F.R. 20.1400-20.1411, and seek help from a qualified representative before filing such a motion. See discussion on representation below. Remember, the Board places no time limit on filing a CUE review motion, and you can do this at any time. How do I reopen my claim? You can ask your local VA office to reopen your claim by simply sending them a statement indicating that you want to reopen your claim. However, to be successful in reopening your claim, you must submit new and material evidence to that office. See 38 C.F.R. 3.156(a). Can someone represent me in my appeal? Yes. You can always represent yourself in any claim before VA, including the Board, but you can also appoint someone to represent you. An accredited representative of a recognized service organization may represent you free of charge. VA approves these organizations to help veterans, service members, and dependents prepare their claims and present them to VA. An accredited representative works for the service organization and knows how to prepare and present claims. You can find a listing of these organizations on the Internet at: http://www.va.gov/vso/. You can also choose to be represented by a private attorney or by an "agent." (An agent is a person who is not a lawyer, but is specially accredited by VA.) If you want someone to represent you before the Court, rather than before the VA, you can get information on how to do so at the Court’s website at: http://www.uscourts.cavc.gov. The Court’s website provides a state-by-state listing of persons admitted to practice before the Court who have indicated their availability to the represent appellants. You may also request this information by writing directly to the Court. Information about free representation through the Veterans Consortium Pro Bono Program is also available at the Court’s website, or at: http://www.vetsprobono.org, mail@vetsprobono.org, or (855) 446-9678. Do I have to pay an attorney or agent to represent me? An attorney or agent may charge a fee to represent you after a notice of disagreement has been filed with respect to your case, provided that the notice of disagreement was filed on or after June 20, 2007. See 38 U.S.C. 5904; 38 C.F.R. 14.636. If the notice of disagreement was filed before June 20, 2007, an attorney or accredited agent may charge fees for services, but only after the Board first issues a final decision in the case, and only if the agent or attorney is hired within one year of the Board’s decision. See 38 C.F.R. 14.636(c)(2). The notice of disagreement limitation does not apply to fees charged, allowed, or paid for services provided with respect to proceedings before a court. VA cannot pay the fees of your attorney or agent, with the exception of payment of fees out of past-due benefits awarded to you on the basis of your claim when provided for in a fee agreement. Fee for VA home and small business loan cases: An attorney or agent may charge you a reasonable fee for services involving a VA home loan or small business loan. See 38 U.S.C. 5904; 38 C.F.R. 14.636(d). Filing of Fee Agreements: If you hire an attorney or agent to represent you, a copy of any fee agreement must be sent to VA. The fee agreement must clearly specify if VA is to pay the attorney or agent directly out of past-due benefits. See 38 C.F.R. 14.636(g)(2). If the fee agreement provides for the direct payment of fees out of past-due benefits, a copy of the direct-pay fee agreement must be filed with the agency of original jurisdiction within 30 days of its execution. A copy of any fee agreement that is not a direct-pay fee agreement must be filed with the Office of the General Counsel within 30 days of its execution by mailing the copy to the following address: Office of the General Counsel (022D), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420. See 38 C.F.R. 14.636(g)(3). The Office of the General Counsel may decide, on its own, to review a fee agreement or expenses charged by your agent or attorney for reasonableness. You can also file a motion requesting such review to the address above for the Office of the General Counsel. See 38 C.F.R. 14.636(i); 14.637(d). VA FORM DEC 2016 4597 Page 2 SUPERSEDES VA FORM 4597, APR 2015, WHICH WILL NOT BE USED