Citation Nr: 22012371 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 08-18 895 DATE: March 3, 2022 ORDER Service connection for bilateral hip disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability is denied. Service connection for bilateral knee disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability is denied. Service connection for bilateral shoulder disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability is denied. FINDINGS OF FACT 1. The Veteran's bilateral hip disability is not secondary to service-connected cervical spine, thoracic spine, and lumbar disability, and is not otherwise caused by an in-service injury or disease. 2. The Veteran's bilateral knee disability is not secondary to service-connected cervical spine, thoracic spine, and lumbar disability, and is not otherwise caused by an in-service injury or disease. 3. The Veteran's bilateral shoulder disability is not secondary to service-connected cervical spine, thoracic spine, and lumbar disability, and is not otherwise caused by an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hip disability as secondary to service-connected cervical spine and thoracolumbar spine disabilities have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2021). 2. The criteria for service connection for bilateral knee disability as secondary to service-connected cervical spine and thoracolumbar spine disabilities have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2021). 3. The criteria for service connection for bilateral shoulder disability as secondary to service-connected cervical spine and thoracolumbar spine disabilities have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from January 1976 to January 1980. This matter comes before the Board of Veterans' Appeals (Board) from a January 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The issues were previously before the Board. Most recently, in July 2021, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. In pertinent part, the Board directed the AOJ to: afford the Veteran a new VA examination to address the nature and etiology of the claimed bilateral hip disability while specifically discussing prior diagnoses of trochanteric bursitis and mild osteopenia shown in the VA treatment records from February and March of 2017; to obtain a VA medical opinion to clarify whether it is at least as likely as not that the Veteran's bilateral shoulder and knee disabilities were caused or aggravated by her service-connected cervical, thoracic, and lumbar spine disabilities while addressing the Veteran's contention of misalignment. In August 2021, the Veteran was afforded a VA examination for her bilateral hip disability, bilateral knee disability, and bilateral shoulder disability. The August 2021 VA examiner specifically discussed the Veteran's contention of her spinal disabilities causing and/or aggravating her bilateral knee disabilities. In October 2021, a VA examiner submitted an addendum opinion addressing the Veteran's VA treatment records from 2017. Thus, the Board finds that the AOJ substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998). Before the matter was certified to the Board, in an October 2021 rating decision, the RO granted service connection for major depressive disorder with sleep dysfunction, drowsiness, inability to concentrate and unspecified sexual dysfunction and assigned an initial 70 percent rating, effective July 11, 2006. The award of service connection constitutes a complete grant of the benefit sought on appeal. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned). As explained in the prior Board remand, in October 2010, the Veteran testified at a Board hearing before Veterans Law Judge Mackenzie. In December 2019, the Veteran testified before Veterans Law Judge Francis. A Veterans Law Judge who conducts a hearing must participate in making the final determination of the claim involved. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. By law, appeals may be assigned only to an individual Veterans Law Judge or to a panel of not less than three members. 38 U.S.C. § 7102(a). Thus, when a veteran has had a hearing before two separate Veterans Law Judges covering one or more of the same claims on appeal, a third Veterans Law Judge is assigned to participate in a panel decision with respect to those claims. Accordingly, a third Veterans Law Judge was assigned to participate in a panel decision in this case. See 38 U.S.C. § 7102(a); 38 C.F.R. § 20.707. Veterans have a right to a hearing before all three Veterans Law Judges involved in a panel decision. See Arneson v. Shinseki, 24 Vet. App. 379 (2011); 38 C.F.R. § 20.707. As all of the Veterans Law Judges remain on the Board, the panel for the prior Board decision participated in this decision. Service Connection Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for a disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) 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 present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability that is proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected condition is also compensable under 38 C.F.R. § 3.310(a). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). "It is in recognition of our debt to our veterans that society has [determined that,] [b]y tradition and by statute, the benefit of the doubt belongs to the veteran." Gilbert, 1 Vet. App. at 54. 1. Service connection for bilateral hip disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability The Veteran contends that she incurred a bilateral hip disability in service in May 1977 due to falling off a horse while serving in a pentathlon unit. She reports that when she fell, she injured her hips. In the alternative, she contends that the bilateral hip disabilities were caused or aggravated by her service-connected cervical, thoracic, and lumbar spine disabilities, particularly due to "misalignment" of her spine. In July 2021, the Board found that the Veteran's service treatment records showed treatment in May 1977 for a complaint of headache and dizziness after falling off a horse and noted the Veteran's testimony of hip and knee pain since service. Then, as discussed above, the Board noted the diagnoses of right trochanteric bursitis and mild osteopenia in February and March 2017 respectively and directed the AOJ to obtain a medical opinion addressing the Veteran's contentions. In her report of medical history at the time of separation in August 1979, the Veteran reported swollen or painful joints, headaches, dizziness, eye trouble, chronic or frequent colds, shortness of breath, pain or pressure in chest, palpitation or pounding heart, frequent or painful urination, recent gain or loss of weight, recurrent back pain, foot trouble, frequent trouble sleeping, and that she had been treated for a female disorder. She did not report any problems with her hips although she separately reported a concussion under "illness or injury other than those already noted." The corresponding medical examination showed that the Veteran did not have any abnormalities. The Board also notes that while the Veteran reported "swollen or painful joints," that it is not a report or complaint of hip pain as the Veteran herself consistently reported that her hip pain was a radiating pain from her back and did not originate from her hips or hip joints and as a hip complaint was not separately noted in the corresponding medical examination. VA Medical Center treatment records show that as recently as in July 2021, the Veteran had normal gait. Imaging study from July 2011 also show that the Veteran's bilateral hips were unremarkable with no fracture, subluxation or deformity. In August 2021, the Veteran was afforded a VA examination for her claim of service connection for bilateral hip disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability ("bilateral hip disability"). The examiner opined that it was less likely than not that the Veteran's bilateral hip pain was due to service as there is no medical record of a chronic hip condition. The examiner further explained that the Veteran's spine disability did not cause any gait changes or weight bearing. In an October 2021 addendum opinion, the examiner added that the Veteran stated that her hip condition had its onset in 2007 and that the VA Medical Center treatment records from 2017 were consistent with the Veteran's current medical examination finding no evidence of offloading or gait disability from the spinal disability that may contribute to, or aggravate, the hip. The Board finds that the August 2021 VA medical opinion, supported by the October 2021 addendum, is adequate because it considered the history, lay evidence, and the results of a clinical examination and assessment. The Veteran also did not report any chronic hip pain during service and after discharge, as highlighted by her report of medical history in August 1979. The Board finds that had the Veteran experienced symptoms of chronic hip pain, she would have reported it in a clinical setting as she did with her other ailments. Cf. Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (Lance, J., concurring) (holding that silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder (citing Fed. R. Evid. 803(7))); see AZ v. Shinseki, 731 F.3d 1301 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). For example, in her July 2001 statement for her claim, she stated that the misalignment of her spine caused pain that "radiates down" to her hips and did not describe her pain as "chronic" as she did with her other symptoms. To the extent the Veteran asserts that a relationship exists between her hip disability and her fall in May 1977, the Board finds that such assertions do not provide persuasive evidence in support of the claim. The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals. Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011)), here, the etiology of the Veteran's bilateral hip disability is a complex medical matter that falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Thus, lay assertions as to the etiology of the Veteran's bilateral hip disability have no probative value. In summary, in the absence of competent medical or scientific evidence documenting a relationship between the Veteran's bilateral hip disability and her fall in May 1977 or her spine disabilities, service connection must be denied. There are no medical opinions of record supporting a causal relationship between the Veteran's bilateral hip disability and her service-connected spine disabilities. Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54. The weight of competent and credible evidence is against the Veteran's claim, and as such entitlement to service connection for bilateral hip disability is denied. 2. Service connection for bilateral knee disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability 3. Service connection for bilateral shoulder disability, to include as secondary to a cervical spine, thoracic spine, and lumbar spine disability The Veteran contends that she incurred bilateral shoulder and knee disabilities in service due to the May 1977 fall from a horse. She alleges that she initially fell onto her back, neck, and shoulders, and then fell onto her hips and legs. In the alternative, she contends that the claimed bilateral shoulder and knee disabilities were caused or aggravated by her service-connected spine disabilities. Specifically, she asserts that her spine disabilities caused a "misalignment" of her spine, which in turn caused or aggravated the claimed shoulder and knee disabilities. She did not submit a medical opinion supporting her contention. In July 2021, the Board found that the VA examinations added to the Veteran's file in January 2021, but conducted in December 2020, did not address whether the Veteran's claimed disabilities were aggravated by her service-connected cervical, thoracic, and lumbar spine disabilities and remanded the claims. In August 2021, the Veteran was afforded VA examinations for her claims. The Veteran was diagnosed as having bilateral rotator cuff tear in 2020 when she fell from a standing position, and bilateral anterior cruciate ligament tear in 1997 while playing volleyball. The Veteran reported that her bilateral knee pain "continued since surgery." The examiner, after reviewing the medical evidence of record and examining the Veteran in-person, opined that the Veteran's bilateral knee and shoulder disabilities were not aggravated beyond their natural progression by her service-connected spine disability, to include misalignment. In his rationale for the Veteran's bilateral shoulder pain, the examiner stated that there was no medical evidence of record supporting the Veteran's claim that her spinal disabilities contributed to her shoulder pain. In his rationale for the Veteran's bilateral knee pain, the examiner stated that her thoracic scoliosis or cervical lordosis did not "typically affect the knees" and that for the Veteran's specific case, there was no evidence of gait changes related to her scoliosis causing a gait or weight bearing change. The Board also observes that in July 2021, VA Medical Center treatment records show that the Veteran had normal gait. Thus, the Board finds that the August 2021 VA examination to be adequate, as it addressed the Veteran's contentions, is based on accurate factual basis, and as its opinion is supported by rationale pertaining to the Veteran's specific case. In addition, as discussed in the July 2021 Board decision, the December 2020 VA examiner found that the Veteran's claimed shoulder and knee disabilities were less likely than not directly caused by service or service-connected disabilities. In his rationale, the examiner cited the lack of contemporaneous medical evidence including the Veteran's report of medical history in August 1979. As discussed above, in her report of medical history, the Veteran did not complain of shoulder or knee pain, although she did report "swollen or painful joints." The Board, however, finds that the report did not pertain to the Veteran's knees or shoulders as the corresponding medical examination found that her knees and shoulders were "normal" and as the Veteran herself reported in August 2021 that she injured her knees in 1997 playing volleyball and her shoulders in 2020 when she fell from a standing position. Thus, the Board finds that the December 2020 VA examinations to be adequate because the examiners considered the history, lay evidence, and the results of a clinical examination and assessment. As with her claim of service connection for her bilateral hip disability, the Veteran also did not report any chronic bilateral shoulder or knee pain during service and after discharge, as highlighted by her report of medical history in August 1979. The Board finds that had the Veteran experienced symptoms of chronic shoulder and knee, she would have reported it in a clinical setting as she did with her other ailments. Cf. Kahana, 24 Vet. App. at 440; see AZ, 731 F.3d at 1301. The Board also assigns great probative weight to her own statements in August 2021 reporting onset of knee and shoulder pain in 1997 and 2020 respectively. To the extent the Veteran asserts that a relationship exists between her bilateral knee and shoulder disability and her fall in May 1977, the Board finds that such assertions do not provide persuasive evidence in support of the claim. The matter of the medical etiology of the disability here at issue is one within the province of trained medical professionals. Jones, 7 Vet. App. at 137-38. Although lay persons are competent to attest to matters within their own personal knowledge, to include symptoms experienced or observed (as appropriate), as well as to provide opinions on some medical issues, such as those perceived through the senses (see Kahana, 24 Vet. App. at 435), here, the etiology of the Veteran's bilateral knee and shoulder disabilities are complex medical matters that fall outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1372. Thus, lay assertions as to the etiology of the Veteran's bilateral knee and shoulder disabilities have no probative value. In summary, in the absence of competent medical or scientific evidence documenting a relationship between the Veteran's bilateral knee and shoulder disabilities and her fall in May 1977 or her spine disabilities, service connection must be denied. Again, there are no medical opinions of record supporting a causal relationship between the Veteran's bilateral knee and shoulder disabilities and her service-connected spine disabilities. Therefore, the evidence in this case is not so evenly balanced as to allow application of the benefit-of-the-doubt rule as required by law and VA regulations. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 54. The weight of competent and credible evidence is against the Veteran's claim, and as such entitlement to service connection for bilateral knee and shoulder disabilities are denied. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals R. FEINBERG Veterans Law Judge Board of Veterans' Appeals A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H.S. Yun, Associate Counsel 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