Citation Nr: 22028186 Decision Date: 05/12/22 Archive Date: 05/12/22 DOCKET NO. 18-02 491 DATE: May 12, 2022 ORDER An initial disability rating in excess of 10 percent for right knee strain is denied. An initial disability rating in excess of 10 percent for left knee strain is denied. FINDINGS OF FACT 1. The Veteran's right knee disability is manifested by pain and functional impairment; knee flexion is to 80 degrees at worst and there is no limitation of extension; there is competent and credible evidence of right knee pain, but there is no significant or sustained additional loss of motion due to factors such as pain, weakness, lack of endurance, fatigability, incoordination, or flare ups; there is no knee ankylosis, semilunar cartilage dislocation or removal, symptomatic tibia or fibula impairment, or genu recurvatum. 2. The Veteran's left knee disability is manifested by pain and functional impairment; knee flexion is to 70 degrees at worst and there is no limitation of extension; there is competent and credible evidence of left knee pain, but there is no significant or sustained additional loss of motion due to such factors as pain, weakness, lack of endurance, fatigability, incoordination, or flare ups; there is no knee ankylosis, semilunar cartilage dislocation or removal, symptomatic tibia or fibula impairment, or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 10 percent for right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DCs) 5003, 5055, 5010, 5256-63. 2. The criteria for an initial disability rating in excess of 10 percent for left knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5003, 5055, 5010, 5256-63. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Air Force and Air National Guard from February 1999 to March 1999, January 2000 to July 2000, and July 2008 to February 2017. These matters come before the Board of Veterans' Appeals (Board) on appeal from March 2017 and May 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Board denied the matters of entitlement to initial disability ratings in excess of 10 percent each for right and left knee strain. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court). In August 2021, the Court granted a Joint Motion for Remand (JMR) in which the parties agreed the Board's decision as to these matters should be vacated and the appeal remanded to the Board for further development. The issues were before the Board again in January 2022 when they were remanded for further development pursuant to the terms set forth in the JMR. Increased Ratings 1. Entitlement to an initial disability rating in excess of 10 percent for right knee strain 2. Entitlement to an initial disability rating in excess of 10 percent for left knee strain The Veteran contends that her service-connected right and left knee disabilities are more severe than what is represented by the current 10 percent ratings. In the August 2021 JMR, the parties agreed that the Board relied on inadequate examinations in denying the Veteran's increased rating claims for her knee disabilities in December 2020. The parties found that a July 2016 VA examination noted that the Veteran had "right knee pain and swelling with prolonged walking and stair climbing," but the VA examiner reported that the Veteran did not have flare ups. The Veteran was also not examined after repetitive use over time. The parties also agreed that the May 2018 VA examination was inadequate because the Veteran was not examined immediately after repetitive use over time or during a flare-up. The parties found that "the VA examiners did not attempt to estimate the loss of range of motion immediately after repetitive use over time or during a flare-up or explain why such an estimate could not be made as required in Sharp." Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). The Veteran's right and left knee disabilities are rated under 38 C.F.R. § 4.71a, DC 5260, for limitation of flexion of the leg. Under DC 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F. 3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Although the JMR concluded the 2016 and 2018 VA examinations were inadequate with respect to assessing potential functional loss following repetitive use over time or during flare-ups as required by Sharp, this does not mean the entire examination reports are inadequate and must be discounted. There is no allegation that the objective findings shown in those reports, such as results of range of motion testing, or muscle strength, or joint stability, were inadequate or inaccurate in some way. Therefore, the Board has relied on those reports as probative evidence, except with respect to the question of functional loss following repetitive use over time and during flare-ups, which was addressed in the 2022 examination. A July 2016 VA examination report of the right knee reflects that the Veteran reported that she experienced pain in her right knee with stair climbing. She reported that with recent weight gain, she continued to experience pain in the knee. She denied instability. She reported pain laterally and with prolonged walking, her knee would swell. She did not report flare-ups. She reported functional loss/impairment described as pain and swelling with prolonged activity. Initial range of motion testing of the right knee was all normal. Pain was noted on examination and caused functional loss. Range of motion exhibited pain on flexion. There was no evidence of pain with weight-bearing. There was objective evidence of localized tenderness on palpation superiorly and laterally. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss/range of motion after three repetitions. Pain, weakness, fatigability or incoordination did not significantly limit functional ability. There was no reduction in muscle strength and no muscle atrophy. There was no ankylosis. There was no recurrent subluxation, lateral instability, and recurrent effusion. There was no joint instability. The Veteran did not have recurrent patellar dislocation, medial tibial stress syndrome, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment. The examiner noted mild nonpitting, right knee edema. There were no assistive devices needed. Imaging testing results did not reveal arthritis. Private physical therapy notes from January 2017 reflect that the Veteran reported right knee pain, swelling, decreased range of motion, difficulty ambulating, and audible pop at the time of injury (clicking/popping started about a week prior to this date). On examination, there was pain with range of motion testing of the right knee with pain on flexion/extension, testing of meniscus, and some pain on testing of collaterals. VA treatment records from May 2017 indicate that the Veteran had chronic right knee pain. She stated that her right knee locks up, gives out, and catches. There was moderate size knee joint effusion. In July 2017, radiology imaging revealed moderate right knee joint effusion. There were cartilage defects in the patella and medial femoral condyle. Extension was to 0 degrees and flexion was greater than 100 degrees. Patellar crepitus was mild. A May 2018 VA examination report reflects that the Veteran reported flare-ups bilaterally. She described the flare-ups in her right knee as pain and swelling and the left knee as overcompensating. She reported functional loss/impairment described as pain on walking, stairs, and bending. Initial range of motion of the right knee was abnormal/outside of the normal range. Flexion was to 80 degrees and extension to 0 degrees. Range of motion itself contributed to functional loss described as pain. Pain was noted on examination and caused functional loss. Range of motion exhibited pain on flexion and extension. There was evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint. Initial range of motion of the left knee was abnormal/outside of the range. Flexion was to 70 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on examination and caused functional loss. Range of motion exhibited pain on flexion and extension. There was no evidence of pain with weight-bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint. There was no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or ROM, bilaterally. The examiner was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time because the Veteran was not flaring and there were no repetitive movements. Additional factors contributing to disability of the right knee is less movement than normal due to compensatory pain in the right knee. As to the left knee, additional factors contributing to disability were less movement than normal and weakened movement due to pain on weight bearing. There was no muscle atrophy, no ankylosis, no subluxation, no lateral instability, and no recurrent effusion. The Veteran did not have recurrent patellar dislocation or a meniscus condition. Imaging studies did not reflect arthritis. There is no evidence of pain on passive range of motion testing of the right knee. There is no evidence of pain on non-weight bearing of the right knee. There is no evidence of pain on passive range of motion testing of the left knee. There is no evidence of pain on non-weight bearing testing of the left knee. A March 2022 Disability Benefits Questionnaire (DBQ) reflects that the Veteran reported flare-ups of the knees daily. The Veteran reported that on days when "she walks a lot and fluid builds up, then it feels like it slips." Initial range of motion testing of the knees were normal. Flexion was to 140 degrees and extension to 0 degrees. Range of motion exhibited pain on extension in the right knee. Range of motion did not change upon passive range of motion testing. In the right knee, there was pain on active and passive motion that did not result in or cause functional loss. There was no objective evidence of crepitus. In the right knee, there was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or ROM, bilaterally. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The right knee examination was being conducted during a flare up and pain, fatigability, weakness, lack of endurance and incoordination did not significantly limit functional ability with the flare up. The left knee examination was not being conducted during a flare up, but the examiner noted that there was no functional loss or change in range of motion during flares, just increased pain. There was no muscle atrophy, no ankylosis, no subluxation, and no persistent instability. The Veteran did not have recurrent patellar dislocation or a meniscus condition. VA treatment records were reviewed in connection with the claim. Symptoms of the Veteran's bilateral knee disability were consistent with the VA examination reports. Upon review of the evidence of record, the Board finds that the Veteran's symptoms more nearly approximate the 10 percent disability ratings currently assigned for the right and left knee disabilities under DC 5260 based on the Veteran's report of pain and limitation of motion. At worst, the Veteran's right knee produced a range of motion of no less than 80 degrees and her left knee produced a range of motion of no less than 70 degrees with pain noted on examination. Pain caused functional loss; however, the Veteran described her functional loss as pain with walking, climbing stairs, and bending. The examiner did not describe functional loss to the level of flexion limited to 30 degrees. The 10 percent ratings contemplate the Veteran's symptoms. A 20 percent rating would require flexion limited to 30 degrees and the Veteran did not report flare-ups indicated to be so severe as to result in additional limitation of motion more nearly approximating this criterion. Although the Veteran reported flare-ups, they were not severe enough to result in significant functional limitation. Likewise, the Veteran's right and left knee disability produced a range of motion to 0 degrees extension with pain noted on movement during the VA examinations. The evidence shows that even considering pain and other functional factors, the Veteran's right and left knee symptoms have not been shown to be so disabling to actually or effectively result in limitation of knee extension more nearly approximating 10 degrees; or, limitation of knee flexion more nearly approximating 30 degrees, which are the requirements for a 20 percent rating for limitation of knee flexion under DC 5260 and for a compensable (10 percent) rating for limitation of knee extension under DC 5261, respectively. The Veteran does not have arthritis, so a separate rating under DC 5003 is not warranted. See 38 C.F.R. § 4.71a, DC 5003. There is also no evidence of ankylosis in the right or left knee as indicated by the examinations of the Veteran. Moreover, there is no evidence of removed semilunar cartilage or impairment of the tibia and fibula warranting separate or higher ratings under DC 5259 or 5262. The Board acknowledges May 2017 VA treatment records indicating that the Veteran's knee gives out and the March 2022 DBQ indicating that she has slipping of her knees following walking and fluid buildup. As a result, the Board has considered whether separate ratings are warranted under DC 5257 for recurrent subluxation or lateral instability. The Board notes that the Veteran is competent to report knee symptoms, including instability, as this is within the realm of her personal perception. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018) (suggesting that lay evidence of knee instability is generally competent). Here, the Veteran's statements regarding knee instability are not credible, given the inconsistency with the other evidence in the appellate record. None of the VA examinations conducted between 2016 and 2022 have found instability of either knee. The VA examinations were conducted using an objective standard. The examination reports referenced above include a section asking the examiner whether the Veteran had any recurrent subluxation or persistent instability, and the examiners each marked "No." The Board is cognizant that objective medical evidence is not categorically more probative than lay evidence when it comes to determining the degree of knee instability the Veteran has experienced during the appellate period. See English, 30 Vet. App. 352. Yet, in this case, the Veteran's lay statements describing instability are contradicted by the evidence. This is not an instance where the Board is negating the probative value of the Veteran's lay statements simply because they are unaccompanied by supporting contemporaneous medical evidence, which would be in contravention of Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009). To the contrary, the medical evidence of record, to include all examinations in the appellate period, are inconsistent with and contradict the presence of knee instability as presented in her lay statements. See Madden v. Gober, 125 F. 3d 1477, 1481 (1997) (finding the Board entitled to discount the credibility of evidence in light of its own inherent characteristics and its relationship to other items of evidence). Accordingly, these statements are afforded little evidentiary weight in this determination. Accordingly, the Board finds that the Veteran is not entitled to separate disability ratings under Diagnostic Code 5257. The Board has also considered whether separate ratings are warranted under DC 5258. See Lyles v. Shulkin, 29 Vet. App. 107 (2017) (there is no prohibition of separate evaluation under 38 C.F.R. § 4.71a , DC 5257 or 5261 and a meniscal DC, i.e., DC 5258 or 5259). Under 38 C.F.R. § 4.71a , DC 5258, a 20 percent disability rating is assigned for dislocated semilunar cartilage with frequent episodes of "locking," pain and effusion into the joint. Semilunar cartilage is synonymous with the meniscus. There is no evidence of dislocated semilunar cartilage. Effusion of the right knee was noted in the medical evidence of record in a September 2011 x-ray and in May and July 2017 physical therapy notes reporting moderate knee joint effusion. The March 2022 VA examination noted a history of frequent effusion of the knee, but the VA examiner specifically indicated that the Veteran did not have a semilunar cartilage condition. Additionally, while the Veteran reported locking of the right knee once, this was never reported again and was not noted in the VA examination reports. As such, a separate rating under DC 5258 is not warranted. For the foregoing reasons, the evidence is against the claims for initial ratings in excess of 10 percent for the Veteran's right and left knee disabilities. The benefit of the doubt doctrine is therefore not for application and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. B. J. KOMINS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Morrad, 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