Notice of Disagreement: Agency Information Collection Activity

Abstract:

Appellate review of the denial of VA benefits may only be initiated by filing a Notice of Disagreement with the Board. 38 U.S.C. § 7105(a). The VA Form 9, “Appeal to Board of Veterans’ Appeals,” is required to complete a legacy appeal to the Board. The completed form becomes the “substantive appeal” (or “formal appeal”), which is required by 38 U.S.C. §§ 7105(a) and (d)(3) in order to complete an appeal to the Board. Additionally, the proposed information collections allow for withdrawal of services by a representative, requests for changes in hearing dates and methods under 38 U.S.C. § 7107, and motions for reconsideration pursuant to 38 U.S.C. § 7103(a). The Board is requesting to revise the currently approved OMB Control No. 2900-0674, adding four information collections previously approved under OMB Control No. 2900-0085, and one new information collection. Revised Control No. 2900-0674 would contain all appeals-related information collections for the legacy and new systems. 2900-0085 will be discontinued upon approval of this request to renew 2900-0674.

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published at 83 No. 164 on Thursday, August 23, 2018, pages 42769 and 42770.

Affected Public: Individuals and households.

Estimated Annual Burden: 114,877.78 hours.

Estimated Average Burden per Respondent: 40.83 minutes.

Frequency of Response: Once.

Estimated Number of Respondents: 168,800.

  • VA Form 10182: Notice of Disagreement (new) = 40,000.
  • Nonstandard Form: Notice of Disagreement (legacy) = 60,000.
  • VA Form 9: Appeal to the Board of Veterans’ Appeals (legacy) = 64,500.
  • Nonstandard Form: Withdrawal of Services by a Representative = 500.
  • Nonstandard Form: Requests for Changes in Hearing Dates or Methods = 2,800.
  • Nonstandard Form: Motions for Reconsideration =1000.

By direction of the Secretary.

Cynthia D. Harvey-Pryor,

Government Information Specialist, Department of Veterans Affairs.

[FR Doc. 2018-24759 Filed 11-13-18; 8:45 am]

BILLING CODE 8320-01-P

AGENCY: Board of Veterans’ Appeals, Department of Veterans Affairs.

ACTION: Notice.

SUMMARY:

In compliance with the Paperwork Reduction Act (PRA) of 1995, this notice announces that the Board of Veterans’ Appeals, Department of Veterans Affairs, will submit the collection of information abstracted below to the Office of Management and Budget (OMB) for review and comment. The PRA submission describes the nature of the information collection and its expected cost and burden and it includes the actual data collection instrument.

DATES: Comments must be submitted on or before December 14, 2018.

ADDRESSES:

Submit written comments on the collection of information through www.Regulations.gov, or to Office of Information and Regulatory Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 17th St. NW, Washington, DC 20503 or sent through electronic mail to oira_submission@omb.eop.gov. Please refer to “OMB Control No. 2900-0674” in any correspondence.

FOR FURTHER INFORMATION CONTACT:

Sue Hamlin, BVA, (01C2), Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420, (202) 632-5100 or email sue.hamlin@va.gov.Please refer to “OMB Control No. 2900-0674” in any correspondence.

SUPPLEMENTARY INFORMATION:

Start Printed Page 56919

Authority:

Public Law 115-55; 38 U.S.C. 5104B, 5108, 5701, 5901, 7103, 7104, 7105, 7107.

Title: Decision Review Request: Board Appeal (Notice of Disagreement) and Appeal to the Board of Veterans’ Appeals, VA Form 10182 and VA Form 9

OMB Control Number: 2900-0674.

Type of Review: Reinstatement with Change of a currently approved collection.

Understanding Decisions from RAMP

Background

Guest Post from Hill & Ponton

RAMP (Rapid Appeals Modernization Program) is the VA’s pilot program for the new appeals system created by the VA Appeals Improvement and Modernization Act of 2017. RAMP is an optional program, available to veterans with claims that are currently on appeal. If a veteran does not want to opt into the RAMP program, they do not have to submit anything to the VA; their appeals will continue to be processed in the current appeals system now referred to as the Legacy Appeals System.

Information on RAMP Rating Decisions

Now that the RAMP program has been in effect for several months, veterans who opted in are receiving rating decisions. It is important to understand the information included in these decisions, and also what your options are if you are not happy with the decision.
The appearance of rating decisions hasn’t changed much with the RAMP program. However, the information that must be included in the rating decision has changed slightly. RAMP rating decisions must list all favorable findings that the VA identified when reviewing the case, including listing what evidence was considered as favorable. The VA must also identify the evidencethey considered to be unfavorable. In the narrative part of the rating decision, the VA must explain how the favorable and unfavorable evidence was weighed in coming to their ultimate finding. In addition to listing the evidence, the VA also has to include a list of all regulations and laws that were applied in making their decision.

Forms Included in RAMP Rating Decisions

In addition to the explanation and the list of evidence and regulations,  RAMP decisions will have two forms attached. These two forms are the RAMP Review Rights form and the RAMP Selection form.
The RAMP Review Rights form gives information about how to appeal the decision. The different ways to appeal a decision from RAMP are based on the different lanes that make up the RAMP program.  The appeal options include:

  • Supplemental Claim: If you are unhappy with the rating decision and would like to submit new evidence, this is the appeal option to select. Once the new evidence (must be new and relevant) is submitted, a different rater will review the case.
  • Higher Level Review: This appeal option can only be selected if the decision being appealed was issued out of the supplemental claim lane,  and you do not have any additional evidence to submit. (Note: if opting into RAMP, the only requirement is that no additional evidence can be submitted.) A higher-level VA employee will review the decision that is being appealed based on the evidence of record.
  • Board of Veterans’ Appeals (BVA): If you are unhappy with the rating decision and want to take your appeal straight to the BVA, use this appeal option (Note: the BVA will not begin deciding RAMP appeals until October 2018). If you choose to appeal to the Board of Veterans’ Appeals, you will have to select one of three options. These options are:
  • Direct Docket: Select this if you have no additional evidence to submit, and you do not want a hearing. The BVA will issue their decision based on the evidence of record.
  • Evidence Only Docket: Select this if you would like to submit additional evidence, but do not want a hearing. After submitting your appeal, you will have 90 days to submit additional evidence.
  • Hearing Docket: Select this if you would like to have a hearing with a Veterans Law Judge. You will also be able to submit additional evidence up to 90 days after submitting your appeal.

The second form that will be attached to a RAMP rating decision is the RAMP Selection form. After deciding which appeal option is best for you, fill out the RAMP Selection form. This form requires you to specify which issues you are appealing, and which appeal option you are choosing.

Veterans Appeals Improvement and Modernization Act

The new VA appeals process explained by Matt Hill, grab a cup of coffee and a notepad, as to be expected from VA, it’s not a simple straightforward line.

The final rule has been published you can view it here.

The VA appeals process is going through its biggest change since the 1980s. In 2017, Congress passed the Veterans Appeals Improvement and Modernization Act. This act takes apart the current appeal system and replaces it with a new process aimed to improve the experience for all involved in the process.

New VA Appeals Process! | Appeals Modernization Act | Is Your VA Claim Ready?

Let’s take a look at the new VA appeals process and what it means for filing a claim in this new environment.For a FREE Case Evaluation go here: https://www….

First, let’s recap what the system currently looks like. Ready?

Claimant files a claim. The VA regional office, RO, sends VCAA letter. After that, RO mails notice of its decision. Claimant files notice of disagreement. The claimant must file NOD within one year of mailing of rating decision.

The claimant has the option of requesting a DRO review, but the claimant must request DRO review within 60 days of VA letter offering it. If the claim is denied, VA mails a statement of the case, SOC. Note, if the VA grants the claim, then you go back to the beginning of this process. The claimant has 60 days to file the Substantive Appeal VA Form 9 from the date of the SOC or a year from the date of the rating decision, whichever is later.

Board of Appeals decides the case, appeals to the CAVC within 120 days. Of course, if a claim is granted at any point, then it goes back to the beginning of this cycle, and the appeal process starts all over again. Ugh.

Let’s take a brief look at what stays the same and what is changing. Then we can talk about how the process works.

There will still be a rating decision after every claim is filed. A claimant will still have the opportunity to have a more seasoned adjudicator review the decision in the regional office. The claimant can still appeal to the Board of Veterans’ Appeals.

What’s gone?

State of the case, gone.

VA Form 9, gone.

Reopened claims? Not anymore.

The need for new and material evidence, gone.

DRO decision, gone.

What is replacing these? Supplemental claims, relevant evidence, higher level review, one NOD filed directly to the Board of Veterans’ Appeals.

The middleman is gone.

In the current system, when a veteran is dissatisfied with a decision and wants to preserve the date of the claim, he has only one route: file an NOD. Forgot to file a necessary document? File an NOD. Missing a piece of evidence? File an NOD. The VA made a mistake of law? File an NOD.

Veterans Appeals Improvement and Modernization Act

Now, when a veteran files a new claim, the VA will issue a rating decision that must contain the following: what issues were decided, summary of evidence considered by the VA, summary of applicable laws and regulations, identification of findings favorable to the claimant, explanation of why claim was denied, explanation of how to get evidence used in making the decision, and identification of criteria that must be satisfied to grant service connection or the next higher level of compensation. After this rating decision, you have one year to take action. You are to appeal for a higher review at the RO, file new evidence or file an NOD to go to the Board of Veterans’ Appeals.

Higher Level Review

You have one year from the initial claim to seek this route. This lane allows for a quality check on the original opinion while still at the VA regional office. Now, you cannot submit additional evidence or request a hearing here. The review is de novo, which is fancy Latin meaning review without giving weight to the prior decision. If the decision is favorable, your original claim date is preserved. If it is unfavorable, you have an option to file a supplemental claim or to file an NOD to appeal to the board.

Supplemental Claim

Welcome to the new evidence lane. You have one year from the date of your decision to file additional evidence. Under the new law, this is now referred to as a supplemental claim. In this lane, you may submit additional evidence that is new and relevant. Upon receipt of your new evidence, VA will attempt to make a decision within 125 days. Your effective date, the day from which the VA will pay your benefits, will be the day you file the first claim.

Once the adjudicator makes a decision, you must ask yourself, are you satisfied with this decision? At this point, you get to choose from the three options again: one, as you’ve already done, you can submit additional evidence within a year and preserve the date of your claim; two, you can request a higher level review; or three, board review lane.

Board Review Lane

This is where you file an NOD and your case moves from the regional office to the Board of Veterans’ Appeals. Here, there will be three lanes to choose from: one, fully developed appeal, a claim that is ready for decision by the BVA and there is no further evidence to submit; two, hearing request with the chance to submit additional evidence; or three, request to submit evidence but not hold a hearing. If the decision is favorable, your original claim date is preserved. If it is unfavorable, you have an option to file a supplemental claim within a year, or you can file an appeal to the Court of Appeals for Veterans Claims. You only have 120 days to file this appeal though.

File an appeal with the CAVC and win, and your original claim date is preserved. If you do not prevail, then you have a year to file a supplemental claim. Should you win after that, you still preserve your original claim date.

Reprinted with permission from Hill and Ponton Disability Attorneys

More

Further Reading

BVA No 09-48865 Entitlement to service connection for an acquired psychiatric disorder, to include schizophrenia, depression, and post-traumatic stress disorder (PTSD).

BVA NO. 09-48 865 Citation Nr: 1717500 Decision Date: 05/19/17 Archive Date: 06/05/17
On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona

THE ISSUE

Entitlement to service connection for an acquired psychiatric disorder, to include schizophrenia, depression, and post-traumatic stress disorder (PTSD).
REPRESENTATION
Veteran represented by: Disabled American Veterans
WITNESS AT HEARINGS ON APPEAL
The Veteran
ATTORNEY FOR THE BOARD
Kate Sosna, Associate Counsel

INTRODUCTION

The Veteran had active duty service from October 1972 to April 1977, as well as subsequent periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) with the Wisconsin Army National Guard from January 1985 to January 1986.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona.
The Veteran testified at an RO hearing in October 2009 and a Board hearing at the local RO before the undersigned Veterans Law Judge in May 2012. Transcripts from these hearings have been associated with the record.
The case was remanded by the Board for additional development in January 2013 and July 2014.
In November 2015, the Board denied entitlement to service connection for an acquired psychiatric disorder. The Veteran appealed the Board’s November 2015 denial of service connection for an acquired psychiatric disorder to the United States Court of Appeals for Veterans Claims (Court), which, in June 2016, on the basis of a May 2016 Joint Motion for Partial Remand (JMPR), vacated the Board’s decision and remanded the matter to the Board for further action. Thereafter, in October 2016, the Board remanded the claim again for additional development pursuant to the JMPR.
A review of the record reveals that additional documents were added to the file after the issuance of the February 2017 supplemental statement of the case. However, in a February 2017 submission, the Veteran’s representative waived the right to have any additional evidence submitted by the Veteran considered by the RO. 38 C.F.R. § 20.1304(c) (2016). Therefore, the Board may properly consider such newly received evidence.
This appeal was processed using the Virtual VA (VVA) and Virtual Benefits Management System (VBMS) paperless claims processing systems.

FINDINGS OF FACT

1. The Veteran does not have PTSD as a result of a verified in-service stressor.
2. An acquired psychiatric disorder other than PTSD is not shown to be causally or etiologically related to any disease, injury, or incident during service, and a psychosis did not manifest within one year of the Veteran’s discharge from active service.

CONCLUSION OF LAW

The criteria for establishing service connection for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C.A. §§ 101(24), 1101, 1110, 1112, 1131, 1137, 5107 (West 2014); 38 C.F.R. §§ 3.1(d), 3.6(a), 3.102, 3.303, 3.304, 3.307, 3.309 (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

I. Due Process Considerations

The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2016).
In the instant case, VA’s general duty to notify was satisfied by a March 2008 letter sent prior to the issuance of the rating decision on appeal. Thereafter, a March 2013 letter and attachment provided the Veteran with the notice required for claims for service connection for PTSD (to include, as requested in the January 2013 remand, claims for service connection for PTSD based on personal assault), and a PTSD stressor questionnaire for the Veteran’s completion was attached to this letter. While this letter was not provided prior to initial adjudication, the deficiency in the timing of this notice was remedied by readjudication in subsequent supplemental statements of the case in December 2013, December 2014, and February 2017. See 38 U.S.C.A. §§ 5102, 5103, 5103A; 38 C.F.R. § 3.159; see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015); Pelegrini v. Principi, 18 Vet. App. 112 (2004); Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006); Mayfield v. Nicholson, 444 F. 3d 1328, 1333-34 (Fed. Cir. 2006); Prickett v. Nicholson, 20 Vet. App. 370 (2006).
The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This “duty to assist” contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4).
In the instant case, the Board finds that all relevant facts have been properly developed and that all evidence necessary for equitable resolution of the issues decided herein has been obtained. The Veteran’s service treatment records (STRs), service personnel records, and post-service VA and private treatment records have been obtained and considered. He has not identified any additional, outstanding records that have not been requested or obtained.
Additionally, the Veteran was afforded a VA examination in December 2013 and addendum opinions were provided in September 2014 and January 2017 addressing the claim decided herein. The conclusions reached following these examinations and in the addendum opinions are, in their totality, based on an interview with the Veteran, a review of the record, and a full psychiatric examination. Moreover, the clinicians offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion…must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Accordingly, the Board finds that VA’s duty to assist with respect to obtaining a VA examination and opinion regarding the issue decided herein has been met.
The Veteran also offered testimony before a Decision Review Officer (DRO) of the RO in October 2009 and the undersigned Veterans Law Judge at a Board hearing in May 2012. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the Court held that 38 C.F.R. § 3.103(c)(2) requires that the DRO or Veterans Law Judge who chairs a hearing to fulfill two duties: (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked.
During the October 2009 DRO hearing and the May 2012 Board hearing, the DRO and the undersigned Veterans Law Judge noted the issue on appeal. Also, information was solicited regarding the Veteran’s in-service experiences he alleges resulted in his psychiatric disorder, the type and onset of symptoms, and his contention that his military service caused his psychiatric disorder. Therefore, not only were the issues “explained…in terms of the scope of the claim for benefits,” but “the outstanding issues material to substantiating the claim,” were also fully explained. See Bryant, 23 Vet. App. at 497. As the hearing discussions raised the possibility that there were outstanding treatment records available through the Veteran’s National Guard unit, the Board remanded the case to obtain such records. Additionally, the testimony suggested the need for a VA examination addressing the claim for service connection adjudicated herein, and as indicated above, such was conducted in December 2013, and addendum opinions were obtained in September 2014 and January 2017. Under these circumstances, nothing gives rise to the possibility that evidence had been overlooked with regard to the Veteran’s claim decided herein. As such, the Board finds that, consistent with Bryant, the DRO and the undersigned Veterans Law Judge complied with the duties set forth in 38 C.F.R. 3.103(c)(2) and that the Board may proceed to adjudicate the claim based on the current record.
Furthermore, the Board finds there has been substantial compliance with the Board’s January 2013, July 2014, and October 2016 remand directives and no further action in this regard is necessary. See D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a Board remand is required pursuant to Stegall v. West, 11 Vet. App. 268, 271 (1998)). In January 2013, the Board directed the Agency of Original Jurisdiction (AOJ) to afford the Veteran notice of the types of evidence that may be considered in a personal assault claim under 38 C.F.R. § 3.304(f) and request that he provide a detailed description of the incidents of personal assault. Such was accomplished by way of the aforementioned March 2013 VCAA letter. The January 2013 remand also directed the AOJ to obtain the Veteran’s service personnel records, which was accomplished in May 2013, as well as records regarding the Veteran’s period of service with the Wisconsin Army National Guard, which were received in May 2013 as well as in August 2014, after the July 2014 remand requesting additional records. The January 2013 remand also directed that the Veteran be provided an opportunity to identify any outstanding records and obtain updated VA treatment records, which was accomplished in the March 2013 VCAA letter and VA treatment records dated through December 2013 were subsequently obtained. Notably, while VA treatment records have not been associated with the record since that time, the Veteran has not reported and the record does not suggest that any outstanding, relevant treatment records exist. Finally, the January 2013 remand directed that the Veteran be afforded a VA examination in order to determine the current nature and etiology of his claimed disorders, which was accomplished in December 2013.
Additionally, and as requested in the July 2014 remand, an August 2014 letter from the AOJ asked the Veteran to provide more specific dates with respect to the injuries he claimed occurred during his time with the Wisconsin Army National Guard, and to provide any ACDUTRA or INACDUTRA orders. However, he did not reply to such letter. Therefore, development to obtain any additional National Guard records is not indicated. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Moreover, the Veteran did not complete the PTSD stressor questionnaire provided to him in March 2013, and given the nature of the stressors as described below, which are inherently unlikely to be verified (even if they were sufficient to result in a valid diagnosis of PTSD), the Board finds that additional development with regard to stressor verification is also not indicated. Id. Finally, as directed by the July 2014 remand, an addendum opinion was obtained in September 2014.
Most recently, in October 2016, the Board remanded the appeal for procurement of a medical opinion as to whether there is evidence of behavioral changes to indicate that any incidents of personal assault occurred, to specifically include the Veteran’s claimed stressor of being the victim of a mugging while he was in service. The requested addendum was provided in January 2017 and, as discussed above and further discussed below, the Board finds that the opinion is adequate to decide the claim.
Therefore, the Board finds that the AOJ has substantially complied with the January 2013, July 2014, and October 2016 remand directives such that no further action is necessary in this regard with respect to the claim adjudicated below. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008); Dyment v. West, 13 Vet, App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002).
In light of the foregoing, the Board finds that VA’s duties to notify and assist have been satisfied. Thus, appellate review may proceed without prejudice to the Veteran. See Bernard v. Brown, 4 Vet. App. 384, 394 (1993).

II. Analysis

A Veteran is a person who served in the active military, naval, or air service and who was discharged or released under conditions “other than dishonorable.”
38 C.F.R. § 3.1(d). The term “active military, naval, or air service” includes:
(1) active duty; (2) any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty; and (3) any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty. 38 U.S.C.A. § 101(24); 38 C.F.R. § 3.6(a).
Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R.
§ 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).
Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996) [(table)].
Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, to include psychoses, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service.
38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. According to 38 C.F.R. § 3.384, as applicable in the instant case, the term ‘psychosis’ includes a brief psychotic disorder; delusional disorder; psychotic disorder due to general medical condition; other specified schizophrenia spectrum and other psychotic disorder; schizoaffective disorder; schizophrenia; schizophreniform disorder; and substance/medication-induced psychotic disorder.
Alternatively, service connection may be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. The United States Court of Appeals for the Federal Circuit clarified that the law providing for awards of service connection on the basis of continuity of symptomatology is limited to “chronic” diseases such as psychoses listed under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).
In addition to the general principles governing service connection, to establish entitlement to service connection for PTSD the evidence must satisfy three basic elements. There must be: 1) medical evidence diagnosing PTSD; 2) a link, established by medical evidence, between current symptoms of PTSD and an in-service stressor; and 3) credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f). A diagnosis of PTSD must be established in accordance with 38 C.F.R. § 4.125(a). In this regard, the Board notes that for cases certified to the Board prior to August 4, 2014, as is the case here, the diagnosis of PTSD must be in accordance with the DSM-IV.
With regard to the second PTSD element as set forth in 38 C.F.R. § 3.304(f), evidence of an in-service stressor, the evidence necessary to establish that the claimed stressor actually varies depending on whether it can be determined that the Veteran “engaged in combat with the enemy.” See 38 U.S.C.A. § 1154(b); 38 C.F.R. 3.304(d).
If it is determined through military citation or other supportive evidence that a Veteran engaged in combat with the enemy, and the claimed stressors are related to combat, the Veteran’s lay testimony regarding the reported stressors must be accepted as conclusive evidence as to their actual occurrence and no further development or corroborative evidence will be necessary. See 38 C.F.R. § 3.304(f).
Additionally, effective July 13, 2010, VA has amended its adjudication regulations governing service connection for PTSD by liberalizing, in certain circumstances, the evidentiary standard for establishing the required in-service stressor.
Personality disorders are not “diseases” for which service connection can be granted, and as a “matter of law” are not compensable disabilities. 38 C.F.R.
§ 3.303(c); Beno v. Principi, 3 Vet. App. 439, 441 (1992). However, disability resulting from a mental disorder superimposed upon a personality disorder may be service-connected. 38 C.F.R. § 4.127.
Similarly, for claims filed after October 31, 1990, service connection may not be granted for substance abuse on the basis of service incurrence or aggravation. 38 U.S.C.A. §§ 105, 1110; 38 C.F.R. § 3.301 (a); VAOPGCPREC 2-98. However, the law does not preclude a Veteran from receiving compensation for an alcohol or drug abuse disability acquired as secondary to, or as a symptom of, a service-connected disability. Allen v. Principi, 237 F.3d 1368 Fed. Cir. 2001).
When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).
The Veteran contends that he has an acquired psychiatric disorder as a result of his military service.
Review of the Veteran’s service personnel records do not reflect that he served in combat. As such, his unsupported assertions of service stressors are not sufficient to establish the occurrence of such events. Rather, his alleged service stressors must be established by official service records or other credible supporting evidence. 38 C.F.R. § 3.304(f); Cohen v. Brown, 10 Vet. App. 128 (1997); Doran v. Brown, 6 Vet. App. 283 (1994). The regulatory requirement for “credible supporting evidence” means that “the Veteran’s testimony, by itself, cannot, as a matter of law, establish the occurrence of a non-combat stressor.” Dizoglio v. Brown, 9 Vet. App. 163 (1996).
However, VA recognizes that, because a personal assault is a personal and sensitive issue, many incidents are not officially reported, which in turn creates a proof problem in establishing they did. It is not unusual for there to be an absence of service records documenting the events the Veteran has alleged. Therefore, evidence from sources other than service records may corroborate an account of a stressor incident that is predicated on a personal assault. See, e.g., Patton v. West, 12 Vet. App. 272, 277 (1999). Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. 38 C.F.R. § 3.304(f)(5).
Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in the mentioned sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. VA may submit any evidence that it received to an appropriate mental health professional for an opinion as to whether it indicates that a personal assault occurred. Id.
The STRs, to include the February 1977 discharge examination, do not reflect a psychiatric disability. The Veteran did report having “nervous trouble” on a medical history completed in conjunction with separation from service. A service hospital report for treatment for hepatitis showed that the Veteran reported a history of nervous condition prior to service. He had seen a psychiatrist, but no diagnosis was given.
The Veteran was discharged because he had been found to be dependent on alcohol or other drugs. In April 1977, he was treated at the VA for drug abuse, and an October 1977 VA examination showed a diagnosis of drug abuse, opiate type, in remission, by history. No other psychiatric diagnosis was given, although the Veteran reported previously being diagnosed with schizophrenia.
In July 1981, the Veteran was admitted to the VA following a suicide attempt. The diagnosis was mixed personality disorder with borderline, histrionic and explosive components. Again, in September 1987, the Veteran was admitted to the VA for a suicide attempt. The diagnosis was depression with suicidal ideation. During this period, clinical records also showed a diagnosis of PTSD and acute adjustment disorder. He was again admitted for drug abuse in May 1989. A VA treatment record in September 1993 showed that the Veteran was admitted for treatment for adjustment disorder with depressed mood. Follow up treatment records showed treatment for depression as well as PTSD. He was afforded a VA examination for pension purposes in September 1997. The examiner diagnosed major depressive disorder, but did not provide any sort of etiological opinion.
Additional VA and Vet Center records continued to document ongoing psychiatric treatment, to include in a PTSD group. In his hearing testimony, the Veteran asserted that he received psychiatric treatment while stationed at Fort Hood. He also reported that he was mugged while in service. The Veteran further alleged that he was “slapped around” by his drill sergeant and indicated that he experienced an incident where he dropped a grenade that caused him stress as well as more problems with his drill sergeant. He further claimed that he used drugs in service to self-medicate and that his symptoms have continued since service.
The January 2013 remand requested a VA psychiatric examination in which the examiner was to specifically indicate whether the Veteran met the diagnostic criteria for PTSD. In making this determination, the examiner was directed by the Board to offer an opinion as to whether there was evidence of behavioral changes to indicate that any incidents of personal assault occurred during service and, if so, whether any currently diagnosed PTSD was causally related to such incidents. For each currently diagnosed acquired psychiatric disorder other than PTSD, the examiner was to offer an opinion as to whether such was as least as likely as not related to the Veteran’s military service.
The requested VA psychiatric examination was completed in December 2013, and the conclusion, documented on the reports from this examination to have included a review of the claims file, was that the Veteran did not meet DSM criteria for a diagnosis of PTSD or other acquired psychiatric disability, and that the only current diagnosis was a personality disorder; namely, “Personality Disorder NOS with antisocial, narcissistic, schizotypal, and schizoid traits.” The examiner indicated that the Veteran’s personality was longstanding, beginning in his late adolescence, and was manifested as a “pervasive and persistent pattern of behaviors and cognitions that deviate from the cultural norm.” The Veteran’s stressors reported at that time were recorded as: an incident in which a drill sergeant embarrassed him in formation for marching in the wrong direction by slapping him on the side of his head, and another incident in which a drill sergeant yelled at him and embarrassed him when he dropped a hand grenade during training; the Veteran apparently did not report the alleged mugging incident. The examiner noted that neither of the reported stressors was adequate to support a diagnosis of PTSD and that neither stressor was related to a personal assault.
As noted in the July 2014 remand, the December 2013 examiner did not address whether the personality disorder diagnosed at this examination was subject to a superimposed disease or injury that resulted in additional disability. Additionally, while the 2013 examiner determined that the Veteran’s alleged stressors were insufficient to support a diagnosis of PTSD and that the Veteran had no other psychiatric disorder other than a personality disorder, she did not reconcile these determinations with the evidence of record showing diagnoses and treatment for a variety of disorders, such as major depressive disorder, reflected on records contemporaneous to the VA examination, including December 2013 VA treatment records. As such, in July 2014 the Board remanded the appeal and requested an addendum opinion from the December 2013 VA examiner. The examiner was asked to identify all of the Veteran’s acquired psychiatric disorders that met the DSM criteria and offer an opinion as whether (1) the Veteran’s personality disorder was subject to a superimposed disease or injury during service that resulted in additional disability; and (2) reconcile the determination at the December 2013 VA examination that the Veteran did not have a psychiatric disorder other than a personality disorder with the substantial evidence of record showing diagnoses and treatment for a variety of acquired psychiatric disorders, to include major depressive disorder, contemporaneous to the VA examination, i.e., in December 2013 VA treatment records.
The requested addendum opinion, by the mental health professional who conducted the December 2013 VA examination, was completed in September 2014. She found with respect to Question 1 posed in the July 2014 remand that there was “no supporting documentation that would indicate a nexus for his…personality disorder, which has progressed normally, with[out] any service related event or diagnosis.”
As for Question 2 posed in the in the July 2014 remand, the clinician responded as follows:
At the time of the December 2013 exam[,] the patient had been carrying only the following [diagnoses]: depression by history, alcohol dependence by history, [and] polysubstance abuse by history[.] [The Veteran was] discharged from therapy by both his psychiatrist 9/2/12 and his psychologist 5/10/13. He returned to care Nov 8, 2013 but continued to carry [diagnoses] only [of] depression by history, and r/o anxiety disorder or PTSD. On Nov 22, his psychologist diagnosed him with Major Depression, however the symptoms which were described at this time were not sufficient to support such diagnosis. After a review of the patient’s records in their entirety including efile, and remand, and the C&P exam and interview of Dec 2013, it is the opinion of this examiner that the patient meets DSM[-]5 criteria for the following diagnoses: Personality Disorder NOS with borderline, antisocial, narcissistic, schizotypal and schizoid traits….
The patient over an 18 year period has been variously diagnosed with Major Depression, adjustment disorder, polysubstance dependence, cocaine dependence, anxiety disorder nos, alcohol dependence, depression nos, r/o [] schizophrenia, PTSD, and since 8/12/11 by psychiatrist H[] and psychologist D[] with “depression by history, polysubstance abuse by history, and alcohol abuse by history.” A diagnosis which contains the phrase “by history” does not imply that the patient meets criteria for that diagnosis at the time of the note, otherwise it would simply be noted as “Depression,” rather it indicates either that the patient has a history that contains that diagnosis and/or that the patient has some symptoms of that diagnosis but does not fulfill sufficient diagnostic criteria to support the diagnosis. In the case of [the Veteran], this has consistently been the case.
The patient over the years has consistently exhibited or reported the symptoms which support the DSM[-]IV and DSM[-]5 diagnosis of Personality Disorder NOS as described above with the most frequent symptoms reported being irritability and rumination about incidents during which he felt he was not sufficiently appreciated or respected. His mood component has always been reactive and generally related to issues of abandonment or rejection, and again the symptoms [the Veteran] reports consistently are irritability or anger over his treatment by others. There is nothing which connects the patient’s personality disorder to his military experience. Although he has some DSM[-]IV symptoms of PTSD[,] there is nothing in his reported military stressors which would support this diagnosis, which fact has been noted by several providers most recently Dr. H[]. He was given a diagnosis of MDD on 11/22/13[,] however the provider’s assessment did not document symptoms which would support this diagnosis and indeed the assessment in this note does not vary from previous notes which indicated that he met only criteria for depression by history. Additionally[,] his note of 12/18/13 lists his mood as “happy go lucky” by his own report. Given his history, his affective symptoms are clearly accounted for most effectively by the DSM[-]IV and DSM[-]5 diagnosis [of] Personality NOS as described above.
In light of the above, it is the opinion of this examiner that the patient meets most clearly the criteria for a diagnosis of Personality Disorder NOS which has progressed normally without evidence of exacerbation or aggravation and that he has met this criteria for many years and that it is less likely than not that his Personality Disorder NOS was caused by or the result of by any event in his military service.
In the June 2016 JMPR, the parties found that, as the 2013 and 2014 opinions did not address whether “any incidents of personal assault occurred[,]’ and “whether any currently diagnosed PTSD [was] related to such incident[,]” the VA examiner did not address the Veteran’s claimed stressor of being the victim of a mugging while he was in service. Thus, in October 2016 the Board remanded the appeal to obtain an addendum medical opinion to specifically address the Veteran’s claimed stressor of being the victim of a mugging while he was in service.
Accordingly, in January 2017, the VA examiner who performed the 2013 examination and provided the 2013 and 2014 opinions provided another addendum opinion to specifically address the whether the Veteran meets the DSM-IV criteria for PTSD based on a personal assault. Following a comprehensive review of the record, the examiner found that there is no evidence of an eligible or credible stressor that occurred in the military and, therefore, the Veteran cannot meet the DSM-IV or DSM-5 criteria for PTSD, and he did not meet the DSM-5 criteria for any diagnosis with a clear nexus to his military service.
Regarding the Veteran’s claim for PTSD, the examiner reviewed all of the Veteran’s claimed stressors, starting with his most recently alleged stressor and working backwards. First, she noted the alleged stressor of a suicide attempt during service. The examiner observed that there was no record of this event nor any mental health issue (besides substance abuse) in the Veteran’s STRs or for some time after service. Here, the Board observes that the examiner erroneously noted 1987 as the Veteran’s first suicide attempt but the records indicate an attempted in 1981; however as neither date was during the Veteran’s service, the Board finds this error is without consequence. Returning to the alleged in-service attempt, the examiner further noted that not only were there not records of such in the Veteran’s STRs, but that his post-service reports regarding the attempt were inconsistent in that the Veteran alternatively reported that he made the attempt by slashing his wrists, overdosing, and/or hanging.
Turning to the second alleged stressor, the Veteran reported being involved in a “serious” bus accident and hospitalized thereafter. However, the examiner noted that the Veteran’s STRs do not support his assertion that the accident was traumatic or serious in nature. In fact, the Board observes that the STRs do not reflect an accident occurred; rather such show that the bus stopped suddenly to avoid an accident. Specifically, the March 1975 record states that the Veteran was “involved in [an] accident while on [a] Greyhound bus…talking to another passenger behind him when the bus made [a] sudden stop[,] avoiding accident[.]” Moreover, as acknowledge by the examiner, the Veteran was not hospitalized after the accident. He was seen in sick call and advised to apply heat to his back which he injured when the bus suddenly stopped.
The third alleged stressor of being slapped “upside” the head by a drill instructor was address in the 2013 and 2014 opinions. The examiner again found that this stressor was insufficient to support a diagnosis of PTSD. Similarly, the fourth stressor of being humiliated in front of his peers when a drill instructor yelled at him for dropping a grenade was also addressed by the examiner previously and was found not to support a diagnosis of PTSD.
The fifth stressor involved the Veteran’s reports that a drill sergeant “jumped him and beat him up[.]” However, the examiner noted that there was no record of this in the Veteran’s STRs and that the report was not consistent with the Veteran’s reports during the 2013 examination with regard to his interactions with his drill instructor.
The sixth alleged stressor was being “stabbed by an ice pick” during service. Here, the examiner observed that an August 1975 STR (discussed below) notes the Veteran’s report that he was “playing around” with a friend when he was accidentally stuck with a hair pick. Thus, the examiner noted that being accidentally struck with a hair pick was not sufficient to support a diagnosis of PTSD and that the Veteran had provided inconsistent information regarding the incident.
The seventh alleged stressor relates to the alleged personal assault via mugging. In this regard, the Veteran reported someone was going to hit him over the head (apparently with a knife) but that he blocked the attack with his arm resulting in a serious laceration to his arm. The examiner observed that there was no evidence of this alleged attack in the Veteran’s STRs, despite the fact that “he used sick call frequently and in fact used it for several of his other reported traumas including the ‘bus accident’ and being ‘stabbed with an ice pick.'” The examiner further noted that there was no military police report regarding this alleged attack.
The eighth stressor was an alleged attack with a straight razor during a card game. Like the alleged mugging, the examiner observed that there was no documentation of treatment related to this incident and that there was no police report related to it.
The ninth and final stressor relates to the Veteran’s reports that he was a combat veteran who began using drugs in Vietnam and that “in situations when he has felt like others were attacking him or humiliating him[,]” he spoke in Vietnamese. However, the examiner found that the Veteran was never in Vietnam and his DD 214 does not show that he had any overseas service.
In addition to reviewing the Veteran’s reported stressors, the examiner also considered whether the Veteran may have exhibited certain behaviors in the military indicating he had been personally assaulted but was reluctant to discuss it. Specifically, she observed that he had numerous legal issues in service including an incident of misconduct (1973), civilian confinement in jail (1973), disobeying orders (1975), sleeping on duty (1976), being absent without leave (AWOL) (1976), being continuously late for formations (1976), being AWOL (1977), and a 1976 recommendation that the Veteran be dishonorably discharged to his shirking of his duties and lying.
After reviewing the alleged stressors and the Veteran’s military record, the examiner opined that it was less likely than not that the Veteran was mugged during service as:

1. It was [the Veteran’s] habit to use sick call frequently including for wounds or injuries received outside the line of duty and there is no evidence of this wound in his STRs, nor was it reported to the police/MPs.

2. There is actual documented evidence in the [Veteran]’s efile that many of [his] claimed stressors either did not occur or did not occur in the traumatic manner he has later stated.

3. During 2016 the patient did not report his mugging as being his trauma but instead specifically report[ed] his trauma was interaction with [a] drill [sergeant]…, suicide attempt while in the military…, and being in a serious bus accident and hospitalized….

[4]. The only markers (frequent disciplinary actions…) of psychological issues for this patient are entirely consistent with his known severe drug abuse diagnosis which was the focus of treatment for 5 months prior to being discharged due to rehab[ilitation] failure.”

Here, the Board also observes that there is no record of the Veteran being a victim of a mugging in his STRs. However, in March 2017, after the January 2017 addendum opinion was provided, the Veteran submitted a statement from his ex-wife and from a comrade, both of whom reported remembering the Veteran reporting to them that he had been attacked and stabbed. They reported taking him to the hospital for treatment of his alleged stab wound. Here, the Board notes that, while the Veteran, his ex-wife, and his comrade are competent to report what they witnessed, the reports regarding the mugging lack credibility in light of the evidence of record.
In this regard, the Veteran’s STRs contain records related to three left arm injuries. The first incident occurred in August 1975, and while the Veteran subsequently reported to treatment providers that he was injured by an ice pick (see above), treatment records indicate that there was a puncture wound to the left wrist that occurred “while playing around with a buddy who accidentally struck [the Veteran] with a hair comb…called a pick.” The second injury, which also occurred in August 1975, was reported as a laceration to the left forearm “while washing dishes[,]” which required stitches. Notably, the Veteran claimed at his October 2009 DRO hearing that, while he did not report the alleged mugging to any psychiatric treatment providers during service, he did report the mugging to the medical professionals who stitched his arm following the attack. Again, the records indicate that the left arm stitches the Veteran received were related to an injury incurred while washing dishes. In fact, when the Veteran sought service connection for the residual scar of his left forearm in 1994, he made no reference to a mugging, he subsequently reported in September 2002 that he received an “accidental knife wound,” and in October 2009 that he was stabbed by a fellow soldier, not an unknown assailant. The third left arm injury occurred in April 1976 when the Veteran “allegedly incurred [a left palm injury] when [he was] cleaning [a] .22 caliber pistol that fired into [his] left palm” while he was off duty. In addition to the fact that the records do not support the Veteran’s assertions of the in-service mugging, the record also indicates that the Veteran has other characteristics that call his veracity into question including the fact that he was a well-documented drug abuser during his service, he was cited for stealing property of other veterans during service, and attempted “to shirk his duties and trie[d] to lie his way out of it” during service.
Given the foregoing, the Board finds that the Veteran’s descriptions of his in-service mugging are inconsistent and not supported by the contemporaneous record, and, therefore, lack credibility. In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d 78 F.3d 604 (Fed. Cir. 1996). In the instant case, the Veteran has not provided specific details surrounding such alleged stressors so as to allow verification, to include dates or names of the persons involved. Furthermore, there is no record in the Veteran’s STRs or personnel records that he ever experienced a mugging incident during his service, despite his reports to the DRO that he told the medical professionals about his mugging. In fact, the records document the Veteran’s left arm injury occurred while washing dishes, and clearly attribute his alleged injuries to other incidents, not a mugging. Finally, the Board acknowledges the Veteran’s comrade and his ex-wife’s reports that the Veteran told them he had been mugged and that they took him to the hospital for treatment of his injuries. However, neither person claims to have witnessed the mugging and their lay observations are based on the Veteran’s reports, which have been found to lack credibility. Therefore, in light of the fact that the Veteran’s statements regarding the alleged mugging are inconsistent with the available evidence, and were not reported until he had a self-interested reason for doing so, the Board finds that the Veteran’s statements describing his alleged in-service mugging to be not credible and they are afforded no probative weight. Similarly, the other lay statements of record that are based on the Veteran’s non-credible testimony are also afforded no probative weight.
Notably, in conjunction with the 2017 addendum opinion, the examiner again revisited whether the Veteran had any non-PTSD psychiatric diagnoses related to service. She acknowledged that the Veteran’s in-service diagnosis was related to substance abuse and that post-service diagnoses continued to be substance abuse. Moreover, his reports of using illicit substances to treat depression was not made until significantly after service, indicating no nexus to the Veteran’s military service. In this regard, the examiner observed that the Veteran’s post-service depression diagnoses were reactive in nature and were documented in his records as variously related to relationship issues, drug issues, legal issues, work stress, behavioral issues, anger issues, and the residuals of these. In fact, the criteria for an actual diagnosis, when met, was of an adjustment disorder with depression and anxiety, and the examiner noted that the Veteran experienced remission and/or improvement of these symptoms based on environmental factors. Thus, she found his post-service mental health disability was most consistent with an adjustment disorder, but that he did not exhibit symptomatology consistent with such a diagnosis during the appeal period.
Rather, the only diagnosis manifested during the appeal period was an unspecified personality disorder/personality disorder as was fully discussed in the 2013 and 2014 examination reports. Importantly, the parties to the JMPR found no fault in the Board’s discussion of any issue except as to whether the Veteran exhibited a PTSD diagnosis based on the alleged in-service mugging stressor. Carter v. Shinseki, 26 Vet. App. 534, 542-43 (2014), (vacated on other grounds sub nom. Carter v. McDonald, 794 F.3d 1342 (Fed. Cir. 2015) (“[W]hen an attorney agrees to a [JMR] based on specific issues and raises no additional issues on remand, the Board is required to focus on the arguments specifically advanced by the attorney in the motion, see Forcier [v. Nicholson, 19 Vet. App. 414,] 426 [(2006)], and those terms will serve as a factor for consideration as to whether or to what extent other issues raised by the record need to be addressed.”)
The above September 2014 and January 2017 addendum opinions are not directly contradicted by any other competent evidence, and the Board finds the comprehensive opinions, which clearly reflect detailed consideration of the entire record, to be definitive as to the matter of whether the Veteran has an acquired psychiatric disorder that is the result of service or a disability of in-service origin resulting from a mental disorder superimposed upon a personality disorder. See Nieves-Rodriguez, supra; Stefl, supra. In addition, given the lack of any evidence of a psychosis within one year of service, presumptive service connection on the basis of chronic disease, to include based on continuity of symptomatology, is not warranted. 38 U.S.C.A. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309; Walker, supra.
In making this determination, the Board has considered the Veteran’s assertions with regard to why he feels his psychiatric problems are the result of his experience during service. However, a determination as to whether the Veteran has an acquired psychiatric disorder that is related to service or a mental disorder superimposed on a personality disorder requires the expertise of a mental health professional as such a determination may only be made after a clinical analysis that a lay person does not that have the requisite training or knowledge to undertake. As such, the matter of whether the Veteran has an acquired psychiatric disorder that is the result of service, or a disability of in service origin resulting from a mental disorder superimposed upon a personality disorder, are complex questions that may not be competently addressed by lay evidence, and the Veteran’s own opinion in this regard is nonprobative evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, the most probative evidence of record does not support the Veteran’s contentions and, rather, his statements are substantially outweighed by the conclusions set forth in the September 2014 and January 2017 opinions. Additionally, as fully discussed above, the Board finds that his statements regarding the alleged in-service mugging, the only element of the claim with which the parties to the JMPR found fault, are not credible.
In light of the above and in conclusion, the Board finds that service connection for an acquired psychiatric disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the probative evidence is against the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder. As such, that doctrine is not applicable, and this claim must be denied. 38 U.S.C.A.
§ 5107; 38 C.F.R. § 3.102; Gilbert, supra.

ORDER

Service connection for an acquired psychiatric disorder, to include schizophrenia, depression, and PTSD, is denied.
____________________________________________
A. JAEGER
Veterans Law Judge, Board of Veterans’ Appeals
Department of Veterans Affairs

VA DISABILITY BENEFITS: Opportunities Exist to Better Ensure Successful Appeals Reform GAO-18-349T: Published: Jan 30, 2018

What GAO Found

The Department of Veterans Affairs’ (VA) plan for implementing a new disability appeals process while attending to appeals in the current process addresses most, but not all, elements required by the Veterans Appeals Improvement and Modernization Act of 2017 (Act). VA’s appeals plan addresses 17 of 22 required elements, partially addresses 4, and does not address 1. For example, not addressed is the required element to include the resources needed by the Veterans Benefits Administration (VBA) and the Board of Veterans’ Appeals (Board) to implement the new appeals process and address legacy appeals under the current process. VA needs this information to certify, as specified under the Act, that it has sufficient resources to implement appeals reform and make timely appeals decisions under the new and legacy processes.
VA’s appeals plan reflects certain sound planning practices, but it could benefit from including important details in several key planning areas:
Performance measurement: VA’s plan reflects steps taken to track performance, but could articulate a more complete and balanced set of goals and measures for monitoring and assessing performance on a range of dimensions of success. Specifically, the plan reports that VA is developing a process to track timeliness of the new and legacy processes. However, contrary to sound planning practices, the plan does not include timeliness goals for all five appeals options available to veterans, does not include goals or measures for additional aspects of performance (such as accuracy or cost), and does not explain how VA will monitor or assess the new process compared to the legacy process. Unless VA clearly articulates a complete and balanced set of goals and measures, it could inadvertently incentivize staff to focus on certain aspects of appeals performance over others or fail to improve overall service to veterans.
Project management: VA’s plan includes a master schedule for implementing the new appeals plan; however, this schedule falls short of sound practices because it does not include key planned activities—such as its pilot test of two of the five appeals options. In addition, the schedule does not reflect other sound practices for guiding implementation and establishing accountability—such as articulating interim goals and needed resources for, and interdependencies among, activities. Unless VA augments its master schedule to include all key activities and reflect sound practices, VA may be unable to provide reasonable assurance that it has the essential program management information needed for this complex and important effort.
Risk assessment: VA has taken steps to assess and mitigate some risks related to appeals reform by, for example, pilot testing two of the five appeals options through its Rapid Appeals Modernization Program (RAMP). However, as designed, RAMP does not include key features of a well-developed and documented pilot test. For example, VA has not articulated how it will assess RAMP before proceeding with full implementation. In addition, RAMP is not pilot testing three options and, as a result, VA will not have data on the extent to which veterans will appeal directly to the Board when given the option. Unless VA identifies and mitigates key risks associated with implementing a new process, VA is taking a chance that untested aspects will not perform as desired.

Why GAO Did This Study

VA’s disability compensation program pays cash benefits to veterans with disabilities connected to their military service. In recent years, the number of appeals of VA’s benefit decisions has been rising. For decisions made on appeal in fiscal year 2017, veterans waited an average of 3 years for resolution by either VBA or the Board, and 7 years for resolution by the Board. The Veterans Appeals Improvement and Modernization Act of 2017 makes changes to VA’s current (legacy) appeals process, giving veterans new options to have their claims further reviewed by VBA or appeal directly to the Board. The Act requires VA to submit to Congress and GAO a plan for implementing a new appeals process, and includes a provision for GAO to assess VA’s plan.
This testimony focuses on the extent to which VA’s plan: (1) addresses the required elements in the Act, and (2) reflects sound planning practices identified in prior GAO work. GAO’s work entailed reviewing and assessing VA’s appeals plan and related documents against sound planning practices, and soliciting VA’s views on GAO’s assessments.

What GAO Recommends

In its forthcoming report, GAO is considering recommending that VA: fully address all legally required elements in its appeals plan, articulate how it will monitor and assess the new appeals process as compared to the legacy process, augment its master schedule for implementation, and more fully address risk.

Full Report

Accessible Version

VA Launches Program Aimed at Providing Veterans More Options in Claims Disagreements 

Former Veterans Affairs Attorney Robin M. Webb writes on her blog

By its own terms, the VAIMA does not go into effect until February 2019 and does not apply to current claims and appeals, but recently, VA announced that it was initiating this month the Rapid Appeals Modernization Program (RAMP), to provide some of the benefits of the VAIMA.  Participation is voluntary at this time.

In this respect, as to whether to stay in the current appeals process, which is called “legacy,” or to opt-in and participate in RAMP, one needs to keep in mind that once you leave “legacy,” you cannot go back.  Your appeal stays in RAMP.

I mention this as an important consideration because RAMP is being initiated without any implementing regulations at all.  Let me explain.  A statute, like the VAIMA, is a law.  In turn, to implement a law, the appropriate agency drafts regulations, putting into place “rules” that govern how that agency enacts, applies, and enforces the statute, the law; in other words, the “rules” lay out what the law really means and its legal and practical effects.  There is none of that with RAMP.

Veterans Affairs Press Release
11/02/2017 WASHINGTON
Veterans Affairs announced that it will launch the Rapid Appeals Modernization Program, or “RAMP,” with the goal of providing Veterans with the earliest possible resolution of their disagreement with VA’s decision on their benefit claims.
RAMP will provide expanded opportunities for Veterans to enter the new, more efficient claims review process outlined in the Veterans Appeals Improvement and Modernization Act of 2017, which was signed into law by President Donald J. Trump on Aug. 23.
“At its core, VA’s mission is to provide Veterans with the highest quality of service,” said VA Secretary Dr. David J. Shulkin. “The new process under the RAMP initiative reflects major steps in not only VA’s effort of continuous improvement, but also in providing greater choice for Veterans and their families.”
VA began its 18-month implementation of the new process immediately after the bill became law.
By February 2019, all requests for review of VA decisions will be processed under the new, multi-lane process. VA’s legacy appeals process was slow and complex. The new law streamlines the process and includes safeguards ensuring claimants receive the earliest effective date possible for their claims.
Participation in RAMP is voluntary; however, Veterans can expect to receive a review of VA’s initial decision on their claim faster in RAMP than in the legacy appeals process. The initiative allows participants to have their decisions reviewed in the Higher-Level or Supplemental Claim review lanes outlined in the law.
The reviewer can overturn previous decisions based on a difference of opinion, or return it for correction. Participants who select the Supplemental Claim Lane may submit new evidence and may receive VA’s assistance in developing evidence in support of their claim.
Veterans who disagree with the decisions they receive in RAMP can appeal to the Board of Veterans’ Appeals in the new process and have their appeal decided by the Board when the new law becomes effective in February 2019.  Veterans who participate in RAMP will not be able to return to the legacy appeals process.
VA encourages eligible Veterans with pending appeals to participate in RAMP and the benefits of the new review process. VA will begin sending eligible Veterans an invitation to participate in early November and continue the program until February 2019.
VA will continue working with Congress, Veterans Service Organizations and other Veteran advocates to implement the new appeals process over the next several months as VA continues to make bold, positive change on behalf of Veterans, their families and survivors.

Scott v. McDonald, 789 F. 3d 1375 – Court of Appeals, Federal Circuit 2015

[ezcol_1half]

789 F.3d 1375 (2015)

Curtis SCOTT, Claimant-Appellant
v.
Robert A. McDONALD, Secretary of Veterans Affairs, Respondent-Appellee.

No. 2014-7095.
United States Court of Appeals, Federal Circuit.June 18, 2015.1376*1376 Jennifer Librach Nall, Baker Botts, LLP, Austin, TX, argued for claimant-appellant. Also represented by Christopher Granaghan, David B. Weaver, Jeffrey S. Gritton, Vinson & Elkins LLP, Austin, TX.
William James Grimaldi, Commercial Litigation Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent-appellee. Also represented by Joyce R. Branda, Robert E. Kirschman, Jr., Claudia Burke; Y. Ken Lee, Amanda R. Blackmon, Office of General Counsel, United States Department of Veterans Affairs, Washington, DC.
Before DYK, MAYER, and REYNA, Circuit Judges.
DYK, Circuit Judge.
Curtis Scott appeals from the decision of the United States Court of Appeals for Veterans Claims (“Veterans Court”) denying his claim for service connection for hepatitis C. We affirm.

BACKGROUND

Scott served on active duty for training in the United States Marine Corps Reserve from January to July 1972. On November 18, 1999, Scott tested positive for hepatitis C. He applied for disability benefits on February 4, 2005, alleging that he contracted hepatitis C in service. His primary theory was that he was infected with hepatitis C when he received air-gun inoculations during his military service. The Department of Veterans Affairs (“VA”) regional office (“RO”) denied Scott’sclaim for service connection on September 20, 2005.

[/ezcol_1half] [ezcol_1half_end]This case is significant as it relieves the Board from searching the record to address procedural arguments not raised by the Appellant.
Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015):
In this case, the incarcerated Appellant requested a Board hearing and noted that his next potential opportunity for parole was over a year later. The RO scheduled the hearing in the interim and the Appellant did not attend. The Appellant requested a rescheduled hearing, but the Board denied the Appellant’s request and denied the appeal on the merits. The claim was appealed to the CAVC, where the Appellant was represented by counsel. The hearing issue was not raised to the CAVC, but the case was remanded on other grounds. The Board then remanded the case to the RO for additional development while noting that the Appellant “has not renewed his request” for a hearing. The Board eventually denied the claim again. During the second appeal to the CAVC, the Appellant argued that the Board erred by denying him his right to a hearing. The CAVC refused to consider the argument because it had not been raised either in the prior CAVC appeal or to the Board during the intervening proceedings.The Federal Circuit affirmed the CAVC. In doing so, it acknowledged that the doctrine of issue exhaustion was appropriate both before the Board and the CAVC in certain circumstances. However, the Federal Circuit also noted that the Board has a special obligation to read filings liberally, whether submitted by counsel or pro se appellant.
The Federal Circuit then analyzed what constituted a liberal construction for these purposes, stating: “There is a significant difference between considering closely-related theories and evidence that could support [an Appellant’s] claim for disability benefits and considering procedural issues that are collateral to the merits.” The Federal Circuit stated that, for procedural issues, an Appellant’s interest “may be better served by resolution of his claims” rather than by a remand that may not change the final outcome. As a result, the Federal Circuit stated: “Having initially failed to raise the procedural issue, the [Appellant] should not be able to resurrect it months or even years later when, based on new circumstances, the [Appellant] decides that raising the issue is now advantageous.” Accordingly, the Federal Circuit held: “[t]he Board’s obligation to read filings in a liberal manner does not require the Board or the [CAVC] to search the record and address procedural arguments when the [Appellant] fails to raise them before the Board.
This case is significant as it relieves the Board from searching the record to address procedural arguments not raised by the Appellant.
[/ezcol_1half_end]On April 24, 2006, Scott appealed to the Board of Veterans’ Appeals (“Board”) and requested an evidentiary hearing before the Board. See 38 C.F.R. § 20.700(a) (right to a hearing). Scott was incarcerated at the time of his appeal to the Board. On December 6, 2007, the RO sent a letter to Scott, “acknowledg[ing] [his] request for a Video Conference hearing before the Board,” and “request[ing] that [Scott] provide us with the date [Scott is] expected to be released from [his] incarceration so we may schedule [his] video conference hearing accordingly.” J.A. 575. Scott responded to the RO on December 13, 2007, reiterating his request for a hearing and informing the Board that his “minimum expiration parole date for release is January 1377*1377 13, 2017,” and his “next parole review date is scheduled for March of 2009.” J.A. 573. On January 14, 2008, the RO notified Scott that his hearing had been scheduled for March 14, 2008, in Houston, Texas.Scott, who was still incarcerated on the scheduled hearing date, failed to appear for the hearing.

On March 23, 2008, Scott requested a rescheduled hearing because he “could not appear for [his] hearing because of [his] incarceration.” J.A. 826. The Board denied Scott’s request, finding that Scott had “not shown good cause for failing to appear for [his] hearing,” but made no mention of Scott’s incarceration. J.A. 683. The Board subsequently denied Scott’s claim for service connection, noting thatScott “failed to report for his scheduled hearing in March 2008” and that the Board denied his request to reschedule it. J.A. 677.

On appeal to the Veterans Court, Scott, who by this time was represented by counsel, did not raise the hearing issue. The Veterans Court vacated and remanded to the Board due to an inadequate medical examination, without mentioning the hearing issue. In remanding to the RO, the Board noted the hearing issue but that Scott “has not renewed his request” for a hearing. J.A. 221. On November 18, 2011, the RO continued the service connection denial without mentioning the hearing issue. Scott again appealed to the Board via a re-certification of appeal form which checked “YES” in answer to “WAS HEARING REQUESTED?”, but Scott did not raise the hearing issue with the Board. J.A. 183. The Board affirmed, again noting that Scott “has not renewed his request” for a hearing. J.A. 16.

On appeal to the Veterans Court, on July 26, 2013, Scott raised the hearing issue for the first time since his March 23, 2008, request for a rescheduled hearing. The Veterans Court affirmed, holding that Scott “did not raise this [hearing] issue in either proceeding,” referring to Scott’s prior appeal to the Veterans Court and his current appeal before the Board. J.A. 1-2. The Veterans Court held that raising the hearing issue at this late stage “amounts to an effort to engage in undesirable piecemeal litigation, and [Scott] provides no compelling basis to permit it.” J.A. 2.Scott appeals. We have jurisdiction pursuant to 38 U.S.C. § 7292(a). We review legal determinations of the Veterans Court de novo. Moffitt v. McDonald, 776 F.3d1359, 1364 (Fed.Cir.2015).

DISCUSSION

I

The Supreme Court has recognized the importance of issue exhaustion with respect to administrative tribunals. In United States v. L.A. Tucker Truck Lines, Inc., 344 U.S. 33, 73 S.Ct. 67, 97 L.Ed. 54 (1952), the Court held that “orderly procedure and good administration require that objections to the proceedings of an administrative agency be made while [the agency] has opportunity for correction in order to raise issues reviewable by the courts,” such that “as a general rule … courts should not topple over administrative decisions unless the administrative body not only has erred but has erred against objection made at the time appropriate under its practice.” Id. at 37, 73 S.Ct. 67.[1] But Scott argues that the Supreme Court’s decision in Sims v. Apfel, 530 U.S. 103, 120 S.Ct. 2080, 147 L.Ed.2d 80 (2000), precludes 1378*1378 application of the issue exhaustion doctrine in the context of veterans benefits because proceedings before the VA are non-adversarial in nature.

We addressed this issue even before the Supreme Court’s decision in Sims, inMaggitt v. West, 202 F.3d 1370 (Fed.Cir.2000). We articulated a case-by-case balancing test for issue exhaustion in the VA system: “The test is whether the interests of the individual weigh heavily against the institutional interests the doctrine exists to serve.” Id. at 1377 (citing McCarthy v. Madigan, 503 U.S. 140, 146, 112 S.Ct. 1081, 117 L.Ed.2d 291 (1992)). We remanded to the Veterans Court to determine, inter alia, “whether invocation of the exhaustion doctrine [was] appropriate” with respect to the veteran’s request to reopen his claim for service connection based on constitutional and statutory arguments that he had not raised before the Board. Id. at 1378-79.

Thereafter, in Sims, the Supreme Court addressed issue exhaustion in the context of Social Security Administration (“SSA”) benefits. The Court noted that “SSA regulations do not require issue exhaustion.” 530 U.S. at 108, 120 S.Ct. 2080. When that is so, “the desirability of a court imposing a requirement of issue exhaustion depends on the degree to which the analogy to normal adversarial litigation applies in a particular administrative proceeding.” Id. at 109, 120 S.Ct. 2080. A plurality of the Court concluded that “[t]he differences between courts and agencies are nowhere more pronounced than in Social Security proceedings,” such that “a judicially created issue-exhaustion requirement is inappropriate.” Id. at 110, 112, 120 S.Ct. 2080. But the majority also recognized that “it is common for an agency’s regulations to require issue exhaustion in administrative appeals. And when regulations do so, courts reviewing agency action regularly ensure against the bypassing of that requirement by refusing to consider unexhausted issues.” Id.at 108, 120 S.Ct. 2080 (citations omitted). Justice O’Connor’s concurrence also made clear that Sims does not apply, and exhaustion is required, where applicable statutes or regulations impose an exhaustion requirement. See id. at 113, 120 S.Ct. 2080 (O’Connor, J., concurring). Thus, in light of Sims, we must determine the extent to which statutes or agency regulations require issue exhaustion in the veterans benefits context.

In previous veterans’ cases we have considered issue exhaustion in three specific contexts and have held that the statutes and regulations require issue exhaustion in appropriate circumstances. First, in an appeal from the RO to the Board, 38 C.F.R. § 20.202 specifically requires that the errors by the RO be identified either by stating that all issues in the statements of the case are being appealed or by specifically identifying the issues being appealed.[2]See Robinson v. Shinseki,557 F.3d 1355, 1361 (Fed.Cir.2009) (“We … do not suggest that under the regulations 1379*1379 the veteran is entirely relieved of his or her obligation to raise issues in the first instance before the VA where the record is being made. The regulations quite clearly impose such an obligation even in direct appeals….” (citing 38 C.F.R. § 20.202)).

Second, where the alleged error was made by the Board, we have held that the statute, 38 U.S.C. § 7252(a), requires issue exhaustion before the Board in appropriate circumstances.[3]See Ledford v. West, 136 F.3d 776, 779-80 (Fed.Cir.1998) (Under § 7252, “the [Veterans C]ourt’s jurisdiction is premised on and defined by the Board’s decision concerning the matter being appealed,” and “while the doctrine of exhaustion of administrative remedies is not jurisdictional,” exhaustion is normally required.). Thereafter, in Maggitt, we held that exhaustion was not required in all cases, distinguished Ledford, and concluded that “[n]othing in the statutory scheme providing benefits for veterans mandates a jurisdictional requirement of exhaustion of remedies which would require the Veterans Court to disregard every legal argument not previously made before the Board.” See202F.3d at 1376-77. As noted above, “the test is whether the interests of the individual weigh heavily against the institutional interests the doctrine exists to serve.” Id. at 1377 (citing McCarthy, 503 U.S. at 146, 112 S.Ct. 1081).

In Bernklau v. Principi, 291 F.3d 795 (Fed.Cir.2002), decided after Sims, we upheld the Veterans Court’s application of issue exhaustion to arguments that the veteran had failed to raise before the Board, holding that Maggitt did not require an explicit balancing of interests in the individual case. See id. at 799, 801-02. We held that new arguments for an earlier effective date based on past events allegedly supporting an informal claim for individual unemployability “TDIU” were properly rejected as not raised before the Board. See id. at 800-02.[4]

Third, in an appeal from the Veterans Court to this court we have held that 38 U.S.C. § 7292(a) requires issue exhaustion at the Veterans Court level.[5] InBelcher v. 1380*1380 West, 214 F.3d 1335 (Fed.Cir.2000), we explained that “38 U.S.C. § 7292(a) speaks directly to the requirement of issue exhaustion.” Id. at 1337 (citing Sims, 530 U.S. at 106-09, 120 S.Ct. 2080). In Belcher, the veteran raised an argument for the first time on appeal to this court that the Veterans Court failed to follow a VA regulation relating to service connection. Id. at 1336. We declined to consider the argument, holding that we lacked jurisdiction to hear it because it was not addressed by or presented to the Veterans Court. Id. at 1337.

The statutes and regulations thus impose a requirement of issue exhaustion in appropriate circumstances. While the requirement of exhaustion is relatively strict in proceedings before the Veterans Court, we have concluded that the non-adversarial nature of proceedings before the VA mandates a less strict requirement, as we now discuss.

II

In view of the non-adversarial nature of proceedings before the Board, it is appropriate in the first and second situations listed above that the Board and the Veterans Court give a liberal construction to arguments made by the veteran before the Board, as is specifically required by § 20.202 of the regulations in the case of appeals from the RO to the Board. “In various decisions we have made clear that the Board has a special obligation to read pro se filings liberally.”Robinson, 557 F.3d at 1358-59. In Robinson, we held that this obligation extends to cases in which the veteran is represented by counsel. See 557 F.3d at 1359-60. This obligation extends to all proceedings before the Board. It follows from the test articulated in Maggitt. See 202 F.3d at 1377.

Our prior cases have illuminated what is required by a liberal construction. In Roberson v. Principi, 251 F.3d 1378 (Fed.Cir. 2001), the Veterans Court affirmed the Board’s service-connection denial because the veteran had failed to allege TDIU. Id. at 1382. We held, in the context of clear and unmistakable error (“CUE”) claims, that the VA must “fully and sympathetically develop the veteran’s claim to its optimum before deciding it on the merits.” Id. at 1384 (quoting Hodge v. West, 155F.3d 1356, 1362 (Fed.Cir.1998)). Thus, “[o]nce a veteran submits evidence of a medical disability and makes a claim for the highest rating possible, and additionally submits evidence of unemployability, the `identify the benefit sought’ requirement of 38 C.F.R. § 3.155(a) is met and the VA must consider TDIU.” Id.

In Comer v. Peake, 552 F.3d 1362 (Fed. Cir.2009), we held that where the veteran made a claim for service connection and record evidence supported total disability based on TDIU benefits, the Board was required to consider that evidence as a TDIU claim even though the veteran had not specifically raised a TDIU claim. See id. at 1366-69. Comer held that the requirement to liberally construe a veteran’s arguments extended to arguments that were “not explicitly raised” before the Board. Id. at 1366.

Similarly, in Robinson, we held that where the veteran made a claim for service connection and record evidence supported secondary service connection, the Board was required to consider that evidence as a claim for secondary service connection even though the veteran had not specifically raised secondary service connection. 1381*1381 See Robinson, 557 F.3d at 1361-62; see also Rivera v. Shinseki, 654 F.3d 1377, 1382 (Fed.Cir.2011) (“In light of the Board’s obligations to read veterans’ submissions liberally and to consider the full context within which those submissions are made, we conclude that section 7105(d)(3) does not impose such a[n explicit statement] requirement, at least in the context of a case involving the single factual question of the sufficiency of the veteran’s evidence to reopen a claim.”).

Roberson, Robinson, and Comer thus require the Veterans Court to look at all of the evidence in the record to determine whether it supports related claims for service-connected disability even though the specific claim was not raised by the veteran. They also require that veterans’ procedural arguments be construed liberally, but those cases do not go so far as to require the Veterans Court to consider procedural objections that were not raised, even under a liberal construction of the pleadings.

There is a significant difference between considering closely-related theories and evidence that could support a veteran’s claim for disability benefits and considering procedural issues that are collateral to the merits. As to the former, the veteran’s interest is always served by examining the record for evidence that would support closely related claims that were not specifically raised. As to procedural issues, that is not always the case. A veteran’s interest may be better served by prompt resolution of his claims rather than by further remands to cure procedural errors that, at the end of the day, may be irrelevant to final resolution and may indeed merely delay resolution. Under such circumstances, the failure to raise an issue may as easily reflect a deliberate decision to forgo the issue as an oversight. Having initially failed to raise the procedural issue, the veteran should not be able to resurrect it months or even years later when, based on new circumstances, the veteran decides that raising the issue is now advantageous. For this reason, absent extraordinary circumstances not apparent here, we think it is appropriate for the Board and the Veterans Court to address only those procedural arguments specifically raised by the veteran, though at the same time giving the veteran’s pleadings a liberal construction.

In short, we hold that the Board’s obligation to read filings in a liberal manner does not require the Board or the Veterans Court to search the record and address procedural arguments when the veteran fails to raise them before the Board. Under the balancing test articulated in Maggitt, the VA’s institutional interests in addressing the hearing issue early in the case outweigh Scott’s interests in the Veterans Court’s adjudication of the issue.

A review of Scott’s pleadings to the Board confirms that Scott did not raise the hearing issue in his current appeal to the Board. The regulations do not require that the Board or the Veterans Court address the veteran’s argument that the Board erred in not providing him with a hearing.

AFFIRMED

COSTS

No costs.

[1]See also Hormel v. Helvering, 312 U.S. 552, 556, 61 S.Ct. 719, 85 L.Ed. 1037 (1941) (“Ordinarily an appellate court does not give consideration to issues not raised below…. And the basic reasons which support this general principle applicable to trial courts make it equally desirable that parties should have an opportunity to offer evidence on the general issues involved in the less formal proceedings before administrative agencies entrusted with the responsibility of fact finding.”).

[2] Section 20.202 provides, in relevant part:

If the Statement of the Case and any prior Supplemental Statements of the Case addressed several issues, the Substantive Appeal must either indicate that the appeal is being perfected as to all of those issues or must specifically identify the issues appealed. The Substantive Appeal should set out specific arguments relating to errors of fact or law made by the agency of original jurisdiction in reaching the determination, or determinations, being appealed. To the extent feasible, the argument should be related to specific items in the Statement of the Case and any prior Supplemental Statements of the Case. The Board will construe such arguments in a liberal manner for purposes of determining whether they raise issues on appeal, but the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination, or determinations, being appealed.

38 C.F.R. § 20.202; see also 38 U.S.C. § 7105(d)(3) (“The appeal [to the Board] should set out specific allegations of error of fact or law, such allegations related to specific items in the statement of the case. The benefits sought on appeal must be clearly identified.”).

[3] Section 7252(a) provides: “The Court of Appeals for Veterans Claims shall have exclusive jurisdiction to review decisions of the Board of Veterans’ Appeals…. The Court shall have power to affirm, modify, or reverse a decision of the Board or to remand the matter, as appropriate.” 38 U.S.C. § 7252(a).

[4]Scott relies on cases from other circuits which held that issue exhaustion did not apply to various agency proceedings. But none of these cases involved a statute or regulation that specifically imposed an issue exhaustion requirement. See Alaska Survival v. Surface Transp. Bd., 705 F.3d 1073, 1081 (9th Cir. 2013) (declining to apply issue exhaustion to an appeal from the Surface Transportation Board because the “administrative process lacks an adversarial component” with no mention of a statute or regulation requiring otherwise); Vaught v. Scottsdale Healthcare Corp. Health Plan, 546 F.3d 620, 630 (9th Cir.2008) (“No ERISA statute precludes courts from hearing objections not previously raised … nor does any ERISA statute or regulation require claimants to identify all issues they wish to have considered on appeal.”); Coalition for Gov’t Procurement v. Fed. Prison Indus., Inc., 365 F.3d 435, 463 (6th Cir.2004) (“In considering whether the district court properly imposed an issue exhaustion requirement in the case sub judice, we initially observe that such a requirement exists in neither [the agency’s] organic statute nor its regulations.”).

[5] Section 7292(a) provides, in relevant part:

After a decision of the [Veterans Court] is entered in a case, any party to the case may obtain a review of the decision with respect to the validity of a decision of the Court on a rule of law or of any statute or regulation… or any interpretation thereof (other than a determination as to a factual matter) that was relied on by the Court in making the decision.

38 U.S.C. § 7292(a).

90-147 Gleicher v. Derwinski

[no_toc]ALFRED GLEICHER, APPELLANT, V. EDWARD J. DERWINSKI, SECRETARY OF VETERANS AFFAIRS, APPELLEE. 2 Vet App 262 Vet. App. 26; 1991 US Vet App LEXIS 1361991 U.S. Vet. App. LEXIS 136
No. 90-147 (PDF Version) December 17, 1991, Decided UNITED STATES COURT OF VETERANS APPEALS Before KRAMER, MANKIN, and HOLDAWAY, Associate Judges.

“In denying the appellant a total rating based upon unemployability, the BVA did little more than point to appellant’s relatively advanced education and occupational experience and opine that his disabilities did not “preclude all forms of substantially gainful employment.”

This clearly is insufficient in providing “reasons and bases” for the decision.

Hatlestad v. Derwinski, U.S. Vet. App. No. 90-103, slip op. at 10 (Mar. 6, 1991) (BVA decision failed to explain the conclusion of the BVA that appellant was not unemployable)”
ALFRED GLEICHER, APPELLANT, V. EDWARD J. DERWINSKI, SECRETARY OF VETERANS AFFAIRS, APPELLEE. 2 Vet App 262 Vet. App. 26; 1991 US Vet App LEXIS 1361991 U.S. Vet. App. LEXIS 136
No. 90-147 (PDF Version) December 17, 1991, Decided UNITED STATES COURT OF VETERANS APPEALS Before KRAMER, MANKIN, and HOLDAWAY, Associate Judges.

Counsel
Rick Surratt (non-attorney practitioner) was on the brief for appellant.
Robert E. Coy, Acting General Counsel, Barry M. Tapp, Assistant General Counsel, Andrew J. Mullen,
Deputy Assistant General Counsel, and John D. Lindsay were on the pleadings for appellee.

Opinion
 Editorial Information: Prior History
On Appellee’s Motion for Summary Affirmance
Opinion by: HOLDAWAY
{2 Vet. App. 27} HOLDAWAY, Associate Judge: The appellant, Alfred Gleicher, a veteran of World War II and a former prisoner of war, appeals a decision of the Board of Veterans’ Appeals (BVA) which denied him a total disability rating for a psychiatric disorder. The Court holds that the BVA was not clearly erroneous in determining that appellant was not entitled to a rating in excess of 70%. The Court also holds that the BVA was clearly erroneous in finding that appellant was able to follow or secure a substantially gainful occupation. Appellant, therefore, as a matter of law, is entitled to a total disability rating under _CFR_4.16 38 C.F.R. § 4.16 (1991).
FACTS
The appellant served in the Army Air Corps during World War II. In July 1944, while serving as a flight officer on a B-24 crew, his aircraft was shot down and the appellant was forced to parachute into enemy territory where he was captured and held as a prisoner until termination of hostilities. He was awarded a 10% disability rating in 1947 for the residuals of gunshot wounds received during his capture. He apparently led a fairly normal life for many years, obtaining a degree in engineering and an advanced degree in management. However, as a result of his wartime experiences, the appellant began to develop psychiatric problems and was ultimately awarded a 70% disability rating by the Veterans’ Administration (now Department of Veterans Affairs) (VA) Regional Office (RO) for these problems on November 18, 1988. He appealed that decision to the BVA and requested a 100% schedular rating. In its decision, the BVA continued the 70% rating.
The facts that led to the 70% rating for severe psychiatric disturbance disclosed a man who had retired from his employment as an engineer in 1982 because he was having great difficulty in dealing with people. As his illness progressively worsened, he had withdrawn into a life where he was essentially a “loner.” It was noted in a VA psychiatric examination report of August 26, 1988, that appellant’s inability to trust people continued to make him an “unreliable potential employee” and that if he “was forced to associate with others he would become severely upset and probably become physically ill.” A VA social and industrial survey dated October 24, 1988, also concluded appellant was “incapable of securing or maintaining employment.” Nonetheless, despite these somewhat forbidding facts, the BVA found him employable and in support of that decision stated: “The veteran remains in contact with reality and his conversation is logical and coherent. In addition the veteran has significant educational and occupational experience . . . .”
DISCUSSION
The appellant argues, firstly, that the BVA decision was clearly erroneous in failing to award a 100% schedular rating. Secondly, he argues that even assuming the BVA was not in error in failing to assign a 100% rating, he should, nonetheless, be given a total rating pursuant to 38 C.F.R. § 4.16 . Section 4.16 allows, inter alia, a total rating where a veteran with a 70% rating for a mental disorder is “unable to secure or follow a substantially gainful occupation.” We disagree with the appellant’s first contention, but agree as to his second one; we therefore affirm the decision {2 Vet. App. 28} of the BVA in part and reverse in part as discussed below.
A. We will deal summarily with the issue of whether, based on the severity of the appellant’s disability, the BVA was clearly erroneous in not assigning a 100% schedular rating. A decision as to the severity of a disability is a factual determination. Lovelace v. Derwinski, U.S. Vet. App. No. 90-55 (Oct. 31, 1990). This Court may not, of course, as to factual determinations made by the BVA, substitute its judgment for that of the BVA if there is a plausible basis for the decision. 38 U.S.C. § 7261 (a)(4) (formerly § 4061(a)(4)); Gilbert v. Derwinski, U.S. Vet. App. No. 89-53, slip op. at 4-5 (Oct. 12, 1990). After a review of the record we are satisfied that the BVA’s determination as to the severity of the disability was fully supported by the evidence. It follows that a 70% schedular rating was appropriate; moreover its written decision was sufficient in giving “reasons and bases” for this determination. 38 U.S.C. § 7104 (d) (formerly 4004(d)). See Gilbert, slip op. at 11.
B. The BVA decision was, however, inadequate in dealing with the question of the appellant’s claimed unemployability. The BVA erred in finding that the veteran was able to follow or secure a substantially gainful occupation based on the evidence of record. It also failed to provide adequate “reasons or bases” for its conclusion.
In denying the appellant a total rating based upon unemployability, the BVA did little more than point to appellant’s relatively advanced education and occupational experience and opine that his disabilities did not “preclude all forms of substantially gainful employment.” This clearly is insufficient in providing “reasons and bases” for the decision. Hatlestad v. Derwinski, U.S. Vet. App. No. 90-103, slip op. at 10 (Mar. 6, 1991) (BVA decision failed to explain the conclusion of the BVA that appellant was not unemployable); Hyder v. Derwinski, U.S. Vet. App. No. 90-245, slip op. at 6 (Apr. 15, 1991) (BVA decision failed to give reasons or bases for the conclusion that veteran’s back disorder did not prevent her from substantially gainful employment in view of her age, education and work experience). In point of fact, to merely allude to educational and occupational history, attempt in no way to relate these factors to the disabilities of the appellant, and conclude that some form of employment is available, comes very close to placing upon the appellant the burden of showing he can’t get work. At a minimum, therefore, this case is deficient in providing a reasoned analysis for the decision that appellant was able to secure or follow a substantially gainful occupation. There is, however, an even more fundamental defect in the BVA decision.
A veteran with a 70% disability rating is entitled to an “extra schedular” total disability rating if he is unable to secure or follow a substantially gainful occupation as a result of the disability. _CFR_4.16 38 C.F.R. § 4.16 . Appellant meets the requirement in section 4.16 of having a mental disability rated to be 70% disabling. That rating was upheld by the BVA and affirmed by this Court in the instant decision. Appellant was awarded a 70% rating and would therefore be entitled to a total disability rating under section 4.16 if he is found unable to secure or follow a substantially gainful occupation.
As noted above, the BVA determined that appellant’s psychiatric disability was not of sufficient severity to preclude him from some form of substantially gainful occupation consistent with his education and occupational experience. We find that the BVA was clearly erroneous in its factual determination concerning employability. The facts principally relied on by the BVA, i.e., the appellant’s advanced educational and occupational experiences are, at best, equivocal. It could be argued with at least equal force that a person who has spent his employed life as an engineer and manager and who has a severe mental disability and minimal social skills is likely to be less employable than a person with similar disabilities whose occupation has not been as demanding as to the use of his mental faculties and social skills.
{2 Vet. App. 29} Moreover, in its evaluation, the BVA failed to consider the 1988 VA psychiatric examination report and the 1988 VA social and industrial survey, both of which concluded that the appellant was incapable of securing or maintaining employment. There is no evidence of record to the contrary. We have previously held that the conclusion of an examining psychiatrist is a medical conclusion which the BVA is not free to ignore. Willis v. Derwinski, U.S. Vet. App. No. 90-27, slip op. at 7 (Aug. 21, 1991). After a review of all the evidence we are left with a “definite and firm conviction that a mistake has been committed” concerning the BVA’s finding of fact as to the appellant’s employability. Gilbert, slip op. at 4. The BVA decision regarding appellant’s employability is implausible and thus clearly erroneous. Appellant is therefore entitled to total unemployability under _CFR_4.16 38 C.F.R. § 4.16 as a matter of law because he meets the requirements of the regulation. Accordingly, while we AFFIRM the BVA as to its decision that a 70% rating was appropriate for the appellant’s service-connected mental disorder, we REVERSE the decision as to employability and REMAND the case to the BVA with directions to assign the appellant a 100% rating in accordance with _CFR_4.16 38 C.F.R. § 4.16 .
2 Vet. App. 24::CARTRIGHT v. DERWINSKI::December 17, 1991, Decided

Veterans Affairs Claims Self Help Guide

There are two types of service-connection
There are three requirements to establish a direct service connection for residuals of injuries and diseases;

1) In-service documentation of an injury or disease.
2) A current condition with a medical diagnosis.
3) and a medical nexus connecting 1 and 2.

An in-service injury/disease means that, for the most part, it must be documented in the veteran’s service medical records (SMRs). One thing to remember is that, generally, the in-service injury/disease must be shown to be “chronic” during in-service. If it is not shown to be a “chronic” condition while in-service, then you’ll more than likely need an Independent Medical Opinion (IMO) to substantiate the claim. Suppose a veteran doesn’t have a documented “chronic” condition or an IMO. In that case, the VA will more than likely state that the claimed condition is “Acute and Transitory,” meaning that the injury/disease resolved itself and there are no residuals.

A current condition with a medical diagnosis means that the claimed condition has to show current residuals from that in-service injury and must have a current diagnosis from a physician. A lot of times, the diagnosis can and will be obtained from the VA C&P exam.

Suppose the VA sees that your condition was “chronic” while in the service or that you have medical documentation of continuity of treatment since discharge. In that case, more often than not, they will schedule the veteran for a C&P exam to obtain the needed diagnosis and current disabling effects of the claimed disability.

Something connecting the two means either continuity of treatment of the claimed disability from time of discharge to the present, or, if this is not the case, an IMO will be needed from a physician. A lot of times, an IMO is a critical part of the veteran’s claim. An IMO can sway the benefit of the doubt in the veteran’s favor if the claim is borderline, or it can flat out prove service connection when one of the three components of establishing service connection aren’t met! For example, by borderline I mean let’s say that a veteran was seen for lower back pain once while on active duty over a period of a five year enlistment. And now it is ten years since his discharge and the veteran hasn’t been seen for the lower back until recently, or only had one episode of back pain within those ten years since getting out of the military. The veteran will need an IMO stating something to the effect that his current lower back condition is some how related to the episode while on active duty. If the RVSR (Rating Veteran Service Representative, or “Rating Specialist”) is very liberal in applying the regulation, he/she may award service-connection without the IMO. However, if the RVSR is “by the book,” then he/she may deny service-connection in the absence of a good IMO. An example of where an IMO can establish service-connection with which one or more of the three criteria listed above are absent would be, let’s say that a veteran was seen one time for a knee condition while on active duty and this incident is noted in his SMR’s. Ten years later the veteran is experiencing pain in that same knee but didn’t have any type of treatment since his discharge, he would need a really good IMO to establish that his current disability is somehow related to the in-service episode.

As far as presumptive service-connection is concerned, a veteran needs to be able to show that a condition listed in §3.307, §3.308, and §3.309 has manifested itself within the prescribed time limits after separation from the service. A presumptive condition does not need to be noted in a veteran’s SMR’s, hence presumptive, or it’s presumed that the said disability/disease occurred while in the service. There are some presumptive disabilities that do need to have manifested themselves within the first year after separation and to the degree of 10% disabling in order to warrant presumptive service-connection. One common one is Arthritis.

Filing the claim:
Once you have determined that you have met three basic criteria of disability compensation, you should then file the claim with your local Regional Office. There are two types of claims for initial service-connection; an Informal claim and a Formal claim.

An Informal claim is some type of communication to your local regional office in which you state you intend to apply for disability compensation. This communication can be a written letter, or fax, a telephone call or even an email. The best way, however, is something in writing. When a claimant makes an informal claim with VA, they need to clearly identify the disability for which they intend to apply for, give the VA your SSN and dates and branch of service, and make sure you send it via certified mail with return receipt! After you have sent your informal claim to VA, you have up to one year to send the VA your Formal Claim. In this one year period, I would recommend that you get together all of your medical records and so forth that will support your claim. If you send the VA your formal claim within the one year time period of the informal claim and VA grants your claim, the effective date, or the day you start to receive disability compensation, is the date of your informal claim. This could mean a lot of money in retro!

A Formal Claim for disability compensation is the VA Form 21-526. You should fill this out to the best of your ability. You should attach any Service Medical Records, Private Treatment records relevant to your claimed disability(ies), certified copy of your DD 214, copies of marriage certificates, divorce decrees and dependent birth certificates. By attaching these documents, you’ll speed up the processing of your claim quite a bit. However, you do not need to attach those documents if you do not have them in your possession. If you do not have any of those medical records, the VA will assist you in obtaining those by asking you to fill out VA Form 21-4142 for each facility where those records are located. One important side note; make sure you sign the VA Form 21-526!!

Important: You do not need to submit an Informal claim. You can file VA form 21-526 without informing VA of your intention to file for disability compensation.

What happens after I file my Formal claim?
What happens after you file your claim:
After you send VA your Formal claim, there are a number of “teams” at your local regional office that process your application.

There are essentially six “teams” at a Regional office that make up the “process.” When a veteran files a claim for benefits with VA, it is received at what is called a ‘Triage Team.’ This is where the incoming mail is sorted and routed to the different sections or other “teams” to be worked. Picture this as a Triage unit at a Hospital. There they decide who goes where according to the injury/condition involved. This is the way it works at VA too. The main function of the Triage Team is to screen all incoming mail. Within the Triage Team there are other sub components; the Mail Control Point, Mail Processing Point, and to a certain extent supervision of the files activity. The main control point is staffed with VSR (Veteran Service Representatives) who are actually trained in claims processing. This is also where they receive and answer the IRIS inquiries. The mail processing point is where chapter 29/30 claims (a bit later on these types of claims) are processed/awarded, and to a certain extent, dependency issues are resolved.

The next step is the “Pre-Determination Team.” This is where your claim for benefits is sent to be developed, meaning verification of service from the Service Department if a certified copy of the DD 214 is not submitted by the veteran, SMR’s are obtained from St. Louis if they weren’t sent in already by the veteran, any CURR verifications are done for PTSD stressors, any private treatment records are obtained under the “Duty to Assist,” and inferred issued are identified. Once the Pre-Determination Team figures out what you’re claiming, they’ll send you what’s known as a “Duty to Assist” letter or the VCAA letter. This letter states what type of claim you are filing, what conditions you are claiming, and what the regulations say you must show to have your claim granted. It will also state the evidence needed by VA to support your claim, and what VA is doing or has done. The letter will also explain VA’s “Duty to Assist” you in obtaining the evidence to support your claim. There will also be a response from that you should fill out and return. If you do not return this form or mark the box that you have additional evidence to submit, the VA must wait 60 days to further process your claim. As your claim progresses further through the Pre-Determination Team, you may or may not receive other letters. Examples of those letters include: follow-up letters to let you know VA requested something from a third party and there is a delay in their reply, and letters requesting that you provide something to VA to support your claim. The Pre-Determination Team may also send you a computer generated letter telling you they are still working on your claim. That letter is pretty interesting because it means a couple of things have happened with your claim; 1) your claim was reviewed by someone recently or 2) your claim has aged where the computer system is telling the regional office that they must look at your claim. One thing to keep in mind is that every time VA sends you a letter, regardless if it’s for information you already sent them, you should always respond with a letter via Certified Mail with return receipt. If you already sent something to VA that they previously requested, just send them a letter stating that you already submitted the information and when you sent it. Once all the developmental work has been done on a claim, it is then designated as “Ready to Rate” and sent to the Rating Activity.

The Rating Activity or “Rating Board” is where most veterans want to have their claim. This is where the claim for benefits is decided. The RVSR (Rating Veteran Service Representative, or “Rating Specialist”) is the person who rates a veteran’s claim. They review the entire C-file to ensure it is ready to be rated, and schedule any C&P exams that may be needed if not already done so by the Pre-Determination Team. If a C&P exam is needed they go ahead and do the paperwork to schedule this. Once the RVSR has all the needed paperwork to rate the claim, they make their decision. If the RVSR determines that there is something missing from the claim to make a decision, they send the claim back to the Pre-Determination Team for further development. Once they have reached their determination, they produce a rating decision with their decision and forward the C-file to the Post-Determination Team.

The Post-Determination Team is where the rating decision is promulgated. In other words, it is where the decision gets entered into the system and the rating decision is prepared and sent out to the veteran. If the veteran has a Power of Attorney (POA), they give a heads up to them as to what the decision was. If a claim has been granted and the retro involves over $25,000.00, it is sent to the VSCM (Veterans Service Center Manager) or their assistant for a third signature. The Post Determination Team may also do the following actions; accrued benefits claims not requiring a rating, apportionment decisions, competency issues not requiring a rating, original pension claims not requiring a rating, dependency issues, burials, death pension, and specially adapted housing and initial CHAMPVA eligibility determinations when a pertinent rating is already of record.

The Appeals Team handles appeals in which the veteran has elected the DRO review. They also handle any remands that have been sent back from the BVA and the Court. The Appeal Team is a self containing unit within the Regional office. They make determinations on appeals, make rating decisions that are on appeal, do any developmental work on any issue that may be on appeal, and issue any SOC’s and SSOC’s in conjunction with their review.

The Public Contact Team’s primary functions are to conduct personal interviews with, and answer telephone calls from veterans and beneficiaries seeking information regarding benefits and claims. In some regional offices, depending on their workload, also handles IRIS inquiries and fiduciary issues.

As one can see the VA claims process can be complex. In essence a veteran’s claim is continuously going from one team to another until it has been decided. This process can be rather lengthy depending on what regional office has jurisdiction over your claim and their pending workload. During this process a veteran may want to find out the status of their claim. This should be done through the VA’s IRIS website inquiry system. Through this inquiry system, the veteran will get much more accurate information than by calling the 1-800 number. The 1-800 will only connect you to the regional offices “Public Contact team.” These employees aren’t really trained to deal with the different processing stages and so forth and aren’t able to give very accurate information in that regard. The intention of the 1-800 number and the Public Contact team is really to give general benefits information and send out forms to claimants, not to try and track a veteran’s claim. Furthermore, veterans’ claims aren’t like tracking a UPS package where it travels in a straight line to its end destination. Veterans’ claims will end up bouncing from team to team at the regional office until all of the work required to make a decision is done.

Appealing an issue with VA;
When you receive your rating decision from the VA, look over it carefully. Make sure all of the evidence you sent them is listed in the ‘evidence” section of the rating decision. In the “Decision” section will be what VA decided. In the “Reasons and Bases” section will be VA’s rationale for their decision. If you disagree with VA’s rating decision, you can appeal that decision.

In any type of appeal, the first step is submitting a Notice of Disagreement (NOD) with your regional office telling them what issue you disagree with and why you disagree with that decision made by them. You have one year from the date of the rating decision to submit your NOD. In the NOD you should also specify which way you wanted your appeal handled i.e. the traditional way (Board of Veterans Appeals, or “BVA”), or through a DRO review. If you don’t tell the VA which one, they will send you a letter asking which route you want. You then have 60 days from the date of that letter to choose. If you don’t answer the letter, the VA automatically processes the appeal through the traditional process. Also in the NOD you should state if you want a hearing or not.

NVLSP suggests adding this into the I-9 form- usually there is enough space under the hearing questions on the I-9 form.
“I take exception to and preserve for appeal ALL errors the VARO may have made or the Board hereafter might could make in deciding this appeal. This includes all legal errors, all factual errors, failure to follow M21-1,all due process errors and any failures to discharge the duty to assist as violation of basic VA laws and regulations within 38 USCS and 38 CFR.”

A DRO review is where a Decision Review Officer, hence DRO, who is a senior rater with many years of experience that works in the appeals Team, will completely review your claims folder and NOD and decide whether or not he/she can grant the benefit the claimant is seeking. If the DRO grants the appeal in full, he/she will produce a rating decision telling the claimant of the percentages etc… just like the Rating activity would on a normal claim. If the DRO cannot grant the appeal in full, then he/she will issue a Statement of the Case (SOC) explaining the actual laws and rational which pertain to the denial. Even if the DRO is able to grant a partial appeal, they still must send out a SOC. For example, let’s say you are appealing a PTSD rating of 50%. The DRO grants an increase to 70%, but since the DRO didn’t/couldn’t grant the highest possible award pertaining to the disability, they must still produce a SOC. In this scenario, the DRO would send out a rating decision with the grant in increase from 50% to 70%, and a SOC stating why he/she couldn’t grant the full benefit allowable i.e. the 100% rate. Once a claimant receives a SOC, they have 60 days from the date of the SOC to either “perfect’ their appeal by submitting VA Form 9, which will prompt the RO to send the appeal to the BVA, or submit ‘New” evidence that were not before the decision maker when he/she made their prior determination. When the claimant submits “new” evidence, the VA will evaluate the new evidence and either grant the benefit sought on a appeal or issue a Supplemental Statement of the Case (SSOC) outlining why the new evidence was unable to be used to grant the appeal. A SSOC will only address the new evidence the claimant submitted. From the date of the SSOC, the claimant again has 60 days to either “perfect” the appeal by submitting VA Form 9, or again submitting “new” evidence. If the claimant submits new evidence again, then the process of either a grant in benefits sought or a SSOC will repeat itself until the claimant “perfects” their appeal.
The traditional appeals process is where the claimant wants to skip the DRO review and appeal directly to the BVA. In this case, the claimant still must send a NOD to the VA. The VA, more specifically the rating activity that made the prior decision, will send out a SOC. Once the claimant receives the SOC the process afterwards is the same as when the DRO issues a SOC. You either can submit “new” evidence and have the Rating activity reconsider their previous decision, which will either prompt them to grant the benefit sought on appeal or they will send you a SSOC, or you can “perfect” your appeal by sending in VA Form 9. Once the VA Form 9 is sent in, the regional office then prepares your claims folder for the BVA where it gets put on the docket. Remember you only have 60 days from the date of the SOC or SSOC to submit the VA Form 9!

Requesting a “Reconsideration” of a prior decision:
Another route that may be of some interest is the “reconsideration” route. This is where a claimant has received a rating decision and may disagree with that decision, but has “new” evidence that the Rating activity was unaware of at the time of their decision, and may think that the “new” evidence might result in a more favorable decision than the prior one. In this case, the claimant has the one year appeals period to send in the “new” evidence and request that the Rating Activity “Reconsider” their previous decision. The claims folder would then go back to the Rating activity to be reconsidered and the RVSR would send out a new rating decision where the “new” evidence is considered and an new decision rendered. One thing to keep in mind is one MUST submit “new” evidence in order for the VA to “reconsider” their previous decision. Another reason one might consider the “reconsideration” approach is simply because a request for reconsideration generally goes faster then an appeal because the claims folder goes back to the RVSR and is worked according to the date of the request for reconsideration. If the request for reconsideration warrants a favorable decision, the effective date may be the date of the original claim, depending what the evidence submitted dictates . A request for reconsideration is simply “re-opening” a claim within the one year appeals period [(see 38 CFR, §3.400(q) for effective dates concerning reconsiderations) also see “Re-opening claims” for an explanation].

Another topic concerning “reconsideration” is whether or not one should file a Notice of Disagreement (NOD) if the VA hasn’t yet rendered a decision before the one year appeals period has expired. If one sends in “new” evidence within the one year appeals period and request a “reconsideration” of VA’s prior decision, they better be 100% certain it will change VA’s prior decision; If VA accepts it as a “Reconsideration” (which as stated before is a “Re-opened” claim), they must follow the rules and regulations for a reopened claim and render a formal decision unless one withdraw the claim prior to a decision being made. If they do render a formal decision, they must notify you of this decision which means that they cannot then turn around and accept the request to reopen as a Notice of Disagreement because it is dated and received prior to the latest decision on this issue. The NOD must be received AFTER you have been notified of the latest decision on that claim. Reopened claims and NODs are not worked by the same people nor by the same administrative procedures. If one requests a “reconsideration” with the one year appeals period and then file a NOD before the one year elapses because VA hasn’t made a decision on the “new” evidence, then one is asking that VA go through all the administrative procedures for a “reopened” claim up to and including a review by a Rating Specialist and then if the claim cannot be granted to just stop without a formal decision and send it back out to start reprocessing as an NOD. This would create an administrative nightmare and simply cannot be done. If after requesting a “re-opening” of the claim you then file an NOD, the “re-opened” claim is no longer valid and whatever evidence you submitted with it will be considered as part of the NOD. As soon as the NOD is received on that particular issue, whatever it is, it MUST be worked under the appeal procedures. One cannot have both a reopened claim and an NOD on the same issue at the same time. In short, one must keep an eye on the expiration date for the appeal period so you could convert the “reopened” claim to a Notice of Disagreement (NOD) in the event a decision was not rendered before the appeal period expired. If you disagree with the decision and you aren’t 100% certain that the new evidence will result in a grant, you cannot let that original appeal period run out. If the reopened claim is not granted and you don’t submit an NOD within the appeal period for the first decision, you have lost the date of claim on that decision as a potential effective date. There are a limited number of situations where one should “re-open” the claim instead of filing an NOD, but these are few and far between and one must really, really know what they’re doing when they make the decision to do this. The overwhelming majority of cases a Notice of Disagreement is the best path to take.

Can one ask for reconsideration of a claim without submitting new evidence, if one claims a clear and unmistakable error (CUE)?
Yes, but there has to be a clear and unmistakable error in the decision. If there isn’t it does no good to claim that there is. The person looking at the claim of clear and unmistakable error can only change the prior decision by calling it CUE and this must be signed off on by the Service Center Manager. He/she can’t change the decision simply by substituting his/her judgement for the original decision maker. So consideration of CUE is not really a “reconsideration”. All they are doing is looking to see if there was an error in statement of fact or application of a law that resulted in an erroneous decision (see also “Clear and Unmistakable errors”).

Re-opening claims:
Applying for an increased evaluation:
If you are already receiving service-connected compensation from VA for a/or disability(ies) a/or disease(s) and they have gotten worse since the last rating decision, you can request an increase in evaluation from VA. This is also known as a claim to Re-open. To do this, you just need to write the VA a simply letter with your claims number on it (usually your SSN) stating that you believe your service-connected disability(ies) have gotten worse and you would like an increase in evaluation. Along with this letter you should attach any treatment records pertaining to your service-connected disability(ies) since your last C&P exam and rating decision. Once the VA receives your request for an increase, it will go to the Pre-Determination Team and go through the steps I previously mentioned in reference to an initial claim. In other words, you’ll receive that “Duty to Assist” letter again and all the things surrounding it. After your claim is “Ready to Rate,” it will go to the rating activity for a decision, just like a normal claim would. Once the RVSR has made a decision, the rating goes to the Post-Determination team to be promulgated as would an initial rating does. If you disagree with the RVSR’s decision, you can appeal that decision just as any other rating decision outlined in “Appealing an issue with VA.”

Previously denied claimed:
If you have previously been denied a claim for disability compensation and that decision has become final, meaning the one year appeals period has run out, you can request to have that claim be Re-opened. In order to be able to re-open a previously denied claim, you must submit “New and Material” evidence. This means evidence which is “new,” or was previously not before the decision maker, and “material,” which is evidence that bare directly on the fact as to why the previous claim was denied. Once you have submitted “new and material” evidence and VA re-opens your claim, they again have a “Duty to Assist,” and your claim will go to the pre-Determination Team for development, then to the Rating activity, and Post Determination Team, just as a claim for increase or an initial claim would. Keep in mind that by simply submitting “new and Material” evidence doesn’t mean that your claim will actually be granted. It just means that there is enough prima facia evidence to warrant another look by the VA!

The Board of Veterans Appeals (BVA):
If you have received a decision from VA and sent the Notice of Disagreement to your Regional Office, and have either received a Statement of the Case or a Supplemental Statement of the Case from either a Decision Review Officer or the rating activity, you can further appeal the decision to the Board of Veterans Appeals by sending your Regional Office what is known as VA Form 9. By sending your regional office VA Form 9, you are what is called “perfecting” your appeal. Keep in mind that you only have 60 days from the date of the SOC or SSOC to submit this. Otherwise, the decision becomes final! Once the regional office receives your VA Form 9, they will certify your claim to be forwarded to the BVA and you will be put on the docket. During the time the C-file is being certified to be sent to the BVA, the claimant can submit additional evidence to support their claim. Once the C-file actually leaves the regional office of jurisdiction to the BVA, then the claimant has 90 days to submit any additional evidence.

Miscellaneous subjects concerning the VA
Clear and Unmistakable Errors (CUE):
The phrase “clear and unmistakable error” is a very misunderstood phrase by veterans when dealing with VA. When used by VA, it is a legal phrase which does not necessarily mean what a simple reading of the words would mean to the average layperson. When VA says that there has not been a clear and unmistakable error committed, they aren’t saying that there was no error; there might have been. What it means is that there wasn’t an error that rises to the level of the legal definition of this phrase as applied by VA in VA law. The phrase “clear and unmistakable error” means something entirely different in its legal context than simply saying whether or not VA made an error. Many veterans have the understanding that CUE is something which can appear to be erroneous and yet not be a CUE. To most people using logical thinking, an error is an error However, to qualify as a CUE, the error must not involve judgment on the part of the decision maker (most decisions by RVSR’s involve some type of judgment). That is the key element that confuses many veterans. In order to be a CUE, the decision maker must have reached a decision based on the incorrect application of a regulation or law without judgment being involved, or the decision must be based on an incorrect statement of the facts as they are known at the time. This doesn’t mean that the decision-maker simply stated something that was not accurate, but that the decision itself turned on an erroneous statement of fact as was known at the time of the decision. A CUE must be based on the laws and regulations in effect at the time of the decision. A CUE is the means by which VA can go back and correct an error in a decision that would otherwise be considered final and not subject to correction. The VA has one of the most, if not the most, liberalizing appeals time frames there is in the disability compensation industry, so if there is an error in bad judgment, the veteran has every opportunity to appeal that decision.

Some other elements besides judgment by a decision maker that also aren’t a basis for CUE are, exam protocol and accuracy of the medical reports or completeness of the medical reports (A CUE is based on the accuracy of the decision made by the decision maker on the basis of whatever evidence is in front of him/her, not the accuracy of the content of that evidence, a doctor’s opinion or statement), failure in the “Duty to Assist” except in the most extraordinary cases (where evidence available at the time of the decision were clearly shown that there was no doubt in any ones mind that the claim would have been decided differently if it had not been for the failure of the “Duty to Assist”), and changes in diagnosis (meaning a new medical diagnosis that “corrects” an earlier diagnosis), An example of a claim that would demonstrate a CUE; A veteran is awarded service-connection for IVDS and is awarded a 20% evaluation based on forward flexion of 20 degrees. The C&P exam and the whole medical record are silent for any duration of incapacitating episodes and any other measurements for range of motion. This would be a CUE because the rating criteria specifically states “forward flexion of the thoracolumbar spine 30 degrees or less” would be assigned a 40% evaluation. Now if there was some other forward flexion measurements noted in the rest of the medical records, then this would not necessarily be a basis for a CUE because the RVSR may have based his/her decision on the other forward flexion measurements, which may have more accurate portrayed the current overall limited range of motion.

CUE’s are actually relatively rare, but when they do happen, the majority involves effective dates (EED). The effective date is the date VA determines when compensation payments are to begin. Generally, this is the date the veteran submits a claim.

Reduction in benefits:
Reduction in current awards:
If you are already receiving disability compensation from VA for a disability or disabilities and the VA wants to reduce those awards, the VA will send you a “proposal to reduce” letter showing the proposed action (Proposed rating they want to assign and the effective date of the reduction). This is just a proposal and cannot be appealed. Once you receive a “proposal to reduce,” you have 60 days from the date of that proposal to submit any additional evidence to the Regional Office stating why you think your evaluation shouldn’t be reduced. After the 60 day period is up, a RVSR will make a decision whether to actually reduce the award(s) or maintain the current rating as is. Once the RVSR makes a decision, they will send you a rating decision detailing their decision. If the RVSR decides to reduce the award(s), then the veteran has the one year period to submit a Notice of Disagreement (NOD) to start the appeals process, which is outlined above.

If you want to make the VA hold off on reducing the monetary amount on the proposed date, you can file a request for a hearing. This must be done in writing within 30 days of receiving the “Proposal to Reduce.” Once you have submitted a request for a hearing (just a simple letter as there is no prescribed form) the VA cannot reduce the evaluation on the proposed date until the hearing is held, regardless of how long it takes to have that hearing.

Pyramiding:
Pyramiding is the prohibition of assigning more than one evaluation per bodily etiology based on the same symptoms. CFR 38, §4.14 states;
“The evaluation of the same disability under various diagnoses is to be avoided. Disability from injuries to the muscles, nerves, and joints of an extremity may overlap to a great extent, so that special rules are included in the appropriate bodily system for their evaluation. Dyspnea, tachycardia, nervousness, fatigability, etc., may result from many causes; some may be service connected, others, not. Both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation and the evaluation of the same manifestation under different diagnoses are to be avoided.”

The VA compensates a veteran for symptoms of residuals from injuries or diseases suffered to a body part while on active duty, not the number of injuries or diagnosis to a particular body area. For example, if a veteran has a lower back disability, let’s say IVDS with a scoliosis. The scoliosis would not be rated separately because it is also within the lower back. It would be “lumped” together in the rating with IVDS. Having said that, the lower spine (Lumbar and Thoracic) and upper spine (Cervical) can be rated separately, because they are two separate moving parts of the spine. Another common one that veterans seem to misunderstand is with mental disabilities. A veteran can be only compensated for one mental disability at a time. For example, if a veteran has PTSD and Depression, the VA would determine which of the two warrants the higher rating and “lump” the lesser one with the other.

There is one joint in the body that can have more than one rating without pyramiding. That’s the knee. The knee can obtain two ratings, such as limited range of motion and lateral instability as long as the second one is compensable at the 10% rate or higher. For further reference see VAOPGCPREC 23-97 and VAOPGCPREC 9-98.

Individual Unemployability:
Individual Unemployability (IU) or also known as Total Disability due to Individual Unemployability (TDIU) is a rating that pays veterans at the 100% rate who do not meet the 100% criteria according to the 1945 Rating schedule because they are unable to secure and maintain a substanstial gainful occupation due to their service-connected disability(ies). The requirements needed to be considered for IU are spelled out in §4.16. There it states;
Ҥ4.16 Total disability ratings for compensation based on unemployability of the individual.
(a) Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: Provided, That, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability:
(1) Disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable,
(2) Disabilities resulting from common etiology or a single accident,
(3) Disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric,
(4) Multiple injuries incurred in action, or
(5) Multiple disabilities incurred as a prisoner of war.
It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service-connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. For purposes of this section, marginal employment generally shall be deemed to exist when a veteran’s earned annual income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist, on a facts found basis (includes but is not limited to employment in a protected environment such as a family business or sheltered workshop), when earned annual income exceeds the poverty threshold. Consideration shall be given in all claims to the nature of the employment and the reason for termination. (Authority: 38 U.S.C. 501(a))
(b)It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Therefore, rating boards should submit to the Director, Compensation and Pension Service, for extra-schedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in paragraph (a) of this section. The rating board will include a full statement as to the veteran’s service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue.
[40 FR 42535, Sept. 15, 1975, as amended at 54 FR 4281, Jan. 30, 1989; 55 FR 31580, Aug. 3, 1990; 58 FR 39664, July 26, 1993; 61 FR 52700, Oct. 8, 1996]”
One thing to keep in mind is that if a veteran doesn’t meet the schedular requirements stated in subparagraph (a), there is still the possibility of obtaining IU under subparagraph (b). However, considerations under subparagraph (b) rarely happen because, first, the RVSR must think you are unable to obtain and maintain a substantial gainful occupation due to your service-connected disabilities, which becomes a judgmental call on their part and, second, if the RVSR thinks you can’t work because of your service-connected disabilities, he/she must submit the claim to the Director of Compensation and Pension in Washington, D.C. for extra scheduler approval.
Having said all of this, a veteran still should file the application for IU (VA Form 21-8940) if they are unable to work because of their service-connected disability, regardless of their rating percentages. I say this because when a veteran submits VA Form 21-8940, it also acts as a claim for an increase in evaluation. If the veteran does not meet the schedular requirements stated in subparagraph (a) and submits the IU application, the VA will first see if the disability(ies) warrants an increase in evaluation. If so, they will determine whether the increase then meets the schedular requirement, and if they do, then VA will address the issue of Individual Unemployability. By submitting VA Form 21-8940 when one is unable to secure and maintain a substantial gainful occupation die to their service-connected disability(ies), regardless of their rating percentages, they protect the earliest effective date possible.
If you decide to apply for IU, there are a couple of things you can do to speed the process up a little bit. When sending in VA Form 21-8940, you should have each of your former employers from the last five years fill out and sign VA Form 21-4192 and then attach them to the IU application. Also, if any of your private physicians can write statements concerning you being unable to work because of your service-connected disabilities, they will help and should also be attached to the IU application.
Note: Your service-connected disability(ies) must be the sole reason for being unable to work. If there is any non service-connected disability(ies) involved, then a physician will need to make a statement as to why the non service-connected disability(ies) are a non factor in you being unable to work.
Independent Medical Opinions by your private physician:
An Independent Medical Opinion (IMO) from a treating physician is in many instances a critical part of a veteran’s disability compensation claim. An IMO may sway the “benefit of the doubt” in favor of a veteran’s claim, or it may actually be the missing ‘link’ or nexus in a claim. When a veteran asks his or her physician to compose an IMO, there are a couple of things that should be noted in it. One of the most important things that should be done and mentioned in the IMO is that the medical professional has reviewed the entire medical record, including the veteran’s SMR’s. The medical professional should also state his or her area of expertise and additional training. For example, if the doctor is board certified in radiology, they should state that; especially when rending any comments in regards to radiological film studies. Also, it is very important that the physician give their rationale as to why they have come to a certain conclusion. The physician, when giving his/her rational, should also cite any relevant medical literature that may support the findings. By doing all of this, the IMO becomes probative. There is also certain language the physician needs to use when opening whether or not the disability(ies) at hand is/are related to the veteran’s service. The following phrases are from the Department of Veterans Affairs “Clinician’s Guide for Disability Examination;”
“is due to” (100% sure)
“more likely than not” (greater than 50%)
“at least as likely as not” (equal to or greater than 50%)
“not at least as likely as not” (less than 50%)
“is not due to” (0%)
The phrase “at least as likely as not” is the legal phrase that is needed for VA to award service-connection for a particular disability based on the “Benefit of the Doubt” when an IMO should be the deciding factor in the evidence of record.
Note: You shouldn’t send your regional office any medical articles printed from the internet. They only pertain to the general population and aren’t afforded very much weight when they are being evaluated by the decision maker. The VA needs something from a doctor that states your disability(ies) are related to your service, not something meant for the general public.
Reasonable Doubt rule:
The Reasonable Doubt rule is one of the most important liberalizing rules that VA uses to grant veterans benefits and is defined under 38 CFR, §3.102. The Reasonable Doubt rule means that when there is an equal balance of evidence for and against the claimant, that the claimant be awarded there claim. This is just like in baseball as the “tie goes to the runner.” Keep in mind this doesn’t mean that just because there are ten pieces of evidence for your claim and 10 against that you will be granted your claim. It means that after consideration by the decision maker at VA, they have weighed the evidence, and in their judgment there is an equal balance, then they must resolve reasonable doubt in the claimant’s favor. It also doesn’t mean that if, for example, there are 5 pieces of evidence in favor of a claim and only one against, that a claim will automatically be granted because there is a preponderance of evidence (meaning more evidence in favor of the claim than against) in your favor. The decision maker must still weigh the probative value of each piece of evidence and determine the weight of each piece in relationship to each other and the claim, and then reach a decision as to whether there is a balance of evidence for the claim and against the claim based on the weight given to each of that evidence.
Note: The resolution of the Reasonable Doubt doctrine can not be the basis for a Clear and Unmistakable Error (CUE). Since the Reasonable Doubt doctrine is based on Judgment made by a decision maker, it cannot be a basis for a CUE.
Obtaining a copy of your Claims folder from VA:
The best way to obtain a copy of your claims folder (your C-file) from the VA is to write a letter to your regional office citing the 1974 Privacy Act. When doing so under the 1974 Privacy Act, the VA has, according to federal law, 20 days to respond.
I hope this guide has been able to help you understand how the VA operates and why they need certain things to award disability compensation benefits. The key to being awarded service-connected disability compensation is evidence. If you have evidence of the three portions of a valid disability claim, you’ll receive your deserved benefits.

VA Fast Letters and VA Training Letters

[no_toc]The following is the index with links to the various Training and Fast Letters plus a few miscellaneous. These letters are not necessarily in the original formatting. I have tried to present them in an easy-to-read form instead of some forms as originally presented. Some of the paragraphs were WAAAAYYY too long. lol – HadIt.com Member fanaticbooks
Something to be aware….Some of these letters may be rescinded, outdated, or otherwise no longer viable. I have still included them because sometimes they provide additional insight or just plain more information than the newest version.
Use them wisely.
The oldest letters will display at the bottom with the latest letters displayed at the top, all in sequential numbers.
Coding of the letters…
FL = Fast Letter
TL = Training Letter
First two numbers = last two digits of year of origin

Training Letters

Fast Letters

VHA Directives

VHA DIRECTIVE 2010-045 Introduction Of Disability Benefit Questionnaires (Dbqs) To Support The Compensation And Pension (C&P) Process (October 1, 2010)
VHA Directive 2006-013 Qualifications for Examiners Performing Compensation and Pension (C&P) Mental Disorder Examinations (March 7, 2006)

Miscellaneous

Best Practice Manual for Posttraumatic Stress Disorder (PTSD)