Citation Nr: 0002351 Decision Date: 01/28/00 Archive Date: 02/02/00 DOCKET NO. 95-00 981 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUE Entitlement to a permanent and total disability rating for pension purposes. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD N.J. Ferrante, Associate Counsel INTRODUCTION The veteran served on active duty from July 1971 to January 1975. This appeal to the Board of Veterans' Appeals (Board) arises from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), Phoenix, Arizona. In January 1997 the Board remanded the case for further development. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained. 2. The veteran was born in August 1952. He has a high school education (general equivalency diploma), some college coursework, has had employment experience as a truck driver and heavy equipment operator and has competed his training in welding. The veteran last worked in 1987. 3. The veteran is service connected for residuals of a gunshot wound to the left second toe, currently evaluated as 0 percent disabling. There is no loss of function in the left foot demonstrated. 4. The veteran's nonservice-connected bipolar disorder, rated as 10 percent disabling, is controlled by medication and manifested by no greater than mild social and industrial impairment. 5. The veteran's nonservice-connected chronic bronchitis, rated as 10 percent disabling, is no greater than moderate, and manifested by forced expiratory volume in one second (FEV-1) of 80 percent, forced expiratory volume in one second to forced vital capacity (FEV-1/FVC) of 79 percent, and diffusion capacity of carbon monoxide, single breath, (DLCO (SB)) of 71 percent. 6. The combined evaluation of the veteran's disabilities is 20 percent. 7. The veteran's disabilities are not shown to be of such severity as to permanently preclude the ability to secure and follow substantially gainful employment consistent with his age, education and occupational experience, by reason of his lifetime disabilities CONCLUSION OF LAW The requirements for entitlement to a permanent and total disability rating for pension purposes have not been met. 38 U.S.C.A. §§ 1155, 1502, 1521, 5107 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.342, 4.15, 4.16, 4.17 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is found to be well-grounded under 38 U.S.C.A. § 5107(a) (West 1991). That is, he has presented a claim which is plausible. Murphy v. Derwinski, 1 Vet. App. 78 (1990). The Board is also satisfied that all relevant facts have been properly developed, and that no further assistance is required in order to satisfy the duty to assist mandated by 38 U.S.C.A. § 5107(a). A permanently and totally disabled veteran who served for at least 90 days during a period of war and whose nonservice- connected disabilities are not the result of the veteran's own willful misconduct is entitled to a disability pension. 38 U.S.C.A. § 1521(a) (West 1991). Disability evaluations are determined by the application of the VA's Schedule for Rating Disabilities (Ratings Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Ratings Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.1 (1999). The United States Court of Appeals for Veterans Claims (Court) has held that where a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to the veteran will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Entitlement to a total disability pension may be established if a veteran demonstrates a permanent impairment so severe as to render an "average person" incapable of following a substantially gainful occupation. 38 U.S.C.A. § 1502 (West 1991). Under this analysis each of the veteran's disabilities are rated under the applicable Ratings Schedule diagnostic code. The ratings then are combined and if the combined schedular evaluation of 100 percent is permanent and total then disability pension may be granted. See 38 C.F.R. §§ 3.340, 4.15 (1999); See also Talley v. Derwinski, 2 Vet. App. 282 (1992); Roberts v. Derwinski, 2 Vet. App. 387 (1992); Brown v. Derwinski, 2 Vet. App. 444 (1992). Additionally, a veteran who demonstrates permanent loss of the use of both hands or both feet, or of one hand and one foot, or of the sight of both eyes, who becomes permanently helpless or bedridden, or who demonstrates certain congenital, developmental, hereditary or other familial conditions and disabilities requiring indefinite hospitalization may be considered permanently and totally disabled for pension purposes. 38 C.F.R. §§ 3.342, 4.15 (1999). A veteran may also establish permanent and total disability without a 100 percent combined schedular evaluation by showing a permanent impairment which precludes the veteran from substantially gainful employment. 38 U.S.C.A. § 1502; 38 C.F.R. § 4.17 (1999). This analysis contemplates a more individualized (as distinguished from "average person") review of the severity and effect of each of a veteran's disabilities. A finding of permanent and total disability under this analysis requires a veteran with a single disability to have a disability rating of at least 60 percent. A veteran with two or more disabilities must have a combined disability rating of at least 70 percent, with at least one disability rated a minimum of 40 percent. A veteran found to be permanently and totally disabled under this standard is entitled to a 100 percent schedular evaluation for pension purposes. 38 C.F.R. §§ 4.16(a), 4.17 (1999). Finally, a veteran may be entitled to a permanent and total disability pension under an extra-schedular analysis upon a showing that the veteran is unemployable because of disability, age, occupational background and other related factors. 38 C.F.R. §§ 3.321(b)(2); 4.17(b)(1999). In this case, the veteran filed his original claim in November 1993. Medical evidence of record includes diagnoses of chronic bronchitis and bipolar disorder. Service medical records also show that the veteran accidentally shot himself in the foot in October 1973. The residuals include a scar and frozen second proximal interphalangeal joint of the left foot. The veteran is service connected and assigned a 0 percent evaluation for residuals of a gunshot wound to the left second toe. He has not alleged, and the record before the Board does not indicate that a higher evaluation is appropriate. The record also contains a history of a back injury, however there is no current diagnosis of a back disability and the veteran has not alleged that he has a current back disability which contributes to his alleged unemployability. Chronic Bronchitis The veteran's nonservice-connected chronic bronchitis is currently assigned a 10 percent evaluation. The Board notes that during the course of this appeal, the Ratings Schedule was revised with respect to the regulations applicable to the evaluation of respiratory disorders. These changes became effective October 7, 1996. 61 Fed. Reg. 46720 (Sept. 5, 1996). The record indicates that the RO considered the new criteria in the September 1999 supplemental statement of the case. The Board will evaluate the veteran's chronic bronchitis under both the old and new law. Prior to October 7, 1996, under the general rating formula for chronic bronchitis set forth in the Rating Schedule, a noncompensable evaluation was assigned for mild chronic bronchitis with a slight cough, no dyspnea, and a few rales; a 10 percent evaluation was warranted for moderate chronic bronchitis with considerable night or morning cough, slight dyspnea on exercise, and scattered bilateral rales; a 30 percent evaluation was assigned for moderately severe chronic bronchitis with persistent cough at intervals through the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest, and beginning chronic airway obstruction; a 60 percent evaluation was warranted for severe chronic bronchitis with severe productive cough and dyspnea on slight exertion and pulmonary function tests indicative of severe ventilatory impairment; and a 100 percent evaluation was warranted for pronounced chronic bronchitis with copious productive cough and dyspnea at rest, pulmonary function testing showing a severe degree of chronic airway obstruction, with symptoms of associated severe emphysema or cyanosis and findings of right sided heart involvement. 38 C.F.R. § 4.97, Diagnostic Code 6600 (1996). Under the revised regulations, effective October 7, 1996, a 10 percent rating is assigned when there is evidence of forced expiratory volume in one second (FEV-1) of 71 to 80 percent of predicted, or the ratio of forced expiratory volume in one second to forced vital capacity (FEV-1/FVC) of 71 to 80 percent of predicted, or diffusion capacity of carbon monoxide, single breath, (DLCO (SB)) is 66 to 80 percent of predicted; a 30 percent rating is assigned when there is FEV-1 of 56 to 70 percent of predicted, or FEV-1/FVC of 56 to 70 percent of predicted, or DLCO (SB) 56 to 65 percent of predicted; a 60 percent evaluation is warranted when there is evidence of FEV-1 of 40 to 55 percent of predicted, or FEV-1/FVC of 40 to 55 percent of predicted, or DLCO (SB) of 40 to 55 percent of predicted, or maximum oxygen consumption of 15 to 20 ml/kg/min (with cardiorespiratory limit); and a 100 percent rating is assigned when there is evidence of FEV- 1 less than 40 percent of predicted value, or FEV-1/FVC is less than 40 percent, or DLCO (SB) is less than 40 percent of predicted, or maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation), or cor pulmonale (right heart failure), or right ventricular hypertrophy, or pulmonary hypertension (shown by Echo or cardiac catheterization), or episode(s) of acute respiratory failure, or requires outpatient oxygen therapy. 38 C.F.R. § 4.97, Diagnostic Code 6600 (effective October 7, 1996). The veteran was afforded a general medical VA examination in December 1993. He complained of extertional dyspnea after climbing only one flight of stairs and a chronic cough usually occurring at night. Intermittently he brought up a teaspoon of thick yellow sputum. The veteran gave a history of being a former two pack per day smoker who had cut down to one pack per day. Physical examination found the lungs clear with expiratory wheezing. The impression was chronic bronchitis due to cigarette smoking. The examiner ordered chest x-rays and pulmonary studies, however the record indicates that the veteran failed to keep the appointment. The veteran was afforded another VA examination in October 1997. The examiner noted that the veteran smoked two packs of cigarettes per day for the past 30 years and had a chronic productive cough. The veteran reported having a herniorrhaphy as a child, but otherwise no serious physical maladies. His coughing occurred more at night and the only medication the veteran used was cough drops. The veteran reported only mild dyspnea on exertion which he especially noticed after two flights of stairs, although walking and riding his bicycle did not cause dyspnea. The veteran did not wheeze and he had never had pneumonia or been to the emergency room or in the hospital for any respiratory problems. Physical examination of the chest and lungs revealed normal respiratory excursions. He was not overtly dyspneic or tachypneic and he did not use accessory muscles of respiration. Conversation was normal. The chest was normal to percussion and the diaphragm moved well by percussion. Breath sounds were of normal intensity, were normal otherwise, and without rales, rhonchi or wheezes. The impression was chronic bronchitis. There was no evidence of hyperinflation or emphysema on examination. Symptoms were very limited. It was the examiner's opinion that the veteran was not incapacitated by the chronic bronchitis. A pulmonary function analysis was also performed. Post- bronchodilator results show FEV-1 80 percent; FEV-1/FVC 79 percent, and DLCO (SB) 71 percent. The computerized interpretation was a minimal obstructive lung defect, although the degree of the obstruction may have been underestimated. There was a mild decrease in diffusing capacity. The examiner's interpretation was that spirometry was within normal limits, lung volumes were within normal limits and a mild decrease in diffusion capacity. The Board finds that the evidence in this case warrants no greater than a 10 percent evaluation. The data from the October 1997 pulmonary function test is consistent with a 10 percent evaluation under the new criteria and there is evidence of moderate chronic bronchitis with considerable night or morning cough and slight dyspnea on exercise, consistent with a 10 percent evaluation under the old criteria. An evaluation in excess of 10 percent is not warranted as the objective data from the October 1997 pulmonary function test does not approximate the loss of pulmonary function necessary for a higher rating under the new criteria, and there is no evidence of moderately severe chronic bronchitis with persistent cough at intervals through the day, considerable expectoration, considerable dyspnea on exercise, rales throughout the chest, and beginning chronic airway obstruction which would warrant a higher rating under the old criteria. 38 C.F.R. § 4.97, Diagnostic Code 6600 (Effective before and after October 7, 1996). Bipolar Disorder The RO has assigned the veteran a 10 percent evaluation for non-service connected bipolar disorder. By regulatory amendment effective November 7, 1996, substantive changes were made to the schedular criteria for evaluating mental disorders, including bipolar disorder, as set forth in 38 C.F.R. §§ 4.125-4.132 (1996) (redesignated as 38 C.F.R. §§ 4.125-4.130). See 61 Fed. Reg. 52695-52702 (1996). As stated earlier, where the law and regulations change while a case is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). Prior to November 7, 1996, psychotic disorders, including schizophrenia and bipolar disorder, were evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.132, Diagnostic Codes 9400-9410 (1996). Under the old schedular criteria a noncompensable evaluation was assigned for psychosis in full remission. A 10 percent evaluation required a showing of a mild impairment of social and industrial adaptability. A 30 percent evaluation required definite impairment of social and industrial adaptability. A 50 percent evaluation was warranted where there was considerable impairment of social and industrial adaptability. A 70 percent evaluation was warranted where there was severe impairment of social and industrial inadaptability. A 100 percent evaluation required active psychotic manifestations to be of such an extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. 38 C.F.R. § 4.132, Diagnostic Code 9206 (prior to November 7, 1996). In Hood v. Brown, 4 Vet. App. 301, 303 (1993), the United States Court of Appeals for Veterans Claims (known as the United States Court of Veterans Appeals prior to March 1, 1999) (hereinafter, the Court), held that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." VAOPGCPREC 9-93 (O.G.C. Prec. 9-93); 59 Fed. Reg. 4752 (1994). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c) (West 1991). Bipolar disorders are now rated under the "General Rating Formula for Mental Disorders," Diagnostic Code 9432. 38 C.F.R. § 4.130 (1999). The new criteria for evaluations are as follows: Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or, symptoms controlled by continuous medication - 10 percent. Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events) - 30 percent. Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships - 50 percent. Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships - 70 percent. Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name - 100 percent. 38 C.F.R. § 4.130, Diagnostic Code 9440 (1999). In addition, other related regulations were amended in November 1996. According to the amended rating criteria, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a) (1999). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. Prison medical records from June 1989 to March 1993 show that the veteran had diagnoses of bipolar and personality disorders and was being treated with medication. The records also document suicide attempts in January and June 1990 and described the veteran as hypomanic and manic depressive. Notes from November 1992 show that the veteran's symptoms were well controlled by medication. VA inpatient records show that the veteran was hospitalized in September 1993 for complaints of depression. A week prior to admission he tried to overdose on lithium. The veteran's history of hospitalizations and suicide attempts was noted. Mental status examination revealed that the veteran was clean with shoulder length hair. Speech was fluent, mood was benign, and affect was blunted. There were no delusions or hallucinations. Memory and concentration were intact, abstract reasoning was fair, insight was limited and judgment was fair. The veteran was competent. The diagnoses were bipolar disorder by history, mixed personality disorder (antisocial and borderline features). A score of 55 for past and present was assigned on the Global Assessment of Functioning Scale (GAF). A private medical record from October 1993 shows that the veteran was considered in remission from a bipolar depressive episode, well controlled on current medications and clinically stable in all spheres. The diagnoses were bipolar disorder, rule out rapid cycling, rule out mixed antisocial personality disorder, rule out personality disorder. In December 1993 the veteran underwent a VA examination. He related a history of long standing mood disturbances which first required hospitalization at approximately 13 years of age. Mental status examination revealed that the veteran demonstrated marginal hygiene and grooming. He was cooperative with the interviewer. Speech was of normal tone and quality. Mood was euthymic with a somewhat blunted affect. There was no evidence of psychotic thought content and thinking was logical and goal directed. The veteran was alert and oriented in all spheres. Cognition was grossly intact. The veteran's fund of knowledge was limited, but not inconsistent with his background. He appeared to have adequate recent and remote memory and ability to concentrate. He had adequate judgment to care for his basic needs, however, limited insight. The diagnoses were bipolar disorder, and antisocial personality traits. The GAF score assigned was 60. It was noted that the veteran's recurrent mental illness interfered with his occupational and social functioning. A private psychiatric progress note from April 1995 showed that the veteran was clinically stable without mania or hypomania. He was eating and sleeping well, and without depressive or neurovegetative signs and symptoms and was compliant with his medications. In July 1996 the veteran testified that he had been receiving treatment since May 1995 for manic depression. Transcript at p. 6. He testified that he had worked as a heavy equipment operator and a truck driver, and had completed training to be a welder. He could not get a commercial driver's' license because of his disability. Tr. pp. 5-7. The veteran was afforded another VA examination in October 1997. The examiner reviewed the claims file in conjunction with the examination. The chief complaint was indicated to be: "The combination of the two medicines seems to work." The veteran related his history of manic depressive cycles, but reported that he was currently stable and that he had not had a significant period of being up or down that he was aware of since 1993. He was undergoing private treatment and reported knowing how to slow down or back off when he was getting overloaded with too much. He did report poor sleeping patterns. The veteran reported a personal history of divorce in 1982 and that he had a 16 year old daughter who was being raised by the veteran's mother. He reported that he and his daughter were getting their relationship back. He reported participating in activities with her and seeing her on a regular basis. He had no current legal problems and was taking two college classes. He described having a few friends. Mental status examination revealed that immediate and remote memory was intact, he was oriented in all spheres and speech was normal. Thought production was spontaneous and continuity of thought was goal directed and logical. Thought content contained no homicidal or suicidal ideation. There were no delusions, ideas of reference or feelings of unreality. His abstract ability was concrete and concentration was good. The veteran's mood, as reported by him was "I have no idea; I can control." The examiner evaluated his mood as broad an euthymic and his range of affect as broad. He was alert and responsive and judgment and insight were good. The diagnoses were bipolar I disorder and the GAF score assigned was 70, with 70 being the highest in the past year. The examiner commented that the veteran's bipolar disorder had stabilized with treatment and that as reported by the veteran, there had not been a period of clinically significant mood swings since 1993. After considering all the evidence of record, it is the judgment of the Board that the schedular criteria which most accurately describes the veteran's psychiatric impairment is reflected by the 10 percent evaluation currently in effect. At the time of the recent psychiatric examination accorded the veteran in October 1997, notation was made that the veteran indicated that he was currently stable and that he had not had a significant period of being up or down that he was aware of since 1993. He was attending college courses and actively renewing his relationship with his daughter. The record indicates that treatment had been successful. Mental status examination was essentially normal. The veteran was given a GAF of functioning score of 70, which is indicative of only some mild symptoms, or some difficulty in social or occupational functioning, but generally functioning pretty well, with some meaningful interpersonal relationships. The remaining clinical evidence does not reflect psychiatric symptomatology reflecting more than mild social and industrial impairment. The Board finds that the evidence is indicative of disability picture warranting the assignment of a rating no greater than 10 percent. Permanent and Total Disability Rating As shown above, the Board finds the veteran's nonservice- connected disabilities warrant ratings of 10 percent for chronic bronchitis and 10 percent for bipolar disorder. The service-connected residuals of shell fragment wounds to the left foot, by the veteran's own admission, does not result in significant function loss. See Tr. p. 9. Therefore, the veteran's combined disability rating is 20 percent. See 38 C.F.R. § 4.25 (1999). Consequently, the veteran is not entitled to a permanent and total rating under the "average person" test. See 38 U.S.C.A. § 1502; 38 C.F.R. §§ 3.340, 4.15. The record does not show the veteran experiences the permanent loss of use of both hands or both feet, or of one hand and one foot, or of the sight of both eyes, or that he is permanently helpless or bedridden, and the record does not indicate any congenital, developmental, hereditary or other familial conditions and disabilities requiring indefinite hospitalization which may be considered permanently and totally disabling for pension purposes. See 38 C.F.R. §§ 3.342, 4.15. The veteran may also establish permanent and total disability without a 100 percent combined schedular evaluation by showing a permanent impairment which precludes the veteran from substantially gainful employment. 38 U.S.C.A. § 1502; 38 C.F.R. § 4.17. However, a finding of permanent and total disability under this analysis requires the veteran have a combined disability rating of at least 70 percent, with at least one disability rated a minimum of 40 percent. In this case, as the veteran's combined nonservice-connected disabilities are found to be no more than 20 percent disabling, the Board finds he is not permanently and totally disabled under this standard. See 38 C.F.R. §§ 4.16(a), 4.17. Extraschedular Rating The Board also notes that the RO considered and declined to refer this case for consideration of an extraschedular rating. In exceptional cases a veteran may be entitled to a permanent and total disability pension under an extraschedular analysis upon a showing that the veteran is unemployable because of disability, age, occupational background or other related factors. 38 C.F.R. §§ 3.321(b)(2); 4.17(b) (1999). The Board notes the veteran's contention that he is unable to obtain a commercial driver's license due to his disability, however the record indicates that the veteran has received other training, including in the field of welding, and that he has completed some college coursework. The Board finds the RO's decision not to refer the case to the Director of Compensation and Pension is supportable. Conclusion As shown above, the Board has considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, whether or not they have been raised by the veteran or his representative, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In this case, the Board finds no provision upon which to conclude that the veteran is permanently and totally disabled for pension purposes. When all the evidence is assembled, the Secretary, is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board finds the preponderance of the evidence is against the claim for a permanent and total disability rating for pension purposes. ORDER Entitlement to a permanent and total disability rating for pension purposes is denied. THOMAS J. DANNAHER Member, Board of Veterans' Appeals