Citation Nr: 0002735 Decision Date: 02/03/00 Archive Date: 02/10/00 DOCKET NO. 98-14 943 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in No. Little Rock, Arkansas THE ISSUES 1. Entitlement to an increased evaluation for a right knee disability, currently evaluated as 30 percent disabling. 2. Entitlement to an increased evaluation for a left foot nerve palsy, currently evaluated as 30 percent disabling. 3. Entitlement to an increased, compensable, evaluation for a right little finger disability. 4. Entitlement to service connection for degenerative joint disease of the left knee. 5. Whether new and material evidence has been submitted to reopen a claim for entitlement to service connection for heat stroke. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Michael F. Bradican, Associate Counsel INTRODUCTION The veteran served on active duty from June 1951 to June 1955. This case arises before the Board of Veterans' Appeals (Board) on appeal from a rating decision of May 1998, from the North Little Rock, Arkansas, Regional Office (RO) of the Department of Veterans Affairs (VA). FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's claim has been developed. 2. The veteran has pain, rare swelling, and slight ligament laxity in his right knee. The right knee has a range of motion of 20 degrees of extension to 90 degrees of flexion with no crepitance or clinically reported instability. 3. The veteran has incomplete footdrop on the left side, but has 30 percent of normal strength of dorsiflexion with some sensory loss and the need for a brace; more than severe incomplete paralysis of the peroneal nerve is not shown. 4. The veteran's service-connected right little finger is not amputated, ankylosed, or angulated. There is however some limitation of motion. 5. No competent medical evidence or opinion has attributed the veteran's current left knee disability to either his active service or to his service connected disabilities. 6. The evidence submitted by the veteran to reopen his claim for service connection for heat stroke subsequent to the March 1996 Board decision does not bear directly and substantially on the specific matter under consideration. CONCLUSIONS OF LAW 1. The residuals of the right knee arthroplasty are not more than 30 percent disabling. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.71a, Diagnostic Code 5055 (1999). 2. The criteria for an evaluation in excess of 30 percent for peroneal palsy of the left foot have not been met. 38 U.S.C.A. §§ 1155, 5107(a); 38 C.F.R. §§ 3.321, 4.7, 4.124a, Diagnostic Code 8521 (1999). 3. The criteria for a compensable evaluation for a right fifth finger disability have not been met. 38 U.S.C.A. §§ 1155, 5107(a); 38 C.F.R. §§ 3.321, 4.7, 4.71a Diagnostic Codes 5156 and 5227 (1999). 4. The veteran's claim for service connection for a left knee disability is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 5. Evidence submitted by the veteran with respect to service connection for residuals of heat prostration since the March 1996 Board decision is not new and material and does not serve to reopen his claim for service connection. 38 U.S.C.A. § 5108 (West 1991); 38 C.F.R. § 3.156(a) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS 1. Entitlement to an increased evaluation for a right knee disability, currently evaluated as 30 percent disabling. Generally, claims for increased evaluations are considered to be well grounded. A claim that a condition has become more severe is well grounded where the condition was previously service connected and rated, and the claimant subsequently asserts that a higher rating is justified due to an increase in severity since the original rating. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The Board is satisfied that all relevant facts pertaining to the right knee disability have been properly developed. There is no indication that there are additional pertinent records which have not been obtained. No further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. The appellant claims that his right knee disability has worsened and warrants an increased disability rating. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The percentage ratings in the SCHEDULE FOR RATING DISABILITIES represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1 (1999). Each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). The veteran underwent a right total knee arthroplasty in November 1988. A February 1989 postoperative evaluation report shows that he had no complaints. The knee was stable and could be fully extended and flexed to 100 degrees. It was noted that he was playing golf. He was seen in February 1990, at which time it was noted that his leg could be fully extended and flexed to 115 degrees. There was some instability on testing, but it was not functional in nature. There was no pain or swelling. An April 1990 VA examination found moderate crepitation without effusion or swelling. The left leg could be flexed to 90 degrees and lacked about 10 degrees of full extension. The veteran complained that the knee would begin to hurt after he stood for a period of time, but he could walk for approximately 1 mile or 2 at a reasonable pace. It was recorded that he could stand for about 15 to 20 minutes before his right knee would start swelling and become more uncomfortable. He had difficulty sleeping at night because of either pain in his right knee or a tingling discomfort in his left leg. He had to give up his golf game the prior year. The right knee had not given way since the replacement. An X-ray film was interpreted as showing that the knee replacement was in good position. A February 1991 VA orthopedic evaluation found that the right leg could be fully extended and flexed to 120 degrees. There was excellent tracking and stability, with no synovitis or pain. Essentially the same findings were reported on a January 1992 orthopedic evaluation. During a February 1993 VA examination, the veteran reported that he had been employed as a sales manager at a cemetery since 1986 and had not lost any time from work in the prior 12 months. Examination of the right knee revealed a well- healed anteromedial parapatellar incision scar and an anterior incision scar. There was some effusion in the knee. The right leg could be fully extended and flexed to 125 degrees; no instability was reported. At a personal hearing, conducted in March 1994, the veteran said that he could not walk more than approximately one-half block without having to stop to rest his knee. He said that his knee would swell every day and that, at times, it would give way. He said that he had difficulty climbing stairs, but more difficulty descending them. He reported that he used a cane frequently. A Board decision, dated in March 1996, found that the residuals of the right knee arthroplasty were not more than 30 percent disabling. Evidence submitted subsequent to that decision consists of VA outpatient treatment reports and the report of a VA examination, conducted in April 1998. The outpatient treatment reports show few complaints regarding the right knee disability. Records from June 1997 show the right knee with positive stability and 0-120 degrees of motion. X-ray examination showed no adverse changes. The report of the April 1998 VA examination shows the veteran complaining of constant pain. He took no medication for the discomfort. The knee did not lock or give way. He rarely had swelling of the knee. He reported increased pain with all activities and with weather changes. He reported occasional use of a cane. He was unable to squat, run, or walk more than one block due to the knee. Examination showed a well healed, non tender 21 cm vertical anterior scar. He could extend to 20 degrees and flex to 90 degrees without crepitance. He had slight laxity. No edema was noted. He ambulated with a moderate limp and was unable to squat. He had tenderness along the medial and lateral aspects of the knee. The impression given was postoperative right total knee arthroplasty. Prosthetic replacement of the knee joint is rated 100 percent disabling for one year following implantation of the prosthesis. Following that, it is rated as 60 percent disabling when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. With intermediate degrees of residual weakness, pain or limitation of motion, the residuals of the replacement are under Codes 5256, 5261 and 5262, with a 30 percent minimum rating. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Although not specifically mentioned in Code 5055, subluxation or lateral instability of the knee is rated a maximum of 30 percent disabling when severe. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Limitation of flexion of the leg is evaluated at a maximum of 30 percent when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension is rated 30 percent disabling when the leg lacks 20 degrees of full extension, with higher evaluations being provided for more severe extension lags. 38 C.F.R. 4.71a, Diagnostic Code 5261. Nonunion of the tibia and fibula with loose motion, requiring a brace is rated 40 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5262. Because the veteran is able to extend his right leg to 20 degrees and flex it to approximately 90 degrees, he is not entitled to a higher evaluation on the basis of limitation of motion. Although he has testified that his knee has given way and there was finding of laxity, no subluxation or lateral instability has been reported on the various examinations so as to warrant an increased rating under Code 5257. Disability of the musculoskeletal system is primarily the inability due to damage or infection in parts of the system to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to the absence of part or all of the necessary bones, joints and muscles or associated structures, or to deformity, adhesions, defective innervation or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40 (1999). No atrophy or significant weakness of the veteran's right lower extremity has been reported. Although he has reported giving way of the knee and has said that he uses a cane, it was noted on the February 1993 VA examination that he did not require a walker or cane. On examination in April 1998 it was noted that he occasionally uses a cane. He can walk for one block before he must rest. There is no indication that he requires a brace. Considering these findings, the veteran's subjective complaints are outweighed by the medical findings. Pain is contemplated by the criteria of Code 5055 and there is no medical indication that any pain that the veteran experiences is above that contemplated by a 30 percent evaluation. Accordingly, the Board concludes that the residuals of the right knee arthroplasty are not more than 30 percent disabling. 2. Entitlement to an increased evaluation for a left foot nerve palsy, currently evaluated as 30 percent disabling. As noted above, claims for increased evaluations are considered to be well grounded. The Board is satisfied that all relevant facts pertaining to the left foot disability have been properly developed. There is no indication that there are additional pertinent records which have not been obtained. No further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. During a February 1988 VA examination, it was recorded that the veteran had fallen when his right knee gave way. About 10 days later, he developed a left footdrop. Examination found that the veteran had very little strength in raising the toes of the left foot, probably 20 percent of normal. He had hypesthesia from the lower third of the leg down to the dorsum of the foot, anteriorly. An April 1990 VA examination found numbness on the lateral side of the left leg from the distal third extending into the big toe, with less numbness in the two lateral toes. There was approximately 60 percent of strength in dorsiflexion as compared to the right, and about 80 percent strength on plantar flexion as compared to the right. There was no swelling. During the February 1993 VA examination, it was noted that the veteran had been found to be diabetic in 1988 and was currently on medication for his diabetes. Over the years, he had developed numbness and tingling in his feet, which was fairly symmetrical and caused him to have severe pain, especially at night when he was trying to sleep. He walked with a brace on his left foot because of the footdrop, but did not use a walker or cane. He was able to raise the foot approximately 20 degrees and had good plantar flexion. There was good flexion and extension of the left knee. The left midcalf measurement was 2 centimeters smaller than the right. There was decreased sensation to pinprick from the ankles, distally into both feet and an area of sensory loss to pinprick down the medial portion of the left leg, from below the left knee to the level of the ankle. He had decreased vibratory and proprioceptor sensation in both feet. There were no reflexes in either the left knee or left ankle. The diagnostic impressions were partial footdrop on the left side, secondary to "peritoneal" nerve injury, and bilateral stocking distribution sensory loss secondary to diabetic neuropathy. The report of a VA examination, conducted in April 1998, shows the veteran wearing a brace on the left lower extremity. He reported that his disability has progressively worsened, and that functionally he can only walk about one block now. He reported that his feet are cold and tingle at night. He has been known to have borderline diabetes for the past 6-8 years. Examination showed a partial left foot drop with approximately 30 percent normal strength of dorsiflexion of the left foot. In addition he had mild weakness of the distal musculature of all four extremities with approximately 90 percent normal strength. Atrophy of the intrinsic hand and foot muscles was present. He also had a 5-6 hz resting tremor of both upper extremities. Mild cogwheel rigidity of both upper extremities was present. Sensory examination showed touch and proprioception were intact. Pinprick sensation was decreased in a stocking distribution to the ankles bilaterally. It was further decreased up the left lower extremity in the distribution of the peroneal nerve. Vibratory sensation was absent in the feet, but intact at the knees and in the hands. Ankle jerks were absent bilaterally. Plantar responses flexor bilaterally. The impression given was left peroneal neuropathy with incomplete left foot drop and sensory loss in the distribution of the left peroneal nerve, and distal symmetrical sensorimotor peripheral neuropathy which is most probably secondary to diabetes mellitus. Complete paralysis of the external popliteal (peroneal) nerve is manifested by footdrop and slight droop of the first phalanges of all toes, inability to dorsiflex the foot, loss of extension (dorsiflexion) of the proximal phalanges of the toes, loss of abduction of the foot, weakened adduction and anesthesia covering the entire dorsum of the foot and toes. It is rated as 40 percent disabling. Incomplete paralysis is rated as 30 percent disabling when severe, 20 percent disabling when moderate, and 10 percent disabling when mild. 38 C.F.R. § 4.124(a), Diagnostic Code 8521. The term "incomplete paralysis" indicates a degree of loss or impaired function substantially less than the type picture for complete paralysis. 38 C.F.R. § 4.124(a). The veteran has partial left footdrop. Dorsiflexion was described by the examiner as 30 percent of normal strength but was not lost. He does not have complete footdrop, but does wear a brace. He reported that he believes that the disability is worsening. Loss of sensation was shown, although loss of sensation in a stocking distribution has been attributed to diabetes. Based on these findings, even considering all loss of sensation, severe, incomplete paralysis only is shown, warranting the assignment of a 30 percent evaluation, but the criteria for complete paralysis and a higher evaluation are not present. The veteran's complaints of severe pain have been attributed to the nonservice- connected diabetes. 3. Entitlement to an increased, compensable, evaluation for a right little finger disability. As noted above, claims for increased evaluations are considered to be well grounded. The Board is satisfied that all relevant facts pertaining to the right little finger disability have been properly developed. There is no indication that there are additional pertinent records which have not been obtained. No further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. Service connection for dislocation of the right small finger was granted by a rating decision of December 1955. No residuals were shown at that time and the disability was rated as noncompensable. The report of the most recent examination shows the veteran complaining of rare discomfort in the right fifth finger, but stating he is unable to flex it without the use of the left hand, but can fully extend it. He is right handed and stated that the finger gets in the way when he writes. Physical examination showed a well-healed, non-tender, 2 cm vertical palmar scar over the proximal interphalangeal joint. No tenderness was noted. The veteran could fully extend the finger, but was unable to flex it without assistance. Sensation was intact. X-ray examination showed no significant abnormalities. The impression was residuals, dislocation of the right fifth finger. Favorable or unfavorable ankylosis of the little finger of either hand warrants a noncompensable evaluation. Ankylosis is considered to be favorable when the ankylosis does not prevent flexion of the tip of the finger to within 2 inches (5.1 cm.) of the median transverse fold of the palm. It is unfavorable when it precludes such motion. Extremely unfavorable ankylosis will be rated as amputation under the provisions of 38 C.F.R. Part 4, Diagnostic Code 5156 (1999). Ankylosis is considered to be extremely unfavorable when all of the joints of the finger are in extension or in extreme flexion, or when there are rotation and angulation of the bones. 38 C.F.R. Part 4, Diagnostic Code 5227 (1999). A 10 percent evaluation for amputation of the little finger of the major or minor upper extremity is warranted if the point of amputation is at the proximal interphalangeal joint or proximal thereto, without a metacarpal resection. A 20 percent evaluation requires that the amputation involve a metacarpal resection with more than one-half of the bone lost. 38 C.F.R. Part 4, Diagnostic Code 5156 (1999). The report of the most recent VA examination shows that the veteran is able to fully extend his right fifth finger and can flex it with assistance. No tenderness or lack of sensation was noted. The veteran's right little finger has not been amputated; therefore, the amputation portion of 38 C.F.R. Part 4, Diagnostic Code 5156 (1999), does not apply. Additionally, the most recent examination of the veteran's finger does not reveal extreme ankylosis. That is, he is able to bend the finger at the joints although there is some limitation of motion. Also, there is no evidence showing rotation or angulation of the bones therein. Therefore, it is the conclusion of the Board that the evidence does not support a compensable evaluation. 4. Entitlement to service connection for degenerative joint disease of the left knee. The law provides that "a person who submits a claim for benefits under a law administered by the Secretary shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a) (West 1991). In order to establish a "well grounded" claim for service connection for a particular disability, the appellant needs to provide evidence relevant to the requirements for service connection and of sufficient weight to make the claim plausible or meritorious on its own and capable of substantiation. Franko v. Brown, 4 Vet. App. 502, 505 (1993); Tirpak v. Derwinski, 2 Vet. App. 609, 610-611 (1992); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The three elements of a "well grounded" claim are: (1) evidence of a current disability as provided by medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the inservice disease or injury and the current disability as provided by competent medical evidence. Caluza v. Brown, 7 Vet. App. 498, 506 (1995); see also 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). Where a claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91, 92- 93 (1993). In this case, the determinative issues presented by the claim are whether the veteran had a left knee injury in service or a service incurred disability which caused a left knee injury, whether he currently has a left knee disability, and whether there is a relationship between the two. The veteran contends, in essence, that his current left knee disability is attributable to either his service connected right knee disability or his service connected left foot disability. A review of the veteran's service medical records is negative for complaints of, treatment for, or diagnosis of a chronic left knee disability. VA records, dated in November 1995, show the veteran complaining of left knee pain for three weeks, worse with weight bearing. X-ray examination showed spurring of the articular surface of the left patella. Physical examination in March 1996 showed the veteran was status post total right knee arthrotomy in 1988 and had current complaints of degenerative joint disease of the left knee. X-ray examination in June 1997 showed no adverse changes on the right and minimal if any changes on the left. The left knee was noted to be status quo. VA examination in April 1998 shows no complaints regarding the left knee. The Board has thoroughly reviewed the claims file, but finds no evidence of a plausible claim for service connection for a left knee disability. The only positive evidence presented is the veteran's representative's statements that a left knee disability is attributable to the veteran's other service connected disabilities. This alone, is insufficient to render the claims well grounded. Since the appellant has not met his burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded, it must be denied. Where an appellant has not met the burden of presenting evidence of a well grounded claim, VA has no duty to assist him any further in developing facts pertinent to his claim, including any duty to provide him with a medical examination. 38 U.S.C.A. § 5107(a)(West 1991); 38 C.F.R. § 3.159 (1995); Rabideau, 2 Vet. App. at 144 (where the claim was not well grounded, VA was under no duty to provide the appellant with an examination). However, where a claim is not well grounded, it is incomplete, and depending on the particular facts of the case, VA may be obligated under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his application. Robinette v. Brown, 8 Vet. App. 69, 77 (1995). In this case, however, the RO has complied with this obligation in the September 1998 statement of the case, the January 1999 supplemental statement of the case, and in the above discussion. 5. New and Material evidence to reopen a claim for service connection for heat stroke. The veteran contends that he has residuals of sunstroke. Service connection for this claimed disorder was denied by a June 1955 rating decision. Service connection was most recently denied in a Board decision of March 1996. The March 1996 Board decision noted that service connection for heat prostration was denied by the September 1955 rating decision because it was not shown by the evidence of record. The evidence of record included a service medical record which showed that the veteran was hospitalized in June 1953. Reportedly, he had been working in direct sunlight and had been sunbathing prior to going on sick call. When he was seen in the receiving wing, it was thought that he was suffering from acute heat prostration. Further examination resulted in a final diagnosis of acute tonsillitis. Subsequent to that decision, the Board noted that the veteran submitted a statement from his brother to the effect that the veteran suffered a heat stroke in 1953, and a statement dated in March 1994 by a private physician to the effect that the veteran had been advised in 1981 to avoid excessive heat because of the possibility of heat stroke which he had had in previous years. At his hearing, the veteran testified that he had been on crash, fire, and rescue detail, and that one day he passed out. He said his brother had been stationed with him at the time of the incident and had visited him in sick bay. He reported that he feels that because of the heat stroke he has less tolerance of heat. He said that his private physician has told him not to be out in the sun or heat for too long a time. Subsequent to the March 1996 Board decision the veteran has not submitted any new evidence regarding this issue. He merely stated in his claim, submitted in October 1998, that he wanted his claim for service connection for heat stroke reevaluated. In order to reopen a claim which has been previously denied and which is final, the claimant must present new and material evidence. 38 U.S.C.A. § 5108 (West 1991). New and material evidence means evidence not previously submitted to agency decisionmakers which bears directly and substantially upon the specific matter under consideration, which is neither cumulative nor redundant, and which by itself or in connection with evidence previously assembled is so significant that it must be considered in order to fairly decide the merits of the claim. 38 C.F.R. § 3.156(a) (1999); see also Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). When presented with a claim to reopen a previously finally denied claim, VA must perform a three-step analysis. Elkins v. West, 12 Vet. App. 209 (1999). First, it must be determined whether the evidence submitted by the claimant is new and material. Second, if new and material evidence has been presented, it must be determined, immediately upon reopening the claim, whether the reopened claim is well grounded pursuant to 38 U.S.C. § 5107(a) based upon all the evidence and presuming its credibility. There is no duty to assist in the absence of a well-grounded claim. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997) cert. denied, sub nom. Epps v. West, 118 S.Ct. 2348 (1998). Third, if the reopened claim is well grounded, VA may evaluate the merits of the claim after ensuring that the duty to assist under 38 U.S.C. § 5107(b) has been fulfilled. In the rating decision on appeal, the RO adjudicated this issue according to the definition of material evidence enunciated in Colvin v. Derwinski, 1 Vet. App. 171 (1991) ("a reasonable possibility that the new evidence, when viewed in the context of all the evidence, both new and old, would change the outcome" of the final decision). The Federal Circuit in Hodge declared this definition of material evidence invalid. Therefore, the determination as to whether the appellant has submitted new and material evidence to reopen this claim will be made pursuant to the definition of new and material evidence contained in 38 C.F.R. § 3.156(a), as discussed above. It is not necessary to remand this claim because no prejudice to the veteran results from the Board's consideration of this claim. He was provided notice of the applicable laws and regulations regarding new and material evidence, including 38 C.F.R. § 3.156. See Bernard v. Brown, 4 Vet. App. 384 (1993). Furthermore, the Board's review of this claim under the more flexible Hodge standard accords the veteran a less stringent "new and material" evidence threshold to overcome. After a review of the record, the Board finds that the veteran has not submitted new evidence regarding this issue. Accordingly, the Board concludes that the evidence submitted subsequent to the March 1996 Board decision is not material, as required under the applicable statutory and regulatory provision. Thus, the claim for service connection for heat stroke is not reopened and the Board's March 1996 decision remains final. ORDER Entitlement to an increased evaluation for a right knee disability, currently evaluated as 30 percent disabling, is denied. Entitlement to an increased evaluation for a left foot nerve palsy, currently evaluated as 30 percent disabling is denied. Entitlement to an increased, compensable, evaluation for a right little finger disability is denied. Entitlement to service connection for degenerative joint disease of the left knee is denied. Entitlement to service connection for heat stroke is denied. M. W. GREENSTREET Member, Board of Veterans' Appeals