Bankhead: RATING MENTAL HEALTH CONDITIONS, SUICIDAL IDEATION

Bankhead v. Shulkin, docket no. 15-2404 (Mar. 27, 2017)

HELD: Under 38 C.F.R. § 4.130, “the presence of suicidal ideation alone, that is, a veteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause social and occupational impairment with deficiencies in most areas,” thus warranting a 70% disability rating – and does not require “evidence of more than thoughts,” inpatient treatment or hospitalizations, or total social and occupational impairment.

SUMMARY: Mr. Bankhead was service connected for PTSD, rated 50% disabling. His medical records were replete with evidence of suicidal ideation, but he also repeatedly denied having any plan or intent to harm himself. The Board determined that he was not entitled to a 70% rating because even though his medical records showed many of the symptoms associated with that higher rating, “those symptoms did not manifest with sufficient frequency and severity to meet the criteria for a higher evaluation.” The Board based this determination on its findings that he was at “low risk of self-harm,” was treated on an outpatient basis, was not hospitalized or subject to in-patient treatment, was credible in “his assurances that he would refrain from self-harm,” and that he “retained some social and occupational functioning.”

On appeal, the CAVC recognized that 38 C.F.R. § 4.130 “‘requires not only the presence of certain symptoms’ but also that those symptoms have caused the level of occupational and social impairment associated with a particular disability evaluation.” *8 (citing Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013)). The Court discussed the “longstanding public concern over the prevalence and risk of suicide among veterans” and looked to various sources to define “suicidal ideation.” *9-10. The Court found that “suicidal ideation does not require suicidal intent, a plan, or prepatory behavior” and that “both passive and active suicidal ideation are comprised of thoughts.” *10.

The Court noted that the criteria for a 70% disability rating includes “suicidal ideation” as a symptom that is representative of “social and occupational impairment with deficiencies in most areas” and that “the presence of suicidal ideation alone” may cause such impairment. *10-11. “Suicidal ideation” is only contained in the 70% rating criteria. The Court found that the Board first erred by appearing to require “more than thought or thoughts to establish the symptom of suicidal ideation,” particularly since risk of actual self-harm is “referenced in the criteria for a 100% evaluation.” *11. The Court held that the Board’s failure to differentiate between Mr. Bankhead’s suicidal ideation and his risk of self-harm “resulted in conflation of distinct concepts” and rendered its reasons or bases inadequate. *12.

The second error identified by the Court was the Board’s finding that Mr. Bankhead was not entitled to a 70% rating because he had not been hospitalized or required in-patient treatment. Id. This imposed “a higher standard than the criteria in the DC for mental disorders,” and the Court held that “VA is not at liberty to create evaluation criteria out of thin air in an individual case and then use the absence of those criteria in the veteran’s records to deny a particular mental disorder evaluation.” *12-14.

The third error found by the Court was the Board’s impermissible melding of the 70% and 100% criteria based on its determination that Mr. Bankhead “still retained some social and occupational functioning.” *14. The Court noted that while the 100% rating requires “total occupational and social impairment, a 70% evaluation requires only occupational and social impairment in most areas.” The Court summarized its holding by stating that

VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. [Citation omitted.] Where, as here, the Board fails to adequately assess evidence of a sign or symptom experienced by the veteran, misrepresents the meaning of a symptom, or fails to consider the impact of the veteran’s symptoms as a whole, its reasons or bases for its denial of a higher evaluation are inadequate.

*14-15.

Unfortunately, despite the ample evidence of record of suicidal ideation to support the 70% disability rating, the Court determined that the appropriate remedy was remand and not reversal to enable the Board to address the evidence of suicidal ideation and consider the potential applicability of staged ratings. *16. 

FULL DECISION

Miller: RATING WHOLLY SENSORY CONDITIONS

Miller v. Shulkin, docket no. 15-2904 (Mar. 6, 2017)

HELD: The regulation for rating peripheral neuropathy provides for “a maximum disability rating for wholly sensory manifestations of incomplete paralysis of a peripheral nerve” and does not cover non-sensory manifestations. Nevertheless, a claimant who has sensory and non-sensory manifestations is not automatically entitled to a higher rating.

SUMMARY: Veteran Earl Miller appealed the Board’s denial of a disability rating higher than 10% for his service-connected peripheral neuropathy of the left foot. The symptoms he described in written submissions and in hearing testimony include the inability to walk more than 4-5 blocks, to stand for more than 15-20 minutes, to run, or to climb a flight of stairs. He also reported frequent stumbling and falling. A VA examiner stated that he had a noticeable limp, walked with a cane, and had difficulty standing because of the peripheral neuropathy. The examiner stated that he did not feel that Mr. Miller was employable because of his peripheral neuropathy.

At a Board hearing, he described his symptoms and stated that he used a cane regularly. His wife testified that he fell at least three times a day and that she had stopped working to take care of him. The Board denied a disability rating higher than 10%.

Peripheral neuropathy is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8620. For all peripheral nerve conditions, the regulation states: “When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.” 38 C.F.R. § 4.124a. This issue in this case is whether peripheral nerve conditions that are more than “wholly sensory” must be automatically rated, at a minimum, as “moderately severe.” Mr. Miller argued that because the regulation applies to peripheral nerve disorders that are “wholly sensory,” conditions that are more than wholly sensory must be rated at least “moderately severe,” which warrants a 40% disability rating under VA’s rating schedule. The Secretary argued that the language in the regulation created a maximum disability rating for wholly sensory conditions – not a minimum for conditions that are more than sensory.

The Court first acknowledged that Mr. Miller’s condition is more than “wholly sensory.” The Court examined the language of the regulation and determined that it “provides only a maximum disability rating for wholly sensory manifestations” and “contains no mention of non-sensory manifestations.” The Court found that the provision of a maximum 20% disability rating for wholly sensory manifestations did not entitle a claimant with more than sensory manifestations to a higher rating.

Mr. Miller had also argued that VA’s Adjudication Procedures Manual (M21-1) support his position because it defined both mild and moderate symptoms in “wholly sensory” terms, but it defined “severe” symptoms as involving “more than sensory findings . . . such as atrophy, weakness, and diminished reflexes.” The Court determined that it did not have to consider the M21-1 provision, since it already concluded that the language of the regulation was clear. The Court further noted that the Secretary changed the language in the M21-1 after the parties filed their briefs in this case – and that the new portion now states that the regulation does not mean that any non-sensory impairment “must be evaluated as greater than moderate.”

The Court discussed the Board’s rationale for its determination that Mr. Miller was not entitled to a higher rating, and found that the Board had considered the objective and subjective evidence of record and adequately explained its decision.

FULL DECISION

Doucette: RATING HEARING LOSS

Doucette v. Shulkin, docket no. 15-2818 (Mar. 6, 2017)

HELD: “[T]he rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment,” but do not explicitly contemplate “other functional effects, such as dizziness, vertigo, ear pain, etc.” – and the Board does not have to assess whether referral for extraschedular consideration is warranted unless this is raised by the claimant or the evidence of record.  

SUMMARY: Veteran Richard Doucette appealed the Board’s denial of a compensable disability rating for his hearing loss, arguing that the Board misapplied 38 C.F.R. § 3.321(b)(1) and failed to adequately explain its determination that referral for extraschedular consideration was not warranted.

The Court first noted that VA’s “rating criteria for hearing loss, unlike a majority of the conditions in VA’s rating schedule, do not list any specific symptoms or functional effects.” *3 (citing 38 C.F.R. §§ 4.85, 4.86). Instead, VA rates this condition based on a “mechanical application of a veteran’s audiometric testing results to a rating table.” The testing includes puretone audiometry and speech discrimination that “measure a veteran’s ability to hear certain frequencies at specific volumes and to understand speech.” *4. VA’s rating tables “correlate the results of audiometric testing with varying degrees of disability.” The Court thus held that VA’s “rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA’s audiometric tests are designed to measure.” *4-5.

The Court determined, however, that the rating criteria do not account for other functional effects, “such as dizziness, vertigo, ear pain, etc.” – and further held that the rating schedule did not explicitly contemplate “effects other than difficulty hearing or understanding speech.” *5. Nevertheless, the Court found that referral for extraschedular consideration was not warranted in all hearing loss cases, and that the “Board is only obligated to discuss extraschedular referral for hearing loss when there is evidence in the record which reveals that the appellant’s hearing loss presents exceptional or unusual circumstances or where the appellant has asserted that a schedular rating is inadequate.” *6-7.

The Court reiterated that it was not suggesting “that the rating criteria contemplate all functional impairment due to a claimant’s hearing loss.” The Court pointed out that “a hearing loss claimant could provide evidence of numerous symptoms,” such as “ear pain, dizziness, recurrent loss of balance, or social isolation due to difficulties communicating, and the Board would be required to explain whether the rating criteria contemplate those functional effects.” *8.

The Court found that Mr. Doucette’s hearing difficulties were “contemplated by the schedular rating criteria for hearing loss” and that he had not asserted that his schedular rating was inadequate. The Court thus affirmed the Board’s determination that referral for extraschedular consideration was not warranted. *9.

In dicta, the Court commented that the rating criteria for hearing loss “has led to confusion and inconsistent results for both veterans suffering from hearing loss and adjudicators evaluating their claims,” and questioned “whether it is time for VA to revisit this portion of the rating schedule.” *11.

Judge Schoelen dissented. Although she agreed with the majority that referral for extraschedular consideration was not warranted unless it was raised by the claimant or the record, she believes that the rating criteria for hearing loss “are inadequate to contemplate a veteran’s functional effects and entire disability picture.” She stated that “[b]ecause no symptoms are listed in the rating schedule for hearing loss, there is no way to adequately compare the ‘level of severity and symptomatology’ to the rating criteria,” which is required in determining whether referral for extraschedular consideration is warranted. She pointed out the Court’s prior holding that stated “[u]nlike the rating schedule for hearing loss, § 3.321(b) does not rely exclusively on objective test results to determine whether a referral for an extraschedular rating is warranted.” * 13 (quoting Martinak v. Nicholson, 21 Vet.App. 447, 455 (2007).  

Advocacy note: Even though VA is required by law to construe a claimant’s submissions liberally and assist in developing a claim – and even though VA adjudicators are required to understand the intricacies of VA law and its rating schedule – this decision emphasizes (or maybe even adds to?) the claimant’s burden in establishing entitlement to an appropriate disability rating. One significant flaw in this decision is that it presumes that claimants understand the meaning of “referral for extraschedular consideration” and how to request it, which is a pretty big presumption to impose on claimants seeking benefits in an allegedly claimant-friendly system. In light of this decision, claimants should clearly identify all symptoms related to hearing loss – and, if the rating schedule is not adequately reflecting the level of disability, explain why and request referral for extraschedular consideration.

FULL DECISION

Cook: ADDITIONAL BOARD HEARING FOLLOWING COURT REMAND

Cook v. Snyder, docket no. 15-0873 (Jan. 31, 2017)

HELD: Under 38 U.S.C. § 7107(b), “a claimant who received a personal hearing before the Board at an earlier stage of appellate proceedings in entitled to receive, upon request, a Board hearing following this Court’s remand of the same claim.”

SUMMARY: Mr. Cook was denied service connection for a back condition in 2000. He did not appeal that decision and it became final. In 2006, he filed a request to reopen his claim. The Regional Office (RO) denied the request, determining that he had not submitted new and material evidence that would warrant reopening. He appealed to the Board and testified at a hearing in 2012. The Board determined that new and material had been submitted to reopen the claim, and remanded the issue back to the RO, along with the issue of entitlement to a total disability rating based on individual unemployability (TDIU). The RO continued to deny the claim, and Mr. Cook requested a Board hearing so that he could submit additional evidence. In 2014, the Board acknowledged Mr. Cook’s request for a hearing, but denied the request because he had already been afforded one.

Mr. Cook appealed to the CAVC and the parties entered into a joint motion for remand (JMR) based on the Board’s failure to address favorable a private medical opinion. In November 2014, Mr. Cook again requested a Board hearing so that he could submit additional evidence. In February 2015, the Board denied service connection and TDIU. The Board again acknowledged his hearing request, but stated that the pertinent regulation provides for “a” hearing on appeal, and he already was afforded a hearing.

On appeal to the CAVC, Mr. Cook argued that because he had a protected property interest in obtaining VA benefits, the Board’s denial of a hearing following a remand violated his constitutional due process right to be heard. The Court ordered the parties to submit supplemental memoranda of law regarding any regulatory or non-constitutional authority that addressed a claimant’s right to more than one hearing. Mr. Cook argued that VA’s regulations do not expressly limit a veteran’s right to multiple hearings, specifically asserting that the “indefinite article ‘a’ in [38 C.F.R.] § 20.700(a) does not limit a claimant to one hearing.”

The Secretary argued that neither the statute (38 U.S.C. § 7107) nor the regulation provides for a Board hearing in this situation, asserting that “the indefinite article ‘a’ usually connotes the singular.” He noted that other regulations provide for new hearings “only in certain circumstances not implicated here.” He asserted that even if the statutory and regulatory language were ambiguous, the Court should defer to his interpretation, adding that there are currently thousands of pending Board hearings and allowing for multiple hearings in situations like these “would intolerably burden the system and violate the general rule that agencies are entitled to discretion in implementing their own procedures.” 

The Court first discussed the history of 38 U.S.C. § 7107 and explained the importance of hearings in the VA adjudication process. The Court next considered the statutory language (“The Board shall decide any appeal only after affording the appellant an opportunity for a hearing”) and found that it was ambiguous because it did not “specify that a claimant is limited to one Board hearing irrespective of the number or remands he or she is granted nor does it unambiguously specify that a claimant is entitled to a Board hearing upon request each time a remand is granted.”

The Court did not defer to the Secretary’s interpretation because it found that no VA regulation “resolves the ambiguity in the statute” and because VA’s regulation, 38 C.F.R. § 20.700(a), was promulgated before the statute was enacted. The Court noted that “the statute was enacted to codify the regulatory hearing rights before the Board.” (Emphasis in original.) Therefore, this regulation “cannot possibly have been promulgated to interpret it.” The Court concluded that the Secretary’s interpretation was not persuasive and held that “a VA claimant who has had a Board hearing during one stage in the appellate proceedings is not barred from receiving a Board hearing when the claim is at a different stage in the proceedings, namely, following a remand from this Court.”

The Court further analyzed the statutory language under a less deferential standard, focusing on “its context and with a view to its place in the statutory scheme.” The Court noted that “the VA adjudicatory process ‘is designed to function throughout with a high degree of informality and solicitude for the claimant’” and found that “[r]eading section 7107(b) as barring a claimant who has previously testified at a Board hearing from receiving a Board hearing during a subsequent stage of appellate proceedings – particularly following a remand from this Court – would be neither solicitous of a claimant nor productive of informed Board decisionmaking.”

The Court pointed out that the appellate issue(s) “may change or evolve as a claim wends its way through the VA claims and appeals process” – which is precisely what happened in Mr. Cook’s case. The issue on appeal at the time of his Board hearing was whether new and material evidence had been submitted to reopen his claim. By the time he requested the additional hearing in 2014, the issue had changed to whether the new and material evidence was sufficient to establish entitlement to service connection for a back condition. The Court reiterated its holding as properly interpreting section 7107(b) to allow “a VA claimant the right to request and receive a Board hearing for the purpose of submitting additional evidence after a remand from the Court, even if he or she previously received a hearing before the Board at another stage of appellate proceedings.”

The Court added that “this case implicates the presumption announced in Brown v. Gardner, 513 U.S. 115, 118 (1994), that any doubt in the interpretation of a VA statute must be resolved in favor of a veteran,” and noted that “even where the Secretary’s asserted interpretation is ‘plausible,’ adopting an interpretation that is less favorable to the veteran would be appropriate ‘only if the statutory language unambiguously’ required that less favorable interpretation.” The Court found that the Secretary’s interpretation was not required by the statutory language and was less favorable to the veteran.

Finally, the Court addressed the Secretary’s concerns regarding the burden these additional hearings would impose on VA. The Court stated that it “is not adopting the veteran’s reading of the statute, that he is entitled to a Board hearing at any time on any issue for any reason.” Rather, the Court again reiterated its holding that “a claimant who received a personal hearing at one stage of appellate proceedings before the Board is not barred from requesting and receiving a Board hearing during a separate stage of appellate proceedings before the Board, namely, following a remand from this Court.” The Court added that it “is not convinced that its holding will lead to a wave of requests for additional Board hearings,” noting that a claimant will weigh the right to request an additional Board hearing against the inherent delay in issuing a decision that will be caused by the request.

The Court added that if the Secretary disagrees with the Court, he is free to promulgate a new regulation that resolves the statutory ambiguity. The Court restated its holding again, “under section 7107(b), a claimant who received a personal hearing before the Board at an earlier stage of appellate proceedings is entitled to receive, upon request, a Board hearing following this Court’s remand of the same claim."

Advocacy note: The Court restated the holding of this case at least four times. Read together, the criteria for obtaining an additional Board hearing require that the claimant must (1) request the hearing in writing (2) at a subsequent stage of proceedings (3) following a Court remand of the same claim (4) for the purpose of submitting additional evidence.

FULL DECISION

Kays: CREDIBLE SUPPORTING EVIDENCE, 38 C.F.R. § 3.304(f)

Kays v. Snyder, docket no. 2016-1314 (Fed. Cir. Jan. 25, 2017)

HELD: The Court reviews the question of whether a veteran has submitted “credible supporting evidence” to support the occurrence of a claimed PTSD stressor event under the “clearly erroneous” standard of review.

SUMMARY: Charles Kays sought service connection for PTSD based on two non-combat stressor events. In one event, he claimed he was stabbed during a fight. In another, he claimed that while he was taking diving lessons off duty, he assisted in recovery efforts after a helicopter crash. To establish the occurrence of these events, he submitted lay statements, testimony, and a newspaper article regarding the helicopter crash. The article said nothing about recovery assistance provided by diving students. 

The Board denied his claim because he did not present evidence to support the occurrence of these stressor events. The Board rejected the lay statements because they were unsupported and contradicted by other evidence of record. The Board rejected the credibility of his testimony regarding the helicopter crash recovery because of the “lack of supporting detail in the article, his delay in reporting the event, and his changing and inconsistent story.”

On appeal to the CAVC, Mr. Kays argued that the Court “should review de novo the Board’s decision on whether a veteran has submitted credible supporting evidence that a claimed in-service stressor occurred.” The CAVC rejected this argument, finding that question to be a factual one that is reviewed under the “clearly erroneous” standard of review. Mr. Kays appealed to the Federal Circuit, and the Federal Circuit agreed with the CAVC.

The regulation in question, 38 C.F.R. § 3.304(f) requires that a non-combat veteran seeking service connection for PTSD provide “credible supporting evidence that the claimed in-service stressor occurred.” Mr. Kays argued that this requirement is an evidentiary burden that the Court should review de novo. The Federal Circuit found that while this requirement does impose an evidentiary burden on the claimant, this is “a quintessential factual inquiry” and “precisely the type of factual determination that the Board is tasked with making” and that “the Veterans Court reviews for clear error.”

The Court further noted that de novo review is reserved for situations where the Board “has explicitly interpreted a statute or regulation ‘concerning the correct standard for service connection’” or is “establishing a legal rule to be applied to similar fact situations in future cases.” The Court found that the Board “made quintessential factual determinations regarding Mr. Kays’s evidence, statements, and credibility, and found that he was not entitled to service connection.” The Court thus held that the CAVC “appropriately reviewed these factual determinations under the clearly erroneous standard.”

At oral argument, the veteran asserted that the regulation “requires only evidence that the ‘stressor occurred,’ not that it occurred to the veteran.” (emphasis in original). The Court rejected this argument, stating that the regulation requires “credible supporting evidence that the claimed in-service stressor occurred.” Mr. Kays’s claimed in-service stressor involved his participation in the recovery efforts following a helicopter crash. The regulation thus required him “to submit credible evidence that he was involved in search and rescue activities and not simply that a civilian helicopter crash occurred.”

The Court also rejected Mr. Kays’s argument that his current PTSD diagnosis “assures that the in-service stressor occurred to the veteran,” finding that “a physician’s diagnosis of PTSD does not necessarily identify what stressor caused it.” The Court stated that “the regulation requires the veteran to separately submit credible supporting evidence that the claimed in-service stressor occurred.” The Federal Circuit thus held that the CAVC “applied the proper standard of review” and affirmed its decision “because § 3.304(f) requires credible supporting evidence that the claimed in-service stressor occurred as claimed by the veteran.”

Advocacy note: The focus of this case is on the CAVC’s standard of review of the Board’s factual determination as to whether a veteran has submitted “credible supporting evidence that the claimed in-service stressor occurred.” The CAVC has previously held that the requirement of corroborating evidence under 38 C.F.R. § 3.304(f) does not require “corroboration of every detail including the appellant’s personal participation in the [event].” Suozzi v. Brown, 10 Vet.App. 307, 311 (1997); see also Pentecost v. Principi, 16 Vet.App. 124, 129 (2002) (holding that § 3.304(f) “only requires, as to stressor corroboration, ‘credible supporting evidence’ that the claimed in-service stressor occurred”).

In both Suozzi and Pentecost, the Court held that where there was corroborating evidence of the occurrence of a stressor event, the veteran’s personal involvement could, in certain circumstances, be inferred from the evidence. In Suozzi, the corroborating evidence showed that the veteran’s unit in Vietnam experienced casualties from an attack – and the Court could infer from this evidence that even a “company clerk [the claimant] would assist in the casualty identification.” Suozzi, 10 Vet.App. at 310-11. In Pentecost, the corroborating evidence showed that the veteran was stationed with a unit in Vietnam that experienced rocket attacks – and the Court found that this evidence “strongly suggest[s] that he was, in fact, exposed to the attacks.” Pentecost, 16 Vet.App. at 128.

Although the Federal Circuit in Kays did not mention Suozzi or Pentecost, its decision appears to undermine the holdings of those two cases. One distinguishing factor is that the stressor events in Kays occurred while the veteran was off duty, and, therefore, there were no service records to corroborate these events – whereas the events in Suozzi and Pentecost were corroborated by service records showing that the claimed events actually happened to the claimants’ units, and the Court could thus infer the claimants’ participation in those events.

As a practical matter, advocates should explain the credible, corroborating facts of their cases at the agency level – and, if denied, should argue at the Court that the Board’s rejection of that credible, corroborating evidence was clearly erroneous.

FULL DECISION

Vilfranc: RATING TMJ

Vilfranc v. McDonald, docket no. 15-0904 (Jan. 5, 2017)

 

HELD: The diagnostic code for temporomandibular joint dysfunction (TMJ), 38 C.F.R § 4.150, Diagnostic Code (DC) 9905, allows for “only a single disability rating for limitation of inter-incisal motion.” 

SUMMARY: Veteran Mary Vilfranc appealed a Board decision that denied entitlement to a disability rating in excess of 10% for TMJ, arguing that she was entitled to separate disability ratings for each joint.

The Secretary argued that Ms. Vilfranc was not entitled to an additional rating because she had not shown that she has more than one distinct disability. The Secretary also argued that DC 9905 supports the assignment of a single rating because the temporomandibular joints operate as a single unit.

In her reply brief, Ms. Vilfranc argued that 38 C.F.R. § 4.59 supported the assignment of separate compensable ratings because she experienced pain in each joint.

The Court first discussed the “location and function of the temporomandibular joints,” explaining that the temporomandibular is the combination of three facial bones – the mandible and two temporal bones – that are connected and act in concert, aided by the temporomandibular joint on each side. The Court rejected Ms. Vilfranc’s argument under 38 C.F.R. § 4.59, stating that this regulation provides for a minimum compensable rating for a joint that is actually painful even when evaluating a condition that is not predicated on range of motion – and that she is already in receipt of the minimum compensable rating (10%) for actual limitation of motion. The Court reiterated, “§ 4.59 is meant to compensate a claimant whose pain does not cause enough limitation of motion in a joint to reach a compensable level; it is not for application where, as here the claimant already has a compensable level of limitation of motion.”

The Court then addressed whether the Secretary’s interpretation of DC 9905 – as limiting a claimant to a single disability rating for TMJ – was reasonable and thus entitled to deference. Relying, on the Federal Circuit’s opinion in Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), which dealt with a similar argument regarding the assignment of a single disability rating for tinnitus even when the condition is experienced in both ears, the Court determined that the regulation in question was ambiguous, but that the Secretary’s interpretation was reasonable, even though it was offered for the first time in a brief. The Court concluded that “a claimant is entitled to only a single disability rating for limitation of inter-incisal motion under 38 C.F.R. § 4.150, Diagnostic Code 9905.”

FULL DECISION

Southall-Norman: RATING MUSCULOSKELETAL DISABILITIES; 38 C.F.R. § 4.59

Southall-Norman v. McDonald, docket no. 15-1357 (Dec. 15, 2016)

HELD: VA regulations require the award of a minimum compensable disability rating where there is “evidence of an actually painful, unstable, or malaligned joint or periarticular region and the presence of a compensable evaluation in the applicable DC [Diagnostic Code],” regardless of whether that DC is “predicated on range of motion measurements.” 

SUMMARY: Veteran Crystal D. Southall-Norman was granted service connection for bilateral hallux valgus and hemorrhoids, rated 0% for both conditions. She appealed for compensable ratings, and the Board granted 10% for the hemorrhoid condition and remanded the bilateral foot issue for another examination. She appealed the issue of the 10% hemorrhoid rating to the Court, and the parties entered into a Joint Motion for Remand stipulating that the Board failed to consider whether she was entitled to a separate compensable rating based on loss of sphincter control. The JMR directed the Board to address Ms. Southall-Norman’s reports of fecal leakage and consider the credibility and probative value of those reports in light of the fact that the relevant Diagnostic Code (38 C.F.R. § 4.114, DC 7332) does not require that such leakage “be confirmed by objective findings.”

Meanwhile, Ms. Southall-Norman was afforded another C&P examination for her feet. The examiner diagnosed bilateral pes planus and opined that this condition was related to her service-connected bilateral hallux valgus. The RO granted service connection for bilateral pes planus, rated 50% disabling under 38 C.F.R. § 4.71a, DC 5276 (flatfoot, acquired), effective June 2, 2014, the date of the C&P examination.

The appeal returned to the Board, which denied a compensable rating for her foot condition prior to the date of the C&P examination, under either DC 5276 (flatfoot) or 5280 (hallux valgus), because her symptoms were only mild or moderate symptoms during that time. The Board did not mention 38 C.F.R. § 4.59 (“painful motion”) in evaluating her foot condition. The Board also determined that she was not entitled to a separate rating for sphincter impairment because her reports of fecal leakage were “inconsistent” and “contradicted by the medical evidence of record.” The Board found that she “did not always differentiate between fecal leakage and other types of leakage,” and determined that her reports of fecal leakage “were insufficient to demonstrate constant slight or occasional moderate fecal leakage required for a compensable evaluation under DC 7332.”

In this present decision, the Court first addressed the foot condition and the appellant’s argument that the Board failed to discuss 38 C.F.R. § 4.59. The Secretary argued that the Board was not required to discuss § 4.59 because this regulation only applies when evaluating a joint disability under a DC based on range of motion. Because the relevant DCs in this case - DCs 5276 and 5280 - do not mention range of motion, the Secretary asserted that the Board need not discuss § 4.59. In her reply brief, Ms. Southall-Norman argued that the Secretary’s interpretation was inconsistent with the plain language of the regulation, which did not expressly limit itself to conditions based on range of motion. Alternatively, she argued that the Court should not defer to the Secretary’s interpretation because the Secretary had taken contrary positions in other cases.

The Court examined the language of the regulation and held that the “plain language of § 4.59 indicates that the regulation is not limited to the evaluation of musculoskeletal disabilities under DCs predicated on range of motion measurements.” The Court added:

§ 4.59 does not, as the Secretary contends, condition the award of a minimum compensable evaluation for a musculoskeletal disability on the presence of range of motion measurements in that DC; rather, it conditions that award on evidence of an actually painful, unstable, or malaligned joint or periarticular region and the presence of a compensable evaluation in the applicable DC.

The Court further determined that even if § 4.59 was ambiguous, the Court would not defer to the Secretary’s interpretation “because it does not reflect the agency’s considered view on the matter, as he has not consistently adhered to that interpretation.” To support this conclusion, the Court pointed to the Secretary's contrary position taken during oral argument on another case, as well as a number of single judge (i.e., nonprecendential) decisions.

Advocacy Note: The Court’s Rules allow for citation to nonprecedential authority “for the persuasive value of their logic and reasoning” and only if “no clear precedent exists on point and the party includes a discussion of the reasoning as applied to the instant case.” U.S.C.A.V.C. Rule 30(a).

With respect to a separate compensable rating for sphincter control, the Court determined that the Board did not adequately explain its rejection of Ms. Southall-Norman’s lay statements. More specifically, the Court rejected the Board’s credibility determination. The Court identified one of the “putative inconsistencies” noted by the Board and determined that it was consistent with her prior statement. The Court also found that the Board improperly questioned the credibility of Ms. Southall-Norman’s lay statements as inconsistent with a C&P examiner’s finding because the Board failed to acknowledge other evidence that was consistent with her statement. The Court held that “[a]lthough the Board is allowed to find a veteran not credible based on inconsistencies between medical evidence and lay evidence, . .. it must account for the potentially favorable material evidence of record when doing so.” The Court remanded both issues to the Board.

Advocacy Note: Although the primary holding of this case is that § 4.59 must be considered in evaluating all musculoskeletal disabilities – not just those predicated on range of motion – I found the Court’s review of the Board’s credibility determination to be refreshing. Instead of simply deferring to the Board’s “fact finding,” the Court carefully examined the evidence and rejected the Board’s determination that it was inconsistent with the appellant’s statements. The Court's language regarding the Board's duty to "account for potentially favorable material evidence of record" in making a credibility determination will be useful to advocates in cases where the Board appears to cherry-pick and/or mischaracterize the evidence of record.

FULL DECISION

McCarroll: DISABILITY RATING, HYPERTENSION

McCarroll v. McDonald, docket no. 14-2345 (en banc) (Nov. 7, 2016)

HELD: Because the diagnostic code for hypertension (38 C.F.R. § 4.104, DC 7101) specifically discusses the effects of medication, the Board was not required to consider whether a compensable rating would be warranted if the veteran was not medicated.

SUMMARY: Veteran Billy D. McCarroll appealed the Board’s denial of a compensable disability rating for his service-connected hypertension, arguing that the Board “failed to discount the ameliorative effects of his blood pressure medication.” Without his medication, he argued, his blood pressure would be at compensable levels. For support, Mr. McCarroll cited Jones v. Shinseki, 26 Vet.App. 56, 63 (2012), which held that the Board cannot deny a higher disability rating based on symptoms that are relieved by medication when the diagnostic code does not contemplate the effects of medication on the condition.

The Court held that Jones did not apply in this case because the diagnostic code for hypertension, DC 7101, expressly considers the effects of medication. DC 7101 provides for a 10% disability rating if (1) diastolic pressure is predominantly 100 or more OR (2) systolic pressure is predominantly 160 or more OR (3) “for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.” Although Mr. McCarroll did require medication for his hypertension, his medical records did not show a history of diastolic pressure at 100 or more or systolic pressure at 160 or more. Because of this, the Court further held that the Board did not err when it determined that Mr. McCarroll’s symptoms did not more nearly approximate the criteria for a 10% disability rating. The Court also rejected his argument that he was entitled to referral for extraschedular consideration because he did not raise that issue at the Board or the RO.

In a concurring opinion, two judges argued that Jones should be overturned as it is “predicated on a misunderstanding of the rating schedule.” These judges note that “although some diagnostic codes mention the fact of medication usage as a rating criterion, none require the Board to make any affirmative use of information about the ‘ameliorative effects’ of the medication.” They also note that the Jones holding “invites medical speculation in trying to guess what a veteran’s symptoms might be without the medication, or medical malpractice in the cessation of medication so that the veteran’s symptoms without medication might be recorded.”

In a dissenting opinion, two other judges found that DC 7101 provided three alternative paths to a 10% disability rating – and only one of those “contemplates the ameliorative effects of medication.” The dissenting judges would have held that Jones applies to this case and that the Board erred when it failed to consider the ameliorative effects of medication under the first two paths to a 10% rating under DC 7101.

FULL DECISION

Cox: AFGHANISTAN VETERANS NOT ENTITLED TO PERSIAN GULF PRESUMPTIONS

Cox v. McDonald, docket no. 14-2779 (Nov. 7, 2016)

HELD: Veterans with Afghanistan service are not entitled to the presumption of service connection for certain conditions, including chronic undiagnosed illnesses, provided in 38 U.S.C. § 1117 and 38 C.F.R. § 3.117. VA’s exclusion of Afghanistan from its definition of the geographic area comprising the “Southwest Asia theater of operations” is “reasonable” in light of the legislative history of 38 U.S.C. § 1117, and VA’s Training Letter that indicated that VA was going to amend its regulation to include Afghanistan was not a substantive rule that required a “notice-and-comment” period in order to be rescinded.

SUMMARY: Veteran Clifford Cox appealed the Board’s denial of service connection for back and knee disabilities, arguing to the Court that the Board failed to apply the “Gulf War provisions” of 38 U.S.C. § 1117. This statute and its implementing regulation, 38 C.F.R. § 3.117(b), provide for presumptive service connection for veterans with “qualifying chronic disabilities,” including diagnosed and undiagnosed illnesses, who served in the “Southwest Asia theater of operations.”

Mr. Cox served in Afghanistan in 2009, and began experiencing back and knee problems during that deployment. His current x-rays and examinations were negative for any abnormalities. However, he argued that the statute and case law (specifically, Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014)) state that pain alone “may establish an undiagnosed illness that causes a qualifying chronic disability.” Because the record contained medical and lay evidence of back and knee pain that the Board found credible, he argued that the Board erred by failing to apply the presumptions of 38 U.S.C. § 1117.

He also pointed out that in February 2010, VA issued a Training Letter indicating that it was going to amend its regulation to include Afghanistan in the definition of “Southwest Asia theater of operations.” In October 2010, VA issued a revised version of that Training Letter that deleted the language concerning veterans with Afghanistan service. Mr. Cox argued that the February 2010 Training Letter created a “substantive rule” that VA could not withdraw or change without complying with the “notice-and-comment” requirements of the Administrative Procedure Act.

The Court disagreed with Mr. Cox’s interpretation of the statute and with his characterization of the Training Letter as a substantive rule.

The Court first noted that Congress did not define the geographic area comprising the “Southwest Asia theater of operations” in 38 U.S.C. § 1117 – but instead delegated the authority to VA to issue regulations that defined the area. The Court found that the plain language and the legislative history of the statute did not support Mr. Cox’s position – particularly since Afghanistan was not part of the “Southwest Asia theater of operations” when the statute was first enacted in 1994. After 9/11, when Afghanistan was added by Executive Order as a combat area, Congress amended the statute in December 2001 to expand the definition of included illnesses – but still did not include a definition of “Southwest Asia theater of operations.”

In 2010, VA proposed to amend its regulation to include Afghanistan, but that never made it into the final rule. Based on the plain language of the statute – and the legislative history showing that Congress could have, but did not amend the statue to define the geographic area to include Afghanistan – the Court found VA’s interpretation of the statute as including only the original Desert Storm theater of operations to be permissible.  

With respect to the Training Letter, the Court found that it did not create any substantive “rights” that a claimant could rely on – but that it instead only provided “guidance” to VA personnel regarding potential future changes to the regulations.

The Court acknowledged that VA has publicly recognized that Afghanistan veterans face the same types of exposures to environmental hazards as Iraq veterans – and “encouraged” VA to “review the appropriateness of an overall change to the definition of ‘Southwest Asia theater of operations’ to explicitly include Afghanistan.” Unfortunately, the Court made these statements in footnotes, which do not alter the holding of this case.

FULL DECISION

Mathews: REASONS OR BASES; COMPLIANCE WITH PRIOR REMAND

Mathews v. McDonald, docket no. 15-1787 (Oct. 14, 2016)

HELD: The Board cannot “sub silentio incorporate its reasons or bases from a prior remand order into a later decision”; the Board must “provide or reiterate reasons or bases for unfavorable findings made in prior remand orders – assuming those reasons or bases still apply, given that new evidence or argument may have been submitted in the interim . . . – so that they become part of a final Board decision and subject to appellate review.”

SUMMARY: Mr. Mathews served in the U.S. Navy from 1966 to 1970, including combat service in Vietnam. In 2002, he was treated for a neck “lesion” that was subsequently the subject of various diagnoses, including metastatic carcinoma and melanoma, among others. Two private physicians stated that this condition “could be” related to his exposure to Agent Orange. In June 2003, he filed a claim for “neck cancer.” The RO denied because the evidence did not show that he had a type of cancer on VA’s presumptive list. He appealed the denial, and submitted additional evidence regarding his various diagnoses. In 2004, he appealed to the Board.

In 2007, following a hearing, the Board remanded his appeal, and directed the Appeals Management Center to have his claims file and a tissue sample reviewed by a “panel of three oncologists” who could provide “consensus answers” to the complicated medical questions of the case.

The AMC was unable to find a panel of three oncologists, but was apparently able to have the Board’s remand order “amended” so that they could obtain an opinion by one oncologist. A private physician from the El Paso Cancer Treatment Center provided a negative nexus opinion and the AMC continued its denial in a Supplemental Statement of the Case (SSOC).

In December 2011, the Board remanded again because VA had not obtained authorization to release a tissue sample and because the medical opinion was inadequate. In this remand order, the Board determined that Mr. Mathews was “not prejudiced” by having a medical opinion provided by only one oncologist, instead of three, because the oncologist was qualified to provide the opinion.

In 2013, VA obtained a new negative medical opinion from a registered nurse. Mr. Mathews challenged the adequacy of this opinion, and the Board remanded this appeal for a third time.

In January 2014, a VA staff physician in the hematology/oncology section provided a negative medical opinion. In June 2014, the Board remanded for a fourth time for an addendum opinion, which was provided the following October. The AMC continued the denial in yet another SSOC.

In January 2015, the Board issued the decision on appeal, finding that the AMC had substantially complied with its prior remand orders and continued to deny service connection.

On appeal to the Court, Mr. Mathews argued that the Board provided an inadequate explanation for its determination that the AMC had substantially complied with its prior remand order because the Board did not explain why an opinion from a panel of three oncologists was no longer needed. The Secretary argued that the Board was not required to address that question in the recent decision because it had explained in its December 2011 remand order that there was no prejudice to the veteran by having an opinion provided by only one oncologist. Mr. Mathews argued that “there is no legal authority that permits the Board to sub silentio incorporate its reasons or bases from a prior remand order into a later decision.” The Court agree with Mr. Mathews, noting that “[m]ore than nine years and three Board remands later, VA has still not obtained the ordered opinion from a three-oncologist panel, and the Board in its most recent decision did not explain why such an opinion was no longer necessary.”

Without an explanation from the Board, the Court found that it could not “discern the precise basis for the Board’s finding that the AMC had substantially complied with the May 2007 remand order,” and thus held that “the Board is not permitted to sub silentio incorporate its reasons or bases from a prior remand order into a later decision.”

To support this decision, the Court noted that “all of the Board’s findings in the non-final remand orders are insulated from judicial review because remand orders are not appealable to this Court.” The Court added that it has never stated that “findings in Board remand orders that are unfavorable to the appellant are final and binding,” emphasizing that such a conclusion “would be antithetical to the pro-claimant veterans benefits system.” The Court reiterated that the Board must “provide or reiterate reasons or bases for unfavorable findings made in prior remand orders – assuming those reasons or bases still apply, given that new evidence or argument may have been submitted in the interim . . . – so that they become part of a final Board decision and subject to appellate review.”

The Court further determined that the Board’s reasons-or-bases error in this case prejudiced the appellant because “it must be presumed that the Board in May 2007 determined that, due to the medical complexity of the issues involved, a medical opinion from a panel of three competent oncologists was required to decide the claim.” Because the Board did not explain how “having one competent oncologist assess the veteran’s tumor could satisfy the Board’s May 2007 remand” that called for a “consensus” on the issue by three competent oncologists, the Court found that the Board’s error was not harmless. The Court remanded for further development, if necessary, and readjudication.

FULL DECISION

Hill: ACDUTRA & AGGRAVATION

Hill v. McDonald, docket no. 14-1811 (Oct. 7, 2016)

HELD: Once a claimant has established “veteran” status for a disability incurred or aggravated during a period of ACDUTRA, that status applies to all other disabilities claimed to have been incurred or aggravated during that period – and the veteran is entitled to the presumption of aggravation for those claims, even if there is no entrance examination of record. 

SUMMARY: Mr. Hill had several periods of Reserve and National Guard duty from 1980 to 2002. He also had one period of active duty for training (ACDUTRA) from June 7 to 21, 1997. His service medical records (SMRs) and private records show psychiatric treatment prior to June 1997, and private records also show treatment for a back condition related to a 1994 work injury.

During his 1997 period of ACDUTRA, Mr. Hill’s unit was performing field exercises, when a tree he was standing next to was struck by lightning. He fell and sought medical treatment for knee and back pain. The National Guard investigation report of the lightning strike classified his knee injury as incurred in the line of duty, and his back pain as “in line of duty-[existed prior to service]-aggravation.” The investigator stated that “the force of being thrown to the ground may have aggravated [his back] condition.” The record contains evidence of Mr. Hill’s subsequent reports that his physical and psychiatric symptoms worsened after the lightning strike.

In 2002, he filed a claim for service-connected disability benefits for his back, knee, and memory loss. The Regional Office (RO) granted service connection for the right knee, but denied his back and memory loss claims. He did not appeal that decision and it became final.

In 2008, he attempted to reopen his claims for a back condition and memory loss with PTSD. The RO denied the PTSD claim and determined that new and material evidence had not been submitted to reopen the back claim. Mr. Hill appealed this decision, and submitted internet articles about the effects of lightning strikes. The RO issued a Statement of the Case, continuing to deny the PTSD claim and reaffirming that new and material evidence had not been submitted to reopen his back claim. Mr. Hill perfected his appeal with a VA Form 9 and requested a hearing. He testified that he had been thrown 25 feet as a result of the lightning strike and hurt his knee and back.

In April 2014, the Board determined that veteran status during his period of ACDUTRA had been established for these claims because of his service-connected knee disability. However, the Board determined that new and material evidence had not been submitted to reopen his back claim, rejecting his hearing testimony as “patently incredible.” The Board denied service connection for the psychiatric claim based on a 2010 C&P opinion.

On appeal, the Court addressed the issues of (1) whether the establishment of veteran status during a period of ACDUTRA for one condition extends to other conditions incurred during that period; (2) whether, once veteran status for a period of ACDUTRA is established, the veteran is entitled to the presumption of aggravation with respect to any additional pre-existing conditions; and (3) whether the presumption of aggravation requires an enlistment examination to determine the pre-service severity of a pre-existing condition claimed to have been aggravated during a period of ACDUTRA.

The Court first addressed the issue of “veteran status” and determined, based on the plain language of the relevant statutes, that “once an individual establishes that any disability was incurred during a period of ACDUTRA, he has established that the particular period of ACDUTRA constitutes ‘active, military, naval or air service.’” The Court thus held that “once a claimant has achieved veteran status for a single disability incurred or aggravated during a period of ACDUTRA, that status applies to all disabilities claimed to have been incurred or aggravated during that period of ACDUTRA.”

The Court further held that a veteran who has established veteran status for one condition during a period of ACDUTRA “is now a veteran for the purposes of all other claims based on that same period of ACDUTRA” and is thus entitled to the presumption of aggravation for different, pre-existing conditions that worsened during that period.

With respect to the enlistment examination requirement, the Court first noted that in order to benefit from the presumption of aggravation, the evidence must first show that a condition was “noted” on the veteran’s enlistment examination. The Secretary conceded in this case that ACDUTRA veterans are generally not provided with the same routine examinations as regular military personnel are – and that the record will likely not contain an enlistment examination noting a pre-existing condition for these veterans. To answer the question of whether the presumption of aggravation requires an enlistment examination, the Court again looked to the statutory language, specifically 38 U.S.C. §§ 1111 and 1153.

The Court found that section 1153 “makes no reference whatsoever to an examination,” but that section 1111, the presumption of soundness statute, “makes explicit reference to an entrance examination.” In light of this, the Court determined that the statutory language was ambiguous. The Court then looked to VA’s implementing regulation, 38 C.F.R. § 3.306(a), but found that this “merely parrots section 1153” and that the Secretary’s interpretation was thus not due any deference. The Court concluded that, for the claimant who is already service connected for one condition incurred during a period of ACDUTRA and is attempting to establish service connection for a different, preexisting condition based on that same period, “no entrance examination is necessary where there is contemporaneous evidence of the baseline severity of the preexisting condition.” In other words, as long as the claimant submits evidence showing the severity of the pre-existing condition prior to the aggravation event during the period ofACDUTRA, as well as evidence of a permanent increase in disability during the period of ACDUTRA, that claimant can benefit from the statutory presumption of aggravation – even though there is no enlistment examination of record.

With respect to Mr. Hill’s back claim, the Court determined that the Board clearly erred in determining that his submissions and testimony were not new and material. Specifically, the Court found that one of the internet articles stated that a lightning strike might affect the musculoskeletal system – and that this article was “material to whether the lightning strike could have worsened the appellant’s preexisting back condition.” The Court also determined that the Board clearly erred in determining that Mr. Hill’s hearing testimony was “patently incredible,” finding that “the Board engaged in improper, pre-reopening weighing of the evidence, which is prohibited.” To support this, the Court cited Justus v. Principi, 3 Vet.App. 510, 513 (1992) (holding that, for purposes of reopening, “VA is required to presume the credibility of newly submitted evidence”). The Court directed the Board to reopen this issue on remand.

With respect to the psychiatric claim, the Court found that the Board provided an inadequate statement of reasons or bases for its reliance on a C&P examination as negative evidence – when that report appeared to include favorable findings. The Court directed the Board to obtain clarification or a new medical opinion for the psychiatric claim on remand.

FULL DECISION

Bly: EAJA & EQUITABLE TOLLING

Bly v. McDonald, docket no. 15-0502(E) (Oct. 7, 2016), overruled, Bly v. Shulkin, docket no. 17-1287 (Fed. Cir. Mar. 2, 2018)

HELD: The 30-day appeal period to file an EAJA application is subject to equitable tolling, but the person seeking equitable tolling must show (1) that he has pursued his rights diligently and (2) that extraordinary circumstance prevented timely filing.  

SUMMARY: On January 5, 2016, the Court granted the parties’ joint motion for remand. In its order, the Court stated “this order is the mandate of the Court,” meaning that the Court’s judgment became “final.” On February 5, 2016 – 31 days after the Court’s order – Mr. Bly submitted his application for attorney fees under the Equal Access to Justice Act (EAJA). Because an EAJA application must be filed within 30 days of the Court’s final judgment, the Court ordered Mr. Bly to show cause as to why his application should not be dismissed.

Mr. Bly contended that the application was timely, and alternatively argued that the deadline should be equitably tolled. The Court sent this case to panel to determine whether equitable tolling applies to EAJA applications and, if so, what standard should be applied.

The parties agreed that equitable tolling applies to EAJA applications, but disagreed on the appropriate standard to apply to determine whether equitable tolling is warranted in these cases. Mr. Bly argued that the Court should adopt a standard in which it only asks “whether a veteran would be financially harmed without tolling and whether the Government would be prejudiced by tolling.” The Secretary asserted that the Court should apply the same standard as the general test for equitable tolling, which inquires as to “whether an extraordinary circumstance prevented the timely filing despite due diligence.”

The Court first determined that Mr. Bly’s EAJA application was untimely, rejecting his argument that “final judgment had not entered and he still had time to appeal.” The Court found this argument to be “incorrect as a matter of law,” since the EAJA statute defines “final judgment” to include “an order of settlement” and the Court’s rules provide that judgment is effective when the Court “order states that it constitutes the mandate of the Court.” The Court’s order, in Mr. Bly’s case, expressly stated that “this order is the mandate of the court.” U.S. Vet.App. R. 41(b). In addition to the EAJA statute and the Court’s own rules, the Court also pointed to its precedential caselaw stating that “an order granting a joint motion for remand . . . is final and not appealable.”

Next, the Court determined that “the doctrine of equitable tolling may be applied to the 30-day time limit for filing an EAJA application.” The Court rejected Mr. Bly’s arguments regarding the standard to apply, finding that applying his proposed standard “would essentially swallow the statutory rule that an EAJA application is due within 30 days of final judgment.” The Court explained that to base an equitable tolling determination on the question of whether a veteran would be financially harmed if the EAJA petition were dismissed, could apply to “virtually every case where an EAJA application is untimely filed.” The Court found that Mr. Bly had not shown extraordinary circumstance or due diligence to warrant equitable tolling.

Finally, Mr. Bly had also argued that dismissing his EAJA application would result in a potentially smaller retroactive award to the veteran, if the veteran is awarded benefits on remand. This is because any contingent attorney fee would have been offset dollar for dollar by the EAJA amount, resulting in a higher award for the veteran. The Court rejected this argument, noting that the Secretary and the Court both have the authority to review attorney fee agreements for reasonableness. The Court expressly directed the Secretary to consider the holding in this case when assessing the reasonableness of any potential attorney fees that result on remand.

Judge Greenberg concurred with the portion of the decision that held that the 30-day EAJA filing period is subject to equitable tolling, but dissented from the holding that equitable tolling was not warranted in this case. He emphasized the importance of encouraging lawyers to represent veterans and noted that the application was only one day late and there was “no evidence of prejudice to the Secretary as a result of that delay.” Judge Greenberg stated that “[p]enalizing an attorney for filing 1 day late where there is no prejudice to the Government, not only unnecessarily penalizes the veteran, but also may have chilling effects on worthy veterans obtaining adequate representation.”

FULL DECISION

PARALEGAL ACCESS TO VBMS

Chisholm v. McDonald, docket no. 15-1594 (per curiam order) (Sept. 30, 2016)

HELD: The Court ordered the Secretary to issue a decision on an attorney’s request for paralegal access to VA’s electronic claims system (VBMS) on behalf of the law firm’s clients. 

SUMMARY: VA’s regulations allow representatives to access their clients’ VA claims files electronically via its Veterans Benefits Management System (VBMS). 38 C.F.R. § 1.600-.603. Attorney Robert Chisholm petitioned the Court for a writ of mandamus to compel VA to provide electronic access to paralegals under his supervision or, in the alternative, to compel VA to issue a decision on his request for electronic access by his paralegals.

The Court found that it had jurisdiction to order the Secretary to issue a decision, and granted the petition, in part, to do so. Because it had granted that portion of the request, the Court determined that Mr. Chisholm was not entitled to an order granting his paralegal staff access to their clients’ electronic records. 

FULL DECISION

WITHDRAWAL OF NOTICE OF DISAGREEMENT VIA TELEPHONE IS INVALID

Warren v. McDonald, docket no. 15-0641 (Sept. 14, 2016)

HELD: An appellant or his/her representative may withdraw an appeal, but unless the withdrawal is on the record at a hearing, it must be in writing. A withdrawal “is only effective where withdrawal is explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the claimant.”

SUMMARY: Mr. Warren was denied service connection for sleep apnea in April 2009, and he appealed. The RO continued its denial in Statement of the Case. The RO then received a statement that it treated as a VA Form 9, in which the veteran stated that he was withdrawing his request for review by a Decision Review Officer and instead requesting a Board hearing. The veteran’s representative also submitted a request for a Board hearing.

In April 2010, a VA employee subsequently called the veteran and noted in a “Report of General Information” that she spoke with him over the phone and that he wanted to withdraw his sleep apnea appeal. A few days later, a Report of General Information, completed by a different VA employee, stated that the veteran called to state that he wanted a Board hearing. A few days later, the RO certified his appeal to the Board.

Later that month, on May 28, 2010, Mr. Warren’s representative submitted additional evidence “in support of the pending claim” for service connection for sleep apnea. The RO treated this as a new claim, requiring “new and material evidence” to reopen. Mr. Warren then underwent a Compensation and Pension examination – and the examiner provided a favorable medical nexus opinion. The RO awarded service connection for sleep apnea – assigning May 28, 2010 as the effective date. This decision was not appealed.

In the June 2013, Mr. Warren was afforded a Board hearing in which the presiding Board member characterized the issues to include service connection for sleep apnea. The veteran’s representative stated that the April 2010 Report of General Information mischaracterized Mr. Warren’s request. He clarified that he did not state that he wanted to withdraw his appeal; rather, he wanted to withdraw it from DRO review and proceed directly to a Board hearing.

In its November 2014 decision, the Board stated that the appeal arose from the April 2009 denial of service connection for sleep apnea – but that the April 2010 Report of General Information was a proper withdrawal of that appeal. The Board thus found that May 28, 2010 was the appropriate effective date for the award of service connection for sleep apnea.

On appeal to the Veterans Court, Mr. Warren argued that the Board failed to apply the correct legal standard in finding that he withdrew his appeal. The Secretary did not address this argument – but instead asserted that the Board improperly adjudicated a “freestanding earlier effective date issue” and that the proper remedy was for the Court to vacate the Board’s decision and dismiss the appeal.

The Court noted that the Board’s rules regarding withdrawal of appeals states that only an appellant or his/her representative may withdraw an appeal and that “[e]xcept for appeals withdrawn on the record at a hearing, appeal withdrawals must be in writing.” The Court added that a withdrawal “is only effective where withdrawal is explicit, unambiguous, and done with a full understanding of the consequences of such action on the part of the claimant.” The Court noted that in Mr. Warren’s case, the alleged withdrawal was conducted over the phone and that there was “considerable evidence that Mr. Warren did not intend to withdraw his 2008 sleep apnea claim when he called VA in April 2010,” but that he simply meant to withdraw his request for DRO review. The Court thus reversed the Board’s determination that Mr. Warren had withdrawn his appeal.

As for the issue on appeal, the Court determined that there were two claim streams in this case – (1) the 2008 claim for service connection for sleep apnea that resulted in the April 2009 denial and (2) the May 2010 “claim” that the RO treated as a request to reopen, based on its belief that Mr. Warren had withdrawn his appeal of the April 2009 denial.

The Board characterized the first claim as one for an earlier effective date – but the Court found that the Board did not have jurisdiction over this “claim” because it had not been adjudicated by the RO. The issue that had been appealed to the Board was service connection for sleep apnea – not the effective date.

The Court determined that “because the veteran timely appealed the April 2009 RO decision denying the December 2008 claim, only a Board decision can resolve the December 2008 claim” – and that the September 2010 RO decision could not resolve this issue because “by virtue of his appeal, the Board, not the RO, had jurisdiction over it.”

In this respect, the Court agreed with the Secretary that the Board did not have jurisdiction over the effective date issue. The Board had jurisdiction over the appeal arising from the 2008 claim for service connection. The Court held that the Board clearly erred when it determined that Mr. Warren withdrew his appeal of the April 2009 decision and reversed that portion of the decision. The Court remanded the issue of service connection for sleep apnea – the merits of the December 2008 claim – to the Board, expressly directing it to consider the supporting evidence Mr. Warren submitted in May 2010. 

FULL DECISION

EQUITABLE TOLLING

Aldridge v. McDonald, docket no. 2015-7115 (Fed. Cir. Sept. 9, 2016)

HELD: Equitable tolling is not warranted when veteran failed to demonstrate how the multiple deaths in his family “directly or indirectly affected the timely filing of his appeal.” 

SUMMARY: In December 2013, the Board of Veterans’ Appeals denied Mr. Aldridge’s claims for increased ratings for his service-connected knee conditions. He had until April 23, 2014 to submit a Notice of Appeal to the U.S. Court of Appeals for Veterans Claims. He did not file his appeal until October 27, 2014 – more than six months past the deadline.

He asked the Court to equitably toll the deadline, explaining that there were multiple deaths in his family and that the “resulting depressive state had prevented him from timely filing his notice of appeal.” The CAVC denied his request, finding that he “had failed to demonstrate how the deaths of his mother and sister and stillborn birth of his grandchild ‘themselves directly or indirectly affected the timely filing of his appeal.’” The Court based this determination on the findings that during the relevant period, he had closed the estates of his deceased mother and sister, became his father’s primary caregiver, continued to work as a desk clerk at a VA hospital, and attempted to hire a law firm to represent him. Because of this, the Court was “unconvinced” that his depression “directly or indirectly prevented his appeal from being timely filed.”

The Federal Circuit, sadly, agreed. Mr. Aldridge argued that the CAVC applied a legal standard that was inconsistent with Holland v. Florida, 560 U.S. 631 (2010), a decision in which the Supreme Court determined that equitable tolling is appropriate when an appellant demonstrates “(1) that he has been pursuing his rights diligently, and (2) that some extraordinary circumstance stood in his way.” Mr. Aldridge argued that the CAVC’s “causation analysis” placed a heavier burden on the veteran than what was intended by the Supreme Court in Holland. He asserted that the legal standard in Holland – a showing that “some extraordinary circumstances stood in [the] way and prevented timely filing” – “focuses on whether the extraordinary circumstances created a roadblock to timely filing as opposed to a metaphorical chain of causation that links events through time.”

The Federal Circuit agreed with the CAVC and determined that the requirement “that an appellant demonstrate that ‘some extraordinary circumstance stood in his way’ and prevented timely filing . . . necessarily carries with it an element of causation.” The Court noted that the Supreme Court recently reaffirmed this aspect of Holland, when it stated that “the second prong of the equitable tolling test is met only where the circumstances that caused a litigant’s delay are both extraordinary and beyond its control.” The Federal Circuit held that the CAVC “did not apply an incorrect legal standard when it determined that Mr. Aldridge had failed to demonstrate that the deaths in his family ‘themselves directly or indirectly affected the timely filing of his appeal.’”

In a passionate dissent, Judge Newman stated: “This case puts judicial humanity to the test; the Federal Circuit and the Court of Appeals for Veterans Claims fail the test.” This dissent is powerful – and useful for its language regarding equity and the unfortunately adversarial nature of what is supposed to be a solicitous veterans’ benefits scheme.  

This court has been assigned the responsibility for assuring that the legislative purpose of establishing a veteran-friendly regime is implemented. This case should never have come this far. On the undisputed circumstances that existed in this veteran’s family, the VA could readily have allowed the tardy appeal from the BVA to the Veterans Court. Instead, we see the government in uncompromising litigation to prevent this veteran from appealing the BVA decision on his percentage disability, straining precedent to its equivocal limits. What happened to the recognition that “the veterans benefit system is designed to award ‘entitlements to a special class of citizens, those who risked harm to serve and defend their country. This entire scheme is imbued with special beneficence from a grateful sovereign.’”

Dissent at *5. 

FULL DECISION

VETERAN CANNOT APPEAL DENIAL OF SPOUSE’S CLAIM FOR CHAMPVA BENEFITS

Braan v. McDonald, docket no. 14-4085 (Aug. 26, 2016)

HELD: Because the veteran did not have the right to appeal his spouse’s claim for CHAMPVA benefits, the Board did not have jurisdiction over this appeal and the appeal must be dismissed. 

SUMMARY: The veteran in this case was service connected under 38 U.S.C. § 1151, and rated 100% disabled. His wife applied for CHAMPVA benefits in March 2010. The following month, the VA Health Administration Center (HAC) issued a decision, addressed to Mrs. Braan, stating that she was not entitled to CHAMPVA benefits because “VA benefits granted under [section 1151] do not include CHAMPVA.”

In September 2010, Mr. Braan filed a “Privacy Release Form” with his congressional representative on behalf of his wife, requesting an appeal of the denial. The Congressman forwarded a memo and Mr. Braan’s Privacy Release Form to VA. In January 2011, the VA HAC issued a Statement of the Case, denying Mrs. Braan’s appeal, but the cover letter was addressed to Mr. Braan. In January 2012, Mr. Braan filed a VA Form 9, stating that as a 100% disabled veteran, he is entitled to CHAMPVA benefits on for his spouse – and that section 1151 claims are treated as service connected.

In October 2014, the Board identified the appeal as Mr. Braan’s, but concluded that Mrs. Braan was not entitled to CHAMPVA benefits because his disability was not “incurred or aggravated” in the line of duty. The Board supported this determination with a VA General Counsel Advisory Opinion stating that section 1151’s “quasi-service-connection” only provides for benefits under chapters 11 or 13 of title 38 of the U.S. Code – and entitlement to CHAMPVA is provided under chapter 17.

Mr. Braan appealed to the Court. The Court issued an order directing Mrs. Braan to file a motion to intervene as an appellant, if she wanted to do so. She never filed a motion to intervene.

The issue addressed by the Court was whether Mr. Braan had standing to bring this appeal to the Court on behalf of his wife. The Court held that he did not – and that the Board did not have jurisdiction to hear his appeal of her claim. The Court characterized Mr. Braan as an “interloper” in Mrs. Braan’s claim and stated that, as such, he did not have the right to pursue her claim – and the Board did not have jurisdiction to hear his appeal of her claim. The Court reiterated that “because Mr. Braan had not submitted a claim, the Board lacked the authority to decide his claim in the first instance” and “did not have jurisdiction to hear Mr. Braan’s appeal.

The Court never reached the relevant question of whether service connection under section 1151 entitles a recipient’s spouse to CHAMPVA benefits. The Court never even reached the question of “whether a CHAMPVA’s sponsor [i.e., the service-connected veteran] may ever be a proper claimant for CHAMPVA benefits that are otherwise due his or her spouse or other qualifying dependent,” stating that “it is undoubtedly improper for a CHAMPVA sponsor to wade into the appeals stream on behalf of a CHAMPVA beneficiary when that beneficiary has already filed the initial claim.”

Advocacy note: This is a very sad decision – and a monumental waste of time – that could have easily been prevented at several steps along the way by the veteran, his spouse, the congressional representative, and the VA officials who were issuing decisions on appeals over which they, allegedly, lacked jurisdiction. It is clear that Mrs. Braan applied for CHAMPVA benefits – and it is clear that she was denied these benefits based solely on the fact that her husband was service connected under section 1151. The standing/jurisdiction issues have nothing to do with the merits of this appeal – and all the Court is doing is guaranteeing that the Braans will wait another six years or more until it can address the relevant issue.

The lesson to take away from this case is that it is important to pay attention to who files the claim, the substance of the claim, and who is then entitled to appeal any adverse decision of that claim. It is a shame that the Court “punted” this one away. 

FULL DECISION

FED CIRCUIT DECLINES TO REVIEW PRESUMPTION OF COMPETENCY OF VA EXAMINERS

Mathis v. McDonald, docket no. 2015-7094 (Fed. Cir. Aug. 19, 2016)

HELD: The Federal Circuit denied the veteran’s petition for en banc rehearing of its prior (non-precedential) decision that declined to disavow the presumption of competence afforded to VA examiners. 

In a single-judge memorandum decision, the CAVC rejected the appellant’s arguments regarding the competency of the VA examiner who had provided a negative medical nexus opinion. See Mathis v. McDonald, docket no. 13-3410 (J. Lance, May 21, 2015) (Mathis I). The CAVC held that while the presumption of competency is rebuttable, the first step in doing so is to challenge the examiner’s competency. Because the veteran did not challenge the competency of the examiner at the Board or RO levels, the Court found that he had not met his burden to rebut the presumption. Id.

The veteran appealed to the Federal Circuit, arguing that the Court should “disavow the presumption of competency as it applies to VA medical examiners,” asserting that “VA’s procedure for selecting qualified examiners is inherently unreliable because the VA broadly recommends assigning generalists except in unusual, ill-defined cases.” See Mathis v. McDonald, docket no. 2015-7094 (Apr. 1, 2016) (Mathis II). The Court, somewhat reluctantly, declined to reassess the presumption of competency, although it did discuss the line of relevant cases (Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009); Bastien v. Shinseki, 599 F.3d 1301 (Fed. Cir. 2010); Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011); and Parks v. Shinseki, 716 F.3d 581 (Fed. Cir. 2013)), and noted that the appellant’s argument “presents some legitimate concerns.” Nevertheless, the Court found that it lacked “jurisdiction to make factual findings on appeal regarding the competency” of the VA examiner and “are bound by clear precedent to presume” the examiner’s competency.

In a separate opinion, one of the Federal Circuit judges concluded that “the entire court should review the case law concerning the presumption of competence with the objective of eliminating it.” The judge based his conclusion on VA’s general practice of not providing evidence of an examiner’s qualifications; the appearance that the presumption renders the competency of a VA examiner “unreviewable”; the due process problem in requiring a veteran to challenge an examiner’s qualifications; VA’s “unknown” process in selecting examiners; and, most troubling, VA’s actions since the presumption has been applied. Specifically, since the presumption has been applied, VA has emphasized the use of non-specialists. VA has eliminated the requirement that reports be signed by a physician – now only requiring the signature of a “health care provider.” This judge also highlighted the recent evidence of the “irregularity” in VA’s process for selecting examiners as shown in the controversy surrounding TBI examinations being conducted by unqualified examiners.

Despite this well-crafted opinion, the Federal Circuit declined to rehear this appeal en banc. However, while the order declining en-banc review was only two pages long, the opinion includes an additional 29 pages of separate concurring and dissenting opinions questioning the ongoing validity of applying the presumption of administrative regularity in this context.

Advocacy note: The burden is still on the veteran to challenge the adequacy of an examination and/or the qualifications of the examiner. If the veteran feels that the examination was not adequate and/or the examiner was not qualified to be conducting the examination, the veteran must notify VA of these concerns in writing. 

FULL DECISION