Citation Nr: 18124004
Decision Date: 08/07/18	Archive Date: 08/03/18

DOCKET NO. 10-49 425
DATE:	August 7, 2018
ORDER
Entitlement to an initial rating in excess of 10 percent disabling prior to May 23, 2011; in excess of 20 percent disabling from May 23, 2011 to March 17, 2015; and in excess of 40 percent disabling thereafter for lumbar spine anterolisthesis with degenerative disc disease (DDD) is denied.
Entitlement to an initial rating in excess of 10 percent disabling for lower left extremity radiculopathy is denied.
FINDINGS OF FACT
1. Prior to May 23, 2011, the Veteran’s low back disability was manifested by pain on motion, stiffness, interference with prolonged sitting, tightness, aching, tenderness, weakness, spasms, forward flexion to 90 degrees, combined range of motion of 240 degrees and a normal gait; but not by limitation of motion to 60 degrees of flexion or less, a combined range of motion of 120 degrees or less, abnormal spinal contour, ankylosis, or incapacitating episodes.
2. From May 23, 2011 to March 17, 2015, the Veteran’s low back disability was manifested by moderate to severe pain, tightness, stiffness, limitations on walking, standing and sitting, aching, tenderness, and flare-ups characterized by increased pain; but not by limitation of motion of the thoracolumbar spine to 30 degrees or less, ankylosis, or incapacitating episodes.
3. From March 17, 2015 forward, the Veteran’s low back disability has been manifested by pain on movement, flare-ups every one and a half months, forward flexion to 30 degrees or less, and guarding resulting in abnormal spinal contour; but not by ankylosis or incapacitating episodes. 
4. For the entire appeal period, the Veteran’s left lower extremity radiculopathy has been manifested by radiating pain, decreased reflexes, mild paresthesias and mild constant pain, resulting in mild incomplete paralysis of the sciatic nerve.
CONCLUSIONS OF LAW
1. The criteria for a rating in excess of 10 percent prior to May 23, 2011 for a low back disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.159, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.15, 4.16, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5243 (2017).
2.  The criteria for a rating in excess of 20 percent from May 23, 2011 to March 17, 2015 for a low back disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.159, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.15, 4.16, 4.40, 4.45, 4.59, 4.71a, DC 5243 (2017).
3. The criteria for a rating in excess of 40 percent from March 17, 2015 forward for a low back disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.159, Part 4, §§ 4.1, 4.2, 4.3, 4.7, 4.15, 4.16, 4.40, 4.45, 4.59, 4.71a, DC 5243 (2017).
4. For the entire appeal period, the criteria for a rating in excess of 10 percent for left lower extremity radiculopathy have not been met or approximated. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2012); 38 C.F.R. §§ 3.159, 4.1, 4.2, 4.3, 4.7, 4.10, 4.123, 4.124, 4.124a, DC 8520 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Most recently, in September 2017, as required by a June 2017 Joint Motion for Remand, the Board remanded the Veteran’s claim for further development.  The agency of original jurisdiction (AOJ) substantially complied with the September 2017 remand directives, and no further development is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998).
Increased Rating
Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule).  38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.
Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate.  See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).
If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating.  Otherwise, the lower rating is assigned.  38 C.F.R. § 4.7.
Entitlement to an initial rating in excess of 10 percent disabling prior to May 23, 2011; in excess of 20 percent disabling from May 23, 2011 to March 17, 2015; and in excess of 40 percent disabling thereafter for lumbar spine anterolisthesis with degenerative disc disease (DDD)
The Veteran contends that his lumbar spine disability warrants an increased rating throughout the rating period.
The Veteran’s low back disability is rated under DC 5243. All spine disabilities covered by DCs 5235 to 5243 are rated according to the General Rating Formula for Diseases and Injuries of the Spine (General Formula) based on limitation of motion. 38 C.F.R. § 4.71a, General Formula. Under the General Formula, the spine is evaluated with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. Id. 
Under the General Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees, muscle spasm, guarding or localized tenderness not resulting in abnormal gain or spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a, General Formula.
A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, combined range of motion of the thoracolumbar spine not greater than 120 degrees, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id.
A 40 percent rating is warranted for forward flexion of the thoracolumbar spine of 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Id. 
Concerning disabilities affecting the spine, any associated objective neurologic abnormalities are evaluated separately under an appropriate DC. 38 C.F.R. § 4.71a, General Formula, Note 1. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. Id. at Note 2. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation, with the normal combined range of motion of the thoracolumbar spine being 240 degrees. Id.
Unfavorable ankylosis is a condition in which the entire thoracolumbar spine is fixed in flexion or extension, and the ankylosis results in one of more of the following: difficulty walking because of a limited line of vision, restricted opening of the mouth and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms due to pressure of the costal margin on the abdomen, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms due to nerve root stretching. Id. at Note 5. Fixation of a spinal segment in neutral position always represents favorable ankylosis. Id.
Back disabilities rated under DC 5243 may also be evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (Incapacitating Episodes Formula), which applies to Intervertebral Disc Syndrome (IVDS). 38 C.F.R. § 4.71a, Incapacitating Episodes Formula. An “incapacitating episode” for purposes of totaling the cumulative time is defined as “period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.” 38 C.F.R. § 4.71a, DC 5243, Incapacitating Episodes Formula, Note 1.
Period from August 2009 to May 2011
The Veteran was provided with a VA examination in November 2009. The examiner noted the Veteran’s subjective reports of pain with prolonged sitting, stiffness, cramping at night, decreased motion, and weakness. The examiner noted that the Veteran did not endorse flare-ups of any severity. On examination the Veteran had forward flexion to 90 degrees, extension to 30 degrees, left and right lateral flexion to 30 degrees and left and right lateral rotation to 30 degrees, resulting in a combined range of motion of 240 degrees. 
There was pain on movement, but no further loss of motion or function due to pain or other factors after repetitive testing. The examiner found no evidence of abnormal spinal contour, guarding, atrophy, tenderness or weakness. There is no evidence the examiner was not competent or credible, and as the report was based on the evidence of record and an objective examination it is entitled to significant probative weight concerning the severity of the disability at the time of the examination. Nieves-Rodriguez, 22 Vet. App. 295.
Private and VA treatment records during this period reflect on-going complaints of and treatment for low back pain, tightness, spasms and tenderness. An August 2009 VA treatment record noted an old compression fracture of the low back with no evidence of loss of disc height. Another October 2009 treatment record noted a functional range of motion with some limitation towards the end in each direction, but these limitations were not expressed in degrees. Treatment records during this period are silent for further range of motion testing expressed in degrees or any notations of abnormal spinal contour or ankylosis.
Based on the foregoing, the preponderance of the evidence is against a finding that an increased rating in excess of 10 percent is warranted prior to May 23, 2011. The objective evidence does not show that the Veteran’s range of motion has been limited to 60 degrees or less of forward flexion or less than 120 degrees combined, nor is there any objective evidence of abnormal spinal contour due to guarding, spasms or other factors. While the Board acknowledges the Veteran’s statements concerning additional symptoms such as pain, stiffness and others, these are outweighed by the objective evidence from this period which indicates that the low back disability did not more nearly approximate the level of severity contemplated by a 20 percent rating. 38 C.F.R. §§ 4.7, 4.71a, DC 5243.
In evaluating the Veteran’s current level of disability during the period prior to May 23, 2011, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The medical evidence shows that the Veteran has complained of pain on motion, stiffness, cramping, decreased motion, tightness and weakness, which he is competent to report. However, the November 2009 VA examiner noted these subjective complaints but, after repetitive testing, found that they did not result in any additional loss of function or range of motion. The Veteran also denied flare-ups of the low back disability at the time. As such, the Board finds that the Veteran’s statements concerning further limitation due to factors such as weakness, tightness, pain and other factors are outweighed by the objective findings of the VA examiner. 38 C.F.R. §§ 4.40, 4.45, 4.59.
Period from May 2011 to March 2015
From May 23, 2011 to March 17, 2015, the Veteran reported experiencing moderate to severe pain, aching, tightness, limited range of motion, stiffness, limitations on walking, and flare-ups characterized by increased pain. See, e.g., August 2014 Hearing Transcript at 5-6, 12, 15-17. As the Veteran is competent to report such lay-observable symptoms and there is no evidence the statements are not credible, they are entitled to probative weight. Jandreau, 492 F.3d 1372.
The Veteran was provided with a VA examination in May 2011. The examiner recorded the Veteran’s reports of moderate to severe pain and flare-ups with increased pain once every three months. The flare-ups were noted to result in further limitation of walking, but additional limitation of motion was not endorsed. The Veteran denied incapacitating episodes. On examination the Veteran had forward flexion to 60 degrees, extension to 14, left and right lateral flexion to 25 and left and right lateral rotation to 20, with no further loss of motion or functional after repetitive testing. No ankylosis was present. There is no evidence the examiner was not competent or credible, and as the report was based on the lay and medical evidence of record and an objective examination it is entitled to significant probative weight concerning the severity of the low back disability at the time of the examination. Nieves-Rodriguez, 22 Vet. App. 295.
Private chiropractic and VA treatment records reflect on-going treatment for a low back disability and complaints of pain, tightness, weakness, tenderness and spasms. However, the treatment records do not contain any further range of motion testing or notations of ankylosis of any kind.
Based on the foregoing, the preponderance of the evidence is against a finding that an increased rating in excess of 20 percent for the period from May 23, 2011 to March 17, 2015 is warranted. The objective measurements of record indicate that forward flexion has at no point been at or less than 30 degrees, or even closely approximated limitation of motion of that severity. There is no lay or medical evidence during this period of ankylosis of the lumbar or entire spine. While the Veteran has reported pain, stiffness and other symptoms, these statements are outweighed by the objective findings in the May 2011 examination report. As such, the Board finds that an increased rating in excess of 20 percent during this period is not warranted. 38 C.F.R. §§ 4.7, 4.71a, DC 5243.
In evaluating the level of disability during the period from May 23, 2011 to March 17, 2015, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. During this period the Veteran reported moderate to severe pain, tightness, aching, stiffness tenderness, limitations on walking, standing and sitting, limited range of motion and flare-ups with increased pain. However, the May 2011 VA examiner specifically noted and considered these subjective reports, and on examination found that there was no further loss of function or motion due to these factors after repetitive testing. As such, the Board finds that the Veteran’s statements concerning further limitation due to factors such as weakness, fatigue, and other factors are outweighed by the objective findings of the VA examiner. 38 C.F.R. §§ 4.40, 4.45. 
While the Veteran endorsed severe flare-ups of low back pain during this period, he further indicated that these occur once every month at most. As flare-ups by their nature are a temporary worsening of the normal severity of the disability and its accompanying symptomatology, and as in this case they occurred at most once per month during this period, the Board finds that the severity of symptomatology during these flare-ups is not representative of the Veteran’s baseline level of disability during this period. Further, there is no evidence of record indicating that these flare-ups result in limitation of motion to 30 degrees or less or ankylosis. As such, these flare-ups, in light of their infrequent and transient nature, do not result in the Veteran’s overall disability picture more nearly approximating the level of severity contemplated by a 40 percent rating. 38 C.F.R. §§ 4.40, 4.45.


Period from March 2015 forward
From March 17, 2015 forward, the Veteran experienced pain, restlessness, and flare-ups lasting one or two days every one and a half months. Flare-ups require treatment with ice and pain relievers. These statements are both competent and credible, and therefore are entitled to probative weight.
A VA examination was provided in March 2015. The examiner noted subjective reports of pain on movement, and flare-ups characterized by increased pain lasting one to two days every one and a half months. The Veteran was found to have forward flexion to 30 degrees, extension to 10 degrees, left and right lateral flexion to 15 degrees and left and right lateral rotation to 30 degrees. Pain on movement and weight bearing was present, but no further limitation of function or motion was found after repeat testing. Guarding resulting in abnormal spinal contour was present, but there was no ankylosis, loss of use, or incapacitating episodes. 
However, in a June 2017 Joint Motion for Remand, the United States Court of Appeals for Veterans Claims (Court) found this examination did not comply with Correia standards. See Correia v. McDonald, 28Vet. App.158 (2016). Specifically, the Court held in Correia that the final sentence of 38 C.F.R. §4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.
Subsequently, as required by the September 2017 Board remand, the Veteran attended a Back DBQ examination in December 2017. The examiner noted subjective reports of pain on movement, but no flare-ups were reported by the Veteran. He was found to have forward flexion to 40 degrees, extension to 5 degrees, left and right lateral flexion to 20 degrees and left and right lateral rotation to 15 degrees. Pain on non-movement and weight bearing was present, but no further limitation of function or motion was found after repeat testing. Muscle spasm resulting in abnormal spinal contour was present, but there was no ankylosis, loss of use, or incapacitating episodes. With regard to Correia, the examiner noted passive ROM was not performed as it was not feasible to do in a safe and reasonable manner, there was no objective evidence of pain when the spine was in a non-weight bearing positive at rest, and opposing joint assessment was not applicable because the spine does not have an opposing joint.
Private and VA treatment records are silent for any treatment for a low back condition during this period.
Based on the foregoing, an increased rating in excess of 40 percent is not warranted during this period. There is no lay or medical evidence indicating that the Veteran was unable to move his thoracolumbar spine at any point during this period. The probative medical evidence of record during this period, specifically the December 2017 examination report, which indicates that the Veteran had range of motion, albeit limited, in all directions. As such, the preponderance of the evidence is against a finding that the Veteran’s overall disability picture during this period more nearly approximated that contemplated by a 40 percent rating, which contemplates fixation of the lumbar spine in a neutral or an unfavorable position. 38 C.F.R. §§ 4.7, 4.71a, DC 5243.
In determining the level of disability during this period, functional loss was considered. 38 C.F.R. §§ 4.40, 4.45. The medical evidence shows that the Veteran has, at different times, complained of pain, flare-ups and limitation of motion. However, the VA examiner, after considering these subjective reports, found that there was no additional functional loss due to pain, weakness, fatigue, or incoordination upon repetitive testing and that no ankylosis was present. As such, the Board finds that the Veteran’s statements concerning further limitation due to factors such as pain and other factors are outweighed by the objective findings of the VA examiner. 38 C.F.R. §§ 4.40, 4.45, 4.59.
Again, the Board notes that the Veteran endorsed the presence of flare-ups. Despite this, the examiner still specifically found that the current low back disability was not manifested by ankylosis of the lumbar spine. Further, as flare-ups are not representative of the Veteran’s normal level of disability, and as the flare-ups occur only every one and a half months, the Board finds that they do not, on their own, result in the Veteran’s overall disability picture more nearly approximating the level of severity contemplated by a 40 percent rating during this period. 38 C.F.R. §§ 4.40, 4.45, 4.59.
No additional higher or alternative ratings under different DCs can be applied for any of the periods on appeal. The Board notes that the most recent VA examination provided a diagnosis of IVDS. See 38 C.F.R. § 4.71a, DC 5243, Incapacitating Episodes Formula, Note 1. The Board further notes that the Veteran has argued that he is required to ice his back during flare-ups, which results in incapacitation. However, there is no objective medical evidence of record that the Veteran has at any point been prescribed bed rest for his low back disability, with each of the three VA examiners specifically noting that the low back disability was not manifested by prescribed bed rest or incapacitating episodes. Id. As such, incapacitating episodes for VA purposes have not been shown at any point during the current appeal and therefore ratings in excess of those currently assigned based on incapacitating episodes are not warranted. Id. 
When evaluating disabilities of the spine, any associated objective neurologic abnormalities are to be rated separately under an applicable DC. 38 C.F.R. § 4.71a, General Formula, Note 1. Here, service connection for the Veteran’s left lower extremity radiculopathy has already been granted, and therefore is contemplated by that assigned rating. No other neurologic abnormalities have been noted as being associated with the Veteran’s low back disability. As such, additional separate compensable ratings are not warranted at any point during the period on appeal. 38 C.F.R. § 4.71a, General Formula, Note 1.
The preponderance of the evidence is against an initial rating in excess of 10 percent prior to May 23, 2011, 20 percent from May 23, 2011 to March 17, 2015, and 40 percent thereafter for the Veteran’s service-connected low back disability. 
Entitlement to an initial rating in excess of 10 percent disabling for lower left extremity radiculopathy
The Veteran’s left lower extremity radiculopathy is rated under DC 8520, governing impairment of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. Under DC 8520, a 10 percent rating is warranted for mild incomplete paralysis. Id. A 20 percent rating is warranted for moderate incomplete paralysis, a 40 percent rating is warranted for moderately severe incomplete paralysis, and a 60 percent rating is warranted for severe incomplete paralysis with marked muscular atrophy. Id. An 80 percent rating is warranted for complete paralysis where the foot dangles and drops, no active movement of muscles below the knee is possible, and flexion of the knee is weakened or lost. Id.
Diseases of the peripheral nerves are rated based on the degree of paralysis, neuritis, or neuralgia. The term “incomplete paralysis” indicates a degree of impaired function substantially less than the type of picture for “complete paralysis” given for each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a, Diseases of the Peripheral Nerves, Note. When the involvement is wholly sensory, the rating for incomplete paralysis should be for the mild, or, at most, the moderate degree. Id. 
Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for neuritis not characterized by such organic changes will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. Id. Tic douloureux may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124.
The terms “slight,” “moderate,” and “severe” are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to arrive at a just and equitable decision. Additionally, the use of such terminology by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.
The Veteran contends he is entitled to a rating in excess of 10 percent throughout the appeal for left lower extremity radiculopathy. Throughout the period on appeal, the Veteran has reported experiencing radiating pain into his left lower extremity of varying frequency and severity, as well as weakness and sharp sudden pain with certain actions. These statements are competent as they concern lay-observable symptoms, and as there is no evidence that the statements are not credible they are entitled to probative weight.
The Veteran was provided neurologic evaluations as part of his spine examinations in November 2009, May 2011 and March 2015. The November 2009 examiner noted reports of radiating pain. On examination the examiner found full muscle strength, no atrophy and normal sensation, but did note decreased reflexes. The May 2011 examiner likewise noted complaints of radiating pain. This examiner also noted sensation and muscle strength to be intact in the lower extremities, but that decreased reflexes were present. Finally, the March 2015 examiner also noted complaints of radiating pain, and on examination found normal muscle strength, decreased reflexes, normal sensation, and mild paresthesias and mild constant pain. Overall, the examiner found mild left lower extremity sciatica associated with the low back disability.
In a June 2017 Joint Motion for Remand, the Court found the March 2015 examination was not adequate. Specifically, the Court noted that there was no determination whether the Veteran’s reported history of decreased reflexes noted on the VA examinations of record in November 2009, March 2011, and in March 2015 suggested “symptoms of moderate severity.”
Subsequently, as required by the September 2017 Board remand, the Veteran attended a Peripheral Nerves Conditions DBQ examination in December 2017. The Veteran reported numbness and tingling from his left buttock that radiates to his toes with occasional left leg cramps approximately 4-5 days a week. The examiner noted mild bilateral lower extremity constant pain, intermittent pain, paresthesias, and numbness. With regard to the left lower extremity specifically, the examiner noted mild incomplete paralysis of the posterior tibial nerve, mild incomplete paralysis of the anterior crural nerve, mild incomplete paralysis of the internal saphenous nerve, mild incomplete paralysis of the obturator nerve, mild incomplete paralysis of the external cutaneous nerve of the thigh, and mild incomplete paralysis of the ilio-inguinal nerve. Separate ratings have since been established for these additional nerves.
Based on the evidence of record, the Board finds that for the entire appeal period, a rating in excess of 10 percent is not warranted for lower left extremity radiculopathy. In this case, the Veteran’s symptomatology has been wholly sensory during the entire period on appeal and his symptoms were determined in December 2017 to result in only mild overall impairment of the left lower extremity nerves noted above. Despite the Veteran’s statements regarding atrophy, the medical evidence of record does not indicate that the Veteran’s left lower extremity radiculopathy was manifested by any such physical signs or symptoms.
While the Board notes that the Veteran has on occasion reported severe radiating pain and other symptoms, the Board finds that these statements concerning the severity of sensory symptomatology to be outweighed by the December 2017 examiner’s overall determination that the left lower extremity overall results in mild impairment. As such, the Board finds that the preponderance of the evidence is against a finding that a rating in excess of the 10 percent assigned herein is warranted in this case. 38 C.F.R. §§ 4.7, 4.124a, DC 8520.
Finally, the Board notes that the Veteran is service-connected for right lower extremity radiculopathy and no other neurological findings in the record have been associated with his back disability. 
(Continued on the next page)
 
Based on the evidence of record, the preponderance of the evidence is against an initial rating in excess of 10 percent.
 
BETHANY L. BUCK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R.A. Elliott II, Associate Counsel 

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