Citation Nr: 0432164 Decision Date: 12/03/04 Archive Date: 12/14/04 DOCKET NO. 02-19 350 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Sioux Falls, South Dakota THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Michelle L. Kane, Senior Counsel INTRODUCTION The veteran had active military service from November 1950 to November 1970. He is deceased, and the appellant is his surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2002 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Sioux Falls, South Dakota, which denied the above issue. FINDINGS OF FACT 1. The veteran died in March 2002. The immediate cause of his death was metastatic colon cancer. 2. Prior to his death, the veteran was not service connected for any disability. 3. The veteran served in Vietnam, and it is presumed that he was exposed to herbicides during service. 4. The medical evidence establishes that the primary site of the veteran's cancer was the colon. 5. There is no medical evidence showing the veteran's colon cancer is related to his military service, to include exposure to herbicides. CONCLUSION OF LAW Service connection for the cause of the veteran's death is not warranted. 38 U.S.C.A. §§ 1110, 1112, 1116, 5102, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.312 (2003). REASONS AND BASES FOR FINDINGS AND CONCLUSION A. Veterans Claims Assistance Act VA has a duty to assist the appellant in the development of facts pertinent to her claim. On November 9, 2000, the President signed into law the Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (2000). This law redefines the obligations of VA with respect to the duty to assist and includes an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. First, VA has a duty to notify the appellant and her representative, if any, of any information and evidence needed to substantiate and complete a claim. 38 U.S.C.A. §§ 5102, 5103 (West 2002); 38 C.F.R. § 3.159(b) (2003). Information means non-evidentiary facts, such as the claimant's address and Social Security number or the name and address of a medical care provider who may have evidence pertinent to the claim. See 66 Fed. Reg. 45620, 45630 (August 29, 2001); 38 C.F.R. § 3.159(a)(5) (2003). Second, VA has a duty to assist the appellant in obtaining evidence necessary to substantiate the claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2003). With respect to VA's duty to notify, in April 2002, the RO sent a letter to the appellant explaining the VCAA and asking her to submit certain information. In accordance with the requirements of the VCAA, the letter informed the appellant what evidence and information VA would be obtaining. The letter explained that VA would make reasonable efforts to help her get evidence such as medical records, employment records, etc., but that she was responsible for providing sufficient information to VA to identify the custodian of any records. The letter also explained the legal elements of a cause of death claim. Therefore, the Board finds that the Department's duty to notify has been fully satisfied. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). The Board concludes that the VCAA notification letter sent to the appellant in April 2002 is legally sufficient. See Paralyzed Veterans of America, et. al. v. Secretary of Department of Veterans Affairs (PVA), 345 F.3d 1334 (Fed. Cir. 2003); Disabled American Veterans, et. al. v. Secretary of Department of Veterans Affairs (DAV), 327 F.3d 1339 (Fed. Cir. 2003). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that 38 C.F.R. §§ 3.159(b)(1) and 19.9(a)(2)(ii) are invalid to the extent they provide a claimant "not less than 30 days" to respond to a VCAA notification letter because the regulations are contrary to 38 U.S.C.A. § 5103(b), which provides a claimant one year to submit evidence. In this case, even though the letter did request a response within 60 days, it also expressly notified the appellant that she had one year to submit the requested information and/or evidence, in compliance with 38 U.S.C.A. § 5103(b). Therefore, the claimant was notified properly of her statutory rights. Moreover, the claimant has had a full year to submit evidence after the VCAA notification. The Federal Circuit's concern in PVA that a claimant would be unaware of the time she had left to submit evidence is inapplicable in the specific circumstances of this case. The October 2002 statement of the case (SOC) and the December 2002 supplemental statement of the case (SSOC) informed the appellant that she still had time to submit evidence. When her case was certified to the Board in February 2003, she was again told that she had time to submit additional evidence. Since this claimant was, as a matter of fact, provided at least one year to submit evidence after the VCAA notification, and it is clear from her statements that she has nothing further to submit, adjudication of the claim can proceed. With respect to VA's duty to assist the appellant, the appellant has at no time referenced outstanding records that she wanted VA to obtain or that she felt were relevant to the claim. The RO has obtained or attempted to obtain all evidence identified by the appellant or identified by the veteran in connection with the claim he filed before his death. There is no basis for speculating that evidence exists that VA has not obtained. The Board notes that in statements the appellant has indicated that she would be submitting medical records to prove her case. She did not otherwise identify any outstanding records, with specificity, such as would trigger VA's responsibility to request the records. As noted above, she has been given an ample time period within which to submit any evidence she wanted VA to consider. She has also stated she was trying to get the veteran's death certificate amended, but there is no indication in the record that this was ever accomplished. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim. The RO did solicit such an opinion in September 2002, and the physician had the opportunity to review the claims file and the veteran's medical record and render an informed opinion. Further opinion is not needed in this case because there is sufficient medical evidence to decide the claim. The Board finds that VA has done everything reasonably possible to assist the appellant. In the circumstances of this case, additional efforts to assist her in accordance with the VCAA would serve no useful purpose. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements in the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). VA has satisfied its duties to inform and assist the appellant at every stage of this case. B. Cause of death Service connection may be established for the cause of a veteran's death when a service-connected disability "was either the principal or a contributory cause of death." 38 C.F.R. § 3.312(a); see 38 U.S.C.A. § 1310; see also 38 U.S.C.A. §§ 1110 and 1112 (setting forth criteria for establishing service connection). A service-connected disability is the principal cause of death when that disability, "singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto." 38 C.F.R. § 3.312(b). A contributory cause of death must be causally connected to the death and must have "contributed substantially or materially" to death, "combined to cause death," or "aided or lent assistance to the production of death." 38 C.F.R. § 3.312(c)(1). See generally Harvey v. Brown, 6 Vet. App. 390, 393 (1994). Therefore, service connection for the cause of a veteran's death may be demonstrated by showing that the veteran's death was caused by a disability for which service connection had been established at the time of death or for which service connection should have been established. Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated during service. 38 U.S.C.A. §§ 1110 and 1131; 38 C.F.R. § 3.303(a). In order to prevail on the issue of service connection there must be medical evidence of a current disability; medical evidence, or in certain circumstances, lay evidence of in- service occurrence or aggravation of a disease or injury; and medical evidence of a nexus between an in-service injury or disease and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999); see also Pond v. West, 12 Vet App. 341, 346 (1999). The determination as to whether these Hickson requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a) (2003). In addition, service connection may be established on a secondary basis for a disability, shown to be proximately due to, or the result of, a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The veteran was not service connected for any disability at the time of his death, so these provisions are inapplicable to this case. The veteran died in March 2002. The immediate cause of his death according to the certificate of death was metastatic colon cancer. The appellant argues service connection for the veteran's death is warranted because the lungs were the primary site of his cancer, which then spread to the colon. She argues he was exposed to Agent Orange during his service in Vietnam, which caused the lung cancer. Service connection may also be established for a current disability on the basis of a "presumption" under the law that certain chronic diseases manifesting themselves to a certain degree within a certain time after service must have had their onset in service. The laws and regulations pertaining to Agent Orange exposure provide for a presumption of service connection due to exposure to herbicide agents for veterans who have one of several diseases and served on active duty in Vietnam during the Vietnam Era. 38 U.S.C.A. § 1116 (West 2002); 38 C.F.R. § 3.307(a)(6) and 3.309(e) (2003); see also 67 Fed. Reg. 67792-67793 (Nov. 7, 2002). A disease associated with exposure to certain herbicide agents listed in 38 C.F.R. § 3.309(e) will be considered to have been incurred in service under the circumstances outlined in that section, even though there is no evidence of such disease during the period of service. No other condition other than one listed in 38 C.F.R. § 3.309(a) will be considered chronic. 38 C.F.R. § 3.307(a) (2003). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, and has a disease listed at 38 C.F.R. § 3.309(e), shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, such as Agent Orange, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii) (2003). Furthermore, even if a veteran does not have a disease listed at 38 C.F.R. § 3.309(e), he or she is presumed to have been exposed to herbicides if he or she served in Vietnam between January 9, 1962, and May 7, 1975, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See 38 U.S.C.A. § 1116(f) (West 2002). The Secretary of Veterans Affairs has formally stated that a presumption of service connection based on exposure to herbicides used in Vietnam was not warranted for "any other condition for which the Secretary has not specifically determined a presumption of service connection is warranted." See 68 Fed. Reg. 27630-27641 (May 20, 2003). Nonetheless, the United States Court of Appeals for the Federal Circuit has held that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). That is because the Veterans' Dioxin and Radiation Exposure Compensation Standards Act does not preclude a veteran from establishing direct service connection with proof of actual direct causation (proof that exposure during service caused the disease that appeared years later). Id. The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. Initially, the RO denied this claim, in part, based on a conclusion that there was no evidence showing the veteran had service in Vietnam. The National Personnel Records Center was unable to corroborate the veteran's service in Vietnam, but noted that he served in Thailand from June to October 1966. In connection with the claim he filed before his death, the veteran stated he was stationed at DaNang in Vietnam from June to November 1965. His service personnel records show that he was assigned to a Tactical Fighter Squadron in California during that time period. However, the records also show that he had a temporary duty assignment from June 25, 1965, to October 18, 1965, and his combat report notes he flew missions in South Vietnam between June and October 1965. The appellant has submitted samples from newspapers and books referencing the veteran's presence in Vietnam. Therefore, the Board concludes the preponderance of the evidences shows the veteran served in Vietnam, and he is presumed to have been exposed to herbicides during service. See 38 U.S.C.A. § 1116(f). The evidence shows that the veteran died from colon cancer, and the VA and private medical records show extensive treatment for metastatic colon and/or rectal cancer. Presumptive service connection is not warranted. The veteran's colon or rectal cancer is not a condition subject to presumptive service connection. 38 C.F.R. § 3.309(e) (2003). In fact, the National Academy of Sciences has reviewed the scientific studies on the relationship between gastrointestinal tract tumors (to include colon and rectal cancer) and exposure to herbicides, and the Secretary has concluded that a positive association does not exist. 68 Fed. Reg. 27630-27641 (May 20, 2003). Rather, as noted above, the appellant argues service connection is warranted for lung cancer, as she believes this was the primary site for the veteran's cancer and that it later spread to the colon. She points to a May 2000 pathology report which indicates that the results of a lung biopsy were compatible with a metastatic colon carcinoma, but a primary lung carcinoma cannot be completely excluded. Her son-in-law,[redacted], M.D., indicated in a November 2002 letter that this pathological report establishes doubt as to the primary site of the veteran's cancer and that even though the veteran likely died from the colon cancer, no further clinical testing was done to disprove a primary lung cancer or prove otherwise. Respiratory cancers, such as lung cancer, are identified as associated with exposure to herbicide agents. 38 C.F.R. § 3.309(e). However, presumptive service connection for a cancer listed in 38 C.F.R. § 3.309(e) as being associated with herbicide exposure may not be established if the cancer developed as the result of metastasis of a cancer which is not associated with herbicide exposure. VAOPGCPREC 18-97; see also Darby v. Brown, 10 Vet. App. 243, 245 (1997). Evidence sufficient to support the conclusion that a cancer listed in section 3.309(e) resulted from metastasis of a cancer not associated with herbicide exposure will constitute "affirmative evidence" to rebut the presumption of service connection for the purpose of 38 U.S.C. § 1113(a). The Board is bound by this opinion. 38 U.S.C.A. § 7104. As noted above, the Board must evaluate the probative weight of all the evidence in reaching a decision. Contrary to the appellant's argument and the opinion of Dr. [redacted] is the VA opinion provided in September 2002. That physician reviewed the claims folder and the veteran's computerized medical records. In summary, she concluded that the medical evidence shows the veteran's cause of death was "most certainly" rectal carcinoma that had metastasized to the lungs. The physician stated the primary cancer was in the colon, and there was no primary lung cancer. It was also noted that it is well known that colon cancer can metastasize to the lung, but the reverse does not occur. The Board finds the VA opinion persuasive and supported by the medical records. The pathology report is not sufficient to raise a reasonable doubt in this case. The pathologist did not definitively conclude the lungs were the primary site of the cancer, as opposed to the VA opinion which was conclusive and definitive that the lungs were not the primary site of the cancer. The VA physician also indicated that lung cancer does not metastasize to the colon, as a general medical principle. The death certificate clearly states the colon cancer caused the veteran's death and makes no mention of lung cancer. Dr. [redacted]'s letter really adds nothing to this case, in that he simply referenced the pathology report discussed above, but did not reach any independent conclusions as to the primary site of the veteran's cancer. The Board acknowledges the appellant's argument that the pathology report raises some doubt in this case. Even if that is true, it does not rise to the level of a reasonable doubt. A reasonable doubt exists where there is an approximate balance of positive and negative evidence that does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. Id. It is not a means of reconciling actual conflict or a contradiction in the evidence. Id. There is not an approximate balance of evidence. There is evidence not favorable to the claim that is of more probative value than the favorable evidence, and it is not error for the Board to favor certain evidence. The weight to be accorded the medical evidence must be determined by the quality of it and not by quantity. In this case, the evidence favorable to the appellant - the pathology report - simply does not carry the same probative value as the other medical evidence and does not raise a "substantial" doubt. While the Board may not ignore a medical opinion, it is certainly free to discount the relevance of a physician's statement. See Sanden v. Derwinski, 2 Vet. App. 97 (1992). There is also no medical evidence establishing a relationship is possible between the veteran's diagnosed cancers and his military service on a direct basis. Neither the veteran nor the appellant ever stated that a medical professional indicated that a possible relationship existed between his colon or rectal cancer, or lung cancer, and his military service, to include exposure to Agent Orange. The veteran's service medical records show no pertinent complaints or diagnoses, and the cancer was not diagnosed until almost 30 years after his separation from service. The veteran never stated that he had continuity of symptomatology or treatment since service, and the appellant has also never alleged such. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) [service incurrence may be rebutted by the absence of medical treatment for the claimed condition for many years after service]. The Board recognizes the appellant's sincere belief that the veteran's cancer originated in the lungs and was caused by exposure to Agent Orange during service. However, she does not have the necessary medical training or knowledge to render a probative opinion as to the etiology of any medical condition. The Board would like to take this opportunity to recognize that the veteran had 20 years of honorable and meritorious military service. Nevertheless, without sufficient medical evidence to link his death with some incident of his service, the claim for service connection for the cause of his death must be denied. ORDER Entitlement to service connection for the cause of the veteran's death is denied. ____________________________________________ BARBARA B. COPELAND Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs YOUR RIGHTS TO APPEAL OUR DECISION The attached decision by the Board of Veterans' Appeals (BVA or Board) is the final decision for all issues addressed in the "Order" section of the decision. The Board may also choose to remand an issue or issues to the local VA office for additional development. If the Board did this in your case, then a "Remand" section follows the "Order." However, you cannot appeal an issue remanded to the local VA office because a remand is not a final decision. The advice below on how to appeal a claim applies only to issues that were allowed, denied, or dismissed in the "Order." If you are satisfied with the outcome of your appeal, you do not need to do anything. We will return your file to your local VA office to implement the BVA's decision. However, if you are not satisfied with the Board's decision on any or all of the issues allowed, denied, or dismissed, you have the following options, which are listed in no particular order of importance: ? Appeal to the United States Court of Appeals for Veterans Claims (Court) ? File with the Board a motion for reconsideration of this decision ? File with the Board a motion to vacate this decision ? File with the Board a motion for revision of this decision based on clear and unmistakable error. Although it would not affect this BVA decision, you may choose to also: ? Reopen your claim at the local VA office by submitting new and material evidence. There is no time limit for filing a motion for reconsideration, a motion to vacate, or a motion for revision based on clear and unmistakable error with the Board, or a claim to reopen at the local VA office. None of these things is mutually exclusive - you can do all five things at the same time if you wish. However, if you file a Notice of Appeal with the Court and a motion with the Board at the same time, this may delay your case because of jurisdictional conflicts. If you file a Notice of Appeal with the Court before you file a motion with the BVA, the BVA will not be able to consider your motion without the Court's permission. How long do I have to start my appeal to the Court? You have 120 days from the date this decision was mailed to you (as shown on the first page of this decision) to file a Notice of Appeal with the United States Court of Appeals for Veterans Claims. If you also want to file a motion for reconsideration or a motion to vacate, you will still have time to appeal to the Court. As long as you file your motion(s) with the Board within 120 days of the date this decision was mailed to you, you will then have another 120 days from the date the BVA decides the motion for reconsideration or the motion to vacate to appeal to the Court. You should know that even if you have a representative, as discussed below, it is your responsibility to make sure that your appeal to Court is filed on time. How do I appeal to the United States Court of Appeals for Veterans Claims? Send your Notice of Appeal to the Court at: Clerk, U.S. Court of Appeals for Veterans Claims 625 Indiana Avenue, NW, Suite 900 Washington, DC 20004-2950 You can get information about the Notice of Appeal, the procedure for filing a Notice of Appeal, the filing fee (or a motion to waive the filing fee if payment would cause financial hardship), and other matters covered by the Court's rules directly from the Court. You can also get this information from the Court's web site on the Internet at www.vetapp.uscourts.gov, and you can download forms directly from that website. The Court's facsimile number is (202) 501-5848. To ensure full protection of your right of appeal to the Court, you must file your Notice of Appeal with the Court, not with the Board, or any other VA office. How do I file a motion for reconsideration? You can file a motion asking the BVA to reconsider any part of this decision by writing a letter to the BVA stating why you believe that the BVA committed an obvious error of fact or law in this decision, or stating that new and material military service records have been discovered that apply to your appeal. If the BVA has decided more than one issue, be sure to tell us which issue(s) you want reconsidered. Send your letter to: Director, Management and Administration (014) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 VA FORM JUN 2003 (RS) 4597 Page 1 CONTINUED Remember, the Board places no time limit on filing a motion for reconsideration, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to vacate? You can file a motion asking the BVA to vacate any part of this decision by writing a letter to the BVA stating why you believe you were denied due process of law during your appeal. For example, you were denied your right to representation through action or inaction by VA personnel, you were not provided a Statement of the Case or Supplemental Statement of the Case, or you did not get a personal hearing that you requested. You can also file a motion to vacate any part of this decision on the basis that the Board allowed benefits based on false or fraudulent evidence. Send this motion to the address above for the Director, Management and Administration, at the Board. Remember, the Board places no time limit on filing a motion to vacate, and you can do this at any time. However, if you also plan to appeal this decision to the Court, you must file your motion within 120 days from the date of this decision. How do I file a motion to revise the Board's decision on the basis of clear and unmistakable error? You can file a motion asking that the Board revise this decision if you believe that the decision is based on "clear and unmistakable error" (CUE). Send this motion to the address above for the Director, Management and Administration, at the Board. You should be careful when preparing such a motion because it must meet specific requirements, and the Board will not review a final decision on this basis more than once. You should carefully review the Board's Rules of Practice on CUE, 38 C.F.R. 20.1400 -- 20.1411, and seek help from a qualified representative before filing such a motion. See discussion on representation below. Remember, the Board places no time limit on filing a CUE review motion, and you can do this at any time. How do I reopen my claim? You can ask your local VA office to reopen your claim by simply sending them a statement indicating that you want to reopen your claim. However, to be successful in reopening your claim, you must submit new and material evidence to that office. See 38 C.F.R. 3.156(a). Can someone represent me in my appeal? Yes. You can always represent yourself in any claim before VA, including the BVA, but you can also appoint someone to represent you. An accredited representative of a recognized service organization may represent you free of charge. VA approves these organizations to help veterans, service members, and dependents prepare their claims and present them to VA. An accredited representative works for the service organization and knows how to prepare and present claims. You can find a listing of these organizations on the Internet at: www.va.gov/vso. You can also choose to be represented by a private attorney or by an "agent." (An agent is a person who is not a lawyer, but is specially accredited by VA.) If you want someone to represent you before the Court, rather than before VA, then you can get information on how to do so by writing directly to the Court. Upon request, the Court will provide you with a state-by-state listing of persons admitted to practice before the Court who have indicated their availability to represent appellants. This information is also provided on the Court's website at www.vetapp.uscourts.gov. Do I have to pay an attorney or agent to represent me? Except for a claim involving a home or small business VA loan under Chapter 37 of title 38, United States Code, attorneys or agents cannot charge you a fee or accept payment for services they provide before the date BVA makes a final decision on your appeal. If you hire an attorney or accredited agent within 1 year of a final BVA decision, then the attorney or agent is allowed to charge you a fee for representing you before VA in most situations. An attorney can also charge you for representing you before the Court. VA cannot pay fees of attorneys or agents. Fee for VA home and small business loan cases: An attorney or agent may charge you a reasonable fee for services involving a VA home loan or small business loan. For more information, read section 5904, title 38, United States Code. In all cases, a copy of any fee agreement between you and an attorney or accredited agent must be sent to: Office of the Senior Deputy Vice Chairman (012) Board of Veterans' Appeals 810 Vermont Avenue, NW Washington, DC 20420 The Board may decide, on its own, to review a fee agreement for reasonableness, or you or your attorney or agent can file a motion asking the Board to do so. Send such a motion to the address above for the Office of the Senior Deputy Vice Chairman at the Board. VA FORM JUN 2003 (RS) 4597 Page 2