Faust v. WestFaust v. West
- Reporters:
- , ,
- Before:
- Steinberg, Farley, Ivers
The appellant, veteran Paul L. Faust, appeals through counsel an October 28, 1997, decision of the Board of Veterans’ Appeals (BVA or Board) that reduced from 100% to 70% his Department of Veterans Affairs (VA) disability rating for service-connected post-traumatic stress disorder (PTSD). Record (R.) at 2. The appellant has filed a brief, the Secretary has filed a motion for single-judge affirmance, and the appellant has filed what he styles as a motion in opposition to the Secretary’s motion and requesting single-judge reversal. This appeal is timely, and the Court has jurisdiction pursuant to
I. Relevant Background
The veteran had active service in the U.S. Army from May 1968 to May 1972, including service as a helicopter pilot in Vietnam for which he received, inter alia, the Air Medal with Oak Leaf Cluster and the Distinguished Flying Cross. R. at 23. His service medical records (SMRs) reflected no psychiatric conditions. See R. at 26-189.
In October 1991, he filed with a VA regional office (RO) a claim for VA service connection for “Post Traumatic Stress”. R. at 191. In June 1992, the VARO awarded service connection for PTSD and assigned a 50% rating, effective October 1991. R. at 370-71. The following month, the veteran submitted a Notice of Disagreement (NOD). R. at 372. In April 1993, he testified under oath at a hearing before the RO. He described having nightmares that he said were triggered by seeing helicopters on television (R. at 449-50) and indicated that he was “very susceptible to loud noises” (R. at 450), had difficulty concentrating (R. at 452), and had problems with anger (R. at 453) and depression (R. at 449-55). He further testified that he had, “over the years”, sold insurance and investments but had not sold any “in probably three years and the renewals are decreasing every year”. R. at 456. He also apparently submitted documentation in support of his testimony that his taxable income in 1991 had been $675, whereas in 1987 he had earned $52,000. R. at 456-57. In May 1993, a board of two VA psychiatrists opined that the veteran’s PTSD “is quite severe and that he appears to be nearly completely disabled secondary by [sic] it” and also stated: “[W]e would like to emphasize that we believe [that] he is more than 50% disabled secondary to [PTSD]”. R. at 482.
Based on the April 1993 hearing, the hearing officer in July 1993 issued a decision in which he stated:
The evidence in its entirety demonstrated that the veteran’s [PTSD] results in a severe social and industrial impairment and warrants ... a 70% evaluation pursuant to the provisions of
38 C.F.R. [§] 4.132 , Diagnostic Code [(DC)] 9411 [(1996)] .... However, when applying the provisions of38 C.F.R. [§] 4.16([c]) the veteran is entitled to a 100% evaluation since the evidence shows as substantiated by his 1991 income tax return that he is unable to engage in substantially gainful employment.
R. at 491. The RO then issued an August 1993 decision that, “[i]n accordance with the [h]earing [o]fficer[’s] decision”, assigned a 100% rating, effective October 1991, for PTSD, based on the hearing officer’s having “found [a] reasonable basis for increased rating for service[-]connected PTSD including total (100%) evaluation under provisions of
In July 1994, the veteran’s former spouse, Ms. Johnson, filed a claim for apportionment of the veteran’s benefits on behalf of his son; Ms. Johnson submitted documentation—including financial statements from a business that she and the veteran had operated together and documents related to family-court proceedings—that indicated that the veteran had earned $48,000 in 1993. R. at 504-40. In August 1994, the veteran confirmed under oath before the RO that he had earned $48,000 in 1993. R. at 554.
As part of a September 1994 VA social and industrial survey, the veteran related that he was self-employed and that “he pull[ed] a high salary ... [, but because] the business itself [was] not making money” his business was “barely breaking even”. R. at 570. It was noted that he
In March 1995, the veteran submitted to the RO a request for copies of Ms. Johnson’s statements in support of her claim for apportionment. R. at 574. In April 1995, a “Veterans Service Officer” (VSO) at the RO notified the veteran as follows:
Under confidentiality rules, I may not release documents concerning one party to another without written permission. I do not have Ms. Johnson’s written permission to release copies of her documents to you.
As a result, I must deny your request under the provisions of the Privacy Act,
Title 5, United States Code, Section 552a , andTitle 38, United States Code, Section 5701 .If you do not agree with this decision, you may appeal in writing to: [VA’s Office of General Counsel (OGC) (address provided)].
R. at 560 (emphasis added).
At a VA PTSD examination undertaken in April 1995, the veteran described himself as having unchanged PTSD symptomatology. R. at 578. In the examiner’s report, following a discussion of that symptomatology, it was noted: “Per the patient’s history, and in comparison to the prior ... exam[ination] done 5/20/93, the only significant change for the better that the patient is reporting is that he is making more money and [is] able to support himself a little better.... I cannot see any significant changes at this time other than the increased income.” R. at 579. The RO in April 1995 determined that the veteran met the criteria for a 100% PTSD rating, which then required, inter alia, the following: “The attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community[,] ... [t]otally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality[, and] .... [d]emonstrably unable to obtain or retain employment”. R. at 582 (citing “
In May 1995, the veteran testified under oath at a hearing before the RO regarding the apportionment claim. R. at 585-94. He indicated that his salary was $3,000 a month and his VA compensation was $2,065 a month. R. at 585. Later that month, the RO received documents, apparently from the veteran, indicating that he had earned $38,000 in 1994. R. at 596-612. In July 1995, he requested “copies of the income and expense report(s) submitted by [Ms.] Johnson.” R. at 615. In July 1995, the VSO again refused to provide copies of those documents to the veteran and notified him of his right to appeal the VSO’s decision to VA’s OGC; the VSO also indicated that Ms. Johnson had “reported her net income as $566.42 monthly plus child support [and that her] expenses ... were $2561 monthly.” R. at 617.
The RO issued a June 1995 decision concluding that the veteran’s PTSD was “greatly over evaluated based on his current employment status”, and stating that a psychiatric examination should be conducted “at once”. R. at 619. At an August 1995 VA PTSD examination, the veteran reported that he had earned $36,000 in 1994, “based on business that he developed prior to PTSD becoming a problem for him in 1991”, and that since 1991 he had not experienced growth in his income. R. at 622. He also stated that he was “unable to work more than two days a week on average because of his PTSD.” R. at 623. The examiner diagnosed the veteran as continuing to have PTSD and indicated that he suffered “[m]ajor impairment in work, mood[,] and family relations.” R. at 625.
In a September 1995 decision, the RO, noting that the veteran was “self-employed
At a February 1996 hearing before the RO, the veteran testified under oath that he “might effectively work three days a week”. R. at 656-57; see also R. at 661 (veteran’s sworn testimony that in the past he had been able to work 60-70 hours per week, but, due to the PTSD, was only able to work 16 hours per week). He stated that his salary was then $36,000/year (R. at 657) but asserted that if he “would be able to work effectively [he] ... should be able to do well in excess of $100,000” (R. at 660); he appears to have been asserting that if he were not the owner of the business he would have been fired from his position due to his short work hours and the fact that “since 1991” he had not “added any new clients”. (R. at 668). In March 1996, the RO reduced from 100% to 70% the veteran’s rating for service-connected PTSD, effective June 1996. R. at 676. The RO noted that such a reduction “may be made when the evidence shows that improvement has been made in the severity of the PTSD symptoms.” Ibid. The RO also stated: “The veteran’s [PTSD] is not considered static (unchanging); therefore, a future examination will be scheduled to review this disability.” R. at 677. The veteran filed an NOD in April 1996. R. at 683.
An April 1996 VA outpatient psychiatric record noted that the veteran had indicated that he was unable “to work with others” but also had “ongoing compulsive work habits to avoid depression.” R. at 695. In May 1996, he made a fourth attempt to obtain information from Ms. Johnson’s claims file and was again notified by the VSO that such information was “protected” and that he could appeal to VA’s OGC. R. at 691. In September 1996, the RO issued an SOC as to the reduction of his PTSD rating, citing, inter alia, “
In August 1997, the Board received the following statement from Ms. Johnson: “I hereby request to withdraw my appeal for apportionment.” R. at 831. Also in August 1997, the veteran testified under oath before the Board that his PTSD condition had not “changed at all” since 1991. R. at 835. He reiterated that during “a really good week” he was able to work as much as 16 hours (R. at 836) and stated that his business had declined since 1991 and was operating at a year-to-date loss of $40,000. R. at 842-45. In the October 28, 1997, BVA decision here on appeal, the Board noted that the veteran’s 100% PTSD rating, assigned by the RO in August 1993 (R. at 494), had been “based on nonmedical evidence which revealed that the veteran was incapable of employment (primarily his W-2 for 1991)” (R. at 16) and that more recent evidence showed him to be earning “$48,000 in 1993 and that his income for 1994 was $3,000 per month” (R. at 18). In addition, the Board stated that the fact that the veteran “is not meeting his full potential in the workplace” did not support an award of a rating of 100% for his service-connected PTSD. R. at 17. The Board concluded that the “preponderance of the evidence support[ed] a reduction in the evaluation of the veteran’s PTSD from 100 to 70[%].” R. at 2.
II. Analysis
The appellant makes multiple arguments. First, he argues that the Board erred when it reduced his 100% rating in
As to the appellant’s assertions that VA failed to follow its own regulations in this case, “[t]he BVA is not free to ignore regulations that the Secretary has promulgated consistent with his statutory authority.... Rather, ‘[t]he BVA is required to apply all relevant statutes and regulations appropriate to the particular case before it.’ ” Wilson (Merritte) v. West, 11 Vet.App. 383, 385 (1998) (citations omitted) (holding that failure of VA to follow its own regulations in terminating dependency and indemnity compensation benefits, based on severance of service connection, constituted prejudicial error); see also Patton v. West, 12 Vet.App. 272, 283 (1999) (“the Court believes that substantial interests of justice dictate that the Court require the Secretary to adhere to his own regulatory provisions”); Buzinski v. Brown, 6 Vet.App. 360, 367 (1994) (“we agree that ... VA is obligated to follow the regulations it promulgates” (citing United States ex rel. Accardi v. Shaughnessy, 347 U.S. 260, 269, 74 S.Ct. 499, 98 L.Ed. 681 (1954); Vitarelli v. Seaton, 359 U.S. 535, 539, 79 S.Ct. 968, 3 L.Ed.2d 1012 (1959))). The Court has specifically required VA to follow its own regulations when it attempts to reduce a veteran’s rating. See Fugere v. Derwinski, 1 Vet.App. 103 (1990) (holding that VA was required to give notice and opportunity to be heard prior to deleting provision of VA Adjudication Procedure Manual M21-1 that had provided regulatory-like procedural protections prior to reducing veteran’s rating, and noting: “Where the rights of individuals are affected, it is incumbent upon agencies to follow their own procedures.” (citations omitted)), aff‘d, 972 F.2d 331 (Fed.Cir.1992). The Court determines de novo whether VA has followed and applied its own regulations in reducing or terminating VA benefits. See Wilson (Merritte) (making determination de novo without so stating) and Fugere (same), both supra; Brown (Kevin) v. Brown, 5 Vet.App. 413, 416-21 (1993) (same); cf. Buzinski, supra (reviewing de novo compliance with VA regulation regarding mortgage foreclosure). If VA affords to a veteran the applicable procedural protections and nonetheless determines that a reduction in rating is warranted, the determination as to the degree of disability under the applicable diagnostic code is a finding of fact subject to the “clearly erroneous” standard of review. See Smallwood v. Brown, 10 Vet.App. 93, 97 (1997); Gilbert v. Derwinski, 1 Vet.App. 49, 53 (1990). In determining whether a finding is clearly erroneous, “this Court is not permitted to substitute its judgment for that of the BVA on issues of material fact; if there is a ‘plausible basis’ in the record for the factual determinations of the BVA ..., [the Court] cannot overturn them.” Ibid.
A. General Rating-Reduction Matters
Prior to reducing a veteran’s disability rating, the Board is required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See
[Such review requires VA] to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.... Thus, in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work.
Brown (Kevin), 5 Vet.App. at 421; see also Schafrath, supra (“[t]hese requirements for evaluation of the complete medical history of the claimant’s condition operate to protect claimants against adverse decisions based on a single, incomplete[,] or inaccurate report and to enable VA to make a more precise evaluation of the level of disability and of any changes in the condition”).
Although it is true that the record on appeal (ROA) contains no medical evidence of a change in the veteran’s PTSD symptomatology, the Board noted that the RO had originally (in August 1993) assigned a 100% rating “based on nonmedical evidence which revealed that the veteran was incapable of employment (primarily his W-2 for 1991).” R. at 16 (emphasis added); see also R. at 493-94 (August 1993 RO decision relying on July 1993 hearing officer decision that had concluded that 100% rating was warranted based on veteran’s “1991 income tax return that [showed that] he is unable to engage in substantially gainful employment”). Thereafter, evidence was submitted that he was in fact employed and earned substantial income. See, e.g., R. at 554 (veteran’s August 1994 sworn testimony that he had earned $48,000 in 1993); R. at 579 (April 1995 VA examination at which veteran reported “that he is making more money and [is] able to support himself a little better”); R. at 622 (August 1995 VA PTSD examination report indicating that veteran stated that he had earned $36,000 in 1994 and worked two days per week). Although none of that evidence indicated a change or medical improvement in the veteran’s PTSD symptomatology, that evidence did show improvement as measured by the nonmedical criteria—his earnings—that had been used by the RO in its August 1993 assignment of a 100% PTSD rating. Based on the BVA’s determination that the RO had relied upon nonmedical evidence such as the veteran’s 1991 tax return cited by the hearing officer, the evidence does reflect “an actual change in the disability”, Brown (Kevin), 5 Vet.App. at 520, because the veteran’s earned income had dramatically increased from “$675” in 1991 to “$48,000” in 1993 and was still “$36,000 in 1994” (R. at 456-57, 554, 622).
The appellant argues that the use of purely economic evidence to find an improvement in his disability violates the requirement that a disability undergo an “actual change ... based upon thorough examinations”, Brown (Kevin), 5 Vet.App. at 421 (emphasis added), before a reduction in rating may be instituted; however, there is nothing in the regulations cited above that requires that the “actual change” be one measured in terms of medical improvement or that it be based on medical data derived from examinations rather than on the “entire evidence of record”,
As to the veteran’s assertions that if he were not disabled by PTSD he would “be able to [earn] ... well in excess of $100,000”, that his business has been in a steady decline, and that if he were not the owner of his own business he would be unable to work for that business or for any other employer (R. at 660, 668 (February 1996 testimony); see also R. at 836-40), the Board stated:
The Board notes that the veteran has argued that as a result of his PTSD he is unable to earn the type of salary consistent with his education and background. In addition, the veteran asserts that this business has not grown since 1991 and is on the decline. The Board notes that the criteria for a 100[%] evaluation requires [sic] that the veteran is demonstrably unable to obtain or retain employment (old criteria [sic]) or has total occupational impairment (new criteria [sic]). However, the Board finds that the veteran does not meet this criteria [sic] merely by showing that he is not meeting his full potential in the workplace. Moreover, the Board acknowledges that the veteran has severe occupational impairment and a 70[%] evaluation takes such impairment into consideration.
R. at 17 (emphasis added). The Board considered the veteran’s PTSD disability “in relation to its history”,
B. Special Protections for 100% Ratings
In certain rating-reduction cases, VA benefits recipients are to be afforded greater protections, set forth in
1.
(c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more).
2.
(a) General. Total disability ratings, when warranted by the severity of the condition and not granted purely because of hospital, surgical, or home treatment, or individual unemployability will not be reduced, in the absence of clear error, without examination showing material improvement in physical or mental condition. Examination reports showing material improvement must be evaluated in conjunction with all the facts of record, and consideration must be given particularly to whether the veteran attained improvement under the ordinary conditions of life, i.e., while working or actively seeking work or whether the symptoms have been brought under control by prolonged rest, or generally, by following a regimen which precludes work, and, if the latter, reduction from total disability ratings will not be considered pending reexamination after a period of employment (3 to 6 months).
....
(c) Individual unemployability. (1) In reducing a rating of 100 percent service-connected disability based on individual unemployability, the provisions of § 3.105(e) are for application but caution must be exercised in such a determination that actual employability is established by clear and convincing evidence. ...(2) If a veteran with a total disability rating for compensation purposes based on individual unemployability begins to engage in a substantially gainful occupation during the period beginning after January 1, 1985, the veteran’s rating may not be reduced solely on the basis of having secured and followed such substantially gainful occupation unless the veteran maintains the occupation for a period of 12 consecutive months. For purposes of this subparagraph, temporary interruptions in employment which are of short duration shall not be considered breaks in otherwise continuous employment.
According to the language of the regulation, paragraph (a) of
In this case, the basis of the veteran’s 100% rating is unclear. The August 1993 RO decision (R. at 494) and July 1993 hearing officer’s decision (R. at 489) both cited to
It is clear, however, that the Board should have discussed the application of at least one of those paragraphs and that it failed to discuss either. Cf. R. at 12 (reiterating the contents of, but not applying, paragraph (a) of
a.
The Board notes that the medical evidence of record at the time of the March 1996 rating reduction did not indicate a change in the veteran’s symptomatology; however ..., the veteran’s total evaluation was not based on medical evidence originally, but on evidence that the veteran was incapable of supporting himself as a result of his PTSD. However, the medical evidence of record at the time of the March 1996 determination indicated that the veteran had a high salary (September 1994 [Social and Industrial] survey [(R. at 570)]), reported more income and was able to support himself better (April 1995 VA examination [(R. at 578)]), and made $36,000 in 1994 (August 1995 VA examination [(R. at 622)]). Accordingly, these examination reports reflected material improvement in the veteran’s condition.
R. at 16 (emphasis added). The requirement of “examination[s] showing material improvement” is set forth in
b.
Pursuant to
38 C.F.R. § 3.105(e) , when the RO determines that a rating reduction is warranted, it is required to issue a proposed rating reduction, setting forth the reasons for the proposed reduction, and to allow the veteran a period of at least 60 days to submit additional evidence to show that the rating should not be reduced. Furthermore, when, after such period, the RO issues a decision reducing the rating, that reduction does not become effective until the“[l]ast day of [the] month following 60 days after notice to [the] payee” of the reduction decision. 38 C.F.R. § 3.400(r) (199[8]); see38 C.F.R. § 3.105(e) .The effect of
§§ 3.105(e) and3.400(r) combined is that a rating reduction cannot be made effective for a minimum of 120 days after it is proposed in writing to the veteran.
Brown (Kevin), 5 Vet.App. at 418.
In this case, the RO proposed in September 1995 that the veteran’s rating be decreased from 100% to 70%. R. at 628. The RO decision effectuating that reduction was not issued until March 1996 (R. at 676), well over “60 days” after the September 1995 RO decision (
In addition to requiring that the Board comply with
Similarly,
In order to determine whether in this case there is clear and convincing evidence under
Although
We first consider the “amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person”.
In view of
As to the requirement under
Hence, the Court holds, as a matter of law, that even if
C. Reduction of Rating from 100% to 70%
It is not clear, based on the pleadings presented to the Court, that the appellant challenges the Board’s factual predicate, as distinguished from the Board’s compliance with the legal protections afforded to existing ratings under the applicable VA regulations, for making the rating reduction in this case. In any event, the Court finds a plausible basis in the record for the Board’s determinations that the veteran had originally been evaluated as 100% disabled based on nonmedical criteria and that he no longer meets those nonmedical criteria, and thus, in light of the legal conclusions that we reached in parts II.A. and B., above, the Court holds that the Board was not clearly erroneous in deciding to reduce, as of the date of the March 1996 RO decision, the veteran’s 100% rating to 70%—which is the next-highest rating after 100% provided for under the current and formerly applicable diagnostic codes (see
D. BVA’s Consideration of Evidence Not Made Available to Veteran
In addition to asserting that the proper procedures set forth in VA regulations were not followed in this case, the appellant asserts that the BVA improperly considered evidence that it had obtained in connection with Ms. Johnson’s apportionment claim but that was not made a part of his claims file and has not at any point been provided either to him, or, for that matter, to this Court. Brief at 7-9. Regarding its consideration of information contained in Ms. Johnson’s claims file, the Board stated:
The Board notes that information regarding the veteran’s business and earnings was not only contained in evidence submitted by the veteran’s former spouse, but also in the veteran’s own testimony at an August 1994 personal hearing before the RO....
... [T]he Board notes that evidence submitted regarding one claim may be considered by VA in any matter pertaining to the veteran. ... As this evidence is relevant to the veteran’s claim, it cannot be ignored.
R. at 18 (emphasis added). Based on our review of the BVA decision, it appears to the Court that all of the evidence actually discussed by the Board in support of its decision in this matter—i.e., that the veteran had earned $675 in 1991, $48,000 in 1993, and either $36,000 or $38,000 in 1994—was provided by the veteran himself at VA hearings and medical examinations and in connection with a September 1994 VA social and industrial survey. See R. at 456-57, 554, 570, 596-12, 622. Because this evidence was clearly available from sources other than Ms. Johnson’s claims file, the Board’s statement that claims file “cannot be ignored” (R. at 18) is, on its face, simply not true.
Moreover, as a general matter, VA should not consider in its decisions any evidence not made available to the claimant. Several provisions of title 38 of the U.S. Code require VA to disclose to a claimant and/or to summarize the contents of the evidence relevant to his own case.
As to the inclusion in the ROA of evidence relied upon by the Board, that is, the provision to this Court of such evidence (as opposed to the provision of that evidence to the veteran during the course of the administrative proceedings below), the Secretary is obliged by a standing order of this Court to, “in all ... proceedings before the Court, transmit without further order of the Court ... all records and other materials that are not subject to the protection of
Notwithstanding our disapproval of the Board’s insistence that it could not “ignore[ ]” evidence contained in Ms. Johnson’s claims file that may not have been provided to the veteran in this case, especially when it appears that the evidence required to adjudicate this claim was actually provided to VA by the veteran himself, and notwithstanding as well the fact that the Secretary is required to provide to this Court copies of any evidence relied upon by the Board based on In re Standing Order, supra, and this Court’s Rules of Practice and Procedure, we will not vacate the Board’s decision on this basis for several reasons.
First, regarding any possible violation by the Secretary of In re Standing Order, supra, the Court notes that the ROA in this case does in fact contain copies of Ms. Johnson’s original claim for apportionment as well as several documents that appear to have been submitted to VA in connection with that claim. R. at 500-22. Thus, as a factual matter, it appears that at least some information from Ms. Johnson’s claims file is in fact included in the ROA filed by the Secretary in this case and thus that the Secretary may not in fact have acted in violation of the Court’s Standing Order.
As to the appellant’s complaints that he was not provided with copies of documents contained in Ms. Johnson’s claims file during VA’s adjudication below of the claim
Moreover, because, as discussed above, it appears to the Court that the evidence relied upon by the Board—i.e., the veteran’s income in 1993 and 1994—had been provided to VA by the veteran himself on several different occasions (R. at 554, 570, 596-612, 622, 657), it is unclear to the Court how he can now claim to be prejudiced by the Board’s consideration of evidence in Ms. Johnson’s claims file showing the same such income. See
In view of the lack of any apparent basis for prejudice to the appellant here as well as his apparent failure to exhaust his administrative remedies, and in view of the overwhelming evidence contained in the ROA regarding the veteran’s income that, as a matter of law, justified the reduction of his rating from 100% to 70%, the Court rejects this argument by the appellant for vacating the BVA decision on appeal. See Winters v. West, 12 Vet.App. 203 (1999) (en banc) (“even where the Court concludes that an error has been committed, it need not—indeed must not—vacate or reverse the BVA decision if it is clear that the claimant would have been unsuccessful irrespective of the error” (citing Soyini, supra)); Edenfield, supra.
III. Conclusion
Upon consideration of the foregoing analysis, the ROA, and the parties’ pleadings, the Court holds that the appellant has not demonstrated that the BVA committed error—in its findings of fact, conclusions of law, procedural processes, articulation of reasons or bases, or consideration of the benefit-of-the-doubt rule—that would warrant reversal or remand under
AFFIRMED.