CAVC–Garrett v.Shinseki(SJD) -Whoa! I’m a nurse.

Posted on September 28, 2011 by asknod

Have you ever stepped in dog doo? Disgusting, isn’t it? If there’s nothing to lean against and no stick or water hose handy, you’re stuck with it-literally. If you’re wearing tennis shoes with one of those really nifty positraction soles, you have a stinky hitchhiker for a while.  

     Now imagine denying a claim and when it goes up to appeal and everyone at the BVA assumes a lot of things they shouldn’t. It sticks to their shoe and no matter how hard they try, they cannot divest themselves of it. Then something else sticks to the poo. Pretty soon you have a Bigfoot growing on you.

     Julia M. Garrett, the widow of a very brave soldier, applied for DIC based on her husband’s death. She rightfully believed he picked up his HCV in the service or, in the alternative, via a transfusion in a VAMC in 80. She was not an attorney and did not know to file a separate 38 USC § 1151 claim for SC, but she was a nurse. More about that later. She filed based on his passing from HCC. People with HCV get that quite frequently. VA looked up and blithely whistled past the graveyard and said no. Their theory was to ignore anything but what was filed for. VA does that a lot. The law has been around for a while and there is no ambiguity here. You help the  Vet with his /her claim wherever it leads.

In response, the Secretary argues that the examiner’s failure to note the blood transfusion is of no consequence because such evidence would only help to establish a claim for service connection for Mr. Garrett’s death under 38 U.S.C. § 1151.  See Sec. Br. at 13-14.  He avers that the Court does not have jurisdiction to consider this theory of entitlement because Ms. Garrett has never filed a claim for benefits under § 1151.  See id. VA “has a duty to ‘fully and sympathetically develop a veteran’s claim to its optimum.'” Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004) (quoting Roberson v. Principi, 251 F.3d 1378, 1384 (Fed. Cir. 2001)).  Accordingly, VA must “determine all potential claims raised by the evidence, applying all relevant laws and regulations.”  Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 1998)  (internal  quotations  omitted); see also  38  U.S.C.  §  7104(a) (2011)  (Board is required to consider, and discuss in its decision, all potentially applicable provisions of law and regulation).   Garrett v. Shinseki (2011)

     I have often mentioned that VA examiners and others in their employ are inherently unschooled and lazy. I don’t blame them per se.  They come to convoluted decisions because computer programs lead them there. Witness how this gets the VA in deep trouble because they didn’t read the records closely enough to discover Mr. Hayman J. Garrett’s wife is a documented nurse and has “medical training”.  In their haste to push print and get this over, they go to their Adobe Acrobat button and select “no medical training therefore her lay testimony is worthless” in matters medical. That one alone will provoke a remand, but there are even more errors…


Here, the Board stated “there is no indication in the record that the appellant is a physician or other health care professional. Therefore, as a layperson, she is not competent to provide evidence that requires medical knowledge.” R. at 13.  However, the record in fact indicates that Ms. Garrett is a nurse.  See R.  at  202,  856.  Furthermore, contrary to the Secretary’s argument, it was not incumbent upon Ms. Garrett to provide proof of her medical knowledge and training to the Board; it was not until after the Board decision that she became aware that the Board found her statements inadequate.  See Bernard v. Brown, 4 Vet.App. 384, 394 (1993) (“[W]hen . . . the Board addresses in its decision a question that had not been addressed by the RO, it must consider whether the claimant has been given adequate notice of the need to submit evidence . . . on that question.”) (Garrett supra).

This was just a single judge decision, but it illustrates how these fellows run slipshod over the facts in their headlong rush to deny. If caught in a lie, simply complain loudly that it’s immaterial anyway. I seem to remember a former President using a variation on that defense.

     I certainly get no joy in finding these examples that cause such embarrassment to the Secretary. I do it for you to illustrate VA’s marked propensity to give you short shrift. Fortunately. Ms. Garrett will undoubtedly get her DIC. When VA commits this many errors and is unmasked, they generally do not deny again and risk the wrath of the Judges all over. No, this one’s in the bag for the transfusion if nothing else. Her being a nurse is just icing on the cake. How do you overlook the word Nurse when it’s associated with her in the records? Looks like a reckless speed reading ticket is in order or dyslexia to me. “Well, your Honor. In all honesty, we didn’t know Nurse Garrett was actually a “nurse” nurse. She sure didn’t speak up and mention it to us. That’s bogus. And as for this §1151 business, we’re getting blamed for not doing anything. That’s no fair. What? We have to file everything around here now for the claimants?” It’s almost too bad the Judge didn’t just reverse and remand for a rating. 

http://search.uscourts.cavc.gov/isysquery/1086ce8f-3301-4f71-94eb-690f8cd2edb9/41/doc/

In the upper left hand corner are View, Download and Details. Click on Download to look at it.

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Fed. Cir.–Singleton v. Shinseki–(2011) Fed. Cir.

Posted on September 28, 2011 by asknod

I understand the concept of justice.  I also understand interminable delays on VA’s part. They are famous beyond words for that. Look up delay in the dictionary and there’s undoubtedly a picture of the façade of 810 Vermont Ave. NW. Washington, D.C. 20420.

     George Singleton knows of this phenomenon. He’s been fighting VA since about 1980 for SC on his PTSD. The fact is he had it. No one will argue that any more. VA finally got around to acknowledging this about 2001 and only under threat of the Court.

     They gave him a glorified Fenderson “staged “rating with variable percentages predicated on the progression of the disease over time. Phase III of this progression entailed a slight drop from 100% down to 70% because he was able to hold employment during the ten year term on and off.  Phase IV went back to 100% to present. George felt this was tacky and against the law so he lawyered up with one of the finest VA lawyers around- Kenneth Carpenter. Ken must have thought there was some merit to the argument because they took this all the way up to here. Here being the Federal Circuit.

     Having now lost on appeal to the BVA and the Court, it is unclear why Ken and George thought they could find a sympathetic ear at the Fed’s bench. If you do not attempt it, you will never know, I guess.

     I’m not going to say things like gee, what a greedy bozo he was. I suppose it’s a lot of samoles, but Lord look at the settlement he received.

Period 1 is 8 months @ 50% (1980)= $800/mo.= $6,400.00 (approx.)

Period II is 10 years and 10 months @ 100% (1980)= $2600/mo.=$ 338,000.00 (approx.)

Period 3 is 8 years and 11 months @ 70%(1980)=$1300/mo.= $141,700.00 (approx.)

Period IV is 10 years and 8 months@ 100%(2000-10)=2750/mo.= $352,000.00 (approx.)

    On paper in percent form it doesn’t sink in. When translated into dollar figures it makes one stop and take pause. That’s $838K in rough figures,  slightly more or less for some rug rats.  Without interest for all those years makes it a crime, but we often don’t get a lime in our Corona either. So our buddy George is blowing an ass gasket over another $196,300.00. That’s no small sum and I’m sure Kenny egged him on since he gets 20% of all of it. In the scheme of things old George hit Monty’s cookie jar. I can think of a lot of Vets who might have been happy and gone home. Not George. He and the Kenster started kicking this can up the ladder  once they smelled the money tree. Their logic was infallible, but this was a rare form of justice being administered back into the past based on available evidence. To say that VA can or can’t do  something  they’ve  never been faced with is being pushy. When it’s an argument over 200K or so after over 4/5ths of a million dollars has been proffered is being petty. Maybe I’m just jaded and have different mores.

     The good news is they can take it up to the Supreme Court if they can get certiorari. That’s a big if. 


http://www.veteranslawlibrary.com/files/Fed_Cir_Cases/2011/Singleton_10-7106.pdf

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CAVC–Merczel v. Shinseki- Sorting out the Hickson Elements(SJD)

Posted on September 27, 2011 by asknod

VetCourtAppealsPromoSweet. That’s what this decision is. It tunes in the ICU2TV and let’s us look at another example of what justice is, and isn’t, supposed to be about.  Although the decision is by a single judge and not an en banc precedent- setting one, the lessons to be learned are very important. Even I was a little taken aback by what St. Mary reasoned. You, as a pro se Vet, can use it as well.   VA’s propensity to use absence of evidence to prove a point or rebut lay testimony is well-known.  This decision explains it so well and provides the perfect example.

    Mr. Henry Merczel must be an incredibly patient Vet. He filed in 2002 and got the standard treatment we all do. He filed the NOD and everything moved up to the Board… and back for a remand . Then back to the Board…and back for remand #2. Then back again yet a third time to the Board for his final denial. Henry gladly took a number, moved up to the Court and waited. This why it took so long to get to this part of the story.  I print here the best as an hors d’oeuvres:

First, the Board’s discussion erroneously conflated the second and third elements of a service connection claim. The Board found that the appellant’s claim failed because “[t]he evidence [did]not show in-service incurrence or aggravation of hepatitis C.” (emphasis added).  The second element does not require such particularity; rather, the appellant must show an in-service disease or injury that he alleges caused or aggravated his current disability.    Proving a connection between an in-service disease or injury and a current disability is the requirement of the third element in a service-connection claim. The appellant alleges that either his in-service inoculations, scalp laceration, or index-finger laceration could be the “injury” that led to his contraction of hepatitis C. The Board did not question the credibility of the appellant’s assertions that such incidents occurred, and, in any event, they find support in the record.  When the Board discussed the unlikelihood that any of these incidents were connected with the appellant’s hepatitis C, however, it was making a nexus assessment and erroneously imposing a more demanding showing for the second element of a service-connection claim than is required. (stating that the incidents proffered by the appellant “are not known risk factors for hepatitis C”). This confusion renders the Board’s statement of reasons or bases for its decision inadequate because it prevents the appellant from understanding the basis for the Board’s conclusions and hampers review by this Court.  See Caluza and Allday, both supra.  Merczel v. Shinseki (2011)

VA has always dragged in the “Well, he didn’t have hep. c in service, so that pretty much tells you what you need to know.”. Judge Mary Schoelen has finally unwrapped the phraseology and exposed the error. We owe her a big favor

The second thing this decision represents is that the Court will not tolerate VA’s shenanigans when they are clearly in the wrong.  Here, VA forgot to give this guy SC and a rating for Reynaud’s Syndrome that he had in service. Then they tried to cover their asses by saying he needed a nexus. This is one of the few times you don’t. If you have a documented, chronic disease in service and documented medrecs of it being chronic, then it’s a done deal. You file, you win and you go home. VA, and especially the BVA, had no business denying this claim and Judge Mary reminded them by reversing and handing  Henry a blank SC slip for Reynaud’s.  We have always looked for a legal way to get around this and Groves did overturn established law in this vein. Judge Mary was also quick to point Groves out to the VASEC who begrudgingly acknowledged she was right. In order to maintain his ego, he wanted another do over (number 3) so he could hang old Henry out to dry for another 2 years.  Judge Mary wasn’t having any of that as you will read. She went into a long self-check legal menu of when it would be permissible to remand an error of this breadth and depth of perfidy. At the end, she delivered the riposte and said “Naw. No vacatur. I’m reversing. If you hadn’t been such assholes and wasted 10 years of his life, I might be inclined to remand.”

     It’s a relatively short read (10 pages) as legal filings go, and gives you a shiteatten grin when you observe Uncle Eric get the bitchslap. I apologize for my risqué language today but I feel colorful. Ebonics evokes such rich metaphors compared to  my dry, whitebread language.

MerczelH_09-3487

  And what should my wondering eyes behold today than Mr. Merczel’s win at the BVA. Not only that, but he nailed them for Reynaud’s Phenomenon in the right hand as well but he got it on presumptive in § 3.307. $100 says that’s related to the hep. It’s cryoglobulinemia and the buildup of IgG globulins in the small veins is like blood mud in cold weather. 

downloadThe reason the decision reads like a short story is the remand instructions from St. Mary Schoelen above at the CAVC. She’s onto the BVA for the asinine rationale for denial all the way up the ladder since 2002. They’ve been playing him like a small mouth bass and keeping him in deep water away from snags. Have you ever seen a BVA Judge say “Well, there are competing opinions so let’s blow off the VA examiner’s pipedream and give the benefit of the doubt to Henry.” Shit oh dear. Either Judge Deborah Singleton is a blood relative of Henry Merczel or she’s smoking some killer Matanuska Thunder f**K  and was too stoned to bang the gong. Perish the thought that Laura Eskinazi happened to run into her in the hallway at lunch and tell her to “rocket docket” old Henry  for SC.

Of course it could be the OGC realized they had stepped on their necktie and if it ever went back up to 625 Indian Ave. NW, there would be hell to pay. As we say at Asknod, the squeaky mouse gets what behind door number 3. This time it was Monty’s Cookie Jar for the full meal deal. Congratulations, Henry on a well-deserved win. Another twelve year claim finally extricated from the backlog. Onward through the fog.

Now serving BVA Vet

download (1)

Number 527,675

Posted in BvA HCV decisions, HCV Risks (documented), Important CAVC/COVA Ruling, Jetgun BvA Decisions, Jetgun Claims evidence, Nexus Information | Tagged , , , , , , , , , , , , , , , , , , | 2 Comments

CAVC–Clark v. Shinseki -SJD–Absence of Evidence is Not Negative Evidence

Posted on September 27, 2011 by asknod

VetCourtAppealsPromoWhen I set out on my own to defend myself in early 2008, I did so with the idea that I couldn’t do any worse that the chuckleheads collecting a paycheck for it (my VSO). I began by starting in 1994 and reading every single BVA HCV or HBV decision to find out what I did so wrong in 1994.  No one had appealed this kind of thing up to the Court then so there was no precedent there. Besides noticing I didn’t have a nexus, I saw a pattern in the denials. Some Vets without nexi won, but they all had combat badges, medals or evidence of hep in service. 

     Then a sea change ensued. VA formed a huddle and a quick game plan emerged.  Suddenly Vets needed that nexus or all was lost. Some still won, granted, but there was a dramatic increase of denials. Face it; there was also a dramatic increase in claims for this (HCV) that were starting to be a noticeable blip on the VHA radar. More and more denials suddenly developed a drug overtone whether there was evidence of it or not. Alcohol abuse, “strange behavior”-even homelessness were often cited as evidence of a risky lifestyle. Soon after, any time spent in prison more than 3 days was accorded the same risk. All these items could be cherry picked to fit the claimant’s lifestyle.  New risks were added all the time-some almost inherently incredible. 

      When the jetguns entered the picture, a few got by. VA poobahs convened again and issued the FAST letter hoping that would quell it. By now, doctors could determine if you had ever had Hep. A or B and began the practice of denial based on only having had evidence of HBV in service. Suddenly, the absence of any C in the records in 1974 was grounds for denial. Or the opposite finding of Hep. A provoked the insinuation that your hep. in service was A and not C. Testing in the 70’s for which hep. you had was sporadic at best. If you survived and it only lasted a week or so, it was probably A . If you got puke sick and it gave you a raging case of OJ skin for 4 weeks then it was B. They finally developed a test later that determined if it was B. If it wasn’t positive for B then you had A.  Brilliant test idea.  Now, in the 90s to present, we have witnessed the beginning of the end for this logic. The judges are becoming educated and can see through that ruse.   

     VA had such wonderful success with that denial ploy that they convened again several years ago and moved on to a higher plateau. They had to come up with a new idea to deny. Can you imagine a smoky room with a bunch of perspiration-soaked VA lawdogs and their lackey doctors arguing for a new strategy to combat the utter tsunami of hep. c claims washing up on their shores? Suddenly the epiphany dawns on one. “What if? What if we begin denials based on no evidence of the risk in the SMRs (also known now as STRs)? Like, you know, the Vet claims he was exposed to sharing razors and toothbrushes, but it’s not in his medrecs? We could deny on that, right?” And so was born a new age of denials. Judges didn’t think this shittus up. They ruled on what was provided for them to rule on. The untermenshen did the dirty work and stuck it under their noses. Unless a judge had a good grip on the Hepatitis C disease process, he would be inclined to sign off on this.

     This has worked quite well for a time. Now it is starting to backfire. I saw it in a Single judge decision and wrote it up for the CAVC decisions forum under Strong v. Shinseki – Shared Razors:

 

First, there is no reason to believe that a soldier’s sharing of razors with other soldiers would be documented in the soldier’s service medical records, and this absence of “corroboration” cannot be dispositive.  Second, the examiner did not discuss the risk factors for hepatitis C at all, including the relative level of risk involved in intravenous or intranasal cocaine use versus the level of risk involved in smoking cocaine, which is how Mr. Strong has consistently alleged he abused the drug. Therefore, the examiner’s conclusion that Mr. Strong’s hepatitis C is more likely than not related to his drug abuse is presented without any rationale and renders the opinion inadequate Strong v. Shinseki (2011)

     Kahana v. Shinseki, recently decided, found another common error we are seeing. That is, the overlooking of obvious facts contained in the medrecs. VA has always done this, but was admonished to knock it off years ago. Apparently they need to be re-educated.

     The new reality is that non-evidence is now negative evidence. VA is knee-deep into this new cesspool. Now they are unmasked.  I posted a blurb with color illustration of the non-evidence method of denial in the Members Q&A under “What Wasn’t Said Is Important”. 

     What the Vet can discern here. I hope, is the constant shape-shifting aspect of VA’s denial process. As quickly as we can identify a new denial method, they shift to a newer one. They always seem to be several steps ahead of us in this respect. Remember the old Maxson v. Gober decision stating that claiming something 30+ years later is rather suspect? It, too, is listed in the CAVC forum. That worked until a judge noted that that is the very hallmark of Hep. C. It’s a stealth virus that surfaces decades later and goes undetected in the interim. Nevertheless, that was the banner for denial for years on Hep. C and is still cited on occasion by those who haven’t had “the briefing”. 

     The recent spate of decisions exhibiting this new ploy will slowly abate and a brand new, as yet unseen and unforeseeable “gottcha” will soon appear. Mark my words. What it will entail is classified and still being thrashed out in the aforementioned room somewhere at 810 Vermont Ave. NW by those perspiration-challenged attorneys and doctors. Rest assured they will not rest until this epidemic of hep. c claims is conquered- not the disease. This just confirms my belief that they start with a denial and extrapolate backwards to construct the scene of the crime, the drugs involved and the character of the claimant.  Mathematically it looks like this:

      Z= D + R(X) + N, where Z equals denial; D equals any form of drugs or alcohol; R equals risk factor multiplied by (X); X equals willful misconduct risks or risks experienced after service (intercurrent); and lastly, N equals a VA nexus by a VA examiner that concurs in the finding of “less likely than not”.  This formula is malleable and subject to reinterpretation when vacated and remanded by the Court to the BVA. Flexibility is a plus here.

     Gradually we will attain victory but I suspect there will be few of us standing when they finally issue the FAST letter that states all future claims for hep. C where the claimant was exposed to Pedojet or Munji guns will be approved based on a presumptive risk.  It’s small consolation to dead Vets. I know I will sleep better in my urn knowing this.                                                                                                                                                                                                  At any rate, the following single Judge decision enunciates all the hallmarks of the Kahana decision. The finding that absence of evidence is not negative evidence is refreshing and finally becoming a gale force wind rather than an occasional breeze. We hope to see more of this and less obfuscation by the lower tribunals. It’s way overdue. Mr. Clark will benefit from this and hopefully prevail.

ClarkEE_09-1496

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Fed. Cir.– Padgett v. Shinseki Fed. Cir. (2011)–Substitution on the Claim

Posted on September 27, 2011 by asknod

We do not normally look at Federal Circuit decisions unless they involve Vets. This one is like the iceberg that the Titanic struck- and with similar results for the BVA and the CAVC.

Clara Sue Padgett took over her husband’s long and tortuous case after he succumbed during its pendancy. We can all relate to this. The phrase “deny until they die” rises in the back of my throat, but I will resist it.

Barney O. Padgett was a survivor of the “Big One”. He was awarded SC for a bum knee in 1945. Fast forward to 1993 and a filing for a right hip injury related to service. He did it right complete with two nexi from accredited doctors no less. The RO showed him the door. This started a very long ping pong game with his claim. The BVA would remand on some minor technicality and the RO would deny yet again. And so on and on. Finally, in 1999 the ping pong game moved to the Court where the same process ensued. Starting in 2001, it went back down to the BVA and back up to the Court and yet again to the BVA.

Barney and the VASEC asked the Court for an en banc review which they accepted in 2004. In April of 2005 (12 years after this all began) the en banc Court reversed the BVA and found in Barney’s favor. As usual, this began another jaunt down to the BVA and thus to the RO for a rating Perhaps this was too much for old Barney’s heart because he set sail on his new life adventure in November of that year. I don’t blame him.

This didn’t set well with the VASEC. He promptly petitioned the Court to recall the en banc decision as moot in light of Barney’s recent departure. Clara Sue didn’t cotton to this as she had a lot of law dog time invested. Moreover there was a lot owing due to the VA’s fighting tooth and nail with her for over a decade. The Court agreed with VASEC and bingo- bye bye to Clara Sue’s petition to be substituted in the claims process. Clara armored up and headed up to the Fed. Cir. and won! So, Back down to the Court where it was handed back to the BVA where it was handed back to the RO(again).

Clara was getting her sea legs now and concurrently filed for accrued benefits on Barney’s claim. VA denied and that began another legal brouhaha. First the RO denied, then fell on their sword and admitted CUE in old Barney’s hip claim. The Court reinstated the en banc decision in 2008 and all seemed fine in Mudville. Unfortunately, the VASEC just couldn’t leave well enough alone. One would think with his track record recently against aggrieved war widows, he would have tucked his tail between his legs and quietly exited the building.

But noooooo! He couldn’t walk away after being dissed by an old woman. She filed an EAJA claim for $87+ K for all this work as rightfully she should have. After all, she had won this hands down and the Fed. Cir. concurred. The VASEC got rather purple in the face and said no way- Barney’s dead and this has to end. The Court decided she was only partially entitled to the funds due – but only up to and ending upon Barney’s ending. That amounted to about $27K and left a substantial sum still due and payable for work done after he passed to obtain a judgment for monies owed from before he passed. When you get rid of all the sua spontes and nunc pro tuncs and turn this into  DickandJanespeak, it  suddenly makes perfect sense. It did to Clara at any rate.

So, guess what ? Back to the Fed. Circuit yet again to get what should never have been a bone of contention. The Feds agreed and not only agreed, but reversed the CAVC and sent them an accelerated payment plan- Pay Up!

What Clara Sue has accomplished for us is monumental. This is a piece of work 18 years in the making of legal wrangling to obtain that which should have been granted long ago. How many trees did they have to cut down to print all this? Why? Law is cut and dried. It sometimes takes some legal reasoning to discern the trees for the forest but this is a classic example of “we’ll see it when we believe it” rather than the obverse. Thank you Clara Sue from all of who will benefit from your dogged determination to see justice accomplished. If this isn’t a teaching moment of how far VA will go to deny one their due, I don’t know that I can supply a more illustrative example.

http://www.veteranslawlibrary.com/files/Fed_Cir_Cases/2011/Padgett_10-7081.pdf

 

Print this up and take a nice glass of iced tea out to the porch with you. This will warm your heart.

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CAVC–Trusty v. Shinseki (2011)– Never Trust a VA Patient Advocate (SJD)

Posted on September 27, 2011 by asknod

VetCourtAppealsPromoHere is another one of those “Can you believe this ?” decisions. It’s a Single Judge decision so we can’t use it for a precedent, but it sure does a wonderful job of illustrating what can happen to you in this system that was geared towards He who shall have borne the battle, his widow and his orphan child…

Carol Trusty, widow of Edward L. Trusty, filed a claim in May, 2005 after the demise of her Vietnam Veteran husband. She claimed DIC in that the VA had given him substandard care as envisioned under 38 USC § 1151. There was some evidence of this in his VA medical records, but the RO denied. They raced out and grabbed a VA “yes man” for an IME to state that he was really whistlin’ like a locomotive right up to about  a week before he completed his bucket list. Well, not exactly- as Avis is wont to say. He’d been circling the drain with a possible drug reaction/interaction for almost a year and VA was giving him the pat on the back and the “it’s nothing to worry about.”chat.

In July of 06 they sent Carol the Dear John letter and said they’d really done all they could for him and how this whole unfortunate thing unfolded in such a short period of time that there was really nothing doctors could do for him. Again, all this discussion of his impending demise was focused entirely on a 7-day period prior to death and never addressed the salient facts in the file that showed this brewing like a hurricane off the Azores in the Atlantic (two months out).

The BVA essentially gave a rubber stamp to the RO’s version with their blessing. Big mistake. Carol rightly decided it was better to be pissed off than pissed on. She lawyered up and headed to Indiana Ave. NW for some real justice. She caught the ear of Judge Schoelen with her claims of  a misdiagnosis and negligent treatment. The VASEC went NASDAQ and cried foul. Apparently, in his mind, she had never raised these issues on appeal and had no legal right to bring them up at this late stage. This is where having a good law dog or long eyelashes helps. The Judge had this to say about that argument:

Contrary to the Secretary’s assertion, the evidence of record reasonably raised the issue of whether the veteran’s death was caused by mistreatment by the Evansville Clinic.  First, the record indicates that the appellant informed VA that the veteran was treated at the Marion VA hospital and the Evansville Clinic. Second,records from the Evansville Clinic show that the veteran received lab results indicative of a problem with his liver.  Moreover, the veteran’s hospital discharge records from the Evansville Clinic show that the veteran received lab results indicative of a problem  summary, which listed “liver failure” as a cause of death, noted that a workup was in progress as an outpatient for the veteran’s abnormal liver function tests.  R. at 91.  Although the veteran’s death certificate identifies the immediate cause of the veteran’s death as “cardiopulmonary failure,” the evidence clearly shows that in the days preceding death, the veteran was being assessed for probable liver cancer and the discharge summary notes that he was in liver failure.   Given that the veteran was treated by the Evansville Clinic for liver problems in the months preceding his death and the evidence clearly suggests that the veteran was in liver failure at the time of his death, the Court finds that the issue of whether the veteran received proper treatment from the Evansville Clinic for his liver-related problems was reasonably raised by the record.  Trusty v. Shinseki (2011)

So, kids, this little faery tale is more proof that its simply not over until the Judge sings. Carol will more than likely prevail on this because VA usually gets the message on these things when they boomerang. If she does come back, the VA will have had to do some extraordinary IME work to come up with a better “yes man” and a lot of money to elicit the magic incantation from him. They have too many fish to fry at the moment so this one will be catch and release.

I was saving the most egregious error for last (add the Dragnet-Badge 714 music here). During the inception of her claim, she sought the services of the VA Patient’s Advocate, someone she undoubtedly came in contact with when her husband was gravely ill. My wife elicited the services of one of these bobbleheads when it looked dicey for me in 09, too. When asked how to proceed, the Advocate pointedly omitted telling her (and my wife, too) of her option to sue the Government ( and VA) via the Federal Tort Claims Act (FTCA). This allows you to sue for malpractice. The statute of limitations is 2 (two)(deuce)(a pair of) (24 months) years from the date of the mistake. Not two years, 20 hours, 16 minutes and 31 seconds but two (2) years exactly. The Government doesn’t cut you any slack on that unless the two year anniversary occurs on a Sunday and then you get until midnight Monday to have it postmarked. And if you are lucky, one of your Vet friends will say “So you filed your SF 95, right?” before two years elapses.

Carol opted for the only thing she could get after this “justice” was dispensed. Her filing was for injuries suffered due to the 38 USC  § 1151 statute which fortunately has no time restriction. She simply sought DIC for this and was unceremoniously  rebuffed. Shakespeare decidedly had someone like Carol in mind when he opined about a woman dissed.

Carol will have her claim remanded back to the BVA and a whole new trial will be trotted out. This time they will have to take off the blinders, hire an IME who isn’t so myopic and truly address the medical facts. Odds are way better than even, maybe 4 to 1 that she will prevail. She’s probably 60-ish like all of us Vietnam leftovers and won’t put a hole in the financial bucket. DIC only pays about 1300/mo. and VA isn’t going to go to the floor over that. They thought they had her buffaloed until she bolted up to the Court like Asparagus in July . This time it isn’t worth the hassle. The cat’s out of the bag, so to speak.

Meet one tough cookie, ladies and gentlemen- Carol (NMI) Trusty. I’m willing to bet she has a concealed pistol permit, too.

Trusty v. Shinseki

 

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CAVC–Kahana v. Shinseki (2011)–Another Faceplant

Posted on September 27, 2011 by asknod

   

In keeping with a long tradition of screwing up Veterans’ claims, our exalted Leader has once again stepped on his  necktie and  had another unproductive tête-a-tête  with the CAVC. This one is so predictable I’m surprised they didn’t just give it a single judge disposition and be done with it.

Rick K. Kahana comes before the Court to plead for justice. He has an airtight, open and shut case and the Secretary simply refuses to acknowledge it. He (the Secretary) therefore instructs all his horses and men to fight with all they have to obfuscate, temporize and prevent justice from reaching fruition. If they spent this much time on our claims in the first instance we wouldn’t have these problems. As it is, they have spent hundreds of thousands of dollars wrongfully denying this poor boy what is rightfully his. The Court agreed and vacated the Board’s findings. This is the bitchslap. A remand is the Court’s method of telling the VA to shut up, sit down and take notes on what is going to be said. The Court will order the VA to give Rick a new review and to be quick about it. Chances are you are not going to see Rick back at Indiana Ave. NW on appeal again for this issue.

Rick hurt his left knee in service and no one disputes that. VA gave him SC for that in 1980 shortly after his discharge. Although the Court transcript is unclear, Rick was afforded a Board hearing in 2007 so he must have filed for the right knee prior to that and gotten the bum’s rush from the RO. Knowing it takes a while to get that  hearing, you can interpolate backwards and figure he filed in 02 or thereabouts. The Board made a litany of errors so basic that one wonders who was behind the wheel-if anyone. In another of our CAVC postings, we brought you Colvin v. Derwinski- Nobody here but us Doctors. This case parallels Mr. Colvin’s dilemma- namely the Board putting on their Ben Casey outfits and playing doctor. This is why we feel this should never have been assigned to a panel. Perhaps it was a “teaching moment” for the Court to enunciate the Colvin holding. Who knows? The important thing is the Court felt obligated to reacquaint  the Secretary with how business is conducted and the consequences of violating the protocols. Remands based on 1991 decisions are few and far between and are necessarily rare-as they should be. With that said, we are seeing more and more of them every year. This is disturbing for any number of reasons, the least of which is that had Rick not appealed, he would have been sucking the hind teat.

Consider this. VA regulations summed up in 38 CFR are not that onerous or confusing. They are rather static and change very rarely, if at all. Being cognizant of these regulations is all VA is required to be versed in. That is a relatively narrow field of law with unique rules applicable to only Vets. The process is well-defined and requires less law training than a comparable attorney would encounter in the real world. So why are they clueless and confused?  Patience, Gentle Reader. Therein lies the enigma.  VA is predisposed to deny any and all claims. They generally decide to deny and then craft the reasons to fit the facts. In the event that evidence supporting the claim is present, the approved method is to simply ignore it. If they get caught with their pants down later, they can simply apologize and cough up the bucks. No harm. No foul (or at least not an irrevocable one)

This is what happened to the Rickster. There was mention in his SMRs of an injury to his right knee, but nothing glaring or definitive. Bingo. VAthink kicks in and sayonara to that rating. The Court had this to say about the Board’s disingenuous  attempt to gloss over the SMRs:

The Secretary further argues that since the SMRs show no right knee injury during service, “there was no bias or impartiality in the addendum request.”  Secretary’sBr.at 16.  The Court does not agree.  As noted above, there appears to be one notation in the SMRs as to a right knee injury. R. at 634.  In any event, the lack of medical evidence in service does not constitute substantive negative evidence.  McLendon v. Nicholson, 20 Vet.App. 79, 85 (2006).  The examiner could have potentially determined,  based on  other evidence  of  record including lay statements and  private medical opinions, that, regardless of the lack of documentation in the appellant’s SMRs, the appellant injured his right knee in service.  The statement in the request that there was no right knee injury in service indicated to the examiner that all of the evidence had already been analyzed and a conclusion reached, and thus impeded her impartiality. Kahana v. Shinseki (2006)

This bears out my contention that VA will deny in spite of evidence supporting a contrary or plausible conclusion. The fact that they decided to play dress-up doctor compounded the error with interest. I have always held that this is their modus operandi. It works like a charm unless or until a Veteran appeals to the Court. The house of cards disintegrates when subjected to a closer examination. We at Ask Nod do not arbitrarily assign fault to the Veterans Law Judge who hears this. Remember, he is ably (ha!) served by no less than 12 young eager wannabe VLJs who sometimes do sloppy research just as the ROs do with their flawed examiner’s logic predicated on the M21 manual. The difference is that once the decision is set in stone at the BVA,  the Secretary is loathe to upset the scales of justice and correct the error. Whether this is due to embarrassment or to assuage the feelings of the VLJ is immaterial. Letting a flawed decision stand is wrong. Rigorously defending it to the tune of untold dollars and delay to the Vet is unconscionable. Yet it happens so frequently that it has become the norm rather than the exception.

Where does this leave you? Well, without insulting your intelligence, it’s apparent that a failure to appeal makes as much sense as screen doors in submarines. You have a lot of time invested into your claim when you finally get the wave off from the VLJ. If your claim truly has merit and the facts have been  obscured or ignored, a trip up to Indiana Ave.is imperative. Veterans may not be aware of this, but the Court is not part of the VA. It has been set up as a watchdog to restrain the excesses of the VA. The mere fact that Congress felt a need in 1988 to enact the Veterans Judicial Reform Act is very telling.  The old adage that “If it ain’t broke, don’t fix it” says it all. Congress, it would seem, saw a broken process and decided to remedy it. VA has never been the same since. The Secretary considers his authority has been abridged and has had his proverbial heels in the dirt since. This is why we find ourselves denied virtually automatically at the RO. The same process follows almost invariably at the Board absent any new evidence.

Rick’s predicament was salvaged by errors discovered by a process VA has consistently held to be arbitrary and redundant (the Court). Our rejoinder at Ask Nod is “Who’s the fool, fool?” Read all about Rick’s exciting adventures in D.C. below.

http://www.uscourts.cavc.gov/documents/Kahana_09-                                                            3525_published_opinion_June_15_2011.pdf

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CAVC–Nelson v. Shinseki 2011- AWOL= No Dough (SJD)

Posted on September 27, 2011 by asknod

his is another in a series of Hepatitis-related Single Judge Rulings (SJR). Veterans ask us frequently what kind of treatment they can expect to receive at the Court. This will give you an idea how respectable and forthright the Judges are. This one is before Judge Alan G. Lance who treats the Veteran with the utmost respect. 

     Mr. Gary L. Nelson approaches the Court, hat in hand asking for a reversal of what could politely be described as a train wreck of a claim. He has more problems with this than even he knows. I wonder if he told his legal help all the details before or on the way to his Court date. In any case, he is going to be given another bite of the apple. This won’t result in a win. Nothing he can do will ever allow him to prevail absent the Army giving him a new DD214 and a Form 256 with the word “honorable” on it. 

     Gary, it seems, went off the reservation as soon as he got in-country in Vietnam. He got caught in the wrong part of town where the poontang roam (7/70), reckless driving and disrespecting an officer (11/70), Absent from his guard post (1/71) and last but not least shooting at an unarmed Vietnamese civilian. The first three netted him an Article 15 each. The last one cost him some R &R at the Long Binh Stockade for 57 days (4/71). 

      Feeling the need for more unscheduled R & R, Mr. Nelson stepped out again in late June of 1971. They found him and returned him to Long Binh 201 days later in January of 1972. The next day he was transferred to the hospital with a bad case of poppyitis (heroin addiction). Amazingly, the Army still tried to salvage him instead of giving him the boot. He rewarded them with 4 more AWOLs in quick succession. The last one was for all the marbles. They preferred charges against him and he agreed he was doomed. He asked for, and was granted, an administrative discharge for the good of the Army (not to mention for the good of Gary). Unfortunately this “divorce” came in the form of an Undesirable Discharge printed on Form DD 258. Since we all know that the Tooth Fairy only visits those Vets who possess either a Form 256 or 257, the following should not have come as a big surprise. 

     In 1977 Mr. Nelson petitioned for an upgrade to his undesirable. He was granted a General under Honorable conditions in 1978. Thinking he had bearded the lion, he applied for VA bennies. His balloon was popped in May of 1979 when the VA pointed out that his AWOL status in excess of 180 days (201), in conjunction with the other 4 AWOLs and his unarguably poor behaviour towards his superior officers, precluded his ever getting a dime out of the VA. He didn’t appeal and that was the end… for a while. 

     Twenty six years later in 2006, Garbo returned and asked for his share of the Nehmer class bucks for his DM2.  He had also picked up Hep C from that steady diet of smack. The chickens had finally come home to roost and he wanted a seat at the VA compensation table.

     VA once again patiently explained to him how this was not going to be in his cards. He lawyered up and headed for the BVA. They did a sloppy job and turned him down too. But when you turn someone down at the BVA, you have to do it politely and legally. The Board only satisfied the first tenet. Legally, he currently is not entitled, but it is necessary to do it and say it in legalese. This they didn’t do and this is what the Court is taking them to task on.

     Gary doesn’t stand a chance of getting away with this and by now he should realize it. His best bet is to sharpen his pencil and go down to the Social Security office.  President Carter issued a Presidential Proclamation in 1977 to allow Vets to upgrade their discharges if they were less than General. It had one little clause in it that precludes any VA benefits if you had deserted or were AWOL from a combat zone. We discussed the Undesirable, but there is a special place in military hell for Vets with the BCD. Nicknamed The Big Chicken Dinner, the Bad Conduct Discharge (DD Form 259) is only given out when you go AWOL, come back from Canada 12 years later-and accidentally get caught speeding. The Army has a long memory. You can get the Dinner for killing too efficiently (think unarmed civilians in a FFZ), for killing a fellow soldier, bank robbery or for any number of underhanded things. It usually is accompanied by an all expenses paid vacation at Fort Leavenworth in Kansas for several years before they give you your Certificate of Achievement. Nevertheless, Gary was and is in “Undesirable” hell because Congress passed a law in 1995 denying VA benefits even with a upgrade to honorable. Were he to go before a Army Discharge Review Board, seek and be granted a similar concession from them, then he would be eligible for full VA benefits. We here at AskNod see his chances as about equal to the proverbial snowball’s. But, as they say, Nothing ventured, nothing gained. 

     We say go for it, Gary. I looked up the rules on this and VA does have some compassion. He can get free medical as they will turn no Vet away.  Above and beyond that? Nothing. No VA Home Loan either. This is rather sad and was so utterly avoidable. 

So if you think you have problems, meet Mr. Gary L. Nelson.

http://search.uscourts.cavc.gov/isysquery/44a4c223-8ba0-4761-88dd-6aec838cb13e/24/doc/NelsonGL_09-3266.pdf#xml=http://cavc-isys1.cavc.adir/isysquery/44a4c223-8ba0-4761-88dd-6aec838cb13e/24/hilite/

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CAVC–Fenderson v. West – Staged Ratings

Posted on September 27, 2011 by asknod

Asknod inc logo VECTORHere’s another one of those cases where you hear the term and wonder who or what it refers to and what it means where you are concerned. Before I start, look at the claim structure VA employs. There are new (original) claims never presented before, reopening an old claim, claims for increase of an existing SC disease or injury and lastly a collateral attack on a prior final decision based on clear and unmistakable error. VA does not consider a claim for dependency to be different from a claim for increase. 

     At the Regional Office (RO or VARO) level in your state, the process begins and here is where most claims seem to suffer from what at best can be politely described as misinterpretation. This is what happened to Mr. Joseph A. Fenderson. He was “represented” by the American Legion. They are normally a stand up outfit with the same spotty record as most VSOs. Unfamiliarity with the law is the reason for all VSOs’ ineffectiveness. They mean well, but that says it all. Murphy’s first law says no good deed goes unpunished. All VSOs aspire to greatness and a good result for their clients but the absence of any legal training leaves them in an awkward posture when it is needed. I digress and apologize.

     Mr. Fenderson was actively engaged in his claims process while still being represented by AmLeg. This can and does cause confusion as to who is driving the car. This confusion caused Mr. Fenderson to miss filing for some issues he wished to appeal (varicose veins). That’s unfortunate but when you have this haphazard representation and start doing things yourself, you can guarantee things will go haywire.

     The VA got terribly confused on this, too. They tried to interpret it with their Ouija Board and tea leaf readers. They came to the conclusion that old Joe was simply asking for an increase on claims that they had only recently granted when what he was asking for was an increase on the initial ratings. There is a distinct difference. An example is in order. You file for a hangnail and VA grants you 0%. You file your NOD and ask for 10% but they refuse. Finally on appeal five years later, you win and get the 10% you were fighting for. However, in the interim your hangnail became ingrown, infected and they had to hacksaw your finger off. You deserve more-you want more. You have to go back to the RO for that and you lose. Back to the BVA for more and finally you arrive 5 years later at the Court. Let’s say by now the finger beside it got infected and they amputated that too?  You would be entitled to more and it would have to commence on the day the hangnail first started, not the day you got around to filing for it as an increase of the original claim.

     The VA has an odd habit of examining correspondence you send in through binoculars backwards. This causes problems. They have a whole section devoted to trying to understand just exactly what it is you meant to say or claim. Because they want to make sure you get what’s coming to you, they will perform what is known as prognostication. You will read it later when the appeal says “it appeared the Veteran was filing for…” or “VA interpreted this to be a claim for.. .” My personal favorite is “It was construed to be…”. God, are we all that illiterate and word challenged?

     Joe had only recently been service connected for varicose veins, plantar fasciitis, migraine headaches and problems after testicular surgery. Naturally when he sent in the disagreement with the ratings they assigned, this enlightened group of prognosticators ignored his file and “construed”   it be a NEW claim for increase. And off they went on their merry way. You cannot get the VA to put the horses back in the barn when this happens. You have to go to appeal to straighten it out which buys time for the VA to come up with an excuse for screwing it up. Oddly, nobody gets a nasty letter in their personnel file for these inadvertent slip ups.

     Joe had to go all the way to the Court to unravel this one. The big boys had no problem dissecting this and agreed with him on almost all of it except for his verbally challenged attempt on the varicose veins. For that he had to go back and start a new increase claim. What they also did is what will give Mr. Fenderson his name in lights for years to come. AB v. Brown (1993) held that a Veteran is seeking the maximum benefit available to him when he files a claim. He shouldn’t have to beg again and again for morsels from the VA’s table. VA should give him that to which he is entitled when he is entitled rather than piecemeal. I guess the M-21 manual hasn’t been updated with that provision yet. It certainly wasn’t in there in 1999.  

     The Court decided that a rating is flexible and if, during the course of your appeal, the injury or disease gets worse (or better), then the rating percentage must follow that development. This principle is called a staged rating or a Fenderson rating. This is a very important distinction. If you win and do not disagree with what they hand out, you agree that it is correct. If you come back several years later and say “Hold the phone! I should have been given 20% back then. You screwed me.”, you are too late. The time to disagree is when the rating is granted. You can file a NOD as Joe did to accomplish this as long as it is done in the traditional one year grace period for objecting. Just make sure that you use single syllable words and make it crystal clear what it is you are trying to “construe”.

     In 1994 I filed for “PCT as a residual of Hepatitis or as a residual of Agent Orange exposure”. VA’s crackerjack sleuths interpreted this to mean I wanted to file for a) residuals of Hepatitis and b) PCT due to AO. This allowed them to a) declare I wasn’t currently suffering from Hep. and b) I was never in Vietnam and therefore I was never exposed to AO. Pretty tricky, huh? Get used to this practice. It happened to me in 94, it happened to Joe in 97 and you can be damn sure it will happen to you if it hasn’t already. It buys them time to come up with more creative ways to deny you as the claim progresses. One of their personal favorites used to say that you claimed Hep. C but you had Hep. B in service. Bingo. Wrong. Go back to Go. Do not collect $200.00 and please refile. If you are not allowed to make medical diagnoses about your illness when submitting lay testimony, how is it that they can hold you to this when you file? Welcome to the VA Hall Of Mirrors Funhouse.

     At any rate, Mr. Fenderson provided us with one more tool in the pursuit of our claims. It is a very important one and prevents the VA from depriving you of a rating % when it is legitimately due. The mere fact that Veterans have to negotiate this legal minefield to obtain that which is their due speaks volumes about the process and the people hired to administer the system. Never lie down and take it. Never rationalize it and say “Oh, there are so many other Vets that are more deserving.” VA is counting on you doing this. It’s factored in that a certain percentage of us will give up and go home. A very large percentage, I might add.

     Below is Mr. Fenderson’s rematch with Goliath.                                                                                                                                                                                                                                        Fenderson_96-947

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COVA–Bell v. Derwinski (1992)–Constructive Possession

Posted on September 27, 2011 by asknod

With all the talk these days of the indiscriminate shredding of Veterans files at VAROs by lazy employees, we should look back 20 years to a seminal case  that was the precursor to any of this. 

     VA is adamant for the most part that its records, and by extension, its recordkeeping, are above reproach. If something turns up missing, it is the fault of the Veteran for not submitting it. This submittal is usually accomplished by the VSO representing him/her, so this maligns the VSO as well. This is why we so strongly advocate for Veterans to do all their filing with Certified Mail, Return Receipt Requested (CM3R).  The VA cannot call the USPS a liar and get away with it. The USPS may have a lot of faults, but recordkeeping is certainly not one of them. 

     Mrs. Velma Bell, the widowed spouse of a Veteran of the Second World War was seeking DIC (we presume this as the record is unclear) and ran up against a big problem. The evidence before the BVA Court Section was missing four very important documents, three of which were produced by the VA and one (a Form 21-4138 Statement in Support of Claim) by her. The BVA and the Secretary pretty much told her she was out of luck as the documents in question weren’t in the record. Velma cut this Gordian knot in half by promptly supplying copies she had of the missing documents. Catch 22 kicked in when the BVA said that the documents in question could not be submitted later if they were not before the Board at the beginning of the Appeal. Mrs. Bell was nonplussed to say the very least. How could it be that the keeper of the sacred records was missing the same records they created and then took the legal position that the decision had to stand as is because it was against the law to introduce them after the fact? 

     Velma might have been born at night, but she was not born the night before this legal wisdom was handed down to her. She promptly lawyered up and went to the Court for some answers. The Court, bless them, looked at this and immediately saw the dichotomy, circular logic and the Secretary’s defective reasoning. 

     The Court held that if you properly submit records, or more importantly, if the VA creates records of any judicial or medical nature related to you or your claim, they are responsible for maintaining them and assuring that they are properly filed in a central repository- namely your C-file. While this would be the ideal method, the Court went further and held that any documents or medical records held by VAMCs, while not explicitly in the C-file, were still in the VA’s “constructive possession”.  

     Case in point. I had a medical exam for Agent Orange after all the information started to surface in 1991 about this chemical. My exam was in September of 1993. I filed for hep. in March of 94 but these records, clearly showing a liver dysfunction, were never included in my C-file. My SO/future used car salesman from AMVETS assured me this would occur soon as “VA is like so totally suuuper-efficient, man.” We will not discuss VSOs today. That is still a sore point seventeen years later.   Add to that his sudden departure to become a used car salesman (due, undoubtedly to a mid-life crisis) and taking my F-9 with him.

     When I finally got my hands on my C-file in 2009, lots of things were amiss. One was that these records were still absent. These are important documents that VA has a responsibility to safeguard. Fortunately they were archived at the VAMC and I was able to get a copy of them there. They will be very instrumental in proving that my liver was misbehaving in 1994 when my claim for an earlier effective date is granted. 

     Most Vets are vaguely aware of some of their rights before the VA courts. Unfortunately VA has an ugly habit of shading the truth, failing to inform you of things that might help your claim and sometimes outright mistruths. I hesitate to use the word “lies” as I would sooner believe it’s due to inefficiency and low I.Q.  As for missing or misplaced records, Veterans would be strongly advised to maintain a set for themselves. VA has a “paper file” system, one of the last in existence from what we hear. If you were to ask them a question on some facet of your claim, it would require a month and a personal search by hand of a file in a filing cabinet. Add to that the chance that something can slip out and land on the floor when searching it or, God forbid, the “files technician” absentmindedly refiles something in John Jones file- right after your (Jack Jones) file. Oops! Color that gone with the wind. It will not see the light of day until or unless someone is reviewing Johnboy’s file. Up until Velma pitched a bitch, that evidence was “regrettably not part of the Veteran’s file”. 

     The VA Secretary and his employees do not like the Court. They feel their “judicial activism” is counterproductive to the job at hand- namely denying Vets. They would prefer that the Court mind its own business and speak when spoken too. This is why there are so many cases that result in a win for Veterans on appeal.  Not because the Court has a judicial hard-on for the Secretary, but that the Secretaries of the VA have a long, storied history of mimicking Chicken Little. They a)over-interpret the regulations to find something that doesn’t exist; b) insist they have done things this way since the dawn of time and: c) warn that any relaxing of the regulation will produce a flood of claims and thus endanger the financial stability of the VA. What this produces is absurd results that disenfranchise some and reward others. We as Veterans need one set of rules to abide by. Left unchecked, this system would be far worse than the Tax code.

     Meet Velma Bell. I bet you had no idea how important her contribution was to your claims process.

P.S. The Bell decision is in the CUE regs as well. If you file a claim for CUE of an action prior to November 26th, 1992 that depended on records VA had but did not incorporate into the file then you cannot claim this precedent. It is oddly the only COVA decision exempted by CUE.

Bell_91-1749

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