Veteranclaims’s Blog

October 9, 2014

Single Judge Application; Cline v. Shinseki, 26 Vet.App. 18, 28 (2012); GAF Scores

Excerpt from decision below:

“The Board acknowledged that a GAF score of 50 denotes “serious symptoms,” but placed more weight on the specific, detailed report of Mr. Manfra’s symptoms contained in the body of the examiner’s report, symptoms that described mild to moderate PTSD. R. at 12-13; see R. at 263-66. As the Board correctly noted, “a GAF score is, of course, just one part of the medical  evidence to be considered and is not dispositive.” R. at 10; see Cline v. Shinseki, 26 Vet.App. 18, 28 (2012) (stating that GAF scores, while probative of the level of  impairment caused by a mental disorder, “are not dispositive of the proper level of disability”);  Brambley v. Principi, 17 Vet.App.

5 The Court’s disposition of the PTSD claim is not based on the Secretary’s
arguments presented in his substitute brief.
6 The Court observes that, in a claim for a higher initial evaluation, the current level of disability is of primary
concern. See Francisco v. Brown, 7 Vet.App. 55, 57 (1994). However, to the extent the Board considered Mr. Manfra’s history of stable marriage and employment, the Board appears to cite these factors as indicative of the veteran’s social and occupational status at the time the claim was pending, and the Court
discerns no error.
9

20, 26 (2003) (holding that the appellant’s GAF score is one factor in determining his degree of
disability). The Board explained why the GAF score of 50 was less probative than the other
evidence contained in the February 2011 examination report, and, based on a review of the type and
severity of symptoms that characterize a score of 50 (see supra note 2) and the psychiatric symptoms
described by Mr. Manfra, the Court cannot conclude that this finding is clearly erroneous.

=====================
Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
NO. 13-2417
JENNIE MANFRA, APPELLANT,
V.
SLOAN D. GIBSON,
ACTING SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before BARTLEY, Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a),
this action may not be cited as precedent.
BARTLEY, Judge: Jennie Manfra, surviving spouse of veteran Edward Manfra,
appeals
through counsel a June 28, 2013, Board of Veterans’ Appeals (Board)
decision that denied Mr.
Manfra a compensable initial evaluation for bilateral hearing loss and an
initial evaluation in excess
of 30% for service-connected post-traumatic stress disorder (PTSD).1
Record (R.) at 3-17. This
appeal is timely and the Court has jurisdiction to review the Board’s
decision pursuant to 38 U.S.C.
§§ 7252(a) and 7266(a). Single-judge disposition is appropriate. See
Frankel v. Derwinski,
1 Vet.App. 23, 25-26 (1990). The Secretary concedes error with respect to
the hearing loss claim.
For the reasons set forth below, the Court will set aside the June 2013
Board decision with respect
to bilateral hearing loss and remand that matter for additional
development, if necessary,2
and
Edward Manfra filed his Notice of Appeal in August 2013. The Court was
notified in May 2014 that the
veteran had died in February 2014. On June 13, 2014, the Court granted the
motion of Jennie Manfra, the veteran’s
surviving spouse, to be substituted in this case. See generally Breedlove
v. Shinseki, 24 Vet.App. 7, 15-21 (2010) (per
curiam order). Therefore, she is pursuing the present claims for the
purpose of obtaining accrued benefits.
Because Mr. Manfra died after October 10, 2008, Mrs. Manfra was permitted
to substitute under the auspices
of 38 U.S.C. § 5121A. See Hyatt v. Shinseki, 566 F.3d 1364, 1367 n.1 (Fed.
Cir. 2009); Breedlove, 24 Vet.App. at 15.
Thus, as explained below, she is not limited to the evidence in the claims
folder at the time of the veteran’s death; rather,
additional evidence may be developed. See VA Fast Letter 10-30 (Aug. 10,
2010) (“Unlike prior accrued benefits
claims, [under section 5121A] the record is not closed on the date of
death of the original claimant[ ] but remains open
2
1

readjudication consistent with this decision. The Court will affirm the
decision with respect to
PTSD.
I. FACTS
Mr. Manfra served on active duty in the U.S. Army from July 1943 to June
1948, including
service in the European Theater during World War II. R. at 364, 366-67. In
September 2010, he
sought service connection for stress, inability to sleep, and ear problems.
R. at 322-37.
Mr. Manfra underwent a PTSD examination in February 2011. The examiner
noted the
veteran’s combat service during World War II and his reports of seeing
comrades injured and killed
and concluded that he “clearly” experienced fear for his life based on
hostile enemy attack. R. at
265. The examiner also observed that Mr. Manfra had been married for 64
years and had three
children and several grandchildren; worked at a meatpacking plant for 38
years until he retired, then
did some security work until 2007 when he had heart surgery; and spent his
leisure time watching
television, shopping, going to the gym, and attending recreational
activities at the senior residential
care center where he lived. Id. The veteran reported no history of
psychiatric treatment, significant
substance abuse, or legal problems following service. R. at 263.
Upon examination, the VA physician found Mr. Manfra generally cooperative
but
occasionally “slightly confused”; he reported that the veteran suffered
from some memory loss,
hyperreactivity to loud noise, regular recollection of military service,
and, at least shortly after
returning from service, increased irritability and a shorter temper. R. at
265-66. The veteran’s
“primary complaint and symptom,” the examiner stated, “is that he has had
and continues to have”
nightmares about dead soldiers, which recur regularly about twice a month
and wake him up. R. at
266. But the examiner noted that the veteran denied panic attacks,
depression, suicidal or homicidal
ideation, delusions, hallucinations, or ideas of reference. R. at 265. The
examiner diagnosed PTSD,
chronic and mild to moderate, and assigned a Global Assessment of
Functioning (GAF) scoreof 50.3
for the submission and development of any pertinent additional evidence.”).
3
The GAF is a scale reflecting the “psychological, social, and occupational
functioning on a hypothetical
continuum of mental health-illness.” DIAGNOSTIC AND STATISTICAL MANUAL OF
MENTAL DISORDERS 34 (4th ed. text
revision, 2000). GAF scores ranging between 41 and 50 are meant to
indicate serious symptoms (e.g., suicidal ideation,
severe obsessional rituals, frequent shoplifting) or any serious
impairment in social, occupational, or school functioning
2

R. at 266.
Mr. Manfra underwent a VA audiology examination in May 2011. The examiner
diagnosed
intermittent tinnitus and bilateral sensorineural hearing loss, with 94%
speech recognition in both
ears. R. at 114-16. Following review of the claims file in June 2011, the
audiologist opined that,
based on audiometric configuration of hearing loss and the veteran’s
recollection of noise exposure,
it was at least as likely as not that tinnitus and hearing loss were
caused by military noise exposure.
R. at 114.
In December 2011, the VA regional office (RO) granted service connection
for PTSD with
a 30% evaluation and for bilateral hearing loss with a noncompensable
evaluation. R. at 99-105.
Mr. Manfra disagreed with these evaluations (R. at 76), the RO continued
its decision (R. at 40-65),
and the veteran appealed to the Board (R. at 35-37). In an informal brief
submitted to the Board, Mr.
Manfra’s representativeindicatedthat,”sincehis VAaudioexamination
of5/13/2011,”Mr.Manfra’s
hearing loss had “worsened dramatically” and “request[ed] the issue be
remanded for a current VA
examination in order to determine the current severity of the condition.”
R. at 33.
In the June 2013 decision on appeal, the Board denied entitlement to an
initial compensable
evaluation for bilateral hearing loss and to an initial evaluation in
excess of 30% for PTSD. When
addressing whether the duty to assist had been satisfied, the Board found
that the May 2011
audiology examination was adequate and no additional examination was
required because “[t]here
[was] no evidence indicating that there has been a change in the severity
of the [v]eteran’s . . .
bilateral hearing loss since the time of the VA examination[ ], including
no assertion of such made
by the [v]eteran.” R. at 6. The Board also found that the February 2011
PTSD examination was
adequate for evaluation purposes. R. at 7. On the merits of the PTSD claim,
the Board reviewed
the lay and medical evidence and stated:
In light of the above, the Board finds that the [v]eteran’s PTSD
disability picture
more nearly approximates the currently assigned 30[%] rating criteria, and
that the
preponderance of the evidence is against assigning a higher rating. As
shown above,
the [v]eteran reports that he has been married for over 64 years, had a 38
year career
with a meat packer and retired at 62, he engages in recreational
activities with his
wife, and his complaints are nightmares, thinking of his war experiences,
(e.g., no friends, unable to keep a job). Id.
3

hyperreactivityto loud noises, and a history of irritability. The Board
finds that these
types of symptoms are already contemplated by the currently assigned 30[%]
rating
criteria, which criteria contemplate symptoms such as chronic sleep
impairment and
mild memory loss, and which criteria contemplate generally functioning
satisfactorily[,] as is the [v]eteran. The symptoms shown do not more
nearly
approximate the criteria for the next higher, 50[%] rating, which, as
noted above,
contemplate occupational and social impairment with reduced reliability
and
productivitydueto suchsymptoms asflattenedaffect,circumstantial,
circumlocutory
orstereotypedspeech,panicattacks,difficultyinunderstandingcomplex commands,
short and long-term memory impairment, impaired judgment, impaired
abstract
thinking, disturbances of motivation and mood, and difficulty in
establishing and
maintaining effective work and social relationships. As noted above, the [
v]eteran
denied panic attacks or depression, and he has maintained a 64-year
marriage and a
38 year career in meat packing. He and his wife did report that he could
get angry
over nothing which affected his relationships with family members; he also
had
nightmares and was nervous and defensive. No deficits with respect to
affect,
speech,judgment, thinking[,] ordifficultyinunderstandingcomplex
commandswere
reported or noted. In addition, the [v]eteran reported that he did engage
in activities
thereby showing there is not disturbance of motivation. Moreover, other
symptoms
similar to and representative of occupational and social impairment with
reduced
reliability and productivity are not reported by the [v]eteran nor were
they found on
psychiatricexamination. Instead,his symptoms whichincludeanxiety,
chronicsleep
impairment, anger, nightmares, and defensiveness more nearly approximate
occupational and social impairment with an occasional decrease in work
efficiency
and intermittent inability to perform occupational tasks.
R. at 11-12. The Board acknowledged that the GAF score of 50 “is
generallyconsistent with serious
symptoms,” but “ultimately place[d] more weight on the more detailed
account of the [v]eteran’s
specificsymptom[s] describedbythe[v]eteranandtheVAexaminer,”
whichshowedthatPTSD was
“mild to moderate.” R. at 12-13. And the Board recognized that lay
statements from Mr. Manfra’s
wife4
reported anger, irritability, nervousness, and nightmares but found that
these symptoms, as
previously discussed in the February 2011 VA examination, were consistent
with a 30% evaluation
but no higher. R. at 13. Thus, the Board concluded that an evaluation in
excess of 30% for PTSD
was not warranted. Id. This appeal followed.
4
These statements are not in the record before the Court.
4

II. ANALYSIS
The assignment of a disability evaluation is a finding of fact that the
Court reviews under the
“clearly erroneous” standard in 38 U.S.C. § 7261(a)(4). See Johnston v.
Brown, 10 Vet.App. 80, 84
(1997). “A factual finding ‘is “clearly erroneous” when although there is
evidence to support it, the
reviewing court on the entire evidence is left with the definite and firm
conviction that a mistake has
been committed.'” Hersey v. Derwinski, 2 Vet.App. 91, 94 (1992) (quoting
United States v. U.S.
Gypsum Co., 333 U.S. 364, 395 (1948)). As with any finding on an issue of
material fact or law
presented on the record, the Board is required to support its finding
regarding the veteran’s level of
disability with a statement of reasons or bases that enables a claimant to
understand the precise basis
for the Board’s decision and facilitates review in this Court. 38 U.S.C. §
7104(d)(1); Gilbert v.
Derwinski, 1 Vet.App. 49, 57 (1990). To comply with this requirement, the
Board must analyze the
credibilityand probative value of the evidence, account for the evidence
that it finds to be persuasive
or unpersuasive, and provide the reasons for its rejection of any material
evidence favorable to the
claimant. Caluza v. Brown, 7 Vet.App. 498, 506 (1995), aff’d per curiam,
78 F.3d 604 (Fed. Cir.
1996) (table).
A. Evaluation for Bilateral Hearing Loss
Mrs. Manfra argues that the Board erred when it stated “[t]here is no
evidence indicating that
there has been a change in the severity of the [v]eteran’s . . . bilateral
hearing loss since the time of
the VA examination[ ], including no assertion of such made by the [v]
eteran” (R. at 6), because this
overlooks the April 2013 statement in which the veteran asserted that ”
since his VA audio
examination of 5/13/2011 his hearing loss has worsened dramatically” (R.
at 33). Appellant’s Brief
(Br.) at 6. Mrs. Manfra asserts that this matter must be remanded for the
Board to address the
veteran’s statement and consider whether additional development is
required under the duty to assist
to determine the severity of hearing loss. Id. at 7. The Secretary
originally conceded that the Board
did not offer adequate reasons or bases to support its finding that Mr.
Manfra had not asserted his
hearing loss had grown more severe since the May2011 VA examination.
Secretary’s Br. at 4-5; see
Reply Br. at 1 (accepting the Secretary’s concession). However, following
the veteran’s death and
Mrs. Manfra’s substitution in this case, the Secretarysought and was
granted leave to file a substitute
brief. Although continuing to concede error in the Board’s statement of
reasons or bases, he now
5

opposesremandbecauseanewaudiologyexamination
cannotbeconductedandbecausehecontends
that a claim for accrued benefits “may be based only on evidence on file
at the date of the [v]eteran’s
death.” Secretary’s Substitute Br. at 4-5.
The Court agrees with the parties that the Board offered inadequate
reasons or bases to
support its finding that Mr. Manfra’s bilateral hearing loss condition had
not worsened after May
2011 and will remand that matter. See Caluza, 7 Vet.App. at 506; see also
Palczewski v. Nicholson,
21 Vet.App. 174, 182-83 (2007). Despitethe Secretary’s argument, the Court
concludes that remand
is the proper remedy. See Tucker v. West, 11 Vet. App. 369, 374 (1998) (
finding that “where the
Board has incorrectly applied the law, failed to provide an adequate
statement of reasons or bases
for its determinations, or where the record is otherwise inadequate, a
remand is the appropriate
remedy”). The Secretary is wrong when he asserts that an accrued benefits
determination must be
based only on the evidence in the file at the date of death. Congress
enacted legislation in 2008 that
explicitlyauthorizedanaccrued-benefits claimantto besubstitutedin
VAproceedingsforadeceased
VA claimant who dies on or after October 10, 2008. See Veterans’ Benefits
Improvement Act of
2008, Pub. L. No. 110-389, § 212, 122 Stat. 4145, 4151 (codified at 38 U.
S.C. § 5121A); Reeves v.
Shinseki, 682 F.3d 988, 995 n.6 (Fed. Cir. 2012). The Court likewise now
permits substitution of
a qualified claimant where an appellant dies on or after October 10, 2008.
See Breedlove v. Shinseki,
24 Vet.App. 7, 8-9 (2010) (per curiam order); see also Hyatt v. Shinseki,
566 F.3d 1364, 1367 n.1
(Fed. Cir. 2009). VA has recognized that, in pursuing accrued benefits, a
survivor who is substituted
(like Mrs. Manfra) is not limited to evidence contained in the claims file
at the time of the deceased
VA claimant’s death. See VA Fast Letter 10-30 (Aug. 10, 2010) (“Unlike
prior accrued benefits
claims, [under section 5121A] the record is not closed on the date of
death of the original claimant[ ]
but remains open for the submission and development of any pertinent
additional evidence.”); see
also Copeland v. Shinseki, 26 Vet.App. 86, 88 (2012) (“The Secretary’s
proposed interpretation of
[section 5121A] is that a substitute claimant—as opposed to an accrued
benefits claimant—’could
submit evidence and generally would have the same rights regarding
hearings, representation, and
appeals as would have applied to the claimant had the claimant not died.'” (
quoting Substitution in
Case of Death of Claimant, 76 Fed. Reg. 8666, 8669 (proposed Feb. 15, 2011
) (to be codified at
38 C.F.R. § 3.1010(f)(3)))).
6

Here, a veteran’s initial disability evaluation is in contention for
accrued benefits purposes,
and the veteran claimed worsening of his disability during the appeal
period. Although the veteran’s
death prevents a new examination of his hearing condition, remand will
allow the Board to obtain
and consider records relevant to the veteran’s hearing condition between
the alleged date of
worsening and the date of death, in order that the Board’s decision as to
an initial compensable
evaluation for bilateral hearing loss for accrued benefits purposes will
be an informed one. See
38 U.S.C. § 5103A(b)-(c)(discussingSecretary’s relativeobligations to
obtainVA, government, and
private medical records); 38 C.F.R. § 3.159(c) (2013) (same).
On remand, Mrs. Manfra is free to submit additional evidence and argument
in accordance
with section 5121A and Kutscherousky v. West, 12 Vet.App. 369, 372-73 (
1999) (per curiam order),
and the Board must consider any such evidence or argument submitted. See
Kay v. Principi,
16 Vet.App. 529, 534 (2002). The Board shall proceed expeditiously, in
accordance with 38 U.S.C.
§§ 5109B and 7112.
B. Evaluation for PTSD
PTSD is evaluated as 30% disabling when it causes
[o]ccupational and social impairment with occasional decrease in work
efficiency
andintermittent periodsofinabilitytoperformoccupationaltasks(
althoughgenerally
functioningsatisfactorily,with routinebehavior,self-care,
andconversationnormal),
due to such symptoms as: depressed mood, anxiety, suspiciousness, panic
attacks
(weekly or less often), chronic sleep impairment, mild memory loss (such
as
forgetting names, directions, recent events).
38 C.F.R. § 4.130, DC 9411 (2013). To qualify for the next higher
evaluation of 50%, PTSD must
cause
[o]ccupational and social impairment with reduced reliability and
productivity due
to such symptoms as: flattened affect; circumstantial, circumlocutory, or
stereotyped
speech; panic attacks more than once a week; difficulty in understanding
complex
commands; impairment of short- and long-term memory (e.g., retention of
only
highly learned material, forgetting to complete tasks); impaired judgment;
impaired
abstract thinking;disturbancesofmotivation andmood; difficultyin
establishingand
maintaining effective work and social relationships.
Id.
The symptoms listed in the rating formula are examples, not an exhaustive
list. Mauerhan
v. Principi, 16 Vet.App. 436, 442 (2002) (finding that “any suggestion
that the Board was required
7

. . . to find the presence of all, most, or even some of the enumerated
symptoms is unsupported by
a reading of the plain language of the regulation”). “[A] veteran may only
qualify for a given
disability rating under § 4.130 by demonstrating the particular symptoms
associated with that
percentage, or others of similar severity, frequency, and duration.”
Vazquez-Claudio v. Shinseki,
713 F.3d 112, 117 (Fed. Cir. 2013). “The regulation’s plain language
highlights its symptom-driven
nature” and “symptom[s] should be the fact-finder’s primary focus when
deciding entitlement to a
given disability rating.” Id. at 116-17. And because § 4.130 requires
that symptoms cause a certain
level of “occupational and social impairment,” “if [the symptoms] are of
the kind enumerated in the
regulation,” then the Board must provide “an assessment of whether those
symptoms result in
occupational and social impairment” to the extent specified in the rating
criteria. Id. at 117-18.
The Secretary must ensure that any examination or opinion VA provides is
adequate. Barr
v. Nicholson, 21 Vet.App. 303, 311 (2007). A VA medical examination or
opinion is adequate
“where it is based upon consideration of the veteran’s prior medical
history and examinations and
also describes the disability . . . in sufficient detail so that the
Board’s ‘evaluation of the claimed
disability will be a fully informed one.'” Stefl v. Nicholson, 21 Vet.App.
120, 123 (2007) (quoting
Ardison v. Brown, 6 Vet.App. 405, 407 (1994)). The examiner must provide ”
not only clear
conclusions with supporting data, but also a reasoned medical explanation
connecting the two.”
Nieves-Rodriguez v. Peake, 22 Vet.App. 295, 301 (2008). The Court reviews
the Board’s
determination that a medical examination or opinion was adequate under the ”
clearly erroneous”
standard of review set forth in 38 U.S.C. § 7261(a)(4). D’Aries v. Peake,
22 Vet.App. 97, 104
(2008).
Mrs. Manfra argues that the Board erred in relying on the February 2011 VA
PTSD
examination because it is inadequate. Specifically, she contends that the
examiner did not address
the symptoms the veteran was suffering from and, instead, focused on the
symptoms he did not
manifest. Appellant’s Br. at 8-9. This, she contends, forced the Board to
rely impermissibly on
“negative evidence.” Id. at 9. She further notes that the examiner’s
reference to nightmares as Mr.
Manfra’s “primary” symptom implies there were other, unlisted symptoms. Id.
Last, Mrs. Manfra
asserts that there must be additional, unlisted symptoms based upon the
GAF score of 50 the
8

examiner assigned. Id. The Court disagrees.5
First, the initial assertion that the examiner failed to address symptoms
that Mr. Manfra
manifested—an assertion upon which Mrs. Manfra bases much of her
argument—is not supported
bythe evidence of record. As the Board found (R. at 11-12), the examiner
reported that the veteran’s
“primary complaint” was recurring nightmares but also that he was
suffering from slight confusion,
mild memory loss, hyperreactivity to loud noise, and increased
irritability (R. at 265-66). This
description of symptoms corresponds directly to the lay statements
submitted by the veteran,
endorsing chronic nightmares as his primary symptom, and Mrs. Manfra,
endorsing sleep problems
and anger. R. at 336-37. As the Board also found (R. at 11-12), the
examiner determined that Mr. Manfra was able to communicate well and was oriented; was not suffering  panic attacks, depression, suicidal or homicidal ideation, delusions, hallucinations, or ideas of  reference; and had stable long-term social relationships and work histories (R. at 265).6
Mrs. Manfra characterizes the examiner’s report as “focus[ing]” on symptoms the veteran did not have (Appellant’s Br. at 9) but, given that the examiner had just discussed the veteran’s active symptoms, the examiner’s clarification that Mr.Manfra did not manifest certain other symptoms included in the 50% or 70%
levels does not render the examination inadequate.
Nor does the Court discern an inadequacy in the February 2011 examination based on the GAF score assigned. The Board acknowledged that a GAF score of 50 denotes “serious symptoms,” but placed more weight on the specific, detailed report of Mr. Manfra’s symptoms contained in the body of the examiner’s report, symptoms that described mild to moderate PTSD. R. at 12-13; see R. at 263-66. As the Board correctly noted, “a GAF score is, of course, just one part of the medical  evidence to be considered and is not dispositive.” R. at 10; see Cline v. Shinseki, 26 Vet.App. 18, 28 (2012) (stating that GAF scores, while probative of the level of  impairment caused by a mental disorder, “are not dispositive of the proper level of disability”);  Brambley v. Principi, 17 Vet.App.

5 The Court’s disposition of the PTSD claim is not based on the Secretary’s
arguments presented in his substitute brief.
6 The Court observes that, in a claim for a higher initial evaluation, the current level of disability is of primary
concern. See Francisco v. Brown, 7 Vet.App. 55, 57 (1994). However, to the extent the Board considered Mr. Manfra’s history of stable marriage and employment, the Board appears to cite these factors as indicative of the veteran’s social and occupational status at the time the claim was pending, and the Court
discerns no error.
9

20, 26 (2003) (holding that the appellant’s GAF score is one factor in determining his degree of
disability). The Board explained why the GAF score of 50 was less probative than the other
evidence contained in the February 2011 examination report, and, based on a review of the type and
severity of symptoms that characterize a score of 50 (see supra note 2) and the psychiatric symptoms
described by Mr. Manfra, the Court cannot conclude that this finding is clearly erroneous. See
Owens v. Brown, 7 Vet.App. 429, 433 (1995) (stating that it is the province of the Board to weigh
and assess the evidence of record); see also Deloach v. Shinseki, 704 F.3d  1370, 1380 (Fed. Cir.
2013) (same).
The Court observes, moreover, that the Board carefully addressed the February 2011 VA
examiner’s findings and engaged in a holistic evaluation of the veteran’s disability picture vis-a-vis
the diagnostic criteria listed in DC 9411. See R. at 12 (explaining that the “types of symptoms” Mr.
Manfra manifested were contemplated by the 30% evaluation rather than the 50% evaluation); cf.
Vazquez-Claudio, 713 F.3dat 115; Mauerhan, 16 Vet.App. at 442 (both stating that symptoms listed
in DC 9411 are non-exhaustive and that consideration of the type, duration, and severity of
symptoms manifested by a particular veteran are paramount). The detail of the Board’s discussion,
which Mrs. Manfra has not challenged, further demonstrates the adequacy of the February 2011
examination report.
In sum, the Court finds no clear error in the Board’s determination that the February2011 VA
examination was adequate. R. at 7; see D’Aries, 22 Vet.App. at 104.

III. CONCLUSION
Upon consideration of the foregoing, the June 28, 2013, Board decision
with respect to bilateral hearing loss is SET ASIDE, and that matter is REMANDED for
additional development, if necessary, and readjudication consistent with this decision. The Board
decision with respect to PTSD is AFFIRMED.
DATED: June 25, 2014
10

Copies to:
Robert V. Chisholm, Esq.
VA General Counsel (027)
11

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