UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

No. 19-4625

ROBERT J. BRIA, APPELLANT,

V.

ROBERT L. WILKIE,

SECRETARY OF VETERANS AFFAIRS, APPELLEE.

On Appeal from the Board of Veterans' Appeals

(Argued December 1, 2020 Decided January 15, 2021)

Ethan F. Maron and Ryan J. McClure, who was on the brief, both of Washington, D.C., 

for the appellant.

Timothy G. Joseph, with whom William A. Hudson, Jr., Principal Deputy General Counsel; 

Mary Ann Flynn, Chief Counsel; and Anna Whited, Deputy Chief Counsel, were on the brief, all 

of Washington, D.C., for the appellee.

Before PIETSCH, GREENBERG, and MEREDITH, Judges.

MEREDITH, Judge: The appellant, Robert J. Bria, through counsel appeals a March 13, 

2019, Board of Veterans' Appeals (Board) decision that denied entitlement to a compensable initial 

disability rating for hepatitis C and to a disability rating in excess of 10% for that condition from 

May 20, 2016. Record (R.) at 4-14. The Board also denied entitlement to special monthly 

compensation (SMC) based on the loss of use of a creative organ. R. at 11. This matter was 

referred to a panel of the Court to consider the meaning of the phrase "loss of use" in 38 U.S.C. 

§ 1114(k) with respect to creative organs. The facts of this case, however, do not require us to 

determine in general what may qualify as loss of use. Instead, we hold that the circumstances

alleged by the appellant—the use of a condom to prevent the sexual transmission of hepatitis C,

resulting in effective infertility—are not the type contemplated by the statute. We therefore affirm 

the Board's decision.

I. BACKGROUND

The appellant served on active duty in the U.S. Army from August 1972 to August 1974. 

R. at 73. He was diagnosed with hepatitis C in June 2004. R. at 1666. A VA regional office (RO) 
2

denied his claim for benefits for that condition in February 2005, and he perfected an appeal to the 

Board. R. at 1856-60, 1901, 1906-07, 1916-17. After several years of activity on the claim, 

including a Board denial in October 2010, R. at 1581-90, and a Court remand in May 2012, R. at 

1492-99, the Board granted the claim in July 2013, R. at 1449-63. 

In October 2013, the appellant underwent a VA liver examination to determine the severity 

of his hepatitis C. R. at 1427-31. The examiner stated that the appellant's "major symptomatic 

condition" was late stage chronic obstructive pulmonary disease (COPD) and that he was not 

receiving treatment for hepatitis C. R. at 1427. The appellant denied experiencing "any 

incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, 

arthralgia, and right upper quadrant pain) due to" hepatitis C in the prior 12 months. R. at 1428. 

Under the heading "Remarks," the examiner wrote: "Active [h]epatitis C without signs of cirrhosis 

or liver dysfunction." R. at 1430.

The RO implemented the Board's grant of benefits in November 2013, assigning a 

noncompensable rating for hepatitis C effective August 4, 2004. R. at 1423-26. The appellant, 

through current counsel, filed a Notice of Disagreement with the assigned rating. R. at 1304-05.

VA medical records dated between March 2014 and December 2015 reflect complaints of 

nausea and vomiting unrelated to his food intake, R. at 524 (Mar. 2014), 1250 (June 2014), 383-84 

(Dec. 2015); declining endurance accompanied by increasing fatigue, R. at 1006 (Oct. 2014); and 

weight loss, R. at 810 (July 2015), 384 (Dec. 2015). Of note, an October 2014 VA treatment 

record reflects the appellant's report of increased bloating "that is causing numbness in the 

epigastric region and pain along the flanks," but the examiner noted that he did "not complain of 

diarrhea, vomiting, or anorexia." R. at 1028. The following month, the appellant reported to his 

medical provider that he experienced intermittent bloating and abdominal pain, R. at 948, but the 

examiner stated that the appellant's pain and bloating was more likely caused by his "recently 

completed gastric emptying study," the results of which were abnormal, R. at 949. The examiner 

further noted that the appellant "denie[d] any symptoms relevant to liver disease," including 

jaundice, edema, ascites, hematemesis, melena, and hepatic encephalopathy. Id. 

At a VA liver examination in May 2016, the examiner found signs of intermittent fatigue, 

malaise, and anorexia, R. at 164, but the appellant denied experiencing any incapacitating episodes 

in the prior 12 months, R. at 165. In October 2016, VA increased the appellant's disability rating 

to 10%, effective May 20, 2016, the date of the most recent VA examination. R. at 158-62. 
3

Through current counsel, the appellant appealed to the Board. R. at 94-101. In his Substantive 

Appeal, the appellant argued that the symptoms noted in the May 2016 examination report, which 

VA determined warranted a higher disability rating, "could not have manifested on the day of [the]

examination," and therefore "a compensable evaluation is warranted throughout the period on 

appeal." R. at 95. He also cited October 2014 and December 2015 VA treatment records to 

demonstrate that his condition had worsened before May 2016. R. at 95-96. Finally, the appellant 

requested SMC for loss of use of a creative organ, arguing that his hepatitis C required him to wear 

a condom during intercourse to protect his partner and that "[c]ondom use effectively precludes 

procreative sex." R. at 96. In an attached affidavit, the appellant stated that he used a condom to 

prevent the transmission of hepatitis C and that he had "refrained from unprotected sexual 

intercourse since June 2013." R. at 98. The appellant's partner also submitted an affidavit stating 

that they use a condom when engaged in sexual intercourse. R. at 99.

In the March 2019 decision on appeal, the Board denied entitlement to a compensable 

disability rating for hepatitis C prior to May 20, 2016; to a rating in excess of 10% thereafter; and 

to SMC based on the loss of use of a creative organ. R. at 4-14. This appeal followed. 

II. ANALYSIS

A. SMC

1. The Parties' Arguments and the Board's Decision

The appellant first contends that the Board misapplied the law regarding SMC based on 

the loss of use of a creative organ. Appellant's Brief (Br.) at 5. Specifically, he asserts that the 

Board erroneously required that his loss of fertility be directly caused by his hepatitis C and did 

not allow for the possibility of "an additional link in the causal chain, i.e., condom use." Id. The 

Board's decision, he argues, violates Payne v. Wilkie, 31 Vet.App. 373 (2019). Id. at 7-10. He 

also argues that 38 U.S.C. § 1114(k) permits the award of SMC for any impairment of sexual 

function that is the result of a service-connected disability. Id. at 10-14. 

The Secretary counters that the appellant "fails to point [to] any evidence of record that he 

is infertile, that he has lost a testicle, or that he cannot achieve an erection," and therefore he has 

failed to carry his burden of demonstrating that the Board misapplied the law. Secretary's Br. at 

5. The Secretary urges the Court to adopt for the purposes of section 1114(k) the definition of 

"loss of use" that the Court established in Jensen v. Shulkin for the purposes of 38 U.S.C. 
4

§ 2101(a)(2)(B)(i), regarding the loss of use of both lower extremities: "a deprivation of the ability 

to avail oneself of the anatomical region in question." 29 Vet.App. 66, 78 (2017); Secretary's Br. 

at 8-9. Under that definition, the Secretary argues, the Board properly denied entitlement to SMC 

because the appellant's hepatitis C "has not deprived him of the ability to have procreative sex," 

Secretary's Br. at 9; rather, the appellant can simply "remove the condom and have procreative 

sex, thereby removing any potential impairment to his fertility," id.

With respect to the appellant's request for SMC, the Board stated:

SMC is available for loss of use of a creative organ. In most circumstances, [it] is 

applied to situations like erectile dysfunction, loss of one or both testicles, or loss 

of one or both ovaries. The [appellant] does not argue, and there is no evidence, 

that he suffers from erectile dysfunction as a result of his service-connected 

hepatitis C, that he is unable to achieve an erection, or that he has been rendered 

infertile as a result of his service-connected disability. While the Board 

acknowledges the contention that the [appellant] must use a condom during 

intercourse, there is no evidence or argument that, if he did not, [] he would be 

unable to conceive a child as a result of his service-connected hepatitis C. Absent 

such a showing, the use of a condom alone does not rise to the level of loss or loss 

of use of a creative organ. SMC is therefore not warranted.

R. at 11 (citation omitted).

2. Statutory Interpretation of Section 1114(k)

Congress has provided that SMC is payable to a veteran who, as the result of a serviceconnected disability, has suffered the "loss of use" of a "creative organ[]." 38 U.S.C. § 1114(k). 

In our recent decision in Payne, the Court held that, "[b]ecause Congress did not explicitly include 

. . . limitations [on qualifying service-connected disabilities] when drafting section 1114(k), the 

Court presumes that it did not intend to limit potential entitlement to SMC(k) only to veterans with 

specific service-connected disabilities." 31 Vet.App. at 384. The Court also held that "the plain 

text of section 1114(k) does not . . . preclude a theory of entitlement [to SMC(k)] based on a multilink causal chain between the service-connected disability and the anatomical loss or loss of use 

of one or more creative organs." Id. at 385. Therefore, the causal chain on which the appellant's 

claim is based (i.e., his service-connected hepatitis C causes him to use a condom which results in 

effective infertility) may not be foreclosed if it results in loss of use of a creative organ.1 That, in 

 

1 Given the Court's holding that the appellant has not demonstrated error in the Board's conclusion that he 

has not suffered the loss of use of a creative organ, we need not decide whether use of a condom may serve as an 

intermediate step in the causal chain between a service-connected disability and such a loss of use.
5

these circumstances, turns on whether section 1114 requires a disability of the creative organ to 

establish loss of use, a question the Court has not had occasion to consider.2 Accordingly, we 

begin, as always, with the statutory language. McGee v. Peake, 511 F.3d 1352, 1356 (Fed. Cir. 

2008); see Williams v. Taylor, 529 U.S. 420, 431 (2000).

"The statute's plain meaning is derived from its text and its structure." McGee, 511 F.3d 

at 1356; see Gardner v. Derwinski, 1 Vet.App. 584, 586 (1991) ("Determining a statute's plain 

meaning requires examining the specific language at issue and the overall structure of the 

statute."), aff'd sub nom. Gardner v. Brown, 5 F.3d 1456 (Fed. Cir. 1993), aff'd, 513 U.S. 115 

(1994). The "plain meaning must be given effect unless a 'literal application of [the] statute will 

produce a result demonstrably at odds with the intention of its drafters.'" Gardner, 1 Vet.App. at 

586-87 (quoting Griffin v. Oceanic Contractors, Inc., 458 U.S. 564, 571 (1982)); see Roper v. 

Nicholson, 20 Vet.App. 173, 180 (2006), aff'd, 240 F. App'x 422 (Fed. Cir. 2007). In assessing 

the language of a statute, courts review the overall statutory scheme "'so that effect is given to all 

its provisions, so that no part will be inoperative or superfluous, void or insignificant, and so that 

one section will not destroy another unless the provision is the result of obvious mistake or error.'" 

Roper, 20 Vet.App. at 178 (quoting 2A NORMAN J. SINGER, SUTHERLAND STATUTES AND

STATUTORY CONSTRUCTION § 46:06 (6th ed. 2000)).

The first question in statutory interpretation is always "whether Congress has directly 

spoken to the precise question at issue." Chevron, U.S.A., Inc. v. Nat'l Res. Def. Council, Inc., 

467 U.S. 837, 842 (1984). "If the intent of Congress is clear, that is the end of the matter; for the 

court, as well as the agency, must give effect to the unambiguously expressed intent of Congress." 

Id. at 842-43. The interpretation of a statute is a question of law that the Court reviews de novo, 

without deference to the Board's interpretation. See Butts v. Brown, 5 Vet.App. 532, 539 (1993) 

(en banc).

 

2

In Jensen, the Court considered the meaning of the phrase "loss[] or loss of use" as it appears in 38 U.S.C. 

§ 2101(a)(2)(B)(i) and 38 C.F.R. § 3.809(b)(1) (pertaining to specially adapted housing), 29 Vet.App. at 68, for 

disabilities "due to the loss, or loss of use, of both lower extremities such as to preclude locomotion without the aid of 

braces, crutches, canes, or a wheelchair," 38 U.S.C. § 2101(a)(2)(B)(i). The Court held that "loss of use" means "a 

deprivation of the ability to avail oneself of the anatomical region in question," there, the lower extremity. Jensen, 

29 Vet.App. at 78. Because the Court in Jensen considered the meaning of "loss of use" in a different context, its 

definition is informative but not controlling, particularly in light of our colleagues' statement in that case that "loss of 

use" is "a general term, one that can readily accept additional specificity in various circumstances," explaining that 

"[a]djacent modifiers and, in the case of SMC, regulatory efforts[,] create that specificity." Id.
6

For several reasons, we conclude that the "text and . . . structure" of section 1114(k), 

McGee, 511 F.3d at 1356, make clear that the ability of the creative organ to function must be 

diminished in order to constitute a "loss of use of . . . [a] creative organ[]."

3

 38 U.S.C. § 1114(k). 

Therefore, the Board did not err in finding that a personal choice to use a condom, even when done

with the intention of preventing the spread of disease, does not alone result in loss of use of a 

creative organ. 

First, section 1114 is part of chapter 11 of title 38, U.S. Code, which is titled 

"Compensation for Service-Connected Disability or Death." Subchapter II begins with section 

1110, which provides that, "[f]or disability," compensation will be paid "as provided in this 

subchapter" when certain conditions are satisfied. 38 U.S.C. § 1110. Section 1114 of that 

subchapter in turn provides that, "[f]or the purposes of section 1110"—i.e., for the purposes of

paying compensation for disability—the listed rates will apply. Subsection (k) then sets forth the 

rate of compensation where a veteran, "as the result of service-connected disability, has suffered 

the anatomical loss or loss of use of one or more creative organs." 38 U.S.C. § 1114(k) (emphasis 

added). Notably, that subsection later provides that, "in the event the veteran has suffered one or 

more of the disabilities heretofore specified in this subsection," a higher rate of SMC is warranted. 

Id. (emphasis added). In that regard, although subsection (k) references generically a "serviceconnected disability" as the beginning of the causal chain, no specific service-connected conditions 

are thereafter listed. See Payne, 31 Vet.App. at 384 (noting that subsection 1114(k) "does not 

specify the types of service-connected disabilities" that may result in compensation under that 

subsection). Accordingly, the phrase "disabilities heretofore specified" must refer to the specific 

conditions enumerated in subsection (k), which includes "loss of use of . . . [a] creative organ[]."

4

The placement of section 1114 and the wording of subsection (k) thus clearly indicate that SMC(k) 

 

3 Nothing in our opinion suggests that the cause of the diminishment must be physical rather than 

psychological. 

4 The Court notes that, in April 2000, VA's Office of General Counsel (OGC) considered whether VA could, 

via rulemaking, compensate service-connected mastectomies under section 1114(k). VA Gen. Couns. Prec. 2-00 

(Apr. 3, 2000). The OGC concluded that "VA may not by rulemaking designate additional injuries or conditions for 

which it will pay k-rate SMC, beyond those specified in section 1114(k), even if it finds that the loss involved is 

comparable to the losses involved in the conditions for which Congress has authorized k-rate SMC." Id. at 2 (emphases 

added).
7

compensates for disabilities of some kind and, as relevant here, that it must be a disability "of . . . 

[a] creative organ[]." 38 U.S.C. § 1114(k).

A "disability" for the purposes of chapter 11 requires "functional impairment," which 

impacts the "'ability of the body as a whole, or of the psyche, or of a system or organ of the body 

to function under the ordinary conditions of daily life.'" Saunders v. Wilkie, 886 F.3d 1356, 1363 

(Fed. Cir. 2018) (quoting 38 C.F.R. § 4.10 (2017)); see 38 U.S.C. § 1110. At a minimum, then, 

the plain language of section 1114(k) conveys that the ability of the creative organ to function 

must be diminished in order to warrant compensation. See Wait v. Wilkie, 33 Vet.App. 8, 15 

(2020). This conclusion is further buttressed by the other circumstances Congress specifically 

listed in section 1114 as warranting SMC, which are conditions affecting specific parts of a

veteran's body or of his or her psyche. See 38 U.S.C. § 1114(k) (including—in addition to the 

anatomical loss or loss of use of a creative organ—the anatomical loss or loss of use of one foot, 

one hand, both buttocks; blindness in one eye; "complete organic aphonia with constant inability

to communicate by speech"; deafness of both ears; the anatomical loss of 25% or more of tissue 

from a single breast or both breasts in combination due to mastectomy; and treatment of breast 

tissue with radiation5), (l) (providing SMC for anatomical loss or loss of use of both feet or one 

hand and one foot, as well as blindness in both eyes), (m) (providing SMC for the anatomical loss 

or loss of use of both hands, or of both legs with factors preventing natural knee action with 

prostheses in place; of one arm and one leg with factors preventing natural elbow and knee action 

with prostheses in place; and blindness in both eyes with only light perception), (n) (providing 

SMC for the anatomical loss or loss of use of both arms with factors preventing natural elbow 

 

5 The Court notes that, when Congress ultimately proposed adding mastectomies to the list of disabilities 

compensated under section 1114(k), VA's Under Secretary for Benefits offered the following: 

Special monthly compensation is currently authorized for certain anatomical losses or losses of use 

for which the rating schedule, which is based solely on impairment of earning capacity, is considered 

inadequate for compensation purposes. The statute recognizes that the loss of a hand or foot, for 

example, or loss of a creative organ, involves loss of bodily integrity which may negatively affect 

self-image and precipitate considerable emotional distress.

The service-connected radical or modified-radical mastectomies covered by [the proposed 

legislation] involve loss of bodily integrity and associated emotional trauma to a degree that is at 

least comparable to the removal of a single testicle, for example, for which special monthly 

compensation is currently payable regardless of its effect on a veteran's procreative ability and 

regardless of whether the veteran is still of procreative age. As a matter of simple equity, these 

mastectomies warrant equal compensation for the veterans who undergo them.

S. REP. NO. 106-397, at 55 (2000) (emphases added). 
8

action with prostheses in place; the anatomical loss of both legs with factors that prevent the use 

of prosthetic appliances; the anatomical loss of one arm and one leg with factors that prevent the 

use of prosthetic appliances; the anatomical loss of both eyes; and blindness without light 

perception in both eyes).

Additionally, the structure of section 1114 indicates that more severe disabilities are 

compensated at a higher level of SMC. See 38 U.S.C. § 1114(k)-(n); Breniser v. Shinseki, 

25 Vet.App. 64, 68-69 (2011). Tellingly, under subsection (k), loss of use of a creative organ is 

compensated at the same level as anatomical loss of a creative organ. This suggests not only that 

Congress contemplated that the loss of use of a creative organ that warrants SMC(k) would be 

comparable in severity to the anatomical loss of a creative organ,

6

but also that the focus of 

subsection (k) is on the level of function, or absence of function, of the creative organ.

In sum, we find that the text and structure of section 1114(k) require that, to establish a 

"loss of use of . . . [a] creative organ[]," there must be diminished function of the creative organ. 

38 U.S.C. § 1114(k). To the extent that, as discussed below, this resolves the current dispute, "that 

is the end of the matter." Chevron, 467 U.S. at 842. 

3. Application

As noted above, the appellant contends that compensation under section 1114(k) is 

warranted because "service-connected [h]epatitis C causes him to refrain from sex without 

condoms, and condom use precludes procreative intercourse."

7

 Appellant's Br. at 10. 

Alternatively, he avers that, even if condom use does not constitute a loss of fertility, he would 

nevertheless be entitled to SMC(k) because reliance on condoms due to hepatitis C is itself "an 

 

6

In that regard, the Court notes that the VA Adjudication Procedures Manual directs an adjudicator as 

follows: "When a VA examiner finds that there is [erectile dysfunction] or other sexual dysfunction, SMC(k) is 

established even though . . . the [v]eteran had a vasectomy prior to the development of the [loss of use] of a creative 

organ, as vasectomies may be reversible while [loss of use] is not." VA ADJUDICATION PROCEDURES MANUAL, M21-1

(M21-1), pt. III, subpt. iv, ch. 4, § I.3.b (emphasis added). 

7 The Court will not address the appellant's arguments first raised in his reply brief, see Reply Br. at 1-5, and 

reiterated at oral argument, see Oral Argument at 8:27-9:01, 12:32-13:15, 15:20-:30, 17:07-:39, 

http://www.uscourts.cavc.gov/oral_arguments_audio.php, that his creative organ is impaired because it is capable of 

transmitting disease. See Carbino v. Gober, 10 Vet.App. 507, 511 (1997) (declining to review argument first raised 

in appellant's reply brief), aff'd sub nom. Carbino v. West, 168 F.3d 32, 34 (Fed. Cir. 1999) ("[I]mproper or late 

presentation of an issue or argument . . . ordinarily should not be considered."); see also Untalan v. Nicholson, 

20 Vet.App. 467, 471 (2006); Fugere v. Derwinski, 1 Vet.App. 103, 105 (1990). The Court notes, however, that 

although he was represented by current counsel below, the appellant does not contend or point to evidence reflecting 

that he raised this theory of entitlement before the Agency, nor does he contend that it was reasonably raised by the 

record. See R. at 96 (June 2017 Substantive Appeal, filed through current counsel, contending that "[c]ondom use 

effectively precludes procreative sex").
9

impairment of normal sexual function." Id. at 11. The Secretary, on the other hand, maintains that 

SMC(k) is not warranted here because the appellant does not suffer from a "medical impairment, 

injury, or disease to [his] creative organ." Secretary's Br. at 9; see id. at 5 ("[T]here is no evidence 

that there is anything wrong with [the a]ppellant's creative organs."). Specifically, he contends 

that the appellant "is capable of having [] sex without a condom and procreating," id. at 8; his 

"hepatitis C has not deprived him of the ability to have procreative sex," id. at 9; and, "[c]onsistent 

with the Board's finding, [he] can remove the condom and have procreative sex, thereby removing 

any potential impairment to his fertility," id. (citing R. at 11). 

Although the appellant appears to contend that use of a condom constitutes a change in his 

sexual "function," the essence of his argument is that SMC(k) may compensate a veteran for a 

change in behavior purportedly resulting from a service-connected disability. See, e.g., Reply Br. 

at 4 ("[The appellant] retains the physical capacity for unprotected intercourse, but chooses to 

refrain from unprotected intercourse."). However, from the above discussion, it is clear that 

Congress intended SMC(k) to compensate for, generally, physical or mental impairment resulting 

from a service-connected disability and, specifically with respect to loss of use, for the 

diminishment of the functional ability of a creative organ that is comparably as severe as

anatomical loss. In that regard, the appellant does not challenge the Board's findings that "there is 

no evidence[] that he suffers from erectile dysfunction . . . . , that he is unable to achieve an 

erection, or that he has been rendered infertile." R. at 11. Nor did he in his principal brief argue 

or point to evidence reflecting that hepatitis C results in any other type of diminishment in the 

ability of his creative organs to function or that his condition results in any mental impairment, for 

example, loss of libido.8 See R. at 11. Because the plain language of section 1114(k) makes clear 

that SMC(k) is not warranted in the absence of any impairment of his creative organ, the Court 

cannot conclude that the appellant has demonstrated that the Board erred in finding that "use of a 

condom alone does not rise to the level of loss or loss of use of a creative organ." R. at 11. 

Accordingly, the Court need not address the appellant's remaining arguments regarding his 

entitlement to SMC(k).

 

8 We note that the M21-1 reflects that SMC(k) is available for the diagnosed conditions of impotence and 

loss of libido, among other conditions. See M21-1, pt. III, subpt. iv, ch. 4, § I.3.b.
10

B. Disability Ratings

The appellant argues that the Board provided inadequate reasons or bases for denying 

entitlement to a compensable disability rating for hepatitis C prior to May 20, 2016, and to a rating 

in excess of 10% thereafter because the Board did not fully address the arguments he raised below 

and relied on the May 2016 VA examination, which he avers is inadequate, to deny higher 

disability ratings. Appellant's Br. at 16-20. The Secretary disputes these arguments and urges the 

Court to affirm the Board's decision. Secretary's Br. at 12-19. Notably, the Secretary asks the 

Court to decline to consider the appellant's argument regarding the adequacy of the May 2016 VA 

medical examination because the appellant did not raise that challenge below, despite being 

represented by current counsel. Id. at 16-17.

The Board is tasked with determining the proper disability rating in the first instance. See 

Hensley v. West, 212 F.3d 1255, 1263 (Fed. Cir. 2000) (stating that "appellate tribunals are not 

appropriate fora for initial fact finding"); see also 38 U.S.C. § 7261(c) ("In no event shall findings 

of fact made by the Secretary or the [Board] be subject to trial de novo by the Court."). The Board's

determination of the proper disability rating is a finding of fact that the Court reviews under the 

"clearly erroneous" standard of review. See 38 U.S.C. § 7261(a)(4); Buckley v. West, 12 Vet.App. 

76, 81 (1998). A finding of fact is clearly erroneous when the Court, after reviewing the entire 

evidence, "is left with the definite and firm conviction that a mistake has been committed." United 

States v. U.S. Gypsum Co., 333 U.S. 364, 395 (1948); see Gilbert v. Derwinski, 1 Vet.App. 49, 52 

(1990). As with any material issue of fact or law, the Board must provide a statement of the 

reasons or bases for its determination "adequate to enable a claimant to understand the precise 

basis for the Board's decision, as well as to facilitate review in this Court." Allday v. Brown, 

7 Vet.App. 517, 527 (1995); see 38 U.S.C. § 7104(d)(1); Gilbert, 1 Vet.App. at 56-57.

1. Adequacy of the May 2016 VA Medical Examination

To begin, the Court will not address the appellant's argument, raised for the first time to 

the Court, that "the May 2016 VA examination report is insufficient for the Board to reach a fully 

informed evaluation" and should have been returned. Appellant's Br. at 19. There is a 

longstanding recognition of "the importance of issue exhaustion with respect to administrative 

tribunals" because "'orderly procedure and good administration require that objections to the 

proceedings of an administrative agency be made while [the agency] has opportunity for correction 

in order to raise issues reviewable by the courts.'" Scott v. McDonald, 789 F.3d 1375, 1377 (Fed. 
11

Cir. 2015) (quoting United States v. L.A. Tucker Truck Lines, Inc., 344 U.S. 33, 37 (1952)). Within 

the context of the VA system, the Court must apply a balancing test to determine whether the 

doctrine of issue preclusion should be invoked: "'The test is whether the interests of the individual 

weigh heavily against the institutional interests the doctrine exists to serve.'" Id. at 1378 (quoting 

Maggitt v. West, 202 F.3d 1370, 1377 (Fed. Cir. 2000)). However, the Court is not required "to 

. . . address procedural arguments when the [appellant] fails to raise them before the Board." Id.

at 1381.

The appellant has been represented by current counsel since at least August 2014. See R. at 

1304-05. In his Substantive Appeal, the appellant through counsel offered arguments related to 

the proper disability ratings for his condition and to SMC, but he did not challenge the adequacy 

of the May 2016 VA medical examination. See R. at 95-96. Because the appellant failed to raise 

this issue below, thus depriving the Agency of the opportunity for correction and failing to raise 

an issue reviewable by this Court, see Scott, 789 F.3d at 1377, the Court, applying the balancing 

test of Maggitt, will not exercise its discretion to review the issue raised for the first time here. See 

Dickens v. McDonald, 814 F.3d 1359, 1361-62 (Fed. Cir. 2016) (affirming the Court's invocation 

of the doctrine of issue exhaustion where the appellant failed to raise a procedural argument to the 

Board).

2. Reasons or Bases

The appellant's hepatitis C is evaluated under 38 C.F.R. § 4.114, Diagnostic Code 7354. 

Under that diagnostic code, a noncompensable rating is warranted where the condition is 

nonsymptomatic, while a 10% rating is warranted where it results in "[i]ntermittent fatigue, 

malaise, and anorexia[;] or[] incapacitating episodes (with symptoms such as fatigue, malaise, 

nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at 

least one week, but less than two weeks, during the past 12-month period." 38 C.F.R. § 4.114, 

Diagnostic Code 7354 (2020). A 20% rating requires "[d]aily fatigue, malaise, and anorexia 

(without weight loss or hepatomegaly), requiring dietary restriction or continuous medication[;] 

or[] incapacitating episodes . . . having a total duration of at least two weeks, but less than four 

weeks, during the past 12-month period." Id. To warrant a 40% rating, the claimant's hepatitis C 

must result in "[d]aily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly[;] 

or[] incapacitating episodes . . . having a total duration of at least four weeks, but less than six 

weeks, during the past 12-month period." Id. A 60% rating is warranted where the condition 
12

results in "[d]aily fatigue, malaise, and anorexia, with substantial weight loss (or other indication 

of malnutrition), and hepatomegaly[;] or[] incapacitating episodes . . . having a total duration of at 

least six weeks during the past 12-month period, but not occurring constantly." Id. Finally, a 

100% rating is warranted where the condition results in "[n]ear-constant debilitating symptoms 

(such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain)." 

Id. An "incapacitating episode" is "a period of acute signs and symptoms severe enough to require 

bed rest and treatment by a physician." Id. at Note 2. 

The appellant contends that the Board failed to fully address an argument that he raised in 

his Substantive Appeal, namely, that "the May 2016 VA examination report is itself evidence that 

the symptoms of fatigue, malaise, and anorexia [on which his 10% rating is based] pre-dated 

May 20, 2016." Appellant's Br. at 17; see R. at 95. The appellant argues that the examiner's 

conclusion is necessarily based on his review of records showing symptoms that warrant a 10% 

rating earlier than the date of the examination. Appellant's Br. at 17.

In the decision on appeal, the Board acknowledged the appellant's argument and 

specifically reviewed the October 2014 and December 2015 treatment records that the appellant 

identified in his Substantive Appeal. R. at 8. The Board found, however, that "[t]he evidence of 

record . . . simply does not support a finding that the [appellant's] increase in disability was 

factually ascertainable prior to the assigned effective date of the stage of May 20, 2016." Id. The 

Board explained that the appellant's VA treatment records "primarily show treatment for 

symptomatology due to [his COPD], gastroesophageal reflux disease (GERD)[,] and swallowing 

disorder," and did not show "that he exhibited the symptomatology necessary for an increased 

rating" for hepatitis C. Id. In that regard, the Board summarized numerous treatment records and 

concluded that none of them indicated that the examiners attributed his reported symptoms to 

hepatitis C. R. at 8-9. The Board therefore found no evidence to support increasing the appellant's 

disability rating for either period on appeal. R. at 9-10.

The Court concludes that the appellant has not carried his burden of demonstrating 

prejudicial error in this regard. See 38 U.S.C. § 7261(b)(2) (requiring the Court to "take due 

account of the rule of prejudicial error"); Shinseki v. Sanders, 556 U.S. 396, 409 (2009) (holding 

that the harmless-error analysis applies to the Court's review of Board decisions and that the burden 

is on the appellant to show that he or she suffered prejudice as a result of VA error). His argument 

consists of summaries of the May 2016 examination report, the argument in his Substantive 
13

Appeal, and the Board's decision, Appellant's Br. at 16-17; a statement that the Board should have 

addressed "why the VA examiner's report is not itself evidence that the symptoms pre-date May 20,

2016," id. at 17; and an assertion that he was prejudiced by the Board's error because his ability to 

understand the Board's decision is hindered, id. Missing from his argument, however, is reference 

to any evidence showing that the symptoms he points to are attributable to hepatitis C or, assuming 

such evidence exists, an explanation of how those symptoms satisfy the requirements for a higher 

disability rating.

The appellant next argues that the Board's determination that the symptoms he reported 

throughout the appeal period were related to his COPD or GERD is an impermissible medical 

conclusion. Appellant's Br. at 18-20; see Colvin v. Derwinski, 1 Vet.App. 171, 172 (1991) (finding 

that the Board is prohibited from "provid[ing] [its] own medical judgment in the guise of a Board 

opinion"), overruled on other grounds by Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Contrary 

to the appellant's argument, however, the Board did not reach a medical conclusion. Instead, the 

Board reviewed the medical treatment records and summarized their contents, including whether 

the medical provider attributed the appellant's reported symptoms to hepatitis C. See R. at 8-9. 

The Board then weighed that evidence against the appellant's assertions that his symptoms were 

more severe throughout the appeal period than reflected in the assigned disability ratings. R. at 

10. It is the Board's responsibility to weigh the evidence in the first instance, and the Court may 

only overturn the Board's conclusion in that regard if the appellant demonstrates that it was clearly 

erroneous. See Washington v. Nicholson, 19 Vet.App. 362, 369 (2005); Owens v. Brown, 

7 Vet.App. 429, 433 (1995). The appellant has not carried that burden here.

The Court acknowledges the appellant's citation to a March 2014 VA internal medicine 

note reflecting that his abdominal pain was "[l]ikely from cirrhosis and known hemangioma in 

[the] liver." R. at 521; Appellant's Br. at 19. The Court also notes that the Board did not expressly 

discuss this record. See R. at 7-10. The appellant, however, has not demonstrated that the Board's 

failure to explicitly account for this evidence is prejudicial to him, again arguing only that the 

Board's inadequate reasons or bases hinder his ability to understand the decision. Appellant's Br. 

at 20; see 38 U.S.C. § 7261(b)(2); Sanders, 556 U.S. at 409.

The appellant raises no other challenges to the Board's decision regarding the proper 

disability rating for hepatitis C for the periods on appeal. The Court will therefore affirm that 

portion of the Board decision.
14

III. CONCLUSION

After consideration of the parties' pleadings, a review of the record, and hearing oral 

argument, the Board's March 13, 2019, decision is AFFIRMED.