Submission of Documents toDepartment Of Veterans Affairs

1El Evidence Intake Center PO Box 4444PO Box 4444Janesville WI 53547-4444

FAX 1-844-822-5246 or 1-844-531-7818

Veteran: Roberto VSC:VBA San Juan PR 355

C-File or SSN: 26

Street Address:

City, State, Zip: Puerto Rico 00949-3544

Date: 12/12/2019 ATTN: VBA 355 Intake

From: Gordon A. Graham Exclusive Contact Requested

Title: NonattorneyPractitioner VA #39029 POA Code E1P

Address 14910 125* Street KP North

City, State Gig Harbor, WA 98329

Tel: (253)-313- 5377 Fax (253) 590-0265

Email: gagraham51@gmail.com

0 VAF 20-0995 Suppl. Claim or VAF 20-0996 Higher Level of Review0 VAF 21-8940/VAF 21-4192 FOR TDIU0 VAF 9 APPEAL TO BOARD OF VETERANS' APPEALS (Legacy)O VAF 21-526EZ CLAIMFOR €ÐMPENSATIONMotion to ReviseO VAF 10182 NOTICE OF DISAGREEMENT (BVA Review)O Privacy Act / Freedom of Information Act (VAF 3288)O Other

Number of Pages Submitted (NOT including this cover sheet): Twenty three (23) pages l

VA Directive 6609, NOVENIBER 9, 2007: NOTICEIAccess to Veterans records is limited to Authorized PersonnelOnly. Information may not be disclosed unless permittedpursuantto 38 CFR 1.500-1.599. The Privacy Actcontains provisions for criminal penalties for knowinglyand willingly disclosing information from the file unlessproperly authorized to do so.

OMB Control No. 290(M)747Rtopendent Burdeli 25 minute

APPLICATION FOR DISABILITY COMPENSATION AND RELATED NADANSMP(Do NOTWRITE IN THISSPACE)

COgP SAT ONIMPORTANT Please read the Privacy Act and Respondent Burden on page 12 before completing the form.

la P ce laim

O FULLY DEVELOPED CLAIM (FDC) PROGRAM STANDARD CLAIM PROCESS

O IDES (Select this option only if you have been referred to the IDES Program by your Military Service Department)

O BDD Program Cimim (Select this option only if you meet the criteria for the BDD Program specified on InstructionPage 5)

NOTE: You may either complete the form anüne or by hand, if completed by hand, print the information requested in mk, neatly, and legibly to expedde process g of the form.

CTlON I: ID FICATION IM INFORMATION(If clalm Is not an original claim, only Section I, IV, and a signature are regulred)

2.VETERANTSERVICE MEMBERNAME (First, MiddleinfiMA [415(

Robert o

3 VETERAN'S SOCIAL SECURITY NUMBER (SSN) 4 HAVE YOU EVER FILED A CLAIM WITH VAT 5. VA FILE NUMBER

[2 YES O NOmurßle

6. DATE OF BIRTH (MMDDJYYY) 7. VETERAN'S SERVICE NUMBER (if appreable) 8 SEX

Month Day Year

MALE FEMALE

9 BDD CLAIMS Otta. F?tOV E INE DATE OR ANTICIPATED DATE OP 10 TELEPHONE NUMB (Šl rpeRELEASE FROM ACT1VE DUTY (Ant,DD,77ry) (include Area Code)

oaytime: (253) 313-5377Month Day Year Evening:

Cel phone: (253)11. CU RRENT MAI LI NG ADDRESS (Nunsber and.street or rural route, P.O. Bar, Cary, State, ZlP Code and Cormtry)

Apt]Unit Number City

sinteirrovine. counar P R ZIP Code/Postal Code 0 0 9 4 9 - 3 5 4 4

12. EMAIL ADDRESS (Optronal)

gagraham51@gmail.comO 13. I F YOU ARE CU RRE NTLY A VA EMPLOY EE, CHECK THE BOX (includes Work StudyIntemship)? (lfyou are nota VA enyloyee skip to Seenon H, japphrable)

ECTlON 11: CHANGE OF ADDÃESS

NOTE: If you are temporarily or permanently changing your address, complete Items 14A through 14C.

14A. TYMPEORFADDRESS CHANGE (CompleNietrapphcable) (Check only one box)

14B. NEW ADDRESS (Numborandstreet ortural route, P.O. Box, Gdy, State, ZIR Code and Country)

IMO. &

Rfrask i I I I I .

Apt]Unit Number City

State/Province CountlY ZIP Code/Postal Code -

14C. EF FECTIV E DATE(S) OF N EW ADDRESS (if your change of address is ternporary, complete both the beginning and ending date of your famporary address)(If your change of address is pennenent please enter youreffecNye date in the begFnning date org)

Month Day Year Month Day Year

BEGINNING DATE: - - ENDING DATE:

'°"? 21-526EZ SUPERSEDES VA FORM 21-526EZ, MAR 2018. NSM

JETERANS SOCIAL SECURITY No.

IMPORTANT: The following questions (items 15A through 16F) should ouiy be completed if you are currently homeless or at risk of becoming homeless.If this itern does not apply to you, skip to Section IV.

15A. ARE YOU CURRENTLY HOMELESS? 158. CI·lECICTHE BOX THÄT APPLIES TOYOUR LÑIl G ÑTÜÃ ON

O YES (If"Yes,"completeltem15Bregardingyoralivingsituation) O LIVINGINAHOMELESSSHELTER

NO O NrO CURRENTLY IN A SHELTERED ENVIRONMENT (e.g., living in a car

O STAYING WITH ANOTHER PERSON

O FLEEING CURRENT RESIDENCE

O OTHER (Specify):

16C. ARE YOU CURRENTLY AT RISK OF BECOMING HOMELESST 15D. CHECIWHE BOX THAT ÀPPLIES TO YOUR LIVING SITUATIOÑ:

O HOUSING WILL BE LOST IN 30 DAYSO YES (If"Yes,"completeltem15Dregardingyourlivingsituation)

O LEAVING PUBLICLY FUNDED SYSTEM OF CARE (e.g., homeless

NOshelter}

O OTHER (SpeciM

15E. POINT OI¯ COÑTACT (Name of person VA can confectIn orderlo getin touch with 7010 15F. POINT OF CONTACT TELE PHONE NUMBER (Include Àrea Codt

SECTION IV: CLAIM INFORMATION16. LIST THE CURRENT DISABILITY(IES) OR SYMPTOMS THAT YOU GLAIM ARE RELATED TO YOUR MILITARY SERVICE AND/OR SERVICE-CONNECTED DISABILITY(If appfteable, identify whethera asabiltry is due to a servlœ-connected disabliny; co;¡finernentas a prisoner of war; exposun to Agent Orange, abertas, manant gas, tonigng mdiation, or GulfWar environmental hdEnnis;ora disability forwhich compensation is payable urafer 38 U.S.C. 1151)NOTE: List your claimed conditions below. See the following three examples for guidance on how to complete Section IV.

EXAMPLESOF EXP NE EXAMP-ESOr HQtlTHEEXAMPLES OF DISABILITY(IES)

TYPE DISABILITY(IES) RELATE TO SERVICE EXAMPLES OF DATES

Exemple 1 HEARING LOSS NOISE HEAVY EQUIPMENT OPERATOR IN SERVICE JULY 1968

Example 2 DIABETES AGENT ORANGE SERVICE IN VIETNAM WAR DECEMBER 1972

Example 3 LEFT KNEE, SECONDARY TO RIGHT KNEE INJUHTE LEF EDEWHEN BRACE ON 6/ /2008

IF DUE TO EXPOSURE, EVENT, OR EXPLAIN HOW THE DtBASIL1TY(IES) APPROXtMATE DATECURRENT DISAB1LITY(IES} IN.JURY, PLEASE SPECtFY RELATES TO TNE IN-SERVK'E DISABILifY(IES)

e.. ., A ent Oran e, radiauon BE AN OR WORSENED

Motion to Revise the 3/23/19 Rating decision baseo on Clear and UnmistakableError. See attached ar ument seven s with Exhibits A-D)

4.

6.

14.

VA FORM 21-526EZ, SEP 2019 Page 9

VETERANS SOCIAL SECURITY NO

YKLíàYVA MEDICAL CENTER(S) (ŸÄMC) AN0 DEWÄßÑËÑÏOFDEÈEÑSE ÜOD) MÏÜŸÃÑŸÏÑEATÑEÑTFÃCÏLIÏÏEŠlMÏF)WHERE YÖl.Ï REnËÏŸED TREÃÏMENTAFTER DISCHARGE FOR YOUR CLAIMED DISABILITY(IES) LISTED IN ITEM 16AND PROVIDE APPROXIMATE BEGINNING DATE (MonthandYear)OFTREATMENT:

NOTE:1f treatment began from 2005 to present, you do not need to provide dates in Item 178.

8 DATE OF TREATMENT C CHECK THE BOX IF

A. ENTER THE DISABILITY TREATED AND NAME/LOCATION OF THE TREATMENT FACILITY (MM/YYYY) YOU DO NOT HAVEDATE(S) OF TREATMENT

O Don't have date

O Don ave date

NOTE ÏF YÖU WSVTOtLÃlM ÁÑY OF THEFOLLOWIN r, IMPLËEi A D ATTÃ IIIL I IIFFh ŸORM(S) AS STATED BEL >W

VA fonns are available at u 0;AaformFor: Required Form(s):

Supplemental Claims VA Form 2eßeBS, Dedslon Revlew Request Supplemental Claim

Dependents VA Form 21-6860 and, if claiming a child aged 18-23 years and in schod, VA Form 21-674

Individual Unemployability VA Form 21-8940 and 21-4192

Post-Traumatic Stress Disorder VA Form 214781 or 21-0781a

Specially Adapted Housing or Special Home Adaptation VA Fomi 26-4655

Auto Allowance VA Form 21-4502

Veteran/Spouse Aid and Attendance benefits VA Form 21-2680 or. If based on nursing home attendance, VA Form 21-0779

SECTION V: SERVICE INFORMATION

18A. DID YOU SERVE UNDER ANOTHER NAME7 18B. LIST THE OTHER NAME(S) YOU SERVED UNDER:

O ygg (If"Yes."complete NO (1f"No,"skiptoItem 18B) Item l M)

19A. BRANCH OFSERVICE (Check all that appfy) 19B COMPONENT (Check alithstapply)

ARMY Q NAVY O MARINE CORPSACTIVE O RESERVES NATIONAL GUARD

O AIR FORCE O COAST GUARD

sT Riciiif AcfÑiisääüië õÃTWi555 žaPËÄÕÈÒFTÄŠT OR ÄNÌÏ0ÏPATED ËFÃÑÃÏÏÕMonth Da Year Key West Fla ARADCOM

ENTRY DATE: ¯1 9 6 8 B Btry 6th Bn (H)

EXIT DATE: - 1 9 7 0 65th Arty USNAS

20C. DID YOU SERVE IN A COMBAT 20D ADDITIONAL PERIODS OF SERVICE (Indicate enkstment and discharge date(s), ifapphcable)ZONE SINCE 9-11-20D17 Enlistment Date(s) Discharge Date(s)

O YES NO

21A. ARE YOU CURRENTLY SERVING OR HAVE YOU EVER SERVED IN 21B COMPONENT 21C OBLIGATION TERM OF SERVICETHE RESERVESOR NATIONAL GUARD7 Month Day Year

O YES (If"Yes,"complerefrems21Btirru21F) U

RODNALFrom: .... -

NO (If"No,"slaptoltem2¾ O RESERVES yo -

21D CURRENT OR LAST ASSIGNED NAME AND ADDRESS OF UNIT 21E. CURRENT OR ASSIGNED ÑÖÑE 21F ÄNE YOU CUR E ÏËCY

NUMBER OF UNIT (Include Area RECEIVING INACTIVE DUTYTRAINING PAY9

O YEs O NO

N u 22B. DATE OF ACTl\ÏÄTION 22C. ANTICIPATED SEPARATION DATEORDERS WITHIN THE NATIONAL GUARD OR {AM,DD,YYYY) (AN,DD.YYYY)RESERVES?

O Yes (II"Yes, " complete Items 228 & 22C) Month Day Year Month Day Year

E NO

23A. HAVE YOU EVER BEEN A PRISONER OF WARY 23B DATES OF CONFINEMENT (AM.DD,YYYY)

From To:

O YES (If"Yes, " complete Item 238) Month Day Year Month Day Year

NO

Month Day Year Month Day Year

I I I-I \ I-I I ll ILLJ-I I-I I I I I

VA FORM 21-526EZ, SEP 2019 age 10

VETERANS SOCIAL SECURITY No.

SECTION Vl: SERVICE PAY (Retired Pay, Separation Pay, and Disability Severance Pay)

24A. ARE YOU RECEMNG MIUTARY RETIRED PAY? 24B. WILL YOU RECEIVE MILITARY RETIRED PAY IN THE FUTURET

OYES (If"Yes," explain below (e.g. futwe ReserveWarianal Guard retirement, pendingOYES (Tf"Yes,"completeItenu24Cand24D ABB/PEBandalsocompleteltems24Cand24D)

NO

NO

240. BRANCH OF SERVICE 24D. MONTHLY AMOUNT 25. RETIRED STATUS

O RETIRED PERMANENT DISABILITY RETIRED LIST

O TEMPORARY DISABILITY RETIRED LIST

IMPORTANT INFORMATIONON MILITARYRETIRED PAY (Includes all Uniformed Services Retired Pay):

Submission of this application constitutes a waiver of military tetired pay in an amount equal to VA compensation awarded, ifyou are entided to both benefits.

Your retired pay may be reduced by the amount of VA compensation awarded. Receipt of the full amount ofmilitary retired pay and VA compensation at the

same time may result in an overpayment, which my be subject to collection. If you qualify for concurrent receipt of VA compensation and military retired

pay, the waiver of retired pay will not apply. If you do not want to waive any retired pay to receive VA compensation, you sbould check the box in Item 26.

Note that if you ebeck the box in Item 26, you will not receive VA compensation, if granted. If you are currently in receipt of VA compensation and

you check the box in Item 26, your VA compensation will be terminated, if you are also eligiblefor military retired pay.

IMPORTANT: VA COMPENSATION PAY IS NON-TAXABLE. THEREFORE, VA COMPENSATION PAY MAY BE THE GREATERBENEFIT.

O 26. Do NOT pay me VA compensation. I do NOTwant to receive VA compensation in lieu of retired pay.

IMPORTANT INFORMATION ON SEPARATION/SEVERANCEPAY:VA compensation, if granted, may be withbeld to recoup any disability severance or separation pay such as involuntary separation pay, voluntary separation

pay, or special separation benefit, you receive from your branch of service. In addition, if you receive a Voluntary Separation Incentive (VSI), your VSI

payments may be reduced if you are awarded VA compensation. Receipt of VA compensation and VSI at the same time may result in an overpayment of VSI,

which migg be subject to collection.27A. HAVE YOU EVER RECElVED SEPARATION PAY, DISABILITY SEVERANCE PAY, OR ANY OTHER LUMP SUM PAYMENT FROM YOUR

BRANCH OF SERVICE?

OYES (If"Yes," complete Items 27B thmugh 27D)

NO

2/B. DATE PAYMENT RECEIVED (MM,DD,YYYY) 27C. BRANGH OF SERVICE 27D. AMOUNT RECElVED (Pronde prMax amount}

Month DEV Year

IMPORTANT INFORMATIONON INACTIVE DUTY TRAINING PAY:You may elect to keep the active or inactive duty training pay you received from the military service department. However, to be legally entitled to keep your

training pay, you must waive VA benefits for the number of days equal to the number of days for which you received training pay. In most instanos, it win be

to your advantage to waive your VA benefits and keep your training pay.

Ifyou waive VA benefits to receive training pay by checking the box in Item 28, VA will retroactively adjust your VA award to withhold benefits equal to the

total number of training days waived and at the monthly rate in effect for the fiscal year period for which you received training pay. This action may result in

an overpayment of compensation, which may be subject to collection.

IMPORTANT: VA COMPENSATION PAY IS NON-TAXABLE. THEREFORE VA COMPENSATIONPAY MAYBE THE GREATERBENEFIT.

O 28. Do NOT pay me VA compensation. I do NOT want to receive VA compensation in lieu of training pay.

SECTION Vil: DIRECT DEPOSIT INFORMATION

The Department of the Treasury requres att Fedemi benefit payments be made by electronic funds transfer (EFT), also called direct deposit. Please attach a voided

personal check a deposit slip _qt provide the information requested below in Items 30, 31 and 32 to enroll in direct deposit. If you do not have a bank account, you

must receive your payment through Direct Express Debit MasterCard. To request a Direct Express Debit MasterCard you must apply at www.usdirectexpress.com or by

telephone at 1-800-333-1795. If you elect not to enroll, you must contact representatives handling waiver requests for the Department of the Treasury at

1-888-224-2950. They will encourage your participation in EFT and address any questions or concems you may have.

O 29 I CERTIFY THAT I DO NOT HAVE AN ACCOUNT WITH A FINANCIAL INSTITUTION OR CERTIFIED PAYMENT AGENT (Ifyou check this 6ex sktp to Section VIII)

30. ACCOUNT NU MBE R (Check only one bar below andprovide the accoanti manber)

Account No.: Established O CHECKING SAVINGS

31. NAME OF FINANCIAL INSTiTUTION (Prowde the name of the bank where you 32. ROUTI NG OR TRANSIT NUMBER (Thefirst mræ monbers located at the

wantyour drect deposit) bottom left ofyour check)

VA FORM 21-526EZ, SEP 2019 Page 11

VETERANS SOCIAL SECURITY NO

SECTION Vill: CLAIMCERTIFICATION AND SIGNATURE

VETERANISERVICEMEMBERCERTIFICAT10NAND SIGNATURE

I certify and authorize the release of information. I certify that the statements in this document are true and complete to the best of my knowledge. I authorize

any person or entity, including but not limited to any organization, service provider, employer, or government agency, to give the Department of Veterans

Affairs any information about me. For the limited purpose of providing VA with this infonnation as it may relate to my claim, I waive any privilege that may

apply and would otherwise make the information confidential and not disclosable.

I certify I have received the notice attached to this application titled, Notice to Veteran/Service Member of Evidence Necessary to Sn6stantiate a ClaimforVeteransDisability Conipensadon and Related Congensation Benefia

1 certify I have enclosed all the infonnation or evidence that will support my claim, to include an identification of relevant records available at a Federal

facility such as a VA medical center; OR, I have no information or evidence to give VA to support my claim; OR, I have checked the box in Item 1, on page

8, indicating I want my claim processed under the standard claim process because I plan to submit additional evidence in support ofmy claim.

33A. VETERAN/SERVICE MEMBER SIGNATURE (REQUIRED) (Sign in mk) 33B. DATE SIGNED (MMDD,YYYY)

( See Section XI Power of Attorney) 12/12/2019

SECTION IX: WITNESSES TO SIGNATURE

34A. SIGNATURE OF WITNESS (Sign in ink) (Note: Ordysagn (vereransigned in item 33A using an "X) 348. PRINTED NAME AND ADDRESS OF WiTNESS

35A.SIGNATUREOFWITNESSf5tgnmmk) (Note.Onlysignifveteransegnedm1tem33A usmgan"X) 35B.PRINTEDNAMEANDADDREŠSOFWITNESS

SECTION X: ALTERNATE SIGNER CERTIFICATION AND SIGNATURE(NOTE: REQUIRED ONLY IF ITEM 33A IS BLANK)

I certify that by signing on behalf of the claimant, that I am a court-appointed representative; OR, an attomey in fact or agent authorizedto act on behalfof a

claimant under a durable power of attorney; OR, a person who is responsible for the care of the claimant, to include but not limited to a spouse or other

relative; OR, a manager or principal officer acting on behalf of an institution which is responsible for the care of an individual; ANÐ, that the claimant is

under the age of 18; OR, is mentally incompetent to provide substantially accurate information needed to complete the form, or to certify that the statements

made an the form are true and complete; OR, is physically unable to sign this form,

I understand that I may be asked to confirm the truthfulness of the answers to the best of my knowledge under penalty of perjury. I also understand that VA

may request further documentation or evidence to verify or confum my authorization to sign or complete an application on behalfof the claimant if necessary

Examples of evidence which VA may request include: Social Security Number (SSN) or Taxpayer Identification Number (TIN); a certificate or order from a

court with competent jurisdiction showing your authority to act for the claimant with a judge's signature and a dateltime stamp; copy of documentation

showing appointment of fiduciary; durable power of attorney showing the name and signature of the claimant end your authority as attorney in fact or agent;

health care power of attorney, affidavit or notarized statement from an institution or person responsible for the care of the claimant indicating the capacity or

vi d other documentation showin such authorization.36A. ALTERNATE SIGNER SIGNATURE (REQUIRED) (&gunrink) 36B. DATE SIGNED (Ant,DD,1TYY)

SECTION XI: POWER OF ATTORNEY (POA) SIGNATURE(NOTE: POA'SCANNOT SIGN FOR AN ORIGINAL CLAW ONLY)

I certin that the claimant has authorized the undersigned representative to file this claim on behalf of the claimant and that the claimant is aware and accepts

the information pmvided in this document. I certify that the claiment has authorized the undersigned representative to state that the claimant ce les the truth

and completion of the information contained in this document to the best of claimant's knowledge.NOTE: A POA's signature wiß not be accepted unless at the time of submission of this claim a valid VA Form 21-22, Appointment of Veterans SerwceOrgani=ation as Claimant's Representative, or VA Form 21-22a, Appointruent ofhidividual As Claimant's Representative, indicating the appropriate POA is

ofrecordwitbVA VA Form 21-22a is on file i VBMSEETELENTATgÑ 5 TORE(Signir ng 37B DATESIGNED(AngDD,YYYY)

12/12/2019Gordon A. Graham VA #39029 POA E

PRIVACY ACT NOTICE Tlie form wdl be o ed to me allowance to compos i fits (38 USC 5101) The responses you submit are considered confidential (38 USC 5701)

VA may disclose the mformation that you provide, meludungSocial Secunty numbers,outside i A if the disclosure is authonzed under the Pitvacy Act, metudmgtheroutme uses identified in

the VA systemof records, 58VA21/22/28, Compensation, Pension,Educadon,and Vocanonal Rehabilitation and Employment Records - VA, publishedin theFederalRegister. The requested

information is consideredrelevant and necessaryto determine maximum benefits under the law Information anbmittcd is subject to verification through computer matching programs with

other agencies. VA may make a "routine use" dieciosure far: civil or criminal law enforcamot, congressional communications, epidemiological or research studies, the collection of moneyowed to the United States, litigation in which the United States is a party or has an interest, the admmistration ofVA programs and delivery of VA benefks.verification of identity and status,

and personnel administration. Your obligation to respand is required in order to obtain or retain benefits. Informadon that you furnish may be utilized in computer matching progmms with

other Federal or State agencies for the pmpose of determining your eligibility to receiveVA benefits,as well as to collect any amount owed to the United States by virtue ofyaur participalian

in any benefit progmm administeredby the Department of Velerans Affairs. Social Security information: You are required to provide the Social Security numbei requested under 38 U.S.C

SIOl(oXl}, VA may disclose Social Security numbersas authorized under the Privacy Act, and, specifically may disclose them for purposesstated above.

RESPONDENT BURDEN: We needthis information to determineyour eligibility for compensation.Title 38, United States Code, allows us to ask for this information.We estirnatethat you

wiH need an avemgeof25 minutes to review the instructions, fmd the infounation, and complete this fann. VA cannot conduct or sponsor a collection of infonnation unless a valid OMB

control number is displayed.You are not required to respond to a collection ofinfmmationifthis munber is not displayed. Valid OMB control numberscan be located on the OMB Internet

Page at www.revinfo.yov/puhHrMo/PRAMain If desired,you can call 1-800-827-1000to get information on where to send commentsor suggestions about this fwm.

PENALTY: The law provides severe penalties which include fine or impnsonment, or both, for the willful submission of any statement or evidence of a rnalerial fact, knowmg rito

be false, er for the fraudulent acœ Unce of an a ment to which ou are not entitled

VA FORM 21-526EZ, SEP 2019 Page 12

NODINC

Dept. of Vet Affairs 12/12/2019Evidence Intake CenterP.O. Box 4444Janesville,WI 53547-4444

Additional pages to VA Form 21-526EZRoberto C 26

Movant, through counsel, now files his motion to revise the 3/23/1972 ratingsdecision denying service connection for Hepatitis C claimed as abdominalpains and liver condition.

Specifically, movant claims an arbitrary and capricious decision, not in

accordance with law occurred in violation of 38 USC §§1112(a)(l); 5110(b);38 CFR §§3.155; 3.157; 3.400 (1970).

FACTS

• 7/15/1970---Releasefrom Active Duty-U.S. Army• 9/10/1970-Admitted to SJVAMC, Puero Rico with Viral Hepatitis• Informal claim dated 10/31/1970 and filed under claim number 26123976

CEST'd EP 020 date stamped by SJVAMC 12/28/1970and received byVBA 1/05/1971 (see VA Form 07-3101 in VBMS)-- Exhibit A

• Liver scan dated 2/24/1971 diagnoses chronic disease process-- Exhibit C

Page 1

• Liver biopsy diagnosisof chronic persistent liver disease on 6/30/1971Exhibit D

• VA Form 21-526 completed and filed at the SJVARO date stamped9/17/1971 within one year of the filing of the 10/31/1970informal claim.Exhibit B

• 3/23/1972 rating decision denying entitlement to hepatitis with no

mention of probative 2/24/1971 liver scan or 6/30/1971 liver biopsyshowing chronicity and compensability.

Discussion

Application of 38 CFR §3.155 (1970)

Movant's diagnosis of hepatitis occurred 9/10/1970.This was 57 days afterseparation. Movant actually reported in the VAMC medical records his

symptoms began several weeks earlier. The provisionsof 38 C.F.R. §3.155(a)(1970) provide that any communication or action indicating an intent to applyfor one or more benefits under the laws administered by the Department ofVeterans Affairs may be considered an informal claim. Such informal claim mustidentify the benefit sought.

The Secretary's VAF 07-3101 REQUEST FOR INFORMATIONdate stamped12/28/1970and 1/05/1971 shows constructive possession of an intent to file an

informal original claim at the San Juan VA Medical Hospital (see Box 3). The

document shows an assigned claims number of C-26 which was, and still

is, the movant's assigned claims number on all VA adjudications. The documentfurther identifies the benefit sought as "hepatitis". See 38 CFR §3.155(a) (1970).

As this motion to revise involves a claim adjudicated prior to March 25th, 2015, no

particular form was required by the Secretary or his forebears.

Page 2

The Secretary's approved form VA 21-526, date-stamped 9/17/1971 (Exhibit B),

clearly was filed by movant within one year of the submittal of the informalclaim. The Secretary acknowledged receipt of the 10/31/1970informal claimindicated by the date-stamps of 12/28/1970and 1/05/1971.

Application of 43.157 (1970)

A report of medical examination or hospitalization which meets therequirements of applicable regulations,will be accepted as an informal claimfor benefits. The date of outpatient or hospital examination or date of admissionto a VA or uniformed services hospital will be accepted as the date of receipt ofa claim. See 38 C.F.R. § 3.157(b) (1) (1970).

As shown by the evidence of record, an EP 020 informal claim was CEST'd

12/28/1970complete with issuance of a claim number. See Exhibit A

Application of 43.400 (1970)

The date of entitlement to an award of service connection is the day followingseparation from active service or date entitlement arose if the claim is receivedwithin one year after separation from service; otherwise, date of receipt ofclaim, or date entitlement arose, whichever is later. See 38 CFR § 3.400(b)(2)(1970).

Movant filed his informal claim on 10/31/1970 - with an effective date of7/16/1970- the day following separation from active duty in the US Army. This is

the date entitlement to benefits arose.

Page 3

Application of 38 USC 41112(a)

From the Secretary's own records, it is clear an informal claim was received andestablished for hepatitis during movant's inpatient status. The claims numberassigned (C- 26 clearly and unmistakably establishes this finding of fact.

38 USC §1112(b)states unequivocally:

[I]n the case of any veteran who served for ninety days or more duringa period of ware chronic disease becoming manifest to a degree of10 percent or more within one year from the date of separation fromsuch service shall be considered to have been incurred in or

aggravated by such service, notwithstanding there is no record ofevidence of such disease during the period of service.

Movant served during the height of the Vietnam War from 1968 to 1970. His

hepatitis was disabling such that he was hospitalized for approximately 20 daysthe first time with continuing debility and hospitalizationsaccompanied by an

anxiety disorder secondary to the hepatitis (See §4.114 DC 7345 (1970).

Application of 38 USC §5110(b)(1)

38 USC §5110(b)states:

(b)(1)The effective date of an award of disability compensation toa veteran shall be the day following the date of the veteran's discharge or

release if application therefor is received within one year from such dateof discharge or release.

Page 4

The evidence of record shows the movant filed his claim on 10/31/1970,seventyeight days after release from active duty. VA transmitted the information to theVeterans Benefits Administration not later than December 28th, 1970. The VBAacknowledged receipt of the claim on 1/05/1971-again, well within the one-

year time limit expressed in 38 USC §5110(b).See also §3.400(1970).

Application of 43.303(d)

38 CFR §3.303(d) (1970) states:

(d) Postserviceinitial diagnosisof disease. Serviceconnectionmay be grantedforany disease diagnosedafter discharge, when all the evidence,including thatpertinent to service, establishes that the diseasewas incurred in service.Presumptiveperiods are not intended to limit serviceconnection to diseases so

diagnosedwhen the evidencewarrants direct serviceconnection.The presumptiveprovisions of the statute and Department of VeteransAffairs regulationsimplementing them are intended as liberalizations applicablewhen the evidencewould not warrant serviceconnection without their aid.

The evidence of record shows movant's disease was diagnosed well within theone-year period post service. The etiology of hepatitis is well known, as is theincubation period. Movant falls well within the medical timeline for incubation ofthe hepatitis virus while on active duty.

The liver scan on 2/24/1971, in combination with the 6/30/1971 liver biopsyclearly and unmistakably diagnosed chronic, persistentviral hepatitis at a

compensable rate within the pendency of the claim and beyond. January 197imental health examination revealed an anxiety disorder as well.

Page 5

Neither of these probative documents were mentioned in the ratings decisionwhich indicates the evidence, as it was known at the time, was not before theadjudicator. See §3.105(a)(1) (i). In fact, the 6/30/1971 liver pathology report was

entered into the claims file on 9/03/2009 according to the Secretary's datestamp.

Reasonable minds cannot differ that the identified disease entity (hepatitis) was

informally filed for within the one-year period following separation. Likewise,reasonable minds cannot differ that a legally filed VA Form 21-526 was timelyfiled within the prescribed one-year window for completing the informal claim.The evidence of record clearly and unmistakably identifies a chronic, persistentdisease which was compensable with secondary manifestations of anxietyneurosis. It would be error n_of to grant entitlement for Hepatitis based on theenumerated findings of fact in the instant motion to revise.

Application of 43.301

Movant was granted an honorable discharge with no reports of willfulmisconduct or lost time throughout his two-year enlistment. As there is no findingof willful misconduct or "Not in the Line of Duty" determination for the etiology ofthe disease originating in service, the presumption of regularity attaches to his

honorable service.

Based on the above enumerated errors of law and proof of the obsence ofunequivocal probative evidence for entitlement being before the adjudicator, itcan only be said the the 3/23/1972 decision was arbitrary and capricious andnot in accordance with the established law at the time of the decision.

Page 6

§3.301 also states in section (a):

(a) Line of duty. Direct service connection may be granted only when a

disability or cause of death was incurred or aggravated in line of duty, andnot the result of the veteran's own willful misconduct or, for claims filedafter October 3L 1990, the result of his or her abuse of alcohol or

druas.

On the 6/30/1971 Pathology Report, one Dr. Mercado MD noted on 6/26/1971"Persistent Viral Hepatitis; repeated liver insult- i.e. drug addiction."Notwithstanding the allegation has been rebutted by lay testimony, §3.301 is

unequivocal that any "drug addiction" would still not be considered willfulmisconduct until the 10/31/1990change in the Secretary's regulation.

Respectfullysubmitted,

Gord GraÃam VÃ 3 POA E1P

Coun r movant Pere of

Attach nts:

Exhibit A - VA Form 07-3101 Request for Information dated 10/31/1970and datestamped by the Regional Office 1/05/1971.(one page)

Exhibit B - VA Form 21-526 Veterans Application for Compensation or Pension(four pages)

Exhibit C - Clinical Record of San Juan PR VAMC Radiographic Reportsdated2/24/1971. (one page)

Exhibit D- Clinical Record of San Juan VAMC Pathological report showingcompensable persistentviral hepatitis dated 6/30/1971 and date-stamped as

received by the San Juan Regional Office (355) on 9/03/2009. (one page)

Page 7 Perez-Soto

Exhibit

A26

First document in VBMS efolder

VA Form 07-3101 acknowledginginformal claims filing 10/31/1970.

Duplicate in VBMS

usuo n . Approved Exception to SF 180

VETERANSaoMINi$7RATl0N Tven or etAm

REQUEST FOlt INFORMAllON onm.2. SEPARATION FORMS ON FILE a DATA REQUESTED

Ov== 6 NO ERVI dBDICA UNTAt. NER

. BRANCH OF SERVICR NATIONAL NATIONALA3A MARINE COAST GUARD auARD OTHEN

ARMY 0- 0- O e- O.us.. <a.» 0<»>BA. 01Alit AND ADDRESSOP VA REquEETING OFFICE BIA ORIG1NATING ypitT 6. CLA3M NO.

vAc su .nia m - Ass av. Div. (21) o- 261239767. INSURANCt NO.

6. LAST NAMR - FIRST NAME•MIODLE IN1TIAL gder whfeb eeg SA. ALL SERVICE NOS. 90. 60CLAL SECURtTV NO.

50 189 919rior sintu t. PL.ACE Og ging; 12. DATE OF DEATH

Unk.13. DATE ENTERED 14. DATE SEPARATED 15. CHARACTER OF 16. LAST GRADE, RATE OR

ACTIVE DUTY FROM ACTIVE DUTY SEPARATION OR DISCHARGE RANK, AND ORGAN)2ATioN

nk. Unk9.

17. ALLEGED DISEASE 18. DATES OF 19. PLACES Oy OD A O

OR INJURY TREATMENT TREATMENT WAS INCURRED

A.

e.

21 IT1ONAL IN MATION REQUES

22A. EuBSCOUENT SERVE OR RETillED STATUS

O-e OR RVE DELISATEDN,{CogipiensItem 2 9) RETIRED (ComipleteHaar 220) RKNO

228. OEILIGA710N TERMINAL DATE 220. RETIRRO STATUSIN PAY NONPAY TEMPORARY DISABILITY RETIRED-

i 0.-. O.-o. -OMETINEDLis? BTATUS UNKNOWN

25 E 24GL T EAWDTITLEOFVAOXerse

.JEúasu +-väiëfäŒ ey seädiEs o sky Gü.WRaAVAILABLE REQuRETED 1TEME E & 9. AND 12 THNOccH 15 ITEMS a a 5. AMD 12 THNDUGH 18

MtcartOs FORWARDED VERIFIED Conne.cr RIF1ED ConitBUT, SKORPT:

19: Hon rel,Health record not on file.If da.tes and places of treatment are Nrnished an effort will be mde to obtainreco-r's of allend +.reatment.

NO.OPENCLDSUMES ORIG. C PY NO.ENCLS.(Co U.) ORIC COPY 31GNA Ti

HEALTH REconDA CLINICAL REConDS INP ,T

PHYsiCAL X-NAYs idATION |CNS

DENTAL REGORDS DAYE SIGNATUnŒ AND fŸr

(N TioNS MEDicAL REconOS RECORDSAT BEPARATion - OTHER RecoRDS

o$li- 07-3101 ,

r.UPERSEDES VA FORM 7-2141. OCT 1980, WHICH WILL NOT Bil USED.

DUPLICATE 3

Exhibit

B26

VA Form 21-526 filed

on 9/16/1971 within

one year of informal claims

filing of 10/31/1970.

Duplicate in VBMS

Fomi ap roved *

Budget Ëurean No. 76-ROOO7

VETERAl(5 ADMINISTRATION (DO NOT WRITE IN THIS SPACE)* VETERAN'S APPLICATION FOR COMPENSATION OR PENSIONIMPORTANT: kead assaohed General and ßpecigo Instmotione before filling in this form. Type-

toride, print or todde plainly.2.SOCIALSECURITYNO.

.MAILINGADDRESS VETERAN (No. afedatorntraf ronie, crgy orP.O., State, and ZIP SB. TELEPHONE NO. 4. RAILRGAD RETIREMENT NO.

.E. DATE 6F BIRTH 6. PLACE OFABIRTH SE

LE O FEMALE

SEltVIÈE1NFORMATIONNOTE: Enter complete infonnation.for each perrod of actzve dirty including Reservist or National Guard status. Attach Form DD 214 or other sepa-tion papers for aff perióde of active dcrty since January 31, 1956 to expedrie processing of your claim.

SA. ENTERED ACTIVE SERVICEBB. SERVlCE NO.

C,. SEPARATED FROM ACTIVE SERV[CE BD. GRADE, RANK OR RATING, ORGANizA-TION AND BRANCH OF SERVICE

9: IF YOU SERVED UNDER ANOTHER NAM IVE NAME AND PERI RING WHICH YOU'SERVED

10. IF RESERVIST OR NATIONAL GUARDSMAN, GIVE BRANCH OF SERVICE.A OD OF ACŸIVE OR INACTIVE T AINING DUTY DURI WH siktTYOCCURRED

I -

11. ARE YOU NOW A M BER OF THE RESERVE FORCES OF THE ARMY, NAVY, t19. BRANCH 0F SERVICEAIR FORCE, MARIN CORP KST GUARD OR THE NATIONAL GUARDY

OYES (If * Yes,?' complete 119)1 EVlOUSLY LED A CLAIM FOR ANY BEN 12 AIM NUMBER

12C. HERE DID YOU FILÈYOUR CLAIMT (Caly andState)

13A. ANE ŸÖÙ NOW ÀECEIVNG RETEREMENŸ OÑ RETAINE AY FROM 138. BÀANCH O€ SERVICE IBC MONTHLY AMOUNTTHE ARMED FORCEST

OYE5 O Ûf " Yes," complete 139 and 130) $

14A. HAVE YOU EVER APPLIED FOR OR RECEtVED DISABILITY SEVERANCE PAY FROM THE ÃRMED ŠÕRÕE5T, ÄÑÑÑÏ

Oves o -v.., =,s.<.us> - ,15A. HAVE YOU RECEIVED LUMP SLMMEAD.itÏSIMENT PAY FROM THE ARMED FORCEST 1SB. AMOUNT

O YES No (If *Yes," complete 15B)16. HAŸE YOÙ EVER PILED A CLAI JØN COMPENSATION FROM THÈ U.S. BUREAU OF EMPLOYEES COMPENSATIONT (Fohnerly the U. S. Employees Componea•

tron Commreszon)

O.ves o17A. AREYOU NOWORHAVEYOU BEEN HOS- 129. DATES OF MOSPITALIZA- 17C. NÁME AND ADDRESS OF INSTITUTIO

PITALIZEDOR FURNISHED DOMICILIARY TION OR DOMICILIARY.CARE WiTHIM THE PAST THREE MON 114$9

YES NO !)and170}

526- '

""HRSE O 52Br ÀUG - ÀÑE

-- , .- .. J

te. .a ORWHICHTHI CLAIMISMADEANDDATEDUPLICATE

NOTE: Items 19 20 and 21 need NOT be completed unless 3o w clanning compensation for a disability incurred m service.

Y RECEIVEDANY TREATMENTWHILE LN SERVICE, FILL IN THE FOLLOWING INFORMATION,

19A. NAM NUMS NR LOCANFI ARŸ+iOSPITAL. FIRST AID STATION. 198. DA,TES OF TREATMENT 19C. NATURE OF SICKNESS, DISEASE OR INJURY

LIST CIVILIAN PHYSIC1ANS AN HOSPITALS WHERE YOU WERE TREATÊDFOR ANY SICKNESS, INJÚRY OR DISEASE SHOWN ABOVE BEFORE,DURING, OR SINCEYOUR SERVICE, AND ANY (MILITARY) HOSPITALS SINCEYOUR LAST DISCHARGE.

..IST PERSONŠ OTHER THAN PHŸSICIANS WHO KNOW ANY FACTS ABOUT ANY SICKNESS, DISEASE OR INJI,iRY WHICH YOL) HAD

BEFORE, DURINÒ, OR SINCE YOUR SERVICE

21A MAKE , 218. PRESENT ADDRESS 21C. DISABILITY 21D. DATE

22. MA SŸATUS(ChecÍc one) . .. 28. NUMBER OF TIMES ŸOU 24. NUMBER OF TIMES YOUR• . . HAVE BEEN MARRIED PRESENT SPOUSE NAS

NEVER MAARIED (If so, do'not complete 23 through 27D)' ' BEEN MAllISIED

O MARRIED WIDOWED DIVORCED

- FuRNISH THE FOLLOWING INFORMATION ABOUT EACH OF YOUR MARRIAGES

25C. HOW MARRIAGE25A. ISATE 'AND LACIŠ Ò MARRIÀQE 258. TO WHOM MARRIED TERMINATED

,

250. DATE AND PLACÊ TERMINATED· (Deain, cavorom)

- # 4FURNISH THE FOLLOWING INFORMATION ABOUT EACH PREVIOUSMARRIAGIf OF YOUR PRESENT SPOUSE

26A. DATE AND PLACE oF MARRIAGE 268. To WHOM MARRIEDIM E

. OT P E TERMINATED

27A DO YOU LIVE TOGETHER† 27-. REASON FOR SEPARATION 27C AROUNT YOU CONTRIBUTE 27D. PRESENT ADDRESS OF SPOUSE- - TO YÓUR Wf FE'S SUPPORT

MONTHLY(If *Wo," fall m 27B -Ov s. O NO 270 and.27D)

ggsg°ÿHO C

ODC

O O O HOTH

28A. PULL NAME OF CHILD 28C. PLACE OF BIRTH .,

280. NAME ANDnAODDDRESSCHAPERSON

N.OTE - If any child above is over 18 years old, idetitify in Item 45, "Remarks," and indicate whether attending school or permanently in-

capable of self-suppo29A. IS YOUR FATHE PENDENT UPON 298. NAME AND ADDRESS OF DEPENDENT FATHER SOA. IS YouR M ER DESSU

YOU FOR SUP TT a T UP OU FOR

(If **Yes," faff an Yu,"Y.ES NO 298) ES NO m 30B

3 31A. NAME AND ADDRESSOF IgEAREST RELATIVE $19. REL'ATIONSHIP OF NEARESTRELATIVE -

FURNISH THE FOLLOWINGINFORMATI0N IF YÒU ÒÜÄIMiÖ BE 'f0TAÏÀ,Ÿ Ì)ÏŠAB1ËÍ)92. DO YOU CLAIM TO SE TOTALLY DISABLIÉDT (Vetenine di asA. ARE YOU NOW EMPLOYED† SSB, DAŸE YOU LAST WOÁKED

years of a or older need not complete tiue rtem, or 33A to 40 .

Incluez e

(If **Yea," consplete (II''No," fzilOv== o ass*•<o.==I= ·•> OYES NO an339)

LIS ÝOUR EMPLOYMENT, INCLUDING SELF-EMPLOYMENT, FOÍt 1 YEAR BEFORE YOU BECAME TOTALLY)ISABLED

84A NAME AND ADDRESS OF EMPLOYER 348. KIND OF WORK MN4

S4D TIM T 84E. TAL

WORKED

Ï.,IST ÃÌ,L YOÜR EMPLOYMENT, INCLUDINÓ SELF-EMPLOYMEN'Í', SINCE ŸOU BECAME TOÌALLY ÒISÄúLED

35A. NAME AND ADDRESS OF EMPLOYER S D OF WORK M HS FR M LNT 3

N

SS. IP YOU WERE SELFÃMPLOYED BEFORE BECONÍ1NG TOTALLi DISABLED, 37. IF YOU ARE 5TILL SELF-EMPLOŸED, JUST WHAT PART OF THEJUST WHAT PART OF THE WORK DID YOU 997 WORK DO YOU DO NOWT

SSA WHATIS THE MOST YOU EARNED fN AN O SBB. WHAT ŸEAÑT SSC. KIND OF WORK IÑ ŸEAR YOU EANNED THE MOSTYEART

39. EDUCATION (Öt Mghest year enirgplated) 40 NATURE OF AND TIME SPENT IN OTHER EDUCATION AND TRAINING

12 5578 1234 1224

(GRADE SCHOOL) [HIGH SCHOOL) (COLLEGE)PAGE L

DUELICATR41. 1NCOMÈ RECE1VED AND.EXPECTIÈDFROÙALL SOUÑCES

NOTE. - Itema- 41A through NC should be ce Apleted only if you-are applyin. for sonaervice-connected peneion. (Veterans of indian Wars,Spanish American War, Bozer Rebellion, or P silippïne Insurrection need not omplete th.ege items..

AMOUNT.rRECEIVED AMOUN.T EXPECTED AMOUb]T EXP.ECTEDFROM.,[ANU.ARY

,1 TO FROM DATE YOU SIGN FOR THE NEXTTYPE OF

DATE YOU SIGN THIS THIS APPLlCATIONTO CALENDAR YEARSQURCE APPLICATION ENDOPTHISCALENDARYEAR '

INCOME - -

VETERAN WIFE VÈTERAN W1FE- VETEifAli WIFE

(41 A) (41 B) (41 C) (41 D) - .(41 E).

(41 F) (41 G) (41 H) -

TOTAL WAGES1. OR SAI-.AR'l '.$ $ $ - .S 5 S .

SOCIAL . .

2. SECURITY

OTHER.RETIREMENT

3. ANÓ ANNUITIES .

DIV)DENDSAND

4. INTE SI

UNEMPLOYMENT

NET PROFIT FROMSECEÆMPLOYMENT

7. OR BUSINESS

NET PROFiÝ, ,a FROM FARM

OTHER INCOME -

TOYAL ,

10. INcous S $ $ S I S

S'lATEME)IT ¥OUR ÑE lfÓÉ'fH-ÑÓT Read ßpecif a Instructions for Items SAto SE, implusive.42A. STOCKS, BONDS, 428. REAL ESÙTE C. OTHER PRO- 42D. TOTAL I ESTS 42E ET W RT 43 IFËLA_lM IS FILED IN BEHALF OF

BANK DEPOSITS; r PERTY AN INCOMPETENT VETERAN,DOESETC,9 THE VALUE OF HIS ESTATE

EQUAL ÓR EXCEED $1.5007

GROSS INCOME FROM SELF-EMPLOXMENT0N PKNMORËUSINÉb5OPERAÏIONNOTE: Answer 4¾ to 44C, inclusive'only if yo care eeff-employed er operate a farm or búsiness., brat frems-44A, 44B and 44C ander "Remažkst' andgrve detailed explanation.

44Ä. TOTÁL ÌÑCóME LAST YEÄ 448. TÒTÃL IÑÒOME SO FÃ ÏHIS YEAR 44Ò. EXVEÒÏÉÙ ÑÒOMÈ FÒR REMAINÖER OFYEAR .

$__ , , .$

_.S

45 REMARKS (Idenirly your atate ses y ther appÌsäabigitem runnbefa. If idditranal space sa ragtfared, attach eeparat sheet and rdenhly statementa by tBârråteânamrbare.)

CERTIFICATIQNAND AUTHORIZATION F0$ËELEASE ðF INF0RMATÏÒN-- I ceriify thaffhè foingoing státeniönts are true and 1:ompleta to the bes

of my knokledge and belief,. I CONŠENT that any physician, surgeon,.dentist or hospital thät.has treated or examined me for any purpose, pr-that I haveconsulted profèssionally may furitish o the Veterans Administration any infofmation about myself and I waivë åny privilegewhichtenders such informa-tion confidential. s.

46. DATE s O 47 A

WITNESSES TONOTE - S ue made by mark antet he witnessed by two paraona.to whom the person making the statement is personally known, and the'aignatures and.

_addrèsses o such lidinesses maat be shown helow..

SIGNATI.iRE bF WÌTNáss 488. ADDRESB-OF WITNESllí

49À S NA RE 01" WITNESS 498 ADDRESS-OF WITNESS

BENALTY -- The Jaw provides severe penalties which include fine or imprisonment, or both, for the willin1 submission of aný statement or evidence of amaterial fact, knowing,it to fálse, or for the fraudulent acóeptance of aný payment to whici ón are not entitled.

*b.S. GOVERNMENT PRETING OFFICE. 1968 O - 37A

Exhibit

C26

Radiographic Report of 2/24/1971

showing evidence of chronic

liver condition.

Duplicate submitted in 2017 as it was

not in the claims folder

standard Form 519

Bildger Circular A-32 2 * O,iL 60TENENENT PRINTING OFFlšE : 1564 0-71 -480

, CLINICAL RECORD RADIOGRAPHIC REPORTS

Liver scan ( Tc sulfur colloid) APviewAo M- sows a siIgh ly enlarged

organ (21 cm wide, 17 cm long). The lower border appears mo Ivex than usual.The distribution of colloid is uniform throughout. The spleen sTTghtly enlarged(11 cm long) but it concentrated colloid only to a moderate degree,

Findings are similar to those in prevlous study dated 9-21-70. They would appear

to point to persistence of the active 1iver. disease.

Nuclear Medicine Service ...-, L

-• ---· - --··• -• - 9• -tr -.. --.-., . naur-tan.prar, usasset nr.msyn.m um. wÀÁn NO.«'n « en h•¢IMI•r . Imiuo; OPD

noloanumc neonts

Roberto"$Ï°j "

DUPLICATE

Exhibit

D26

Pathological Report and Tissue

Examination Clinical Record dated

6/26/1971 and 6/30/1971 and date

stamped 9/03/2009 diagnosingchronic, persistent Viral Hepatitis.

Duplicate in VBMS eFolder

gi

i2

-

1(

94