Old 05-25-2018, 03:55 PM #1 (permalink)
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Default Veterans with PLS VA disability

There are some closed threads on this subject but I am new and need some help.

I was recently diagnosed with PLS and am a veteran. I have submitted two letters form neurologists stating that PLS is a variant of ALS. I tried twice to get the VA to grant me disability but they keep denying it. I went through the DVA. Is there another group I should use? How do I get the VA to understand? I filed my initial claim, was denied. Filed again with the two letters and was denied again.

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Old 05-25-2018, 04:15 PM #2 (permalink)
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Default Re: Veterans with PLS VA disability

It's been mentioned a few times in this PLS subgroup. Links here:

Veteran disability benefits for those with PLS diagnosis.
Another win for veteran with PLS!
PLS and VA Disability......

I am sure ClearwaterAl and other US veterans will step in with way more information shortly. But it looks like there have been successful claims.
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Old 05-25-2018, 04:43 PM #3 (permalink)
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Default Re: Veterans with PLS VA disability

Joe, try the PVA. Paralyzed Veterans of America have a lot of experience in these matters better than the DVA.

Don't give up just yet. Although VA doesn't believe PLS is the same as ALS, I'll look for some guidance about VA and PLS tonight.
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Old 05-26-2018, 02:42 PM #4 (permalink)
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Default Re: Veterans with PLS VA disability

Joe, the only thing I can think... may be the problem is the diagnostic code the Neurologists have assigned to your case. It could be a clerical mistake in their offices. The VA called for your medical records from their offices... letters mean nothing to them.

Mine was changed to ALS.

Check with your Neurologist concerning the code. The codes are yes/no for benefits... VA, Medicare and Medicaid.

What was the summary (explanation) in your denial letters?

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Old 05-27-2018, 01:14 AM #5 (permalink)
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Default Re: Veterans with PLS VA disability

On the VA site at https://www.va.gov/vetapp14/Files2/1417108.txt we find outstainding news:

Citation Nr: 1417108 Decision Date: 04/16/14 Archive Date: 04/24/14

DOCKET NO. 10-47 164 ) DATE

On appeal from the Department of Veterans Affairs Regional Office in Louisville, Kentucky

THE ISSUE Entitlement to service connection for primary lateral sclerosis (PLS).

REPRESENTATION Veteran represented by: Paralyzed Veterans of America, Inc.
ATTORNEY FOR THE BOARD Nicole L. Northcutt, Counsel

INTRODUCTION

Pursuant to 38 C.F.R. 20.900(c), the appeal has been advanced on the Board's docket.

The Veteran served on active duty from March 1963 to March 1965.

This matter is before the Board of Veterans' Appeals (Board) on appeal of a rating decision in July 2009 of a Department of Veterans Affairs (VA) Regional Office (RO).

In March 2014, in accordance with 38 U.S.C.A. 7109 and 38 C.F.R. 20.901, the Board obtained a medical expert opinion from the Veterans Health Administration. As the claim of service connection for PLS is resolved in the Veteran's favor, no prejudice has occurred to the Veteran even though the VHA opinion has not been provided to the Veteran or his representative.

FINDING OF FACT

The Veteran had 90 consecutive days of active duty and is diagnosed with primary lateral sclerosis, a variant of amyotrophic lateral sclerosis.

CONCLUSION OF LAW

The criteria for service connection for primary lateral sclerosis have been met. 38 U.S.C.A 1110, 5107 (West 2002); 38 C.F.R. 3.303, 3.318 (2013).

The Veterans Claims Assistance Act of 2000 (VCAA)

The VCAA, codified in part at 38 U.S.C.A. 5103, 5103A, and implemented in part at 38 C.F.R 3.159, amended VA's duties to notify and to assist a claimant in developing information and evidence necessary to substantiate a claim. As the Board is granting the claim of service connection for PLS, VCAA compliance need not be addressed further.

REASONS AND BASES FOR FINDING AND CONCLUSION

Principles and Theories of Service Connection

A Veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active military service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active military service. 38 U.S.C.A. 1110 (wartime service).

Generally, to establish a right to compensation for a present disability, a Veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, also referred to as the "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service, or if preexisting such service, was aggravated by service. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. 3.303(a).

Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. 3.303(d).

Additionally, VA regulation provides that the development of ALS manifested at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease if the Veteran had active, continuous service of 90 days or more. However, the presumption of service connection for ALS does not apply if there is affirmative evidence that ALS was not incurred during or aggravated by such service, or affirmative evidence that ALS was caused by the Veteran's own willful misconduct. 38 C.F.R. 3.318 (2013).

Evidentiary Standards

VA must give due consideration to all pertinent lay and medical evidence in a case where a Veteran is seeking service connection. 38 U.S.C.A. 1154(a).

Competency is a legal concept in determining whether lay or medical evidence may be considered, in other words, whether the evidence is admissible as distinguished from credibility and from the weight of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997).

Competency is a question of fact, which is to be addressed by the Board. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007).

When the evidence is admissible, the Board must then determine whether the evidence is credible. "Credible evidence" is that which is plausible or capable of being believed. See Caluza v. Brown, 7 Vet. App. 478, 511 (1995), aff'd per curium, 78 F. 3d 604 (Fed. Cir. 1996) (the determination of credibility is a finding of fact to be made by the Board in the first instance).

If the evidence is credible, the Board, as fact finder, must determine the weight or probative value of the admissible evidence, that is, does the evidence tend to prove a material fact. Washington v. Nicholson, 19 Vet. App. 362, 369 (2005). If the evidence is not credible, the evidence has no probative value.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C.A. 5107(b).

Evidence

The service treatment records do not contain a diagnosis of primary lateral sclerosis or amyotrophic lateral sclerosis. And the Veteran does not assert that he developed his current neurological disorder during service or soon after service. Rather, he asserts that his currently diagnosed neurological disorder, developed many years after service, is a variant of amyotrophic lateral sclerosis, entitling him to presumptive service connection pursuant to 38 C.F.R. 3.318.

In 2004, the Veteran was diagnosed with primary lateral sclerosis and records through 2010 continue to refer to the diagnosis.

In January 2009, a private neurologist stated that the Veteran was being treating for a motor neuron disease, which he characterized as "ALS (PLS)," indicating that PLS is a variant of ALS. The neurologist stated that the disease had a slow clinical progression.

On VA examination in October 2010, a VA examiner in internal medicine stated that the Veteran does not have ALS, but rather PLS, indicating that the two diseases are separate clinical entities. The VA examiner noted that a diagnosis of PLS, not ALS, had been rendered by both VA and private neurologists.

In order to clarify whether the Veteran's neurological disorder is a variant of ALS or a separate neurological disorder, the Board requested an opinion from a VHA medical expert, who rendered the requested opinion in March 2014. The VHA expert, a neurologist, stated that the two diseases differ in that PLS affects only upper neurons and has a slower clinical course, whereas ALS affects both upper and lower neurons and progresses more quickly. The VHA expert stated that neurologists would be evenly split on whether PLS is a variant of ALS or a separate neurological disorder, as the answer to this question would depend on whether the neurologist used broad or narrow categories to classify diseases. Accordingly, the VHA expert stated that whether the diseases are different clinical entities was a question of semantics, and thus concluded that it was at least as likely as not that PLS is a variant of ALS.

Analysis

The competent and credible evidence of record on the question of causation in support of the claim consists of the opinion of a VHA expert, a neurologist. The VHA expert expressed the opinion that it was more likely than not that PLS is a variant of ALS, and not a separate neurological disease, although acknowledging that many neurologist would categorize the two diseases as separate clinical entities.

The competent and credible evidence of record against the claim consists of the opinion of a VA physician. The VA physician, an internist, stated that the Veteran does not have ALS, but rather a separate neurological disorder, PLS. In support of this opinion, the examiner noted that the diagnosis of PLS, and not ALS, had been rendered by both private and VA neurologists alike.

With regard to medical opinions, the probative value or evidentiary weight to be attached to a medical opinion is within the Board's province as finder of fact. The guiding factors in evaluating the probative value of a medical opinion include whether the opinion applied valid medical analysis to the significant facts of the case in order to reach the conclusion submitted in the opinion.

When, after careful consideration of the entire record, a reasonable doubt arises regarding a material issue of fact, such doubt will be resolved in favor of the Veteran. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim.

Whereas here the same set of facts have resulted in contradictory conclusions, the Board finds that there is an approximate balance of positive and negative evidence, which does not satisfactorily prove or disprove the claim.

As the positive and negative nexus opinions are of equal probative value, the Board finds that the evidence of record is in equipoise as to the matter of whether primary lateral sclerosis is a variant of ALS, and reasonable doubt is resolved in the Veteran's favor. 38 U.S.C.A. 5107(b).

As the Veteran has had 90 days of consecutive service, and as the Veteran is diagnosed with a variant of ALS, service connection pursuant to the provisions of 38 C.F.R. 3.318 is warranted.

ORDER

Service connection for primary lateral sclerosis, a variant of amyotrophic lateral sclerosis, is granted.
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Old 05-27-2018, 01:26 AM #6 (permalink)
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Default Re: Veterans with PLS VA disability

This case also had the same finding. See https://www.va.gov/vetapp12/Files6/1241096.txt

Citation Nr: 1241096 Decision Date: 12/03/12 Archive Date: 12/12/12
DOCKET NO. 10-34 323 ) DATE

On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida

THE ISSUE

Entitlement to service connection for primary lateral sclerosis (PLS).

REPRESENTATION

Veteran represented by: Florida Department of Veterans Affairs

ATTORNEY FOR THE BOARD

A-L Evans, Associate Counsel

INTRODUCTION

The Veteran served on active duty from October 1959 to October 1979.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida.

On the Veteran's substantive appeal, received at the RO in August 2010, he requested a Board hearing at his local VA office. In a subsequent letter sent to the RO in December 2011, the Veteran withdrew his request for a Board hearing due to the difficulty of making the trip. Accordingly, the hearing request is considered to have been withdrawn. C.F.R. 20.702 (2012).

FINDING OF FACT

1. The competent evidence of record is at least in equipoise as to whether the Veteran's diagnosis of PLS is a variant of amyotrophic lateral sclerosis (ALS).

2. Resolving all reasonable doubt in the Veteran's. favor PLS, shown by the medical evidence of record to be a variant of ALS, is presumed causally or etiologically related to the Veteran's active service.

CONCLUSION OF LAW

The criteria for service connection for PLS are met because PLS is shown by the medical evidence to be a variant of ALS, which is presumed incurred during the Veteran's service. 38 U.S.C.A 1110, 1131, 5107 (West 2002); 38 C.F.R. 3.102, 3.303, 3.318 (2012).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C.A. 1110 (West 2002); 38 C.F.R. 3.303(a) (2012). To establish service connection for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C.A. 5107 (West 2002); 38 C.F.R. 3.102 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Effective September 23, 2008, VA issued a regulation establishing presumptive service connection for ALS. 38 C.F.R. 3.318 (2012); 73 Fed. Reg. 54691 (Sept. 23, 200. That regulation provides that the development of ALS manifested at any time after discharge or release from active military, naval, or air service is sufficient to establish service connection for that disease if the Veteran had active, continuous service of 90 days or more. 38 C.F.R. 3.318 (2012).

However, the presumption of service connection for ALS does not apply if there is affirmative evidence that ALS was not incurred during or aggravated by such service, or affirmative evidence that ALS was caused by the Veteran's own willful misconduct. 38 C.F.R. 3.318 (2012). The regulation applies to all applications for benefits that are received by VA on or after September 23, 2008, or that are pending on September 23, 2008.

The Veteran submitted his claim for service connection for PLS, as a variant of ALS, in December 2008. In support of his claim, the Veteran submitted material from medical websites which provides information regarding the connection between PLS and ALS. In a lay statement, the Veteran asserted that he began noticing difficulty speaking, specifically slurred speech, somewhere between 1999 and 2000. He was examined by Dr. V., a neurologist from Shand Healthcare, once a year from 2003 to 2008. Thorough observational notes and diagnoses provided from each examination are of record. In 2003, Dr. V. diagnosed the Veteran with "slow progressive dysarthia with a suggestion of upper motor neuron deficits." Dr. V. included PLS and ALS among the causes for the deficits and noted that ALS was not possible to rule out, but it could be excluded if the lower motor neuron pathology did not show on future tests.

In all subsequent medical reports, Dr. V.'s diagnoses consistently concluded that the Veteran suffered from PLS. In addition, in a 2006 examination report, Dr. V. stated that he observed a "slowness to initiation of movement in the lower extremities" and again stated that "ALS cannot be entirely ruled out." In the 2008 examination report, Dr. V. noted that there were no abnormalities to suggest prominent lower motor neuron components from that test. However, the Veteran was again diagnosed with an upper motor neuron disability, which was considered PLS.

In July 2007, the Veteran was observed by several doctors at the Mayo Clinic. The medical genetics examiner noted that the Veteran's electromyography (EMG) showed that he had longstanding motor neuropathy, but that the symptoms found were atypical for a diagnosis of ALS. The neurologist concluded the Veteran had PLS based on the EMG and magnetic resonance imaging (MRI) results. The speech pathologist's conclusion was mild-moderate dysarthria. After a review of all the Veteran's lab results and pathology reports, an overall diagnosis was provided by Dr. J. who noted that the Veteran suffered from an "upper motor neuron disease, probably PLS."

In a November 2008 Agent Orange examination, a VA physician indicated that the presumptive diagnosis from a VA examination showed that the Veteran had fairly advanced PLS. In a December 2008 VA neurology consultation, the neurologist opined that the Veteran most likely had PLS. The physician noted that the Veteran had chronic lower extremity spasticity and abnormal speech. The neurologist noted that PLS was generally considered a rare variant of ALS and that test results showed that there was lower extremity spasticity. The physician stated that there was always a possibility for two entities to manifest at the same time. Further, in an April 2009 neurology clinical note, the neurologist diagnosed the Veteran with PLS, again noting that PLS is typically considered an ALS variant. In January 2010, the VA neurologist reviewed the results of an EMG and indicated that he did not believe that the test indicated ALS because he saw few fasciculations and spontaneous activity results from the tested areas.

The medical evidence of record indicates that the Veteran has PLS. Although ALS was not diagnosed as the Veteran's condition, it was noted by Dr. V. on more than one occasion that ALS could not be ruled out. Also, in the December 2008 and April 2009 VA neurology consultations, the neurologist stated that PLS is generally considered a rare variant of ALS. In addition, evidence was submitted by the Veteran regarding a connection between PLS and ALS. Among the information submitted were articles from the Columbia University Medical Center, Department of Neurology website which discussed PLS as a subset of ALS. An article from John Hopkins Medical website stated that PLS is a rare form of ALS. Therefore, the Board has considered whether PLS is a form or variant of ALS. Resolving reasonable doubt in favor of the Veteran, the Board finds that the medical evidence of record shows that PLS is a form or variant of ALS. Therefore, the Board finds that it is at least as likely as not that PLS is a form of ALS and should be subject to the presumptive service connection for ALS provided for by 38 C.F.R. 3.318.

Therefore, the Board resolves all reasonable doubt in the Veteran's favor and finds that service connection for PLS, shown by the medical evidence of record to be a variant of ALS, is warranted. 38 U.S.C.A. 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

ORDER

Entitlement to service connection for PLS is granted.
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Old 05-28-2018, 02:00 PM #7 (permalink)
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Default Re: Veterans with PLS VA disability

Mike... thank you for your service. And... your continued service posting the above.
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Old 06-12-2018, 02:36 AM #8 (permalink)
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Default Re: Veterans with PLS VA disability

Atsugi,
Thank you for your posts!!! Very informative. I am also a Vet (Navy, 1983-2004) and am in the process of filing for disability under Gulf War Illness, as I deployed there 5 times and I think I will be eligible for 'presumed connected'. My quandry is this: My onset was about 3 years ago. Probably like most here, I've undergone oodles of tests with oodles of specialists in order to eliminate oodles of possibilities. My primary neurologist has finally narrowed the differential diagnosis down to two: PLS or HSP. I think it could be decided with one final panel of genetic tests. Tricare denied my referral request to get the test done, but rather than wait for an appeal I could just pay for it and be done with it. But I think I have a better chance of getting my disability claim approved if I have "undiagnosed illness" than if I have PLS, so haven't done it. Do you have thoughts on this?
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Old 06-12-2018, 02:44 AM #9 (permalink)
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...and a second question. I'm a pretty smart cookie and could file my own disability claim. But after I started wading through ebenefits I realized that a truly smart cookie ought to ask folks who do this all the time and know the right things to say to do it for her. My exposure to VSOs up to this point hasn't been favorable. But I visited Paralyzed Veterans of America, and was impressed. I signed up last month. Since then, I sent him my DD214, all of my medical records for the past 3 years, and a summary of my symptoms. I haven't heard boo from him, not even an acknowledgement of receipt. So I'm thinking of yanking that limited POA and doing it myself. He seemed so competent when I talked with him in person, though! And even knew what PLS is! How long does it normally take a VSO to file a claim for someone, do you know? And do you have any advice or insight on this situation? Thanks in advance for any thoughts you might have on this!
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Old 06-12-2018, 03:06 PM #10 (permalink)
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Default Re: Veterans with PLS VA disability

Tracyliz,

I will leave it to others to comment on the VSO question, but I believe your disability claim would be better served with "PLS" than "undiagnosed" as per the rest of this thread.

Welcome.

Best,
Laurie
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Old 06-12-2018, 04:17 PM #11 (permalink)
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Default Re: Veterans with PLS VA disability

My PVA VSO filed my claim the first day we met. The ink was drying as he faxed the package to the Regional Office. However, that said, I came prepared to the first meeting with copies of everything that I knew he would need. I thought about filing the claim myself as I had a bad experience with my initial claim at retirement (the VSO for AMVets at American Lake did nothing to help, nothing), but the local ALSA chapter convinced me to go with PVA. It was the right choice for me. Might want to swing by his office and give him a push.

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Old 06-12-2018, 10:22 PM #12 (permalink)
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Default Re: Veterans with PLS VA disability

Hey, TL.
1) Appeal to Tricare. Just call them and tell the friendly lady that this is really important. Charm works.
2) When you physically sit with the PVA VSO, you'll get better results. Also, take notes with names, dates, and actions done, also note promises made.
3) Follow up exactly on time. My PVA VSO told us "Hey, you can also get $10,000 life insurance paid by the VA." Then he and we filled out the app, he faxed it, and we left the office. Four years later, I thought, hmmm, whatever happened to that? Turns out that he faxed it, the fax machine acknowledged receipt, and then nothing. The VA said they have no record of the app. So I just lost ten thousand dollars.

In short, it's good to be smart. But it's better to have a dozen smart friends and stay close to them.
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Old 06-13-2018, 01:02 AM #13 (permalink)
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Default Re: Veterans with PLS VA disability

Thanks Laurie, good to hear. My VSO seemed to feel the other way, (slow roll the diagnosis), but your advice is more in line with my thoughts, particularly in light of some of these cases, as you point out. Many thanks!
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Old 06-13-2018, 01:06 AM #14 (permalink)
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Default Re: Veterans with PLS VA disability

Good point Dave, thanks. I initially met him in person, but you're right, it is time for me to go high-five him again. It is awesome that your guy filed the claim the first day you met! And is helpful info, as I don't have a handle on how long it takes. He does have all of my records and info...maybe I'll be pleasantly surprised when I see him and find out it's already filed.
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Old 06-13-2018, 01:16 AM #15 (permalink)
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Default Re: Veterans with PLS VA disability

Mike,

Ha! Love it. Yep, I'll be dishing out full body hugs to all my friends on this one I think.

I'll also be taking your good advice on all three points...thanks for the solid insight!
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