Citation Nr: A20019437 Decision Date: 12/30/20 Archive Date: 12/30/20 DOCKET NO. 200212-62295 DATE: December 30, 2020 ORDER 1. Entitlement to service connection for diabetes mellitus type II is denied. 2. Entitlement to service connection for liver damage is denied. 3. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), adjustment disorder with depressed mood, major depressive disorder, and alcohol use disorder, is denied. FINDINGS OF FACT 1. The Veteran did not serve in the Republic of Vietnam and has not been shown to have otherwise been exposed to herbicides, including Agent Orange, during his active duty in Guam; as a result, exposure to an herbicide agent is not presumed. 2. Diabetes mellitus type II did not have its onset during active service or within one year of service discharge and is not otherwise related to active service. 3. Liver damage did not have its onset during active service, did not manifest as cirrhosis of the liver within one year of service discharge, and is not otherwise related to active service. 4. The preponderance of the evidence is against a finding that the Veteran has a diagnosis of PTSD in accordance with the DSM-5 during the pendency of his claim. 5. A psychiatric disorder, to include adjustment disorder with depressed mood, major depressive disorder, and alcohol use disorder, did not have its onset during active service and is not otherwise related to active service. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for liver damage have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 3. The criteria for service connection for a psychiatric disorder, to include PTSD, adjustment disorder with depressed mood, major depressive disorder, and alcohol use disorder, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1971 to July 1974. A rating decision was issued under the legacy system in December 2017 and the Veteran submitted a timely notice of disagreement. In April 2019, the agency of original jurisdiction (AOJ) issued a statement of the case (SOC). In May 2019, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and opted into the modernized review system, also known as the Appeals Modernization Act (AMA), from the April 2019 SOC. In May 2019, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the April 2019 SOC. Thereafter, in February 2020, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal, and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2019 SOC. 38 C.F.R. § 20.301. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation 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. Service connection for PTSD specifically requires the presence of three particular elements: (1) a current medical diagnosis of PTSD; (2) medical evidence of a causal nexus between current symptomatology and a claimed in-service stressor; and (3) credible supporting evidence that the claimed in-service stressor actually occurred. For certain chronic disorders, including diabetes mellitus and cirrhosis of the liver, service connection may be granted on a presumptive basis if the disease is manifested to a compensable degree within one year following service discharge. Additionally, service connection for certain specified diseases, including diabetes mellitus type II, may also be granted on a presumptive basis due to herbicide exposure, provided the disease manifests to a compensable degree within a specified period in a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975. Even where service connection cannot be presumed, service connection may still be established on a direct basis. 1. Entitlement to service connection for diabetes mellitus type II. The Veteran and his attorney assert, including within a March 2019 brief, that the Veteran’s diabetes mellitus type II is due to exposure to herbicide agents during active service at Anderson Air Force Base in Guam. However, following a review of the evidence of record, and as discussed more fully below, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for diabetes mellitus type II. The reasons for this decision follow. Regarding the first element of a service connection claim, the requirement of a current disability, the Board notes that post-service VA treatment records document the Veteran’s diagnosis of diabetes mellitus type II and related treatment since approximately 2010. Thus, the facts establish that the initial element of a service-connection claim is met. As to evidence of an in-service disease or injury, service treatment records do not document complaints, treatment, or diagnosis of diabetes mellitus type II. The Veteran’s October 1971 enlistment Report of Medical Examination documents a normal clinical evaluation of the endocrine system, without any notation of diabetes mellitus as a defect or diagnosis. The Veteran was assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES, where P stands for physical capacity or stamina, U stands for upper extremities, L stands for lower extremities, H stands for hearing and ears, E stands for eyes, and S stands for psychiatric. Additionally, the Veteran denied any sugar or albumin in the urine within a concurrent Report of Medical History at enlistment. Similarly, the Veteran’s subsequent July 1974 Report of Medical Examination at separation from active service also documents a normal clinical evaluation of the endocrine system, without any notation of diabetes mellitus as a defect of diagnosis, and the Veteran was again assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES. Additionally, the Veteran again denied any sugar or albumin in the urine within a concurrent Report of Medical History at separation. The examining physician noted that the Veteran had been seen for a skin rash and non-specific urethritis, but he denied all other significant medical or surgical history. Given the above, the Board finds that the preponderance of the evidence weighs against a finding that chronic diabetes mellitus type II first had its onset during active service. The Board is mindful that the Veteran’s service personnel records document his active service in Guam from September 1972 to December 1973; however, neither service treatment records or service personnel records document exposure to herbicide agents during the Veteran’s active service, and such exposure may not be presumed based upon active service in Guam alone. The Board has also considered the Veteran’s submission of a May 2018 article entitled “Agent Orange testing draws concerns, while GAO will not conduct own sampling,” which reports how Congress did not plan to conduct separate soil tests for Agent Orange on Guam despite reports from some veterans who said they witnessed the hazardous defoliant being sprayed on the island in the 1960s and the 1970s. However, as the report is of a general nature and does not refer to the specific facts of the Veteran’s active service or military occupation specialty while stationed in Guam, it is of no probative value in establishing that the Veteran was directly exposed to herbicide agents during active service. As such, the Board finds that the preponderance of the evidence weighs against a finding of an in-service disease or injury. Finally, there is no probative evidence of a nexus between the Veteran’s current diabetes mellitus type II and his active service. Post-service VA treatment records from July 2014 document the Veteran’s own report that he was diagnosed with diabetes mellitus type II approximately three to four years before, which condition was controlled at that time with diet, which would establish the onset in approximately 2010. Notably, there is no probative evidence that his diabetes mellitus type II first manifested within one year of service discharge in order to warrant presumptive service connection based upon diabetes mellitus as a chronic disease. Additionally, the fact that the probative post-service medical evidence establishes that the Veteran’s diabetes mellitus type II first had onset in approximately 2010 is evidence which weighs against his claim that the disability had its onset in service. To the extent that the Veteran asserts generally that his current diabetes mellitus type II is related to active service, the Board finds that he lacks the medical expertise to render a nexus opinion linking such a condition to his active service. The Board acknowledges that the Veteran was not afforded a VA examination or medical opinion in connection with the claim for service connection for diabetes mellitus type II. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. As discussed previously, the Board finds as fact that the record does not show probative evidence of an in-service event, injury, or disease, including diabetes mellitus type II or claimed herbicide exposure, or a probative indication that the current diabetes mellitus type II may be associated with active service. For a VA examination and/or medical opinion to be warranted, all the above criteria have to be met, and, here, at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for diabetes mellitus type II. Accordingly, the Board finds that VA has met its duty to assist concerning the Veteran’s claim. In conclusion, given the above, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim for service connection for diabetes mellitus type II. As such, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 2. Entitlement to service connection for liver damage. The Veteran and his attorney assert, including within a March 2019 brief, that the Veteran’s liver damage was caused by hepatitis C related to inoculations during active service However, following a review of the evidence of record, and as discussed more fully below, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for liver damage. The reasons for this decision follow. Regarding the first element of a service connection claim, the requirement of a current disability, post-service VA treatment records a diagnosis of hepatitis C in approximately 2010, with related treatment thereafter, including a March 2015 liver MRI that showed chronic changes without any mass lesions. Thus, the facts establish that the initial element of a service-connection claim is met. As to evidence of an in-service disease or injury, service treatment records do not document complaints, treatment, or diagnosis of liver damage. The Veteran’s October 1971 enlistment Report of Medical Examination documents a normal clinical evaluation of the abdomen and viscera, without any notation of a liver defect or diagnosis, and the Veteran was assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES. Additionally, the Veteran denied any stomach, liver, or intestinal trouble within a concurrent Report of Medical History at enlistment. Similarly, the Veteran’s subsequent July 1974 Report of Medical Examination at separation from active service also documents a normal clinical evaluation of the abdomen and viscera, without any notation of a liver defect or diagnosis, and the Veteran was again assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES. Additionally, the Veteran again denied any stomach, liver, or intestinal trouble within a concurrent Report of Medical History at separation. The examining physician noted that the Veteran had been seen by a for a skin rash and non-specific urethritis, but he denied all other significant medical or surgical history. Given the above, the Board finds that the preponderance of the evidence weighs against a finding that chronic liver damage first had its onset during active service. Additionally, there is no probative evidence that cirrhosis of the liver manifested during active service or within one year of service discharge to warrant a grant of presumptive service connection based on a chronic disease. Finally, there is no probative evidence of a nexus between a current liver disability and the Veteran’s active service. VA treatment records from July 2014 document that the Veteran was diagnosed with hepatitis C in approximately 2010, although he did not pursue treatment at that time due to a lack of finances. He reported that he was unsure how he contracted hepatitis C and denied sharing needles, IV drug use, blood transfusions, or exposure to contaminated blood, although his positive risk factors for hepatitis C were noted to include a history of multiple sexual partners and service in the military between 1964 and 1975. A subsequent August 2014 liver ultrasound showed chronic changes related to hepatitis, and a March 2015 liver MRI showed chronic changes without any mass lesions. Thus, the earliest post-service medical evidence of chronic hepatitis C in approximately 2010, which is over 35 years after service discharge, is in itself a fact that weighs against a finding of service connection. Additionally, there is no probative medical evidence of a nexus between a current liver condition, including hepatitis C diagnosed in approximately 2010, and the Veteran’s active service. To the extent that the Veteran asserts generally that he has a current liver disability which is related to active service, the Board finds that he lacks the medical expertise both to diagnose a complex and internal disease process like hepatitis C as well as to render a nexus opinion linking such a condition to his active service, including as due to inoculations administered during active service. The Veteran’s assertion that he did not receive treatment for hepatitis C until approximately 2015, five years after the condition was diagnosed, due to financial troubles, is unfortunate; however, it does not provide probative evidence that the Veteran’s hepatitis C first manifested during active service or is otherwise related to active service. Thus, the Veteran’s lay statements asserting a nexus are afforded no probative value in the context of his claim. The Board acknowledges that the Veteran was not afforded a VA examination or medical opinion in connection with the claim for service connection for liver damage. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. As discussed previously, the Board finds as fact that the record does not show competent evidence establishing that an event, injury, or disease regarding liver damage occurred in service, or an indication that a current liver disability may be associated with the Veteran’s active service. For a VA examination and/or medical opinion to be warranted, all the above criteria have to be met, and here, at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for liver damage. Accordingly, the Board finds that VA has met its duty to assist concerning the Veteran’s claim. In conclusion, given the above, the Board finds that the preponderance of the evidence weighs against the Veteran’s claim of entitlement to service connection for liver damage. As such, there is no reasonable doubt to be resolved, and the claim for service connection is denied. 3. Entitlement to service connection for a psychiatric disorder. The Veteran and his attorney assert, including within a March 2019 brief, that the Veteran has a psychiatric disorder, to include PTSD, as a result of his active service. Specifically, they assert that the Veteran’s service treatment records document evidence of a psychiatric issue during active service, including multiple reprimands for disobedient behavior, drug and alcohol use (including heroin use for a short period of time due to the physically challenging position of his military occupational specialty as part of the 43rd Supply Squadron), and military discipline including an Article 15. The Veteran asserts that he did not seek treatment for his psychiatric symptoms during active service because of the stigma involved; however, he believes that his current psychiatric disorder is due to in-service stressors or started in service. However, following a review of the evidence of record, and as discussed below, the Board finds that the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection for a psychiatric disorder, to include PTSD. The reasons for this decision follow. As to evidence of a current disability, the Board acknowledges that the objective evidence of record documents several psychiatric diagnoses throughout the appeal period. VA treatment records from March 2015 document DSM-5 diagnoses including adjustment disorder with depressed mood, and alcohol use disorder. Similarly, subsequent VA treatment records from December 2015 to December 2017 consistently document diagnoses of alcohol use disorder and major depressive disorder. Although the Board acknowledges that December 2015 and January 2016 assessments of PTSD, such notations do not equate to a DSM-5 finding of PTSD following a full psychiatric evaluation by a VA examiner; moreover, a subsequent June 2016 diagnostic assessment provided prior to an Intensive Outpatient Program (IOP) documents the need to rule out PTSD, which also does not equate to a probative diagnosis of PTSD in accordance with the DSM-5. Thus, the Board finds as fact that the Veteran does not have a diagnosis of PTSD in accordance with the DSM-5 for the purposes of his service-connection claim; however, his claim is properly broadened in light of the evidence of additional psychiatric diagnoses that meet the requirement of a current disability during the pendency of his claim, including alcohol use disorder and major depressive disorder. As to evidence of an in-service disease or injury, service treatment records do not document complaints, treatment, or diagnosis of a psychiatric disorder or symptoms. The Veteran’s October 1971 enlistment Report of Medical Examination documents a normal clinical psychiatric evaluation, without any notation of a psychiatric defect or diagnosis, and the Veteran was assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES, including psychiatric. Additionally, the Veteran denied depression, excessive worry, or nervous trouble of any sort within a concurrent Report of Medical History at enlistment. Similarly, the Veteran’s subsequent July 1974 Report of Medical Examination at separation from active service also documents a normal clinical psychiatric evaluation, without any notation of a psychiatric defect or diagnosis, and the Veteran was again assigned a rating of “1” for a high level of fitness in each category of the Physical Profile Serial of PULHES, including psychiatric. Additionally, the Veteran again denied depression, excessive worry, or nervous trouble of any sort within a concurrent Report of Medical History at separation. The examining physician noted that the Veteran had been seen by a for a skin rash and non-specific urethritis, but he denied all other significant medical or surgical history. Given the above, the Board finds that the preponderance of the evidence weighs against a finding that a psychiatric disorder first had its onset during active service. In this regard, the Board has also considered the Veteran’s statements about his negative behaviors during active service that he claims is evidence of psychiatric symptoms during active service. Service personnel records document a June 1973 Disciplinary Punishment after the Veteran failed to report on time for duty at the Tool Issue Center in May 1973; his resulting punishment was a reduction in grade and forfeiture of pay for two months, which was suspended. In July 1973, the Veteran was noted to have been disrespectful in language toward a superior noncommissioned officer in June 1973. Given this misconduct, the prior suspension of his June 1973 nonjudicial punishment was vacated. In September 1973, the Veteran disobeyed an order to change rooms after he was counseled on at least two occasions about maintaining established standards of cleanliness for his room, for which he was subsequently reduced in grade to Airman Basic, which punishment was suspended until April 1974. In an October 1973 supporting statement, the Veteran reported that he did not feel that he should be required to move out of his room. He noted that he had “been in trouble in the past and didn’t want to get into any more trouble, but it [seemed] as though [his] First Sergeant [was] going out of his way to create trouble for [him].” The Veteran concluded that he was “going to give [his] greatest effort to fulfill [his] military obligation without any further incident.” While the Board acknowledges the above disciplinary incidents, the Board finds as fact that such incidents do not equate of a finding of a psychiatric disorder which had its onset during active service. Notably, the Veteran himself reported in October 1973 that he was going to give his best effort toward his duties, which indicates that he retained the ability process the consequences of his actions. Additionally, a July 1973 service personnel record documents an Airman Performance Report that indicates that the Veteran performed all of his duties as a Squadron Tool Issue Clerk in a satisfactory manner, and that he the proven ability to learn and progress, despite a noted lack of initiative. Finally, an October 1973 service treatment record documents that the Veteran was positive for opiates in his urine, and he reported snorting heroin for two months. However, the Board finds that the Veteran’s in-service behavioral incidents, including his lack of initiative and requirement of “constant supervision,” as well as his admitted drug use, does not equate to a finding that a psychiatric disorder first manifested during active service. Notably, these behavioral incidents do not outweigh the probative and objective findings of the July 1974 Report of Medical Examination at separation which documented the Veteran’s normal psychiatric evaluation, in addition to his own concurrent denial of psychiatric symptoms at discharge. Notably, while the Veteran’s lay testimony alone may establish the occurrence of a claimed in-service stressor in certain circumstances (if the Veteran was diagnosed with PTSD during active service, or if the Veteran engaged in combat with the enemy and that his stressor was related to that combat, or if the claimed stressor is related to a fear of hostile military or terrorist activity and has been confirmed by a VA psychiatric tor psychologist as being adequate to support a diagnosis of PTSD, or if the Veteran was a prisoner of war, or if the Veteran’s claim is based upon an in-service personal assault); however, in this instance, the probative evidence of record does not document that the requirement of credible supporting evidence that the claimed PTSD stressor occurred should be relaxed. Given the above, the Board finds that the preponderance of the evidence is against a finding that the Veteran was experiencing psychiatric symptoms during active service, such that the in-service element of the service-connection claim is not met. Finally, as to evidence of a nexus between a current psychiatric disorder and active service, the Board finds that the preponderance of the evidence weighs against such a finding. For example, post-service records from July 2014 document the Veteran’s report of depressed thoughts related to his diagnosis of hepatitis C and a recent break-up with a girlfriend. In March 2015, the Veteran reported a recent DUI charge after a long period of sobriety, which he stated was likely triggered by various stressors including a recent possible diagnosis of liver cancer and ongoing work-related issues. His initial DSM-5 diagnoses at that time included adjustment disorder with depressed mood and alcohol use disorder. A March 2015 substance abuse treatment program (SATP) evaluation documents that the Veteran was feeling depressed due to financial problems related to his failing water treatment business, a break-up with his significant other a year and a half ago, and ongoing health issues including hepatitis C with possible liver cancer. Regarding his prior alcohol use, he reported drinking for the first time at the age of 15, when he would drink every weekend, and later every day and heavily while in the Air Force. He stated he felt like his time spent in Guam was like a prison and stated that he was harassed by fellow black airmen, which was a traumatic experience for him. After leaving the service, he stated that he drank less but that it was still a lot. He stated he got into the wine and beer business and was very successful, but that he was in a motor vehicle accident while drinking and stopped drinking for 10 years, after which a divorce from his wife triggered his return to drinking. He noted that he was engaged a year and a half ago and that break-up lead to his recent DUI. The Veteran also stated that he tried cannabis in the service but did not like it and had never continued to smoke it. He denied the use of cocaine, opioids, or any other drug use. A subsequent November 2015 SATP consult documents the Veteran’s request to attend IOP for his alcohol problems. He believed that his experiences during active service in Guam led him to leave the service and had a very bad effect on his life. He reported that he was abused by some black service members and superior officers and he sometimes had to fight for his life. He was noted to meet the diagnostic criteria for a substance use disorder and agreed to attend the IOP as many times a week as he could. Subsequent VA treatment records from December 2015 document psychiatric assessment of alcohol use disorder, PTSD, and depressive disorder. In January 2016, he was assessed with alcohol use disorder and PTSD. In June 2016, a Diagnostic Assessment conducted for his IOP program revealed assessments of alcohol use disorder, in full remission, depressive disorder, and rule-out PTSD. More recently, in December 2017, his psychiatric diagnoses included alcohol dependence and major depressive disorder. Significantly, while the Veteran’s lay statements of record are competent insofar as they report observable symptomatology, to the extent that the Veteran’s lay statements attempt to diagnose a certain psychiatric disorder or provide a nexus for such disorder to his active service, the Board finds that such statements are of no probative value, as the Veteran lacks the requisite medical and psychiatric expertise. In this regard, the question of causation involves a medical subject concerning an internal physical and psychiatric process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran’s own opinion is nonprobative evidence. Additionally, to the extent that the Veteran asserts that his current psychiatric disorder is related to maltreatment and abuse during active service, the Board’s review of his service treatment records and service personnel records as discussed in detail above does not document such incidents; therefore, these uncorroborated reports are of no probative value in the context of the Veteran’s claim. Moreover, such reports are inconsistent with post-service treatment records in which the Veteran himself related his psychiatric symptoms to financial, relationship, and health concerns. Indeed, the Board finds it probative that despite the Veteran’s lay assertions that attempt to attribute his psychiatric symptoms to claimed maltreatment and abuse during active service, there is no probative evidence that any psychiatric treating professional has rendered a nexus opinion relating the Veteran’s current psychiatric symptoms to his active service. The Board acknowledges that the Veteran was not afforded a VA examination or medical opinion in connection with the claim for service connection for a psychiatric disorder. The Board finds that the facts of this case do not establish entitlement to a VA examination or medical opinion. For example, VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. As discussed previously, the Board finds as fact that the record does not show competent evidence establishing that an event, injury, or disease regarding a psychiatric disorder occurred in service, or an indication that a current psychiatric disorder may be associated with the Veteran’s active service. For a VA examination to be warranted, all the above criteria have to be met, and here, at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion is not warranted for the claim for service connection for psychiatric disorder. Accordingly, the Board finds that VA has met its duty to assist concerning the Veteran’s claim. For all the reasons laid out above, the Board finds that the preponderance of the evidence is against the claim for service connection for a psychiatric disorder, to include PTSD, adjustment disorder with depressed mood, major depressive disorder, and alcohol use disorder. As the preponderance of the evidence is against the Veteran’s claim, there is no reasonable doubt to be resolved, and the claim for service connection is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.