Citation Nr: 21000986 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 17-22 837 DATE: January 6, 2021 ORDER Entitlement to service connection for dental treatment purposes for fractured front teeth is dismissed. Entitlement to service connection for an ear disability is dismissed. Entitlement to service connection for a low back disability is dismissed. Entitlement to service connection for a neck disability is dismissed. Entitlement to service connection for irritable bowel syndrome is dismissed. Entitlement to an initial rating higher than 10 percent for gastroesophageal reflux disease (GERD) is dismissed. Entitlement to an initial 100 percent rating for posttraumatic stress disorder (PTSD) is granted for the entire appeal period prior to April 17, 2020, subject to the laws and regulations governing the award of monetary benefits. Entitlement to an initial 10 percent rating for status-post left inguinal herniorrhaphy with scarring is granted for the entire appeal period prior to April 17, 2020, subject to the laws and regulations governing the award of monetary benefits. Entitlement to an effective date of January 24, 2013 for the award of service connection for residuals of left inguinal hernia is granted. FINDINGS OF FACT 1. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for service connection for dental treatment purposes for fractured front teeth. 2. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for service connection for an ear disability. 3. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for service connection for a low back disability. 4. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for service connection for a neck disability. 5. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for service connection for irritable bowel syndrome. 6. On the record during the Board hearing on July 29, 2020, the Veteran requested a withdrawal of his claim for an initial rating higher than 10 percent for GERD. 7. During the entire appeal period prior to April 17, 2020, the service-connected PTSD more nearly approximates total occupational and social impairment. 8. During the entire appeal period prior to April 17, 2020 the service-connected residual scar of the left inguinal herniorrhaphy has been painful. 9. On January 24, 2013 the Veteran notified the Department of Veterans Affairs that he intended to apply for compensation benefits for hernia. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the claim for service connection for dental treatment purposes for fractured front teeth have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of the claim for service connection for an ear disability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for withdrawal of the claim for service connection for a low back disability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 4. The criteria for withdrawal of the claim for service connection for a neck disability have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 5. The criteria for withdrawal of the claim for service connection for irritable bowel syndrome have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 6. The criteria for withdrawal for the claim for an initial rating higher than 10 percent for GERD have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 7. The criterial for an initial 100 percent rating for PTSD for the entire appeal period prior to April 17, 2020 have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 8. The criteria for an initial 10 percent rating for status-post left inguinal herniorrhaphy with scarring for the entire appeal period prior to April 17, 2020 have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.118, Diagnostic Code 7804 (prior to and after August 13, 2018). 9. An effective date of January 24, 2013 is warranted for service connection for residuals of left inguinal hernia. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155(a)(effective prior to March 24, 2015), 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 2003 to June 2007. The issues on appeal arise from rating decisions dated in July 2014, March 2017, and August 2017. In a rating decision in October 2020, the Regional Office (RO) granted a 100 percent rating for PTSD effective April 17, 2020. In the October 2020 rating decision the RO also granted a 10 percent rating for linear left inguinal scar, residual of herniorrhaphy, effective April 17, 2020. Thus, these issues are characterized as reflected herein. The Board notes that in January 2020 the Veteran was incorrectly advised that his claim for a higher rating for PTSD was docketed at the Board under the modernized review system created by the Appeals Modernization Act. Such letter was issued as the result of an administrative error as the issue for a higher rating for PTSD remains in the legacy appeals system. In December 2020 the Board sent the Veteran a letter explaining the error. Issues 1-6: Entitlement to service connection for: dental treatment purposes for fractured front teeth, an ear disability, low back disability, neck disability, and irritable bowel syndrome; and, entitlement to an initial rating higher than 10 percent for GERD. Under 38 U.S.C. § 7105, the Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. An appeal may be withdrawn in writing or during a hearing at any time before the Board promulgates a decision. Withdrawal may be made by the claimant or by his or her authorized representative. 38 C.F.R. § 19.55. During the July 29, 2020 Board hearing, on the record, the Veteran requested a withdrawal of his claims of entitlement to service connection for: dental treatment purposes for fractured front teeth, an ear disability, low back disability, neck disability, and irritable bowel syndrome; and, entitlement to an initial rating higher than 10 percent for GERD. (A written transcript of that hearing has been associated with the claims file.) The Veteran’s withdrawal was undertaken with a full understanding of the consequences of such action. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011). In view of the Veteran’s expressed desire, further action with regard to these claims is not appropriate. Accordingly, the Board does not have jurisdiction to review the claims of service connection for: dental treatment purposes for fractured front teeth, an ear disability, low back disability, neck disability, and irritable bowel syndrome; and, entitlement to an initial rating higher than 10 percent for GERD and they are dismissed. Higher Ratings A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Hart v. Mansfield, 21 Vet. App. 505 (2007). Issue 7: Entitlement to an initial rating higher than 70 percent for PTSD prior to April 17, 2020. The Veteran’s PTSD is evaluated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Codes 9411. Under these criteria, a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactory, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to particular symptoms such as: flattened affect; circumstantial, circumlocutory or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126 (a). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126 (b). The Board notes, with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), that ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The United States Court of Appeals for the Federal Circuit emphasized that the list of symptoms under a given rating is a nonexhaustive list, as indicated by the words “such as” that precede each list of symptoms. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It held that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration. Other language in the decision indicates that the phrase “others of similar severity, frequency, and duration,” can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. VA must consider all symptoms of a claimant’s condition affecting the level of occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When determining the appropriate disability evaluation to assign, the Board’s primary consideration is the Veteran’s symptoms, but it must also make findings as to how those symptoms impact the Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). It is the impact of the symptoms on occupational and social functioning that determines the rating. By way of history the RO granted service connection for PTSD with an evaluation of 70 percent effective November 7, 2012. As discussed above, the RO in the rating decision in October 2020 granted a 100 percent rating for PTSD effective April 17, 2020. The Board is cognizant that there is evidence of record showing that the Veteran met the criteria for a rating lower than 100 percent. However, the Board places high probative value on the evidence for the entire appeal period prior to April 17, 2020 showing that the Veteran’s PTSD approximates total occupational and social impairment including due to persistent danger of hurting self and intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene). VA treatment records in November 2008 show that the Veteran had a recent suicide attempt. In January 2009 the records show the Veteran was recently hospitalized for psychiatric stabilization. In May 2011 the records show that the Veteran tried to hang himself in 2008. In August 2011 VA treatment records show that 6 months after returning from his second tour of duty the Veteran had an impulsive suicide attempt and cut his wrists. The examiner noted that the Veteran had 4 to 5 suicide attempts, most recently 4 to 5 months ago. On VA PTSD examination in May 2014, the examiner noted that the Veteran’s diagnoses included PTSD, major depressive disorder, and alcohol use disorder, however the examiner stated that the symptoms would be classified as “stand alone” with or without alcohol consumption. The Veteran’s symptoms included near continuous panic or depression affecting the ability to function independently, appropriately and effectively, difficulty adapting to stressful circumstances including work or a work like setting, and inability to establish and maintain effective work and social relationships. VA treatment records in January 2016 show the Veteran’s last hospitalization for suicidal ideation was in September. On VA Disability Benefits Questionnaire (DBQ) examination for PTSD in June 2016, the Veteran’s only diagnosis was PTSD. The Veteran’s symptoms included panic attacks more than once per week, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a worklike setting, inability to establish and maintain effective relationships, suicidal ideation, neglect of personal appearance and hygiene, and intermittent inability to perform activities of daily living including maintenance of minimal personal hygiene. On VA PTSD examination in August 2019, the diagnoses were PTSD, major depressive disorder, cannabis use disorder, and alcohol use disorder. The examiner opined that it was not possible to differentiate what symptoms are attributable to each disorder. The Veteran’s symptoms included difficulty in adapting to stressful circumstances, including work or a work like setting, and suicidal ideation. The Veteran sometimes thought his name was being called. During the July 2020 Board hearing the Veteran testified that he isolated himself from people and hardly ever leaves his home. He stated that he has had difficulty communicating with his wife and child and has had attempted suicide 5 or 6 times for over the past decade. His attorney noted that he has had several hospitalizations for thoughts of hurting himself. The Veteran explained that one time his sister found him trying to hang himself in the closet. On another occasion his mother found him after he took a bottle of Tylenol PM trying to kill himself. On VA PTSD examination in September 2020, the Veteran’s symptoms included depressed mood, anxiety, near continuous panic or depression affecting the ability to function independently appropriately and effectively, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a worklike setting, obsessional rituals which interfere with routine activities, persistent danger of hurting self or others, and neglect of personal appearance and hygiene. To the extent that the Veteran during the current appeal period may have had psychiatric diagnoses other than his service-connected PTSD, based on the evidence discussed above it is not possible to distinguish the effects of his service-connected psychiatric disorder from other psychiatric disorders, the reasonable doubt doctrine dictates that all such symptoms be attributed to his service-connected psychiatric disorder. Mittleider v. West, 11 Vet. App. 181 (1998). As a final point, the Board notes that the evidence reflects that the Veteran was unable to work due to his service-connected PTSD. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disability may be an element of an appeal for a higher rating. See Rice v. Shinseki, 22 Vet. App. 447 (2009). TDIU may be assigned “where the schedular rating is less than total” and the evidence shows that a veteran is precluded, by reason of his service-connected disabilities, from securing and following “substantially gainful employment” consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16; VAOPGCPREC 75-91; 57 Fed. Reg. 2317 (1992). As the Veteran is now in receipt of a total (100 percent) rating for the entire period on appeal, there remains no time during the period on appeal where the schedular rating is “less than total,” as required for a TDIU. See 38 C.F.R. § 4.16(a). The Board is cognizant of the fact that the receipt of a 100 percent schedular disability rating for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU because a TDIU rating may still form the basis for assignment of special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(s). See Bradley v. Peake, 22 Vet. App. 280 (2008). In Bradley, the Court found that a TDIU was warranted in addition to a schedular 100 percent evaluation where the TDIU had been granted for a disability other than the disability for which a 100 percent rating was in effect. Under the facts presented in that case, there was no “duplicate counting of disabilities.” Bradley, 22 Vet. App. at 293. The facts presented in this case are distinguishable from the Bradley case because the Veteran is service connected for PTSD, which is rated as 100 percent disabling throughout the entire appeal period in light of the decision herein, and his other disabilities included tinnitus rated at 10 percent, GERD rated at 10 percent, left inguinal scar rated at 10 percent (under Diagnostic Code 7804 and anterior trunk scar associated with linear left inguinal scar rated zero percent under Diagnostic Code 7805), and residuals of left inguinal hernia rated zero percent under Diagnostic Code 7338, with a combined rating of 30 percent. If the Veteran were to be awarded TDIU based on PTSD, it would impermissibly result in the same disability being “counted twice” in the assignment of a total rating. See 38 C.F.R. § 4.14. Because his other service-connected disabilities have a combined rating of 30 percent, the Veteran is not eligible for schedular TDIU based on these disabilities alone. See 38 C.F.R. § 4.16. As such, under the facts presented in this case, if TDIU were to be granted, the Veteran would not be eligible for SMC under the first prong of 38 U.S.C. § 1114 (s) and 38 C.F.R. § 3.350(i) because TDIU would be based on the 100 percent schedular rating for PTSD. For these reasons, the issue of entitlement to TDIU at any time during the period on appeal is now rendered moot and will not be addressed further by the Board. Issue 8: Entitlement to an initial compensable rating for status-post left inguinal herniorrhaphy with scarring prior to April 17, 2020. The Board notes that VA amended the criteria for rating skin disabilities during the claim period, effective from August 13, 2018. With regard to the effective date of the new criteria, VA indicated in the Supplementary Information to the Final Rule that its “intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied.” 83 FR 32592 (July 13, 2018). The Veteran’s claim in this case was pending prior to the August 13, 2018 effective date and therefore the Board will consider both the old and new criteria and apply the more favorable criteria. In order to warrant a compensable rating under the old rating criteria, a scar would need to be deep (associated with underlying soft tissue damage) and nonlinear and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (Diagnostic Code (DC) 7801); be superficial (not associated with underlying soft tissue damage) and nonlinear and affect an area or areas of 144 square inches (929 square centimeters) or greater (DC 7802). A compensable evaluation under DC 7804 requires one or two scars that are unstable or painful, a 20 percent evaluation for three or four scars that are unstable or painful, and a 30 percent evaluation for five or more scars that are unstable or painful. Note (1) to this diagnostic code provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) to this diagnostic code provides that if one or more scars are both unstable and painful, 10 percent is added to the evaluation based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code when applicable. 38 C.F.R. § 4.118, DCs 7801-7805 (in effect prior to August 13, 2018). Diagnostic Code (DC) 7805, provides that any scars (including linear scars) should have disabling effects not considered in a rating provided under DCs 7800, 7801, 7802, and 7804 evaluated under an appropriate diagnostic code. Diagnostic Code 7800 is inapplicable as it pertains to scars of the head, face or neck. The Board notes that the provisions of DC 7804 were not changed and the provisions of DC 7805 were not substantively changed. Id. In order to warrant a compensable rating (10 percent) under the new rating criteria, a scar would need to be associated with underlying soft tissue damage and affect an area or areas exceeding at least 6 square inches (39 square centimeters) (DC 7801); not be associated with underlying soft tissue damage, but affect an area or areas of 144 square inches (929 square centimeters) or greater (DC 7802) (in effect from August 13, 2018). 38 C.F.R. § 4.118. The Board notes that the Veteran has been receipt of a noncompensable rating under Diagnostic Code 7804 from November 7, 2013 to April 16, 2020 and a 10 percent rating from April 17, 2020. He also is in receipt of a noncompensable rating from November 17, 2014 under Diagnostic Code 7805 and during the appeal period has been in receipt of a noncompensable rating under Diagnostic Code 7338 for residuals of left inguinal hernia. The Board finds that the evidence approximates the criteria for an initial 10 percent rating for the entire appeal period prior to April 17, 2020 based on a painful scar. On VA DBQ examination for hernia in June 2016, the Veteran’s scar was on the left inguinal region and was 6 centimeters long and.85 centimeters wide. During the examination, the Veteran reported that the scar was painful when bending, walking or standing. During his Board hearing in July 2020 the Veteran stated that his hernia scar has been painful while walking, sitting or bending. He explained that he has had throbbing pain since at least 2013. The Board notes that the Veteran is competent to describe pain and discomfort and the Board finds that his statements are credible. Layno v. Brown, 6 Vet. App. 465, 470 (1994). On VA scar examination in October 2020, the Veteran had a scar on the left inguinal region that was painful. The Veteran reported having intermittent stinging and sharp sensation over the scar line. The scar was not unstable with frequent loss of covering of skin over the scar. The scar was 6 centimeters long and .3 centimeters wide. The scar was not unstable and did not have underlying soft tissue damage. The scar affected an area of 1.8 cm2 of the anterior trunk. The examiner determined that the scar did not result in limitation of function. The Veteran’s attorney during the July 2020 Board hearing stated that all the Veteran was asking for is a 10 percent rating for the painful scar. As the Veteran through his attorney during the July 2020 Board hearing expressed satisfaction with a 10 percent rating being assigned herein for a painful scar for his status-post left inguinal herniorrhaphy with scarring, this decision granting a 10 percent rating represents a full grant of the benefit sought on appeal. AB v. Brown, 6 Vet. App. 35 (1993) (noting that while an appellant is presumed to be seeking the maximum benefit under the law, the appellant can choose to limit the appeal to a lesser benefit). Issue 9: Entitlement to an effective date earlier than November 7, 2013 for the award of service connection for residuals of left inguinal hernia. Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. That is, the effective date of an award “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor.” 38 U.S.C. § 5110(a). The Board notes that effective on March 24, 2015, VA amended its rules as to what constitutes a claim for benefits; such now requires that claims be made on a specific claim form prescribed by the Secretary, which is available online or at the local Regional Office. However, since the present claim for an earlier effective date was pending to the Board prior to March 24, 2015, the rules governing formal/informal claims apply. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151 (a), 3.155. Prior to March 24, 2015, VA recognized formal and informal claims. A claim is defined as a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. § 3.1(p). An informal claim is any communication or action indicating an intent to apply for one or more benefits, and must identify the benefit sought. 38 C.F.R. § 3.155(a). Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within 1 year from the date it was sent to the claimant, it will be considered filed as of the date of receipt of the informal claim. Id. In the instant case, a Report of General Information dated on January 24, 2013 shows that the Veteran’s attorney “clarified that the issues (t)he veteran wishes to claim” include hernia. On November 7, 2013 the Veteran’s underlying claim of service connection for stomach hernia was received. In light of the totality of the evidence, the Board finds that the Veteran is entitled to an effective date of January 24, 2013 for service connection for residuals of left inguinal hernia as that is the date the Veteran’s informal claim was received. During the July 2020 Board hearing the Veteran’s attorney stated that the Report of General Information was an informal claim for hernia. While the attorney referenced 38 C.F.R. § 3.155(b)(1)(3), which is the current regulation in effect, as discussed above the applicable regulation in the instant case is 38 C.F.R. § 3.155(a) prior to March 24, 2015. Nevertheless, this decision represent a full grant of the benefit sought as an effective date of January 24, 2013 for residuals of left inguinal hernia is being granted herein. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.