Citation Nr: 21001109 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-12 633 DATE: January 7, 2021 ORDER New and material evidence having been received, the application to reopen the previously denied claim of entitlement to service connection for bilateral hearing loss and tinnitus is granted. Entitlement to service connection for bilateral hearing loss is denied. Entitlement to service connection for tinnitus is granted. An initial rating of 50 percent, but not more, for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is granted. FINDINGS OF FACT 1. In an August 2003 rating decision, the claims of entitlement to service connection for bilateral hearing loss and tinnitus were denied because the Veteran’s bilateral hearing loss and tinnitus were not cause by, related to, and/or aggravated by service. 2. The evidence added to the records since the August 2003 rating decision relates to an unestablished fact that is necessary to substantiate the claims of service connection for bilateral hearing loss and tinnitus. 3. The Veteran’s bilateral hearing loss was not shown in service or for many years thereafter and it is not otherwise etiologically related to active duty service. 4. Resolving reasonable doubt in the Veteran’s favor, it is at least as likely as not that his tinnitus is related to active duty service. 5. The Veteran’s acquired psychiatric disorder, to include PTSD, has been predominantly characterized by depression, anxiety, nightmares, anger, difficulty expressing his emotions, and disturbances in motivation and mood. However, occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood, due to symptoms such as obsessional rituals which interfere with routine activities, near-continuous panic or depression affective ability to function independently, appropriately, and effectively, spatial orientation, speech that is intermittently illogical, obscure, or irrelevant, neglect of personal appearance and hygiene, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships have not been shown. CONCLUSIONS OF LAW 1. The August 2003 rating decision that denied the Veteran’s claims for entitlement to service connection for bilateral hearing loss and tinnitus is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. As the evidence received subsequent to the August 2003 rating decision is new and material, the requirements to reopen the claims for bilateral hearing loss and tinnitus have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 3. The criteria for entitlement to service connection for bilateral hearing have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. 4. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.385. 5. The criteria for an initial rating of 50 percent, but not more, for an acquired psychiatric disorder, to include PTSD, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from July 1967 to September 1972. The Veteran also had periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) between October 1974 and December 1981. The Veteran testified at a hearing held by the undersigned Veterans Law Judge on October 2, 2020. A transcript is of record. 1. Whether new and material evidence has been submitted to reopen the claim of entitlement to service connection for bilateral hearing loss 2. Whether new and material evidence has been submitted to reopen the claim for entitlement to service connection for tinnitus In order for evidence to be sufficient to reopen a previously disallowed claim, it must be both new and material. If the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. See Smith v. West, 12 Vet. App. 312, 314 (1999); Manio v. Derwinski, 1 Vet. App. 140 (1991). Under the relevant regulation, “new” evidence is defined as evidence not previously submitted to agency decision-makers. “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. If it finds that submitted evidence is new and material, VA may then proceed to evaluate the merits of the claim on the basis of all evidence of record, but only after ensuring that the duty to assist the Veteran in developing the facts necessary for the claim have been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low, and consideration is not limited to whether the new submitted evidence relates specifically to the reason the claim was last denied. Rather, consideration should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). In this case, the Veteran is claiming entitlement to service connection for bilateral hearing loss and tinnitus. The Veteran’s claims were previously denied by the regional office (RO) in August 2003 on the basis that these disorders were not related to or aggravated by service. He did not appeal this decision, nor did he submit any new and material evidence within a year of receiving the decision. See Buie v. Shinseki, 24 Vet. App. 242 (2011). This represents the last final denial of the claims. After a review of the evidence submitted since the August 2003 rating decision became final, the Board of Veterans’ Appeals (Board) determines that the claims should be reopened. The evidence now includes new and material evidence including a new VA examination and private audiological examination, which raises the possibility that his bilateral hearing loss and tinnitus are related to his active duty service. Not only is this evidence “new” in that it was not of record prior to the last final denial of the claim, it is also “material,” as it relates to an unestablished fact necessary to support the claims. Namely, it shows that there may be a nexus between these currently diagnosed disorders and the Veteran’s active duty service. Therefore, the claims should be reopened on this basis. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Certain chronic diseases, including sensorineural hearing loss and tinnitus, are subject to presumptive service connection if manifest to a compensable degree within one year of separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Moreover, for such chronic diseases, an alternative method of establishing the second and third Shedden/Caluza element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a). See 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2014). In cases where a hearing loss disability is claimed, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. 38 C.F.R. § 3.385 does not preclude service connection for a current hearing loss disability where hearing was within normal limits on audiometric testing at separation from service. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Rather, when audiometric test results at a veteran’s separation from service do not meet the requirements of 38 C.F.R. § 3.385, a veteran may nevertheless establish service connection for current hearing disability by submitting medical evidence that the current disability is causally related to service. Hensley v. Brown, 5 Vet. App. 155 (1993). Where the requirements for hearing loss disability pursuant to 38 C.F.R. § 3.385 are not met until several years after separation from service, the record must include evidence of exposure to disease or injury in service that would adversely affect the auditory system and post-service test results meeting the criteria of 38 C.F.R. § 3.385. Hensley, 5 Vet. App. at 155. If the record shows (a) acoustic trauma due to significant noise exposure in service and audiometric test results reflect an upward shift in tested thresholds while in service, though still not meeting the requirements for “disability” under 38 C.F.R. § 3.385, and (b) post-service audiometric testing produces findings which meet the requirements of 38 C.F.R. § 3.385; then the rating authorities must consider whether there is a medically sound basis to attribute the post-service findings to the injury in service, or whether these findings are more properly attributable to intervening causes. Id. at 159. 3. Entitlement to service connection for bilateral hearing loss The Veteran contends that his bilateral hearing loss is related to his active duty service and periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). Specifically, he contends that his job as a communications center specialist subjected him to twelve-hour shifts with constant exposure to loud noises. Furthermore, he reported that after his active duty service, he worked for the Air National Guard as a jet engine mechanic and aerospace ground equipment mechanic and had periods of ACDUTRA and INACDUTRA between October 1974 and December 1981. This required him to work near the flight line and exposed him to constant loud heavy machinery and flight noises. Based on a review of the evidence of record, the Board determines that service connection is not warranted for bilateral hearing loss. First, although the Veteran was exposed to significant noise in service, the service treatment records do not indicate complaints of or treatment for hearing loss, nor was it clinically indicated. A comparison of the Veteran’s tonal thresholds at the time of his entrance examination in June 1967 and around the time of his separation from active duty service in August 1972 does not reflect a significant worsening in the hearing of either ear. Furthermore, when the Veteran entered the Air National Guard in 1974 and when he separated in 1981, his audiograms were generally normal with no evidence of significant tonal threshold shifts. Next, the medical records do not contain any evidence of hearing loss until the Veteran underwent an audiological examination in July 1998, which did indicate some bilateral hearing loss. The first medical indication of hearing loss is 17 years after he left service. The Board has considered the Veteran’s statements that he has experienced bilateral hearing loss since service. However, the Board is unable to grant service connection purely on his statements alone. Specifically, while the Veteran has asserted continuous symptoms, the medical evidence of record rebuts these assertions. Specifically, hearing loss was not documented during service despite almost annual audiograms during service between 1967 and 1981, and the first objective testing revealing bilateral hearing loss occurred 17 years after the Veteran left service. Moreover, the Veteran specifically denied hearing loss symptoms when he left active duty in 1972 and again when he separated from service with the Air National Guard in 1981. Accordingly, service connection for bilateral hearing disability is not warranted based on continuity of either the medical evidence or the Veteran’s statements. Next, although the evidence does not reflect that the Veteran’s symptoms were continuous since service, service connection may nonetheless be established if a relationship is otherwise demonstrated by competent evidence, including medical evidence and opinions. However, the competent evidence fails to establish a relationship between active duty and the Veteran’s current bilateral hearing loss. In this regard, the Board notes the opinion of the VA examiner from July 22, 2003 diagnosing the Veteran with bilateral sensorineural hearing loss. The Veteran reported that his job as a communications specialist in the Air Force required him to work in an enclosed room with constant exposure to noise and no personal hearing protection for 12-hour shifts, and that he was exposed to turbine engines, F-105 aircraft, and ground equipment noise after active duty service when he worked for the Air National Guard for eight years. He reported that his hearing began gradually deteriorating after that, and that he was not exposed to recreational noise, but he sometimes had occasional noise exposure while working in the maintenance department of a college after service. The examiner opined that it is less likely than not that the Veteran’s hearing loss was related to his military service because service treatment records consistently revealed hearing within normal limits. Because the examiner reviewed the record, examined the Veteran, and considered the Veteran’s statements, their opinion is highly probative. A separate VA examiner opined on July 31, 2003 that the Veteran’s hearing loss was more likely than not due to his military service after the Veteran had reported a history of difficulty hearing and the examiner reviewed the file. However, this examiner did not report reviewing in-service audiograms like the July 22, 2003 examiner, and thus, their opinion is not as probative. The Veteran underwent a private audiogram in July 2016, and the physician opined that it is more likely than not that his high frequency hearing loss is due to his military service. However, the physician did not report reviewing the evidence of record in forming their opinion and did not provide a rationale for the opinion, making the opinion not as probative as the opinion of the July 2003 VA examiner who reviewed the service treatment records and medical treatment records and provided a thorough rationale supporting their negative nexus opinion. Finally, in November 2016, the Veteran underwent a third VA examination for hearing loss and reported that he has only had occasional occupational noise exposure since service while working in the building maintenance and repair shop at a college. The examiner diagnosed the Veteran with bilateral hearing loss and opined that it is less likely than not that his hearing loss was caused by or the result of an event in service. The examiner noted that while the Veteran’s job as a communications specialist, jet engine mechanic, and aerospace ground equipment mechanic had a moderate probability for noise exposure, audiological examinations throughout service did not demonstrate a shift in hearing and instead demonstrated normal pure tone thresholds. The examiner also noted that, based on medical literature, there is no reasonable basis for delayed-onset hearing loss. Because the examiner examined the Veteran, reviewed the evidence of record, considered the Veteran’s statements, and provided a well-supported rationale for their opinion, the Board places significant value on their opinion. In arriving at these conclusions, the Board has considered the statements made by the Veteran and his fellow service members relating to the disorder on appeal to his active service. The United States Court of Appeals for the Federal Circuit has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, neither the Veteran nor his fellow service members are competent to provide testimony regarding the etiology of hearing loss disorders. Id. Because such disorders are not diagnosed by unique and readily identifiable features, they do not involve a simple identification that a layperson is competent to make. Therefore, the contentions of the Veteran and his fellow service members linking his disorder to service are found to lack competency. There is otherwise no evidence indicating compensable hearing loss within one year of separation from service, nor is there evidence, aside from the Veteran’s assertions, of a continuity of symptomatology since service. 38 C.F.R. §§ 3.307, 3.309. There is also no evidence that the Veteran’s current bilateral hearing loss is etiologically related to service. Therefore, the claim is denied. In reaching this decision, the Board considered the doctrine of reasonable doubt. However, as the preponderance of evidence is against the Veteran’s claim, the doctrine is not for application. 38 U.S.C. § 5107. 4. Entitlement to service connection for tinnitus The Veteran contends that his tinnitus is related to his active duty service. Specifically, he reports that he began to notice a high-pitched ringing in his ear when he was stationed in Spain that would make it difficult for him to sleep, requiring him to sleep with a fan on all night. Based on a review of the evidence of record, the Board determines that service connection is warranted for the Veteran’s tinnitus. In this case, while the Veteran’s service treatment records do not reflect complaints or symptoms of tinnitus during service, the Veteran reported during his separation examination that he had frequent trouble sleeping, which is consistent with the Veteran’s credible statements that his tinnitus disrupted his ability to sleep. Furthermore, the credible statements from the Veteran in conjunction with post-service medical treatment records are sufficient to demonstrate that his tinnitus was related to active duty service. Specifically, a July 1998 private audiological evaluation report diagnosed the Veteran with tinnitus and noted that the Veteran was “subjected to intensive noise levels” during service. Furthermore, the Veteran reported to VA examiners in July 2003 and November 2016, as well as to a private physician in July 2016, that he had been experiencing tinnitus symptoms since service. Both the VA examiner on July 31, 2003 and a private physician in July 2016 opined that it is more likely than not that the Veteran’s tinnitus was related to his military service. In arriving at this conclusion, the Board acknowledges that the medical evidence includes negative opinions from the July 22, 2003 VA examiner and the November 2016 VA examiner, which indicates that his tinnitus was not related to service because there are no complaints of symptoms in the service treatment records. However, the examiners did not provide any explanation or indication challenging the competency or credibility of the Veteran and his ability to report symptoms of tinnitus since service. Therefore, as the Veteran is competent to report that his tinnitus has been continuous since service, the Board finds that the evidence is at least in equipoise to support service connection. The appeal is granted. Increased Ratings Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. See. Mauerhan v. Principi, 16 Vet. App. 436 (2002); Massey v. Brown, 7 Vet. App. 204, 208 (1994). 5. Entitlement to an increased rating for an acquired psychiatric disorder, to include PTSD, The Veteran is seeking increased ratings for his psychiatric disability, to include PTSD. Specifically, he contends that his service-connected psychiatric disorder causes depression, anxiety, difficulty maintaining daily hygiene, difficulty creating or maintaining personal relationships, anger, lack of motivation, difficulty sleeping, mood swings, nightmares, constant paranoia, a short temper, and a tendency to isolate. Throughout the period on appeal, the Veteran has been assigned a 30 percent rating for a psychiatric disorder, characterized as PTSD under 38 C.F.R. § 4.130, DC 9411. As an initial matter, based upon the evidence of record, the Board finds that an initial rating of 50 percent is warranted. In support, the Board notes that the Veteran’s December 2016 VA examination and medical treatment records indicate that his symptoms on balance caused occupational and social impairment with reduced reliability and productivity. However, after a review of the evidence of record, the Board determines that an initial rating in excess of 50 percent is not warranted. In order to warrant a 70 percent rating, the evidence must show occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; impaired impulse control (such as unprovoked irritability with periods of violence); near-continuous panic or depression affecting ability to function independently, appropriately, and effectively; spatial disorientation; speech intermittently illogical, obscure, or irrelevant; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, DC 9411. Here, while the Veteran has occasional symptoms that could support a higher rating, they do not on balance cause social and occupational impairment with deficiencies in most areas of his daily living. Specifically, at a December 2016 VA examination, the Veteran reported that he experiences intrusive and ruminative thoughts of his service, feelings of guilt, chronic sleep impairment due to delayed sleep onset, nightmares twice per month, depressed mood, irritability, anxiety, hypervigilance, exaggerated startle response, tearfulness, attention and concentration problems, and avoidant symptoms. He was observed as having a depressed and anxious mood and was tearful. Upon examination, he was alert and oriented, denied suicidal ideation, and was noted as being a reliable historian. The Veteran reported that he had been married for 43 years at the time of the examination and that he loves his wife. He also reported a positive relationship with his children despite some financial frustrations within their relationship and stated that he stays in contact with some military and childhood friends via cell phone. While he reported a lack of intimacy with his wife, he noted that this is due to her religious beliefs rather than attributing it to his psychiatric symptoms. He noted that he spends the majority of his free time renovating the house and that he worked consistently until he retired in 2014, but that he did not have problematic work behavior. The examiner opined that the Veteran has occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily with normal routine behavior, self-care, and conversation. While the Veteran’s displayed symptoms are significant, the Board determines that they are most accurately contemplated by a 50 percent rating. Of particular note, the symptoms associated with a 70 percent rating are quite severe, as represented by symptoms such as suicidal ideation, obsessional rituals, severe difficulty communicating, and near continuous panic. It is reasonable to believe that such symptoms would be so severe that even a layperson would readily identify the impairment. Here, such impairment is not shown. Indeed, at the VA examination, the Veteran was an alert and oriented reliable historian who described positive relationships with his family and friends despite displaying a depressed and anxious mood, and he denied any suicidal ideation. The evidence beyond the VA examinations also does not show the level of impairment contemplated by a 70 percent rating. Medical records from August through December 2016 indicate that the Veteran has undergone counseling and treatment with medication for PTSD symptoms that include anxiety, depression, tearfulness, feelings of guilt and shame, becoming overwhelmed emotionally when discussing service in Vietnam, nightmares, anger, and difficulty interacting with others, including his family. The examiner noted that the Veteran became tearful and anxious with rapid speech when discussing Vietnam, he had poor-to-fair insight and judgment, and he had a depressed and anxious mood, but he denied suicidal ideation. The Veteran testified in October 2020 that he was having difficulty with counseling in 2016 but is scheduled to begin seeing a new physician and get back on medication. Despite the Veteran reporting occasional bouts of anger and irritability, it is clear in the 70 percent rating criteria that something more than simple irritability, mood swings, or anger issues must be shown. Overall, while the Veteran may exhibit some symptoms of a 70 percent rating, including irritability, anxiety, and anger, a holistic view of the Veteran’s symptoms are better categorized by a 50 percent rating, particularly in light of the record containing no evidence of psychosis, obsessive rituals, thought disorder, hallucinations, delusions, or suicidal ideation. See Vazquez-Claudio, 713 F.3d at 112, 115-17 (2013). Next, although the general rating formula provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should also consider any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such, the Board has also considered the extent to which there are other indications of occupational and social impairment, such as difficulty in adapting to stressful circumstances or the inability to establish and maintain effective relationships that may cause deficiencies in most areas, to include social and occupational inadaptability. In this regard, the evidence shows that the Veteran’s psychiatric disability and its manifestations are adequately contemplated by a 50 percent rating. As discussed, the Veteran reported to the November 2016 VA examiner that he experiences anger and irritability and that he experiences some frustration with his children’s financial situation. However, he also reported that he loves his wife, they have been married for more than 50 years, he has a good relationship with his children, he maintains contact with military and childhood friends via cellphone. While the Veteran testified in October 2020 that he does not have intimacy with his wife due to his psychiatric symptoms, he reported to the November 2016 examiner that the lack of intimacy was due to his wife’s religious beliefs. The Veteran also testified in October 2020 that he and his wife can go weeks without speaking and she informed him that he is moody, alternating between joking and anger with very little in between. However, the Veteran did not report this to the November 2016 examiner or in his medical treatment records during counseling sessions. The Veteran reported that he would have angry outbursts at work when interacting with coworkers or supervisors and mostly needed to work alone, but he reported to the November 2016 VA examiner that he did not have any behavioral problems at work before retiring in 2014. Finally, the Veteran testified that he can go weeks without bathing, and he was observed during the hearing appearing unkempt, for which he apologized. Although the Veteran’s reports of difficulty maintaining his hygiene appear credible, there are no other observations of poor hygiene in the VA examination report or medical records, and the Veteran was able to consistently work until retirement in 2014. He also maintains a marriage and relationships with friends and family, indicating that his hygiene is not so neglected as to warrant a higher rating In considering the appropriate disability ratings, the Board has considered the statements from the Veteran his service-connected psychiatric disorder is worse than the rating he currently receives, including that his disabilities cause impairment with his activities of daily living. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran and his fellow service members are competent to report symptoms because this requires only personal knowledge as it comes them through their senses, they are not competent to identify a specific level of disability of the Veteran’s service-connected disabilities according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s psychiatric disorders has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which the psychiatric disability is evaluated. Therefore, the Board concludes that a 50 percent rating, but no more, is warranted for the period on appeal. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kimber Veltri, Associate Counsel