Citation Nr: 21001350 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 14-37 288 DATE: January 7, 2021 ORDER Entitlement to an initial disability rating in excess of 30 percent prior to November 5, 2014, for posttraumatic stress disorder (PTSD) is denied. Entitlement to a disability rating of 50 percent, and no higher, for the appeal period from November 5, 2014, and no earlier, until October 9, 2018, for PTSD, is granted. FINDINGS OF FACT 1. Prior to November 5, 2014, the Veteran’s PTSD disability manifested with symptomatology resulting in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). 2. For the appeal period beginning in November 5, 2014 until October 9, 2018, the Veteran’s PTSD symptomatology resulted in occupational and social impairment with reduced reliability and productivity. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD) for the period prior to November 5, 2014 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.130, Diagnostic Code 9411. 2. The criteria for entitlement to disability rating in excess of 50 percent for posttraumatic stress disorder (PTSD) for the period November 5, 2014 until October 9, 2018 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1961 to September 1963. This matter comes before the Board of Veteran’s Appeals (Board) from an April 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Veteran testified via videoconference before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In October 2019, the Board addressed the claims on appeal. The Veteran disagreed with the Board’s decision and appealed to the United States Court of Appeals for Veterans Claims (CAVC). In September 2020, CAVC granted a Joint Motion for Remand (JMR) where the parties agreed that the October 2019 decision had failed to provide sufficient reasons and bases for its findings. The matter is again before the Board. Increased Rating Disability evaluations are determined by the application of the 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. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson, 12 Vet. App. at 126 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The regulations for mental disorders are found in 38 C.F.R. §§ 4.125 -4.130. The Board notes that psychiatric disabilities evaluated under Diagnostic Code 9411, including PTSD, are rated according to the General Rating Formula for Mental Disorders. Pursuant to the rating formula, a 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, 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; mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent evaluation is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms 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 (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted for 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. Id. A 100 percent evaluation is warranted for 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. Id. The psychiatric symptoms listed in the above rating criteria are not exclusive, but are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). 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). When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, 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. 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 solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). 1. Entitlement to an initial disability rating in excess of 30 percent prior to November 5, 2014, for PTSD 2. Entitlement to a disability rating of 50 percent, for the appeal period from November 5, 2014, until October 9, 2018, for PTSD The Veteran asserts that the disability rating initially assigned to his PTSD disability does not reflect the severity of his condition for the appeal period prior to October 10, 2018. As the present appeal stems from disagreement with the initial rating assigned to the Veteran’s PTSD condition, the appeal period is from February 1, 2011, the effective date of the award of service connection for PTSD, forward. Additionally, the Veteran was awarded a 100 percent disability rating for his PTSD from October 10, 2018, forward. Accordingly, as the Veteran was awarded the maximum rating available from October 10, 2018, this period is no longer on appellate status. AB v. Brown, 6 Vet. App. 35, 39 (1993). The Veteran’s medical records have been associated with the claims file. In a January 2011 statement, the Veteran asserted that he suffered from flashbacks, panic attacks and crying spells. See statement of January 2011. In February 2011, the Veteran’s medical records show he reported having difficulty sleeping and isolating himself. He also endorsed having intrusive thoughts and nightmares. The Veteran’s wife reported he was more forgetful, irritable and agitated and that the Veteran isolated himself and watched television all day. See medical records for February 2011. In March 2011, the Veteran reported a bit of improvement in his symptoms with his medication. The Veteran explained he was sleeping a little better, and that his intrusive thoughts, flashbacks and nightmares occurred infrequently. He also reported having gone back to work. The Veteran denied suicidal ideation. See medical records for February 2011. In June 2011, the Veteran’s flashbacks and nightmares were noted to remain infrequent. The Veteran also reported that his medication was helping his anxiety. See medical records for June 2011. A private medical opinion was associated with the claims file in June 2011. The psychologist assessed the Veteran’s PTSD in accordance with the DSM-IV. She noted the Veteran persistently reexperiences the past through recurrent and distressing memories and dreams, and through the psychological distress he feels when exposed to cues that symbolize an aspect of his traumatic experiences. She further noted that the Veteran avoids activities and situations associated with the trauma, has low motivation, feels detached from others, and demonstrates a restricted range of affect. The Veteran was also noted to have sleep difficulties, irritability, difficulty concentrating, hypervigilance, and an exaggerated startled response. The psychologist further noted the Veteran’s symptoms as: depressed mood, guilt, impaired affect modulation, feelings of ineffectiveness and shame, somatic complaints, memory impairment, disillusion with authority, social withdrawal, and impaired interpersonal relationships. See psychological assessment and medical opinion, associated with the claims file in June 2011. In September 2011, the Veteran reported doing “fairly well,” with good appetite and good mood most days. He also reported his flashbacks and nightmares remained infrequently as they happened once in a while. He denied suicidal or homicidal ideation. See medical records for September 2011. In December 2011, the Veteran reported that everything was going pretty good, that he was working around at his church, that he was eating and sleeping well. He also reported occasional nightmares with no intrusive thoughts or flashbacks and denied suicidal or homicidal ideation. See medical records for December 2011. In December 2012, the Veteran reported that he had been moody since running out of medication, reported forgetfulness which he attributed to his age, decreased sleep and occasional nightmares. The physician noted the Veteran had restricted affect, satisfactory grooming, and that he denied suicidal or homicidal ideation. See medical records for December 2012. The Veteran was also administered an Initial PTSD Disability Benefits Questionnaire (PTSD DBQ) in December 2012. In this examination, the Veteran’s PTSD diagnosis in accordance with the DSM IV was characterized as mild. The examiner found that the Veteran’s PTSD caused occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks, only during periods of significant stress or; symptoms that are controlled by medication. The examiner marked “chronic sleep impairment” as the only symptom that applied to the Veteran’s diagnosis. This examiner also noted that although the Veteran reported feeling sad, lacking motivation, among other symptoms, the examiner found the reports to be inconsistent with the medical records. Thus, the examiner opined that although the Veteran reported certain symptomatology, that his symptoms were not as severe as he was reporting them to be in the examination. See PTSD DBQ of December 2012. In March 2013, the Veteran reported poor sleep, occasional nightmares, and feeling depressed sometimes. See medical records for March 2013. In July 2013, the Veteran reported depressed mood as well as passive thoughts of death but no suicidal ideation nor homicidal ideation. The Veteran also reported intrusive thoughts, flashbacks, hypervigilance, avoidance behaviors, and being socially withdrawn among other things. The examiner noted that the Veteran was socially withdrawn with appropriate affect, and a dysthymic mood. See medical records for July 2013. In November 2013, the Veteran reported his mood was good, with no recent flashbacks or anxiety attacks. He also reported hypervigilance, avoidance behaviors, startled response and being socially withdrawn. See medical records for November 2013. In June 2014, the Veteran reported having problems with going out to public places and that he liked to self-isolate. In terms of mood, the Veteran reported it to be ok, but that he continued to have irritability, anhedonia and sadness from time to time. The Veteran also reported trying to participate of activities with his wife and how he occasionally helped others with common laborer type activities. The examiner noted the Veteran’s symptomatology as recurrent intrusive distressing recollection, distressing dreams, sudden acting or feeling as if the event were recurring, effort to avoid thought or feelings associated with trauma, effort to avoid activities that arouse recollection of trauma, diminished interest in significant activities, difficulties with sleep, and difficulty concentrating. See medical records for June 2014. In November 2014, the Veteran reported his medication was not helping his symptoms as he had increased anxiety. He also admitted to having at least one crying spell a week, nightmares 3 times a week, decreased memory, and feeling depressed. No suicidal ideation nor homicidal ideation reported. See medical records for November 2014. In February 2015, the Veteran reported low mood, increased irritability, poor sleep, increased anxiety in public places, and some intrusive memories. The examiner noted that although the Veteran had some difficulty recalling or using dates that were more than 20 years off, he had an intact memory. The Veteran reported that his symptoms had worsened over the past few years. The Veteran also reported that he enjoyed singing at the church choir and watching television. See medical records for February 2015. In March 2015, the Veteran’s wife reported she felt the Veteran had gotten worse. The Veteran reported extreme anxiety in social settings and reported having retired from work due to his PTSD symptoms, as he was unable to drive. The examiner noted that the Veteran and his wife attributed his occupational impairment to worsening anxiety, depression, increased nightmares, and poor response to ongoing treatment. The Veteran also reported he felt his medical records did not accurately reflect his worsening condition or his level of distress. See medical records for March 2015. In April 2015, the Veteran reported having long standing anger issues, detachment from others, irritability, intrusive memories and hypervigilance. He was also noted to be an active member of his church, member of the Board of Deacons and that he participated of some family gatherings. See medical records for April 2015. That same month, the Veteran was administered a PTSD assessment on April 10, 2015. The full report was added as an addendum on April 14, 2015. This assessment noted how the Veteran met the diagnostic criteria for a PTSD diagnosis in accordance with the DSM-5 as well as his symptomatology. It was also noted that the Veteran had last worked in December 2014. See medical records for April 2015. In this assessment, the Veteran identified as areas of need, the following: sleep, isolation, anger/irritability, depression, anxiety, and intrusive thoughts. He also reported having resigned from his job because he could no longer remain consistently focused on his work, forgot important instructions and was easily agitated. See medical records for April 2015. In June 2015, the Veteran reported feeling like he had made very little progress in terms of his PTSD. He continued to report struggles with flashbacks, intrusive thoughts, nightmares and anxiety. The Veteran described his mood as depressed and reported he still avoided crowds and socially isolated himself. See medical records for June 2015. In September 2015 the Veteran reported low mood, low energy, shame and guilt. He also reported feeling irritable and moody during daytime, having difficulty sleeping because of nightmares and continued problems with crowds and dealing with people in general. See medical records for September 2015. In January 2016, the Veteran reported that he was doing fine, with occasional bouts of sadness and occasional nightmares. The Veteran reported his last nightmare as having happened a couple of weeks prior to his visit. See medical records for January 2016. In March 2016, the Veteran’s PTSD symptoms were noted to remain unchanged. The Veteran described himself as depressed and reported having issues with sleep. The Veteran also reported that he had been having memory issues for about 10 years but denied any recent significant worsening. He also reported nightmares and intrusive thoughts. See medical records for March 2016. In May 2016, the Veteran reported an increase of depressive symptoms due to the passing of his sister. The Veteran described his mood as sad and denied suicidal ideation. See medical records for May 2016. In June 2016, the Veteran’s PTSD was noted to remain unchanged with no improvement in mood. The Veteran was noted to remain depressed, anergic, and anhedonic. It was also noted the Veteran liked to isolate and that he continued to report short term memory issues, nightmares and intrusive thoughts. See medical records for June 2016. In August 2016, the Veteran reported he remained depressed, anergic and anhedonic. He noted he had been depressed at that level for several years. He reported he liked to isolate and watch television. The Veteran also noted his memory issues, reported continued nightmares, and intrusive thoughts. The Veteran also reported being active in his church. See medical records for August 2016. In September 2016, the Veteran reported having nightmares 2 to 3 times a week, and that he had been acting out his nightmares in his sleep. See medical records for September 2016. In October 2016, the Veteran reported his PTSD as stable and that he had no suicidal ideation. See medical records for October 2016. In January 2017 the Veteran reported to still have nightmares, feeling depressed, and having difficulty with motivation. The physician noted that although the Veteran’s wife continued to focus on the Veteran’s memory issues, the physician determined the Veteran’s memory appeared to be normal for his age. See medical records for January 2017. In March 2017, the Veteran was noted to be chronically depressed, sleeping 5 to 6 hours per night, continued intrusive thoughts, and that he complained of his short-term memory. See medical records for March 2017. In April 2017, the Veteran’s wife reported that he often repeats questions, has trouble finding words, and that he forgets directions when driving and tasks he wants to accomplish. The physician noted the Veteran showed no memory deficits during examination but referred him for further testing. The Veteran was also noted to continue to have intrusive thoughts and nightmares. See medical records for April 2017. In October 2017, the Veteran continued to express concerns regarding his memory, and continued nightmares. The Veteran described his mood as on the low side, with ongoing irritability and social withdrawal. The examiner noted that the Veteran had undergone a neurophysiological consult that revealed no major neurocognitive disorder and mild cognitive dysfunction. See medical records for October 2017. In January 2018 the Veteran reported doing “ok” in terms of his mood with intermittent nightmares. See medical records for January 2018. In April 2018, the Veteran and his wife reported having lost their home due to an electrical fire, 2 weeks prior to the visit. He reported having increased nightmares and continued to complain regarding his short-term memory. He described his mood as “about the same.” See medical records for April 2018. In June 2018, the Veteran’s wife reported she noted the Veteran more irritable, with increased anxiety and nightmares since the fire that destroyed their home in March. The Veteran reported having intrusive thoughts and complained of short-term memory issues. The Veteran further reported good appetite and fair energy. See medical records for June 2018. In July 2018, the Veteran was noted to have depressive symptoms, anxiety, and difficulty sleeping. The record also noted hallucinations but there is no indication of the type of hallucinations, their frequency or their severity. See medical records for July 2018. In September 2018, the Veteran reported low energy, low mood, shame, guilt, being irritable and moody, and having trouble sleeping at night due to nightmares. The Veteran reported continued difficulty in dealing with people and crowds generating anxiety in him. See medical records for September 2018. In January 2019, the Veteran reported his mood as up and down, with no sustained mood change, variable sleep with nightmares, and short-term memory issues with no progression. See medical records for January 2019. In April 2019, the Veteran reported intermittent nightmares, described himself as moody, and reported his short-term memory issues persisted. The Veteran’s wife described him as irritable. See medical records for April 2019. In June 2019, the Veteran reported his nightmares continued with a frequency of once per week or every other week. He also reported intrusive thoughts. The Veteran described his mood as pretty good, but his wife reported that his irritability remained unchanged. Again, the Veteran complained of short-term memory issues without progression. See medical records for June 2019. In August 2019, the Veteran was administered a PTSD DBQ. In this examination, the examiner determined that the Veteran’s PTSD caused total occupational and social impairment with the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks more than once weekly, chronic sleep impairment, mild memory loss, impairment of short and long term memory, flattened affect, impaired judgment, impaired abstract thinking, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, suicidal ideation, and intermittent ability to perform activities of daily living. See PTSD DBQ of August 2019. Based on all of the above, the Board finds that prior to November 5, 2014, the Veteran’s PTSD symptomatology more closely approximated the 30 percent disability rating as the Veteran’s PTSD mainly manifested with nightmares, intrusive thoughts, depressed mood and isolationist behavior. Prior to November 5, 2014, the medical records show the Veteran had consistently reported doing well on his medication and had characterized the frequency of his nightmares as occasional or infrequent. He also consistently reported his mood as ok, or good. The Board notes that during this period, the Veteran reported having passive thoughts of death once and consistently denied suicidal and homicidal ideation as well as hallucinations. Thus, the Board finds that this single report in the Veteran’s extensive medical records regarding this symptom does not raise to a frequency, intensity or duration that would warrant a higher disability rating during this appeal period. The Board also notes the Veteran reported having panic attacks in a statement in 2011 however, the Veteran’s medical records do not show the Veteran reported panic attacks at any time before November 5, 2014 to his mental health providers. Accordingly, the Board finds that for the period prior to November 5, 2014, the Veteran’s PTSD symptomatology mainly manifested with symptomatology that more closely approximated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). A disability rating in excess of 30 percent is not warranted as the medical evidence of record does not support the finding that the Veteran’s PTSD manifested with symptomatology that more closely approximates the 50 percent disability rating as the medical evidence does not show the Veteran’s PTSD symptomatology resulted in occupational and social impairment with reduced reliability and productivity for this period. The Board notes that throughout the appeal period the Veteran complained of memory issues. However, the Veteran’s medical providers determined that the Veteran’s memory was normal for his age or intact. Thus, the Board finds that for the appeal period prior to November 5, 2014, the Veteran’s PTSD symptomatology more closely approximated the 30 percent disability rating criteria. The Board further notes that although the Veteran’s medical records for February 2011 document forgetfulness, a somewhat blunted affect, nightmares, sleep problems, irritability, and self-isolation; that medical records for December 2012 document increased moodiness, forgetfulness, nightmares, and a “restricted” affect; as well as the medical records for June 2014 document “sad and irritable” mood, with a congruent affect, “difficulty falling or staying asleep,” and “difficulty concentrating”; this symptomatology did not rise to such a level that would warrant a higher disability rating during this appeal period. In November 5, 2014, the Veteran reported a worsening of symptoms with increased anxiety, to his medical providers. In December 2014, the Veteran retired from his employment, due to his PTSD symptomatology according to his and his wife’s reports. This was also noted in a psychological assessment administered to the Veteran in April 2015. This psychological assessment noted that the Veteran resigned from his job because he could no longer remain focused on his work consistently, forgot important instructions, and was easily agitated. In this assessment the Veteran also reported that he did not like driving because it increased his anxiety. Accordingly, the Board finds that the medical records support a finding of a noted worsening in the Veteran’s symptomatology for the period following November 5, 2014. The Veteran’s medical records show he reported an increase in his anxiety, nightmares, depression, intrusive thoughts, among other symptomatology. Resolving doubt in the Veteran’s favor, the Board finds that the Veteran’s PTSD symptomatology for the appeal period from November 5, 2014 forward more closely approximated the 50 percent disability rating as the evidence of record suggests an increase in his anxiety, nightmares, depression, intrusive thoughts, memory and concentration issues- as the Veteran reported having to stop working due to his increased symptomatology. A disability rating in excess of 50 percent is not warranted for the appeal period between November 5, 2014 and October 9, 2018, as the evidence does not support the finding that the Veteran’s PTSD symptomatology resulted in occupational and social impairment, with deficiencies in most areas prior to October 10, 2018. The Board notes that the evidence of record shows the Veteran continued to experience nightmares, anxiety, depressed mood, intrusive thoughts and impaired memory throughout this appeal period. However, the evidence of record reveals that symptoms such 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, spatial disorientation, and neglect of personal appearance and hygiene, were absent. Additionally, although the Veteran reported isolationist behavior throughout the appeal period, which may suggest an inability to establish and maintain effective relationships, the evidence of record reveals that such symptoms still did not result in occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood as the Veteran has been able to maintain his marriage, relationships with his children and has continued participation in church. Additionally, although there is a single mention of hallucinations during this appeal period, the Board finds that this uncharacterized mention of this symptom and absent any further mention of hallucinations throughout the appeal period, does not rise to the duration, frequency or severity that would warrant a higher rating. Hence, during this period, although the Veteran had symptoms that caused some occupational and social impairment, the evidence does not establish that the Veteran’s reported symptoms caused his occupational and social impairment to rise to such a level that the Veteran was deficient in most areas of his life. Accordingly, the Board finds that a rating in excess of 50 percent is not warranted prior to October 10, 2018. In sum, and for the reasons expressed above, the claim of a disability rating in excess of 30 percent for the appeal period prior to November 5, 2014, for the Veteran’s PTSD must be denied as the evidence of record does not support the finding that the Veteran’s PTSD symptomatology resulted in occupational and social impairment with reduced reliability and productivity. Resolving doubt in the Veteran’s favor, a disability rating of 50 percent for the Veteran’s PTSD is granted from November 5, 2014 until October 9, 2018, as the evidence of record supports the finding that the Veteran’s symptomatology worsened. A disability rating in excess of 50 percent for the Veteran’s PTSD for the appeal period from November 5, 2014 until October 9, 2018 is not warranted as the evidence of record does not support the finding that the Veteran’s symptomatology resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Gonzalez-Maldonado 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.