Citation Nr: 21001445 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 16-15 619 DATE: January 8, 2021 ORDER Entitlement to service connection for a cervical-thoracic spine condition, to include as secondary to service-connected disabilities, is denied. Entitlement to service connection for a right ankle condition, to include as secondary to service-connected disabilities, is denied. Entitlement to service connection for a left ankle condition, to include as secondary to service-connected disabilities, is denied. Entitlement to service connection for superior/lateral scar to the left eye, to include as secondary to traumatic brain injury, is denied. Entitlement to service connection for scar other than superior/lateral scar to the left eye, to include as secondary to traumatic brain injury, is denied. REMANDED Entitlement to service connection for a bilateral hip condition, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a traumatic brain injury is remanded. Entitlement to service connection for headaches, to include as secondary to traumatic brain injury, is remanded. FINDINGS OF FACT 1. The Veteran’s cervical-thoracic spine condition is not shown to be etiologically related to service, nor was it caused or aggravated by service-connected bilateral shin splints and left foot stress fracture. 2. The Veteran’s right ankle condition is not shown to be etiologically related to service, nor was it caused or aggravated by service-connected bilateral shin splints and left foot stress fracture. 3. The Veteran’s left ankle condition is not shown to be etiologically related to service, nor was it caused or aggravated by service-connected bilateral shin splints and left foot stress fracture. 4. The evidence of record does not establish that the Veteran’s preexisting superior/lateral scar to the left eye was aggravated beyond its natural progression during service. 5. The preponderance of the evidence fails to establish that the Veteran has or had any scar other than superior/lateral scar to the left eye at any time during the pendency of the appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical-thoracic spine condition, as due to service or service-connected bilateral shin splints and left foot stress fracture, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for a right foot condition, as due to service or service-connected bilateral shin splints and left foot stress fracture, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for a left foot condition, as due to service or service-connected bilateral shin splints and left foot stress fracture, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 4. The criteria for service connection for superior/lateral scar to the left eye are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for scar other than superior/lateral scar to the left eye are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from October 1988 to December 1991. During his period of service, he earned the Army Service Ribbon, National Defense Service Medal, Expert Badge (Rifle M-16), Air Assault Badge, Parachutist Badge, and Overseas Service Ribbon. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Additional laws and regulations apply, when there is evidence that a disability preexisted service. Every Veteran is presumed to have been sound upon entry into the military, except as to conditions noted at the time of the acceptance, examination, or enrollment, or where clear and unmistakable evidence demonstrates that the condition existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). In cases where the presumption of soundness does not apply, the presumption of aggravation may apply where there is an increase in disability during service. Where the evidence shows that there was an increase in disability during service, there is a presumption that the disability was aggravated by service. To rebut the presumption of aggravation, there must be clear and unmistakable evidence (obvious or manifest) that the increase in severity was due to the natural progress of the disability. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a) (2017). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b) (2017); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the Court held that the requirement of the existence of a current disability is satisfied when a Veteran has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a Veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. 1. Entitlement to service connection for a cervical-thoracic spine condition The Veteran contends that he is entitled to service connection for a cervical-thoracic spine condition as a result of an in-service, or in the alternative, due to his service-connected bilateral shin splints and left foot stress fracture. With regard to a present disability, the Veteran’s February 2020 VA examination notes a diagnosis of cervical strain. Thus, the first elements of the Shedden and Wallin analyses have been met. With regard to direct service-connection claim, a review of the Veteran’s service treatment records is silent for complaints, treatment, or diagnosis related to the cervical-thoracic spine during his period of military service. However, at the time of his November 2018 Board videoconference hearing, the Veteran testified that he began experiencing muscle spasms and chronic pain in his neck following a number of falls, including parachute landings, in service. His DD-214 shows that he earned the Parachutist Badge during service. The Veteran is competent to report on his observable symptomatology, such as muscle spasms and neck pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). As multiple parachute jumps are consistent with the circumstances of the Veteran’s service, an in-service injury or event is established. With regard to secondary service connection, the Board notes that the Veteran is service-connected for bilateral shin splints and left foot stress fracture. Thus, the second elements of the Shedden and Wallin analyses have been met. However, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s current cervical strain had its onset during active duty service or is otherwise related to his active duty service; therefore, the third element under Shedden is not met. Further, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s current cervical strain was caused or aggravated by his service-connected bilateral shin splints and left foot stress fracture; therefore, the third element under Wallin is not met. Pursuant to the September 2019 Board remand, the Veteran appeared for a VA back conditions examination in February 2020. The VA examiner opined that the Veteran’s cervical strain was less likely than not incurred in or caused by service. In support of the opinion, the examiner explained that the service treatment records are silent for neck or upper back complaints. Though the examiner noted that parachuting during service placed the Veteran at significantly higher risk for injuries to the lumbar spine and lower extremities due to repetitive high impact with the ground, he indicated that this effect did not likely translate all the way up to the cervical-thoracic spine. Accordingly, the examiner determined that there was not sufficient evidence to indicate the Veteran’s cervical strain was incurred in or caused by active service. The VA examiner further opined that it was less likely than not that the Veteran’s cervical strain was proximately due to, the result of, or aggravated by his service-connected bilateral shin splints and left foot stress fracture. In support of the opinion, the examiner explained that there was no theoretical basis to determine the Veteran’s cervical spine strain was caused or aggravated by his bilateral shin splints or left foot stress fracture. Based on the evidence of record, the Board finds that service connection for cervical strain on a direct basis is not warranted. As the preponderance of the evidence does not show a medical nexus between the presently diagnosed cervical strain and the Veteran’s service, service connection for cervical strain cannot be granted on a direct basis. Further, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s cervical strain was caused or aggravated by his service-connected bilateral shin splints or left foot stress fracture. In reaching these conclusions, the Board finds the February 2020 VA examination report to have great evidentiary weight, as the VA examiner reviewed the Veteran’s claims folder and medical history and examined the Veteran before rendering the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008) (finding an examination report is adequate where it describes the disability in sufficient detail so the Board can make a fully informed decision). Consideration has also been given to the Veteran’s contentions that his cervical strain is related to his service-connected bilateral shin splints or left foot stress fracture. Although laypersons, such as the Veteran, are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the Veteran is certainly competent to report that he experiences muscle spasms and pain, he is not competent to link those complaints to a particular etiology. His assertions are therefore not competent evidence of a medical nexus. Accordingly, the Board finds that the claims of entitlement to service connection for cervical strain must be denied under any theory of entitlement. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 2. Entitlement to service connection for a right ankle condition 3. Entitlement to service connection for a left ankle condition The Veteran contends that he is entitled to service connection for right and left ankle conditions as a result of an in-service, or in the alternative, due to his service-connected bilateral shin splints and left foot stress fracture. With regard to a present disability, the Veteran’s February 2020 VA examination notes a diagnosis of bilateral ankle strain. Thus, the first elements of the Shedden and Wallin analyses have been met. With regard to direct service-connection claim, a review of the Veteran’s service treatment records show treatment for a twisted right ankle during his period of military service. Moreover, at the time of his November 2018 Board videoconference hearing, the Veteran testified that he began experiencing pain in his ankles following a number of parachute landings in service. His DD-214 shows that he earned the Parachutist Badge during service. The Veteran is competent to report on his observable symptomatology, such as ankle pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). As multiple parachute jumps are consistent with the circumstances of the Veteran’s service, an in-service injury or event is established. With regard to secondary service connection, the Board notes that the Veteran is service-connected for bilateral shin splints and left foot stress fracture. Thus, the second elements of the Shedden and Wallin analyses have been met. However, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s current bilateral ankle strain had its onset during active duty service or is otherwise related to his active duty service; therefore, the third element under Shedden is not met. Further, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s current bilateral ankle strain was caused or aggravated by his service-connected bilateral shin splints and left foot stress fracture; therefore, the third element under Wallin is not met. A private opinion from Dr. J. D. was associated with the Veteran’s claims file in October 2015. The physician stated that he “believe[d] that these pains could be compensatory from the left foot or from the bilateral shin splints” for which the Veteran is service-connected, as his locomotion occurred through both legs and rotated through these joints during locomotion. The physician further opined that the Veteran’s right and left ankle conditions “could also be a result of instability and limping coming from the left foot,” as his gait was unbalanced and would cause the symptoms in his ankles. Pursuant to the September 2019 Board remand, the Veteran appeared for a VA ankle conditions examination in February 2020. The VA examiner opined that the Veteran’s bilateral ankle strain was less likely than not incurred in or caused by service. In support of the opinion, the VA examiner determined that the Veteran’s advanced pes planus, which is not service connected, was most likely responsible for the Veteran’s bilateral ankle strain. The examiner explained that the Veteran was seen for right ankle pain after a run during service and had some tenderness to the Achilles tendon. The examiner noted that this was not consistent with the Veteran’s current presentation of ankle symptoms; thus, he determined that it was unlikely that the Veteran’s current right and left ankle condition was related to his documented in-service incident. Likewise, though the examiner acknowledged that parachuting placed the Veteran at significantly higher risk for lower extremity injuries, including injuries to the ankles, he determined that it was less likely as not that the Veteran’s ankle strain was caused by falls or parachute landings in service and was most likely caused by pes planus. The VA examiner further opined that it was less likely than not that the Veteran’s right and left ankle strain was proximately due to, the result of, or aggravated by his service-connected bilateral shin splints and left foot stress fracture. In support of the opinion, the examiner explained that bilateral shin splints and left foot stress fracture do not likely contribute to gait abnormality; therefore, there would not likely be any compensatory strain on the ankles due to these conditions. Based on the evidence of record, the Board finds that service connection for right and left ankle strain on a direct basis is not warranted. As the preponderance of the evidence does not show a medical nexus between the presently diagnosed right and left ankle strain and the Veteran’s service, service connection for right and left ankle strain cannot be granted on a direct basis. Further, the Board finds that the preponderance of competent and credible evidence weighs against finding that the Veteran’s right and left ankle strain was caused or aggravated by his service-connected bilateral shin splints or left foot stress fracture. In reaching these conclusions, the Board finds the February 2020 VA examination report to have great evidentiary weight, as the VA examiner reviewed the Veteran’s claims folder and medical history and examined the Veteran before rendering the medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008) (finding an examination report is adequate where it describes the disability in sufficient detail so the Board can make a fully informed decision). Consideration has also been given to the Veteran’s contentions that his right and left ankle strain is related to his service-connected bilateral shin splints or left foot stress fracture. Although laypersons, such as the Veteran, are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a layperson. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the Veteran is certainly competent to report that he experiences ankle pain, he is not competent to link those complaints to a particular etiology. His assertions are therefore not competent evidence of a medical nexus. Accordingly, the Board finds that the claims of entitlement to service connection for right and left ankle strain must be denied under any theory of entitlement. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 4. Entitlement to service connection for left forehead scar The Veteran contends that he suffers from a superior/lateral scar to the left eye that as aggravated by his military service. With respect to the first element of service connection, the Veteran appeared for a VA scars/disfigurement examination in February 2020, at which time the examiner diagnosed a superior/lateral scar to the left eye. Thus, the current-disability criterion for service connection is met. See Shedden, supra. Next, the Board must consider whether the Veteran sustained a disease or injury in service. Here, the Veteran is not entitled to the presumption of soundness, as at the time of his November 1987 entrance examination, the Veteran was “noted” to have a “small laceration scar: forehead on left.” Thereby, the question becomes whether the Veteran’s forehead scar increased in severity beyond the natural progression of the disability during his period of service. Here, based on the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service, aggravation cannot be conceded because the Veteran’s scar underwent no increase in severity during service. See 38 C.F.R. § 3.306. In this regard, there are no complaints or treatment as it pertains to a forehead scar in the service treatment records. Further, although the Veteran declined a separation medical examination in November 1991, his service treatment records were reviewed. No findings relevant to his forehead scar were noted. As noted above, the Veteran appeared for a VA scars/disfigurement examination in February 2020. The VA examiner opined that the Veteran’s superior/lateral scar to the left eye, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by service. In support of his opinion, the examiner noted that the Veteran reported having this scar at the time of enlistment and denied having any new lacerations or injuries to this area. Thus, the examiner indicated that this scar was the same scar that the Veteran had at the time of enlistment and opined that it was not caused or aggravated by any injury in service. The Board concludes that, while the Veteran has a superior/lateral scar to the left eye, this condition preexisted service and was not aggravated by service. The Board accords substantial probative weight to the competent medical evidence, the service treatment record, and the 2020 VA examiner’s opinion, which combine to show no aggravation in service. In weighing the evidence, the Board finds that the medical evidence of record preponderates against the claim. As the superior/lateral scar to the left eye both preexisted service and may not be presumed to have been aggravated by active service, the Board concludes that service connection for superior/lateral scar to the left eye must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 5. Entitlement to service connection for scars, other than left forehead scar The Veteran contends that he suffers from a scar other than the preexisting superior/lateral scar to the left eye that are related to his military service. A review of the medical evidence of record fails to establish that the Veteran has been diagnosed with scars other than the preexisting superior/lateral scar to the left eye at any time during the appeal period or proximate thereto. The Veteran appeared for a VA scars/disfigurement examination in February 2020. Upon examination, the VA examiner opined that it was less likely than not that the Veteran’s claimed scar was incurred in or caused by service as there was no scar found on his scalp during the examination. Though the Veteran indicated he had a laceration requiring sutures on the top of his head during service, the examiner noted that only one scar was found on examination, which was the superior/lateral scar to the left eye. Accordingly, the Board finds that the evidence does not support a finding that the Veteran has a current diagnosis of a scar, other than the preexisting forehead scar, throughout the appeals period. See Brammer, supra; McClain, supra; Romanowsky, supra. Without such evidence, service connection for a scar other than the superior/lateral scar to the left eye cannot be granted. See Shedden, supra. Accordingly, the first element of Shedden is not met. Although the Board is sympathetic to the Veteran’s claim, the preponderance of the evidence is against the Veteran’s claim of service connection for a scar other than the superior/lateral scar to the left eye. Thus, the claim must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2019); see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). REASONS FOR REMAND 1. Entitlement to service connection for a bilateral hip condition The Veteran appeared for VA hip and thigh conditions examination in February 2020. The examiner diagnosed normal hips. The VA examiner opined that it was less likely than not that the Veteran’s claimed bilateral hip condition was caused by service, as there was no current diagnosis. Moreover, the examiner opined that it was less likely than not that the Veteran’s claimed bilateral hip condition was proximately due to, result of, or aggravated beyond its natural progression by the Veteran’s service-connected disabilities. The examiner explained that the hip pain described by the Veteran was associated with his lumbosacral strain. He further indicated that the involvement of the gluteal muscles in the buttocks area was part of the Veteran’s lower back problem and did not represent a hip condition. Unfortunately, the Board finds the February 2020 VA examination is inadequate for adjudication purposes. In this regard, at the time of examination, the Veteran reported complains of pain in the lower back and bilateral buttocks with flexion and abduction of the right hip, as well as flexion of the left hip. The Board notes that a Veteran may be service-connected for pain with functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (2018). Accordingly, on remand, the Veteran should be afforded another examination to determine whether his bilateral hip pain presents a functional impairment of earning capacity, and if so, whether that impairment is related to his service-connected lumbar spine disability. 2. Entitlement to service connection for a traumatic brain injury The Veteran appeared for a VA residuals of traumatic brain injury examination in February 2020. The VA examiner opined that it was less likely than not that the Veteran’s claimed traumatic brain injury was related to service, as there was no diagnosis of traumatic brain injury. In support of the opinion, the VA examiner stated that the service treatment records were silent for head injury. Unfortunately, the Board finds the February 2020 examination to be inadequate for adjudication purposes, as the examiner failed to consider an October 1989 service treatment record indicating head trauma after a parachute landing fall. The Board acknowledges that once VA undertakes the effort to provide an examination when developing a service connection claim, an adequate examination must be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, a remand is required to obtain a new examination and opinion. 3. Entitlement to service connection for headaches The Veteran appeared for a VA headaches examination in February 2020. The VA examiner diagnosed tension headaches. He opined that it was less likely than not that the Veteran’s claimed headaches were related to service, or proximately due to, result of, or aggravated beyond its natural progression by the Veteran’s claimed traumatic brain injury, as there was no diagnosis of traumatic brain injury. The examiner determined that the Veteran’s headaches were associated with his cervical spine condition, as there was no evidence in the service treatment records of an onset of headaches. Unfortunately, the Board finds the February 2020 examination to be inadequate for adjudication purposes, as the examiner failed to consider an October 1989 service treatment record noting treatment for a mild frontal headache after a parachute landing fall. The Board acknowledges that once VA undertakes the effort to provide an examination when developing a service connection claim, an adequate examination must be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As such, a remand is required to obtain a new examination and opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examinations with the appropriate medical examiner to determine the nature and etiology of his claimed bilateral hip condition, traumatic brain injury, and headaches. The examiner(s) must review pertinent documents in the Veteran’s claims file in conjunction with the examinations. This must be noted in the examination reports. All tests and studies deemed necessary by the examiner(s) should be performed. (a.) With regard to the bilateral hip condition, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s claimed bilateral hip condition (i) had its onset in service or is otherwise etiologically related to active service, or (ii) is caused or aggravated by his service-connected lumbar spine disability. In light of Saunders, 886 F.3d 1356 (2018), the examiner should acknowledge that pain alone can serve as a functional impairment and therefore qualify as a disability. As a result, if there is no diagnosis of a bilateral hip condition, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s reported bilateral hip pain results in a functional impairment of earning capacity, i.e., a disability for VA purposes? (b.) With regard to the TBI claim, the examiner should state whether it is at least as likely as not (a 50 percent probability or greater) that such a disability had its onset in service or is otherwise etiologically related to active service. In providing this opinion, the examiner’s attention is directed to an October 1989 service treatment record indicating head trauma after a parachute landing fall. (c.) With regard to the headache claim, the examiner should state whether it is at least as likely as not (a 50 percent probability or greater) that such a disability had its onset in service or is otherwise etiologically related to active service. In providing this opinion, the examiner’s attention is directed to October 1989 service treatment record noting treatment for a mild frontal headache after a parachute landing fall. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Joseph, Associate 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.