Citation Nr: 21003478 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 09-27 500 DATE: January 21, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include generalized anxiety disorder, and as secondary to service-connected bilateral hearing loss, is denied. Entitlement to service connection for a gastrointestinal disorder, to include as secondary to a service-connected disability, is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. REMANDED Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence does not support that the Veteran’s acquired psychiatric disorder, to include generalized anxiety disorder, is etiologically linked to his active duty service; or that a disorder was caused or aggravated by service-connected bilateral hearing loss. 2. The preponderance of the evidence does not support that the Veteran’s gastrointestinal symptoms are related to his active duty service, or that they were caused or aggravated by any service-connected disabilities. 3. For the entire period on appeal, audiometric examination shows no greater than level I hearing loss bilaterally. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric condition to include generalized anxiety disorder, and as secondary to service-connected bilateral hearing loss, have not been 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 gastrointestinal disorder, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to an initial compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321(b)(1), 4.1, 4.3, 4.7, 4.85, Diagnostic Code (DC) 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1973 to January 1975. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from November 2008 and January 2015 rating decisions issued by the Agency of Original Jurisdiction (AOJ). The appeal was remanded in November 2012, September 2015, and August 2018 for further development. The case was most recently remanded for opinions as to the nature and etiology of the Veteran’s generalized anxiety disorder and obstructive sleep apnea. Gastritis was remanded as intertwined with the pending service connection claims. Medical opinions were obtained in April 2019. The Board finds the examiners’ generalized anxiety disorder and obstructive sleep apnea opinions are supported by sufficient rationale. Thus, the Board determines that there has been substantial compliance with the August 2018 remand directives as to those claims, and further remand is not required. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that remand not required where there was substantial compliance with remand directives). However, as discussed below, the Board finds the opinion rendered in connection with the sleep apnea claim is inadequate. Therefore, further remand of that claim is required. Id. In addition, this appeal was remanded to obtain a VA examination assessing the current severity of the Veteran’s bilateral hearing loss. The Veteran was afforded a new VA examination for hearing loss in April 2019. Therefore, the Board finds there has been substantial compliance with the August 2018 remand directives, and further remand of the increased rating claim is not required. Id. In response to the Veteran’s request in a May 2017 VA Form 9, a June 2017 letter notified the Veteran that he was scheduled for a Decision Review Officer (DRO) hearing in July 2017. However, the Veteran did not attend the hearing. As the Veteran has not requested for the hearing to be rescheduled or provided good cause for not attending the requested hearing, the Board finds that there are no outstanding hearing requests. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 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. Wallin v. West, 11 Vet. App. 509, 512 (1998). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 49. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for an acquired psychiatric, to include generalized anxiety disorder, and as secondary to service-connected bilateral hearing loss. Based on the evidence of record, the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder is denied. The Board acknowledges that the Veteran has been diagnosed with an anxiety disorder and a depressive disorder and thus has satisfied the first element of service connection, a current disability. As for an in-service event, injury or disease, here, no acquired psychiatric disorder to include depression, anxiety and insomnia was “noted” or identified during service. Additionally, there is nothing to suggest that there were characteristic manifestations sufficient to identify an acquired psychiatric disorder during service. 38 C.F.R. § 3.303. However, the Veteran has competently and credibly reported several traumatic in-service events, accordingly, there is an inservice incurrence. Turning to the third element required to award service connection, a nexus, the evidence fails to establish a nexus between the Veteran’s current diagnoses and his active service. The weight of the evidence reflects that the Veteran’s psychiatric disorders are unrelated to his service. VA treatment records from September 2016 reveal the Veteran sought ongoing treatment for his psychological symptoms. A VA mental health professional noted that “[s]ome of the symptoms that he exhibits are aftereffects of stress and pressure received in the military service. However, this statement is of limited probative value as it was not supported by any rationale. The Veteran was afforded VA examinations in January 2013, August 2017, and April 2019. The Board previously found the opinions associated with the January 2013 and August 2017 examinations inadequate. The April 2019 examiner opined that the Veteran did not have an acquired psychiatric disorder, to include anxiety disorder and depressive disorder, that is at least as likely as not incurred in or caused by the events during service. The examiner explained that there is insufficient evidence to support the Veteran’s attribution of his symptoms to stressors in service. The examiner cited several instances in the record where the Veteran attributed his symptoms to current life stressors. Thus, the examiner determined that there was no evidence the Veteran persistently experienced symptoms of a mental disorder related to his military service. In addressing the Veteran’s lay statements, the examiner found that the Veteran consistently reported nonpersistent mood symptoms related to current life stressors. Specifically, the examiner addressed the Veteran’s post-service psychosis and depressive symptoms which manifested relatively close to his military service, in 1976. The examiner noted that the records surrounding the Veteran’s 1976 “depressive reaction” attributed to his symptoms to his job search. Additionally, the examiner found the Veteran’s September 1976 treatment for “post discharge psychosis” was accompanied by a completed mental status exam which did not make a formal diagnosis. He noted similar occurrences in 1977 and 1987 which did not lead to further psychiatric treatment and importantly were followed by long periods of medical records documenting the Veteran’s denial of mental health symptoms. The Veteran was next treated for mental health symptoms in relation to bereavement. Consequently, the examiner found that the Veteran’s symptoms were generally associated with familial stressors. The Board finds the examiner’s opinion is highly probative as it was supported by sufficient rationale. The Board also acknowledges that in a June 2018 Informal Hearing Presentation (IHP), the Veteran's representative indicated that the Veteran's bilateral hearing loss disability affected his anxiety disorder. To the extent that this assertion raised the theory that the Veteran's claimed psychiatric disorder is secondary to his bilateral hearing loss disability, the Board notes that no VA medical opinion has addressed this theory. However, the conclusory generalized lay statement from the Veteran’s representative of an association between a current psychiatric disorder and bilateral hearing loss is insufficient to warrant obtaining a VA medical opinion. Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). The Board has considered the Veteran’s statements. However, the Veteran’s statements are insufficient to establish that the Veteran’s psychiatric disorders are related to his service and/or secondary to his service-connected bilateral hearing loss. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran is competent to report observable symptoms such as anxiety and insomnia, but he is not competent to determine the cause of these symptoms. Such a determination requires medical training and knowledge which, as a lay person, the Veteran does not have. Reviewing the evidence, the Board finds that the most probative evidence is against the claim of entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected bilateral hearing loss. For the foregoing reasons, the preponderance of the evidence is against the claim for service connection. The benefit-of-the-doubt doctrine is therefore not for application, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). 2. Entitlement to service connection for a gastrointestinal disorder, to include as secondary to a service-connected disability. As to service connection for a gastrointestinal disorder, VA treatment records show a current diagnosis of diffuse non-erosive gastropathy. Therefore, the first element of service connection has been established. In a June 2018 Informal Hearing Presentation, the Veteran's representative generally asserted that all of the Veteran's claimed disorders were a consequence of his service. Alternatively, the Veteran has argued that this disorder is secondary to his medications. See October 2013 VA treatment record. Currently, the Veteran is service connected for tinnitus, bilateral hearing loss, and “chronic tonsillitis to include removal of.” In terms of direct service connection, the claim must fail for lack of nexus as the record does not support that the disorder was incurred in service. Regarding secondary service connection, the Board notes that the Veteran has not identified any particular medications as the cause of his gastrointestinal symptoms. In addition, there is no indication that he is taking any medications for his service-connected disabilities. The Board acknowledges the Veteran’s pending claim for a sleep disorder. However, the record also does not indicate he is taking medication for that claimed disorder. Neither the Veteran nor the record has raised any other theory as to how the Veteran’s current gastrointestinal disorder was caused or aggravated by any service-connected disability or the claimed sleep disorder. The Board acknowledges that the Veteran has not undergone a VA examination and a VA opinion has not been sought. However, the Board determines that neither is necessary. While the record reflects a current disability, there is no evidence of an injury, event or disease related to non-erosive gastropathy in service, and no indication that the Veteran’s current conditions are related to his service-connected disabilities. See McClendon v. Nicholson, 20 Vet. App. 79 (2006). The only evidence of a possible connection between the Veteran’s current gastrointestinal disorder and service and/or his service-connected disabilities are the Veteran’s own conclusory statements, and these statements are insufficient to trigger VA’s obligation to obtain and examination or opinion. Waters, 601 F.3d at 1278-79. Although McClendon sets a low bar, that bar has not been met, and no examination or opinion is required. Based on the analysis above, the Board finds that the preponderance of the evidence is against finding that there is a nexus between the Veteran’s gastrointestinal disorder and his active duty service; or finding that his claimed gastrointestinal disorder was caused or aggravated by his service-connected disabilities. Having failed to satisfy the criteria for direct or secondary service connection, the Veteran’s claim must be denied. See 38 C.F.R. §§ 3.303, 3.310; Shedden v. Principi, 381 F.3d at 1167. 3. Entitlement to an initial compensable rating for bilateral hearing loss. Disability evaluations are determined by comparing a Veteran’s symptoms with criteria set forth in VA’s Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran was awarded service connection and assigned an initial noncompensable evaluation for bilateral hearing loss effective from September 26, 2013 under Diagnostic Code 6100. Evaluations for defective hearing are based upon organic impairment of hearing acuity as measured by the results of controlled speech discrimination tests, along with the average hearing threshold level as measured by puretone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second. 38 C.F.R. § 4.85. To evaluate the degree of disability for service-connected bilateral hearing loss, the rating schedule establishes eleven (11) auditory acuity levels, designated from level I for essentially normal acuity, through level XI for profound deafness. Id. Where there is an exceptional pattern of hearing impairment, a rating based on puretone thresholds alone may be assigned. 38 C.F.R. § 4.86. In this regard, and relevant here, when the puretone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86(b). Ratings for hearing impairment are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Lendenmann v. Principi, 3 Vet. App. 345 (1992). The Veteran was afforded a VA examination in January 2015. The Veteran reported that he sometimes could not understand people who were talking to him. The results of the audiological test are as follows, with Puretone thresholds recorded in decibels: HERTZ 1000 2000 3000 4000 RIGHT 15db 15db 20db 45db LEFT 15db 15db 45db 55db Speech audiometry revealed speech recognition ability on the Maryland CNC word list of 100 percent bilaterally. The average of the pure tones between 1000-4000 Hertz was 24 for the right ear and 33 for the left. Using Table VI in 38 C.F.R. § 4.85, the Veteran received a numeric designation of I for the right ear and I for the left. Such a degree of hearing loss warrants a noncompensable rating under Table VII. The Veteran’s audiometric results do not reveal an exceptional pattern of hearing impairment under 38 C.F.R. § 4.86. In addition, the January 2015 examiner noted that the use of the speech discrimination score was appropriate for the Veteran’s left and right ear. See 38 C.F.R. § 4.85(c). Therefore, Table VIa is not for application. VA treatment records reveal the Veteran underwent audiometric evaluation in September 2018; however, there is no indication the audiologist used the Maryland CNC word test as required by 38 C.F.R. § 4.85(a). Additionally, the Veteran’s results did not reveal an exceptional pattern of hearing loss for application of 38 C.F.R. § 4.85 table VIa. The provider also failed to indicate that the use of the speech discrimination score was inappropriate for the Veteran. 38 C.F.R. § 4.85(c). Therefore, the results cannot be considered for rating purposes. The Board further notes that even if these results could be considered for rating purposes, they would not warrant a compensable evaluation. The record noted that the Veteran’s Puretone thresholds, in decibels, were as follows: HERTZ 1000 2000 3000 4000 RIGHT 15db 20db 35db 55db LEFT 15db 15db 50db 55db The average of these Puretone thresholds was 31.25 on the right and 33.75 on the left. The noted word recognition score was 100 percent bilaterally. The application of these values to Table VI yields a numeral of I bilaterally. As noted above, this combination of numerals corresponds to a noncompensable evaluation under Table VII. The Veteran was afforded a second VA examination in April 2019. The Veteran reported that he had difficulty understanding speech during conversations at a distance or in noisy environments. The results of the audiological test are as follows, with Puretone thresholds recorded in decibels: HERTZ 1000 2000 3000 4000 RIGHT 10db 10db 35db 55db LEFT 10db 10db 50db 50db Speech audiometry revealed speech recognition ability on the Maryland CNC word list of 96 percent in the right ear and 100 percent in the left ear. The average of the pure tones between 1000-4000 Hertz was 28 for the right ear and 30 for the left. Using Table VI in 38 C.F.R. § 4.85, the Veteran received a numeric designation of I for the right ear and I for the left. Such a degree of hearing loss warrants a noncompensable rating under Table VII. Again, the Veteran’s audiometric results do not reveal an exceptional pattern of hearing impairment. The examiner also did not certify that the use of the speech discrimination score was inappropriate for the left or right ear. Therefore, Table VIa is not for application. 38 C.F.R. §§ 4.85(c), 4.86. The most probative evidence as to the nature of the Veteran’s hearing loss is the audiometric findings, and those discussed above reveal that the Veteran’s hearing loss does not warrant entitlement to a compensable rating. In reaching this conclusion, the Board has considered the applicability of the reasonable doubt doctrine; however, since the preponderance of the evidence is against his claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board had also considered whether an extraschedular rating is warranted for the service-connected bilateral hearing loss during the relevant period on appeal based on the Veteran’s assertions of how his hearing loss impacts his daily life. Ratings shall be based as far as practicable upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice, therefore, to the exceptional case where the schedular ratings are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. The governing norm in these exceptional cases is: A finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). The United States Court of Appeals for Veterans Claims (Court) has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Thun v. Peake, 22 Vet. App. 111, 115 (2008). Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service connected disability are inadequate. See Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) (“[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted”). Second, if the schedular rating does not contemplate the veteran’s level of disability and symptomatology and is found inadequate, the Board must determine whether the veteran’s disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 116. Third, if the first two Thun elements have been satisfied, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran’s disability picture requires the assignment of an extraschedular rating. Thun, 22 Vet. App. at 116. In other words, the first element of Thun compares a veteran’s symptoms to the rating criteria, while the second element considers the resulting effects of those symptoms; if either prong is not met, then referral for extraschedular consideration is not appropriate. Yancy, 27 Vet. App. at 494-95. With respect to the first prong of Thun, the evidence in the instant appeal does not establish such an exceptional disability picture as to render the schedular criteria inadequate. The schedular rating criteria for rating hearing loss provide for disability ratings based on audiometric evaluations, to include speech discrimination and pure tone testing. Here, all the Veteran’s hearing loss symptoms and described hearing impairments are contemplated by the schedular rating criteria. The Veteran’s hearing loss disability has manifested in difficulty hearing alarms and sirens, oncoming traffic, or people trying to get his attention from short distances. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss in various contexts, as measured by both audiometric testing and speech recognition testing. The ability of the Veteran to hear sounds and voices is measured and rated by an audiometric test, as this test measures different frequencies and captures high frequency hearing loss from sources including voices, music, sirens, and certain high pitched sounds. The ability of the Veteran to understand people and having to ask others to repeat themselves on a regular basis is rated by a speech recognition test, as this test measures conversation comprehension, words, and missed conversations. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss, including exceptional hearing patterns which were not demonstrated in this case, and as measured by both audiometric testing and speech recognition testing. See Doucette, 28 Vet. App. 366 (holding “that the rating criteria for hearing loss contemplate the functional effects of difficulty hearing and understanding speech”). The Board notes that decibel loss and speech discrimination ranges designated for each level of hearing impairment in Tables VI and VIa were chosen in relation to clinical findings of the impairment experienced by veterans with certain degrees and types of hearing disability. The regulatory history of 38 C.F.R. §§ 4.85 and 4.86 includes revisions, effective June 10, 1999. See 64 Fed. Reg. 25,202 (May 11, 1999). In forming these revisions, VA sought the assistance of the Veteran’s Health Administration (VHA) in developing criteria that contemplated situations in which a veteran’s hearing loss was of such a type that speech discrimination tests may not reflect the severity of communicative functioning these veterans experienced or that was otherwise an extreme handicap in the presence of any environmental noise, even with the use of hearing aids. VHA had found through clinical studies of veterans with hearing loss that, when certain patterns of impairment are present, a speech discrimination test conducted in a quiet room with amplification of the sounds does not always reflect the extent of impairment experienced in the ordinary environment. The decibel threshold requirements for application of Table VIa were based on the findings and recommendations of VHA. The intended effect of the revision was to fairly and accurately assess the hearing disabilities of veterans as reflected in a real-life industrial setting. 59 Fed. Reg. 17,295 (Apr. 12, 1994). The inherent purpose of the schedular rating criteria is to determine, as far as practicable, the severity of functional impact resulting from a service connected disability, including any resultant occupational and social impairment, and therefore contemplates the Veteran’s difficulties functioning in a social environment due to hearing loss. Accordingly, the Board finds that the Veteran’s reported hearing related difficulties are factors contemplated in the regulations and schedular rating criteria and referral for extraschedular consideration is not warranted. See also Doucette, 28 Vet. App. 366 (holding that “the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are precisely the effects that VA’s audiometric tests are designed to measure... an inability to hear or understand speech or to hear other sounds in various contexts... are contemplated by the schedular rating criteria”). REASONS FOR REMAND Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. In the August 2018 remand, the Board requested a medical opinion to address the nature and etiology of the Veteran’s claimed sleep disorder. In April 2019, the Veteran was afforded a VA examination, and the examiner determined that the Veteran had a current diagnosis of obstructive sleep apnea. The April 2019 examiner found the disorder was less likely than not incurred in or caused by an in-service injury, event or illness. The examiner reasoned that the Veteran’s service treatment record was silent for complaints, treatment or diagnosis of a sleep disorder. The examiner’s opinion lacks sufficient rationale as it does not account adequately for the Veteran’s competent lay complaints and is over-reliant on the lack of documented in-service and post-service treatment. Importantly, the examiner failed to provide any medical basis to doubt the Veteran’s reports of persistent difficulty sleeping during and after service. Consequently, further remand is required for compliance with the August 2018 remand directives. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the April 2019 VA examiner or, if the examiner is unavailable, from an appropriate clinician that addresses the Veteran’s service connection claim for a sleep disorder, to include sleep apnea. The examiner should identify all current sleep disorders. If obstructive sleep apnea is not identified, the examiner should address the diagnosis from the April 2019 VA examination. For any identified sleep disorder, the examiner should state whether it is at least as likely as not (50 percent probability or more) that the disorder began during, or is otherwise related to, his military service. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. A clear rationale for all opinions should be provided. The examiner is advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account in formulating the requested opinions regardless of contemporaneous treatment. 2. After ensuring completion of the above development, and any indicated development, the AOJ should readjudicate the claim. K.C. SPRAGINS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Sherman 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.