Citation Nr: 21004951 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 14-14 705 DATE: January 28, 2021 ORDER Entitlement to service connection for an esophageal disorder, claimed as secondary to service connected posttraumatic stress disorder (PTSD), is denied. Entitlement to service connection for erectile dysfunction, claimed as secondary to service connected PTSD, is denied. Entitlement to service connection for a sleep disorder, claimed as secondary to service connected PTSD, is denied. Entitlement to service connection for hepatitis C is denied. REMANDED Entitlement to an increased rating for PTSD, rated as 30 percent disabling prior to January 31, 2014 and 50 percent thereafter, is remanded. Entitlement to additional temporary total disability rating for PTSD is remanded. Entitlement to a rating of total disability due to individual unemployability based upon service-connected disorders (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s esophageal disorders are not etiologically related to an in-service injury or disease and were not caused or aggravated by service connected PTSD or medications used in managing PTSD. 2. At no time during the pendency of the claim does the Veteran have a diagnosis of erectile dysfunction, and the record does not contain a recent diagnosis of such disability prior to the Veteran’s filing of a claim. 3. no time during the pendency of the claim does the Veteran have a diagnosis of a sleep disorder, and the record does not contain a recent diagnosis of such disability prior to the Veteran’s filing of a claim. 4. The Veteran’s hepatitis C is not etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for an esophageal disorder, claimed as secondary to service connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for erectile dysfunction, claimed as secondary to service connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a sleep disorder, claimed as secondary to service connected PTSD, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for hepatitis C have not been met. 38 U.S.C. §§ 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 May 1966 to May 1968, which includes verified service within the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) on appeal of separate rating decisions dated March 2011, July 2011, and December 2012 issued by respective Department of Veterans Affairs (VA) Regional Offices (RO). By way of background, the Veteran’s claims were previously before the Board on January 29, 2016 and March 28, 2018, at which times the claims were remanded. The Board further notes in passing that whereas the Agency of Original Jurisdiction (AOJ) denied the Veteran’s claim for a TDIU, the Board takes jurisdiction of the matter (even without a Notice of Disagreement on file as to that rating decision) by inferring a claim for TDIU as part and parcel of the increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). After the most recent Board remand of March 2018, the Veteran was issued a Supplemental Statement of the Case (SSOC) on July 16, 2020. The Board now asserts jurisdiction over the claims as reflected on the title page. For the reasons to be discussed more fully in respective parts below, the Board concludes that the claims for increased ratings for PTSD and for a TDIU must be remanded. For the claims of service connection, the Board concludes that the Veteran has been afforded substantial compliance with all previous remand directives, see Stegall v. West, 11 Vet. App. 268, 271 (1998). 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). Service connection may also be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may be granted based on evidence of (1) a current 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. 38 C.F.R. § 3.304. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Where a Veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, to include peptic (gastric or duodenal) ulcers, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In the instant case, the Veteran has not been diagnosed with peptic ulcers and hepatitis C is not a disease listed under 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established on a secondary basis for a disability that is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). The determination as to whether the requirements for service connection are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. 38 U.S.C. § 7104(a); Baldwin v. West, 13 Vet. App. 1 (1999). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 1. Entitlement to service connection for an esophageal disorder, to include as secondary to service connected PTSD, is denied. By way of background, the Veteran’s claim for service connection for an esophageal disorder was most recently remanded in March 2018. See generally BVA Remand (Mar. 28, 2018). Specifically, the claim was remanded so that the AOJ could obtain opinions as to whether or not the Veteran’s diagnosed gastroesophageal reflux disorder (GERD) or Barrett’s esophagus are entitled to service connection as directly due to a February 1967 notation, secondary to service-connected PTSD, or secondarily aggravated by PTSD or else the medications prescribed to manage PTSD. See id. at Pages 10-14. The AOJ obtained the above requested addendum opinion, and it has been associated with the claims file so that the Board may review it. See VA Exam ( Nov. 5, 2019 ). The examiner concluded that the Veteran’s esophageal disorders are not at least 50 percent likely attributable on a direct basis because even though the examiner clearly considered evidence of subjective complaints in 1967 and 1968, “[these] (as noted above) are NOT consistent with NOR diagnostic for a GERD diagnosis OR a Barrett’s esophagus diagnosis.” See id. at Pages 1-2 (emphasis in original). The examiner instead concluded that the earliest evidence of these diagnoses appears no earlier than 2002. Id. The examiner also explained that the Veteran was incarcerated until 1998, and that there are no such diagnoses in those contemporaneous medical records. Id. Furthermore, the examiner concluded that the Veteran’s esophageal disorders are not at least 50 percent likely attributable to PTSD because “PTSD itself does not affect lower esophageal sphincter function. Furthermore, the medications known to cause heartburn symptoms [or] increase acid reflux DO NOT include the medications the Veteran used for PTSD. […] Barrett’s esophagus is caused ONLY by chronic GERD—not PTSD nor PTSD medications.” See id. at Pages 2-3 (emphasis in original). Finally, the November 2019 VA examiner supplied an opinion as to whether the Veteran’s esophageal disorders are secondarily aggravated beyond normal course of progression by PTSD or medications used to manage it. The examiner specifically acknowledged the Veteran’s underlying alcohol abuse disorder as was indicated in a November 2017 examiner’s opinion; however, the November 2019 examiner indicated that this was not at least 50 percent likely. See generally id. at Page 3. In supplying this negative nexus herein, the examiner indicated that the Veteran exhibits many other risk factors that are known to contribute to GERD, including his age, his male gender, his obesity, and a heavy smoking history of more than 50 years. See id. Furthermore, notwithstanding the multitude of other risk factors, the examiner noted that the Veteran’s GERD was diagnosed in 2002 as “Class A (mildest),” while his GERD and Barrett’s esophagus appeared normal as recently as in 2016. See id.; see also VA Medical Record ( June 5, 2020 ) (denying any acute gastrointestinal discomfort). The November 2019 VA opinion had clear conclusions and supporting data, as well as a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). No contrary medical opinion is of record. Ultimately, the Board concludes that the Veteran was afforded substantial compliance with the previous remand directives. See Stegall, supra. The Board has sympathetically reviewed all evidence of record; however, the preponderance of the evidence suggests that the Veteran’s esophageal disorders manifested no earlier than 2002, and are neither attributable to service on a direct basis, nor secondary to PTSD, nor secondarily aggravated by PTSD. To the extent that this disorder may be considered chronic, there is no evidence of such relevant diagnosis until 2002. 38 C.F.R. §§ 3.307, 3.309. The Board notes that the Veteran has contended that his esophageal disorder was the result of his service and/or his service connected PTSD. Lay witnesses are competent to provide testimony or statements relating to symptoms or facts of events that the lay witness observed and is within the realm of his or her personal knowledge, but not competent to establish that which would require specialized knowledge or training, such as medical expertise. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Lay evidence may also be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). However, "VA must consider lay evidence but may give it whatever weight it concludes the evidence is entitled to." Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). In the instant case, the Board finds that the question regarding the potential relationship between the Veteran's esophageal disorder and any instance or event of his service or service-connected PTSD to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Specifically, while the Veteran is competent to describe his current symptoms, the Board accords his statements regarding the etiology of his hearing loss little probative value because he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issued. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has had any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran are non-probative evidence. Therefore, the preponderance of evidence is against a finding that the Veteran’s claimed esophageal disorders are related to service. For the reasons above, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-4 (1990). 2. Entitlement to service connection for erectile dysfunction, to include as secondary to service connected PTSD, is denied. 3. Entitlement to service connection for a sleep disorder, to include as secondary to service connected PTSD, is denied. The Board has fully and sympathetically reviewed the entire evidence of record, including but not limited to the Veteran’s complete service treatment records and all relevant post-service medical records. There is no evidence that the Veteran has a diagnosis of either erectile dysfunction or a sleep disorder. See, e.g.: VA Medical Records ( May 27, 2016 ) (denying any significant sleep disordered breathing); id. ( July 27, 2018 ) (rec’d July 9, 2020) (failing to list erectile dysfunction or any sleep disorder within “Pertinent Medical History/Pre-Treatment Screen”). The Board further notes that the Veteran was supplied with a VA Form 21-4142 by which he was specifically asked to identify any sources of pertinent non-VA medical records that may have evinced diagnoses of erectile dysfunction or a sleep disorder. See Custom 5103 Notice ( Oct. 18, 2018 ). This was not returned. VA’s duty to assist is not a one-way street. If the Veteran wants help, they cannot passively wait for it in those circumstances where their own actions are essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 191 (1991); Hayes v. Brown, 5 Vet. App. 60, 68 (1993). As noted above, the existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; Degmetich v. Brown, 104 F.3d 1328 (1997). The current disability requirement is satisfied when a claimant “has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim,” McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), or “when the record contains a recent diagnosis of disability prior to…filing a claim for benefits based on that disability.” Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). In the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board acknowledges the United States Court of Appeals for Veteran’s Claims (Court)’s holding in Saunders but does not find a basis for determining that there is functional impairment related to a diagnosis of erectile dysfunction and/or a sleep disorder. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Moreover, the clinical evidence of record does not support a diagnosis of a sleep disorder that confirms with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as is required for compensation for psychiatric disabilities. See Martinez-Bodon v. Wilkie, 32 Vet. App. 393 (2020). In addition, the record does not reflect, and the Veteran has not alleged, that he suffers from impairment of earning capacity due to his claimed erectile dysfunction that is of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 2020 U.S. App. Vet. Claims LEXIS 1609, __ Vet.App. __, 2020 WL 5200689. Therefore, as the evidence of record shows that the Veteran does not have a current erectile dysfunction or diagnosed sleep disorder, the Board concludes that service connection is not warranted and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) (“A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service.”); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection). In the instant case, the Board finds that the question regarding the existence of a current disability as well as the potential relationship between the Veteran’s claimed erectile dysfunction and/or a sleep disorder and any instance of his service to be complex in nature. Woehlaert v. Nicholson, supra. Specifically, while the Veteran is competent to describe any current symptoms, however, the Board accords his statements regarding the etiology of such a disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, supra. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, and requires the administration and interpretation of diagnostic testing. In the instant case, there is no suggestion that the Veteran has any medical training. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the opinions of the Veteran is nonprobative evidence. As discussed, to the extent that the Veteran contends that the erectile dysfunction and/or a sleep disorder was the result of his service and/or his service connected PTSD, the Board finds that contemporaneous medical evidence showing that there was no currently diagnosed disability to be of greater probative value. The Board further concludes that as the Veteran has been afforded every opportunity to substantiate his relevant diagnoses, he has been afforded substantial compliance with the previous remand directives. See Stegall, supra; Dyment v. West, 13 Vet. App. 141, 146-7 (1999); 38 U.S.C. § 5103A(b); D’Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required pursuant to Stegall). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board…to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Accordingly, the Board finds that the preponderance of the evidence is against the claims for service connection for erectile dysfunction or a diagnosed sleep disorder (both including as claimed as secondary to service-connected PTSD), and for these reasons, these two claims each must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Entitlement to service connection for hepatitis C is denied. The Board first notes that the Veteran claims that he was afforded treatment for hepatitis C at the Kansas City VA Medical Center (VAMC) in the 1970s. See BVA Remand (Mar. 28, 2018), at Pages 9-10. The Board has fully reviewed all of the Veteran’s records of medical treatment from the Kansas City VAMC, and the AOJ confirms that no such records exist prior to 1980. See Medical Treatment Records (rec’d Nov. 6, 2018 ); Deferred Rating ( July 2, 2020 ). As a result, the Board concludes that the Veteran has been afforded substantial compliance on this claim for service connection, as the AOJ has taken all appropriate efforts in assisting him in attempting to substantiate the claim. See Stegall, supra. The Board notes in passing that the Veteran’s hepatitis C appears to have achieved sustained virologic response after treatment in 2016. See VA Medical Record ( June 5, 2020 ). Evidence of the diagnosis at any time during the appellate period is accordingly conceded. On the other hand, after the Board’s full review of the evidence of record, the Board concludes that the Veteran’s hepatitis C appears to have manifested no earlier than 2002—postdating discharge by almost 34 years. See Physical Medicine Rehab Consult (Oct. 28, 2011) ( identifying April 11, 2002 as the date of diagnosis). Ultimately, as recounted above, the Board has thoroughly reviewed the evidence of record, and there is no evidence of an in-service event, injury, or disease to support a theory of direct service connection, nor of service connection as secondary to any other service-connected disorder. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The Veteran has offered no specific argument in furtherance of any particular theory. To the extent that the claimed hepatitis C on appeal might be considered chronic, there is no evidence of any current diagnoses until 2002 and no evidence or allegation of a continuity of symptomatology. The Board also notes that hepatitis C is not a chronic disability listed under 38 C.F.R. §§ 3.307, 3.309. The Board acknowledges that by denying the Veteran’s claim for hepatitis C at this time, it is doing so without having afforded VA examinations to the Veteran. The Board determines that no VA examinations are required in this case. A VA examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). See also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i). The service treatment records are otherwise negative for complaints, treatments or diagnoses related to hepatitis C any earlier than 2002. Further, the evidence does not indicate that the disorder may be related to his military service. See McLendon, supra. In this regard, while the Veteran himself has advanced such a theory only by filing the instant claim for service connection, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Therefore, the Board finds that a VA examination and/or opinion is not necessary to decide this claim. Therefore, the preponderance of evidence is against a finding that the Veteran’s claimed hepatitis C is related to service. For the reasons above, the benefit of the doubt rule does not apply, and the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND 1. Entitlement to an increased rating for PTSD, rated as 30 percent disabling prior to January 31, 2014 and 50 percent thereafter, is remanded. 2. Entitlement to additional temporary total disability rating for PTSD is remanded. 3. Entitlement to a rating of a TDIU is remanded. The Veteran appears to have most recently submitted to a VA psychiatric examination on May 15, 2017. See VA Exam ( May 15, 2017 ). Shortly after this examination, the Court held in Bankhead v. Shulkin, 29 Vet. App. 10 (2017) that the presence of suicidal ideation alone, that is, a veteran’s thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas, warranting a 70 percent rating. The Veteran’s post-service medical treatment records appear to memorialize at least two notations whose relevance, or lack thereof, have never been analyzed in light of new binding precedent. See, e.g.: VA Treatment Records (Nov. 29, 2010; Feb. 27, 2012). As the record suggests that the most recent VA psychiatric examination is too old to inform a decision on a higher rating, see 38 C.F.R. § 4.1, the Board concludes that an additional remand is warranted. See generally 38 C.F.R. § 3.159(c)(4); Snuffer v. Gober, 10 Vet. App. 400 (1997). Similarly, to the extent that the Veteran seeks additional periods of temporary total disability for PTSD, the Board construes that claim as one for increased ratings. For this same reason, that claim is also remanded. Finally, to the extent that the Veteran’s claim for a TDIU appears to be inextricably intertwined with the claim for increased ratings for PTSD, the Board also remands this claim on appeal accordingly. While the Board sincerely regrets additional delay that will be caused by this further remand, the Board is ultimately precluded from issuing final determinations as to the Veteran’s increased ratings and TDIU claims, under these circumstances. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). Following the receipt of outstanding records, the Veteran should be afforded a VA examination in order to determine the current severity of his service-connected PTSD. All pertinent evidence should be made available to and reviewed by the examiner. The examiner must make all findings relative to rating the Veteran’s PTSD. In addition to dictating objective test results, the examiner’s report should fully describe the effects of the Veteran’s disabilities on his social and occupational functioning. The examiner is also asked to elicit the Veteran’s testimony as to the progression of his psychiatric disability. The AOJ should ensure that the examiner provides all information required for rating purposes. The examiner should specifically address the relevance (or lack thereof) of all instances of suicidal ideations, considering the recent federal court holding in Bankhead v. Shulkin, 29 Vet. App. 10 (2017), including but not limited to notations dated November 29, 2010 and February 27, 2012. (Continued on the next page)   3. After the above is completed, the Veteran’s remaining and potentially intertwined claims for (a) additional entitlements to temporary total disability ratings for PTSD pursuant to 38 C.F.R. § 4.29 and (b) TDIU should be readjudicated accordingly. If any portion of the Veteran’s above claims should remain denied, then the Veteran and his representative should be issued a Supplemental Statement of the Case (SSOC) and should be afforded a reasonable opportunity to respond, in accordance with appellate procedures. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael B. Engle, 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.