Citation Nr: 21062272 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-31 156 DATE: October 6, 2021 ORDER Entitlement to service connection for bilateral carpal tunnel syndrome (CTS) is denied. Entitlement to service connection for a left knee disability is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for an ocular disorder, diagnosed as a retinal hole, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the appellant's CTS in either hand is related to injury, exertive or otherwise, sustained during ACDUTRA and INACDUTRA or disease sustained during ACDUTRA. 2. The preponderance of the evidence is against a finding that the appellant's left knee disability is related to injury, exertive or otherwise, sustained during ACDUTRA and INACDUTRA or disease sustained during ACDUTRA. 3. The preponderance of the evidence is against a finding that the appellant's lumbar spine disability is related to injury, exertive or otherwise, sustained during ACDUTRA and INACDUTRA or disease sustained during ACDUTRA. 4. The preponderance of the evidence is against a finding that the appellant's ocular disorder is related to eye strain injury sustained during ACDUTRA and INACDUTRA or disease sustained during ACDUTRA. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral CTS were not met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. 2. The criteria for service connection for a left knee disability were not met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. 3. The criteria for service connection for a lumbar spine disability were not met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. 4. The criteria for service connection for an ocular disorder were not met. 38 U.S.C. §§ 101, 1110, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served on active duty for training (ACDUTRA) from August 1977 to November 1977 and had various subsequent periods of ACDUTRA and inactive duty for training (INACDUTRA) through the Army National Guard (ANG) until January 1998. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 Regional Office (RO) decision that denied service connection for the claims set forth on the title page. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 as amended (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). For the CTS, lumbar spine and left eye disability claims, the appellant had July 2013 VA examinations. For these claims, reading the medical opinions in their entirety and in context with the entire record, it is clear the physician or optometrist found that a relationship could not be made to any ACDUTRA disease or injury or INACDUTRA injury. Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012). Their reasons are sufficient to decide these claims as indicated below. Id. For the left knee disability, the physician furnished a positive medical opinion. However, the positive opinion was premised upon a 1989 knee injury occurring during a period of active military service. 38 C.F.R. § 3.6. The additional evidence does not show that the appellant sustained a left knee injury during any ACDUTRA or INACDUTRA period for reasons explained below. Id. An additional remand for more information concerning the July 2013 medical opinion would not change this critical fact and consequently would not benefit the appellant. See Shinseki v. Sanders, 556 U.S. 396, 409-10 (2009). There is no reasonable possibility that any additional assistance VA would provide would substantiate this claim. 38 C.F.R. § 3.159(d). Thus, appellate adjudication of these claims may proceed without prejudice to the appellant. Shinseki, 556 U.S. at 409-10. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § § 3.303(d). As relevant, the term "active military, naval, or air service" includes any period of ACDUTRA during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty and any period of INACDUTRA during which the individual concerned was disabled or died from an injury incurred or aggravated in the line of duty or from an acute myocardial infarction, a cardiac arrest, or cerebrovascular accident which occurred during such training. 38 U.S.C. § 101(24); 38 C.F.R. § 3.6(a). Accordingly, service connection may be granted for disability resulting from disease or injury incurred while performing ACDUTRA and for disability resulting from injury or the specified cardiac or cerebrovascular events incurred while performing INACDUTRA. Id. ACDUTRA is defined, in part, as "full-time duty in the Armed Forces performed by reserves for training purposes." 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c). The term INACDUTRA is defined, in part, as duty, other than full-time duty, under sections 316, 502, 503, 504, or 505 of the title 32 [U. S. Code] or the prior corresponding provisions of law. 38 U.S.C. § 101(23); 38 C.F.R. § 3.6(d). While service on active duty alone is sufficient to meet the statutory definition of veteran, service on ACDUTRA (or INACDUTRA), without more, will not suffice to give one "veteran" status. Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010). Before veteran status can be established for a period of such service, it must first be established that a claimant was disabled from a disease or injury incurred or aggravated in line of duty during ACDUTRA, or that he or she was disabled from an injury incurred or aggravated in line of duty during INACDUTRA. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary must give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). Duty periods and Veteran status As an initial matter, the Board will first address the appellant's duty periods for VA compensation purposes. 38 C.F.R. § 3.6. In October 2012 and August 2013, the appellant reported that she had 20 years of ANG service and had many ACDUTRA periods from Operation Desert Storm and various Hawaiian natural disasters. Her reports are duly noted. Service records show that the appellant had verified ACDUTRA service for the following periods: August 1977 to November 1977 and September 14, 1992 until September 25, 1992 with additional periods of ACDUTRA and INACDUTRA until January 1998. She is not service-connected for any disability from ACDUTRA or INACDUTRA and does not currently meet the statutory definition of veteran. Id. The evidence also indicates that the appellant worked for the ANG in a civilian capacity for the Department of Defense (DOD) while she served in the ANG for at least a portion of her ANG service. This determination is supported by the fact that the appellant filed a Department of Labor (DOL) claim for her June 1996 left knee injury with the DOD listed as her employer, the January 1998 state DOD separation memorandum referencing ANG membership as a condition of employment, and reference to her salary being under the General Schedule (GS) pay scale. The Board emphasizes that it can only consider the ACDUTRA and INACDUTRA periods for VA compensation purposes and is unable to consider injury or disease relating to civilian work duties as an ANG or DOD employee for many years. 38 C.F.R. § 3.6. In this regard, the appellant's ANG Retirement Point record summarizes ACDUTRA and INACDUTRA service from July 1977 until January 1998. Excluding the initial July 1977 to November 1977 ACDUTRA period, the appellant had between 12 and 55 INACDUTRA points and between 0 and 51 ACDUTRA points for the one year periods from November 1977 through January 1998. Thus, on most years between July 1977 and January 1998, the appellant could be considered as having at most two months of INACDUTRA and ACDUTRA service. The occupational assignment history summary for the appellant's ANG service from July 1977 until January 1998 shows that she first had a period of basic training and then served as a reports clerk and clerk typist until July 1980. She then served as a card punch operator from July 1980 until September 1981. She had a computer specialist role from September 1981 until June 1982. From June 1982 until September 1987, she worked as a material storage and handling specialist. She then worked in the fabric repair shop from September 1987 until September 1989 and as a supply accountant from September 1989 until October 1991. She last worked as a supply sergeant from October 1991 until January 1998. Bilateral CTS Service treatment records (STRs) from November 1977 included treatment for a left wrist mass. The provisional diagnosis was listed as ganglion left wrist. The clinician aspirated it and recommended follow up treatment on an as needed basis. June 1989 and March 1993 physical examination reports showed that the appellant's upper extremities were clinically evaluated and deemed to be normal. However, the March 1993 physical examination reported a right forearm scar. On a March 1993 Report of Medical History, the appellant denied having or ever having bone, joint or other deformity or neuritis. In October 2012, the appellant reported that she developed CTS from working on manual typewriters during 20 years of ANG service. In July 2013, the appellant had a VA peripheral nerves examination with a physician. The physician diagnosed bilateral CTS with a 1989 onset. He noted the appellant had a bilateral CTS release surgery in 1989. She reported flare-ups of 4-5/10 severity with extended use but denied any period of incapacitation or missed work. Neurological evaluation showed normal findings for both hands and wrists. Clinical evaluation showed well healed linear scars for both wrists. The physician stated that there was no CTS report from STRs, but CTS scars were found. He reported that it would be speculative to relate CTS to service relying only on the appellant's report. In her August 2013 NOD, the appellant stated that she developed bilateral CTS from typing on a manual typewriter. She stated that she performed a lot of typing as a supply sergeant supporting ANG units. She performed her duties daily and during annual training. October 2018 VA primary care records showed that the appellant developed left wrist pain after lifting a heavy bag. She sought emergency treatment. Left wrist X-ray returned normal. She received a sling with ice for treatment. Her left wrist pain and swelling improved. She continued to have chronic wrist pain and numbness due to bilateral CTS. Left wrist clinical findings were detailed. The clinician assessed left wrist tendonitis. For the following reasons, service connection for bilateral CTS is not warranted. The appellant reports that she developed bilateral CTS from typing on a manual typewriter during INACDUTRA and ACDUTRA periods over her 20 year ANG service. She is competent to report about CTS symptoms and information given to her from treating clinicians. Jandreau v. Nicholson, 492 F.3d 1372, 1377, n.4 (Fed. Cir. 2007). STRs from November 1977 report a left ganglion cyst. Otherwise, STRs from INACDUTRA and ACDUTRA do not include any specific wrist or hand injury report or Line of Duty determination report. The question of whether bilateral CTS is related to overuse injury sustained during INACDUTRA and ACDUTRA periods or the ACDUTRA left ganglion cyst is a complex medical issue. The complex medical issue designation is appropriate because the appellant's ANG service history and alternative cause of exertive activities outside ACDUTRA and INACDUTRA periods leading to bilateral CTS. Thus, identifying exertive or overuse injury incurred during various ACDUTRA or INACDUTRA periods as the cause for bilateral CTS extends beyond a simple and effect type relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Id.; 38 C.F.R. § 3.159(a)(1). The appellant's reports as to this relationship to INACDUTRA and ACDUTRA overuse injury or November 1977 left ganglion cyst are not competent. Id. The competent evidence on this issue is limited to the July 2013 VA medical opinion. It was based upon an examination of the appellant, a review of her treatment records, and consideration of her reported history. Reading the opinion as a whole and in the context of the evidence of record, the physician did not find sufficient evidence to link bilateral CTS to ACDUTRA or INACDUTRA service in a non-speculative manner. His opinion is therefore entitled to some probative weight. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). There is no conflicting medical opinion or competent evidence linking CTS in either hand to exertive type injury from ACDUTRA or INACDUTRA periods or November 1977 left ganglion cyst. For the above stated reasons, the preponderance of the evidence is against the claim for service connection for bilateral CTS. The benefit-of-the-doubt doctrine is therefore not for application, and the claim for service connection for bilateral CTS must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Left knee disability STRs from June 1989 showed that the appellant had decreased left knee flexion and tenderness. The clinician referred to an arthroscopy over tibial tuberosity. He also reported left medial meniscectomy from January or June 1989 and July 1989 left knee strain. March 1993 physical examination reflected that the appellant's lower extremities were clinically evaluated and deemed to be normal. The accompanying Report of Medical History showed that the appellant denied having or ever having a tricked or locked knee. June 1996 private medical records reported that the appellant was treated for left knee pain following a fall injury at work that morning. Left knee clinical evaluation showed edema, effusion, and tenderness on the tibial tuberosity. X-ray was negative. The clinician assessed contusion of left tibial tuberosity. A June 1996 DOL report stated that the appellant was authorized for treatment following a slip and fall injury affecting her knees. The appellant's employer was listed as the DOD. Another June 1996 Office of Workers' Compensation program form completed by a physician reported that the appellant sustained a left knee injury at work and would be totally disabled until July 15, 1996. A July 1996 DOL Work Restriction Evaluation detailed that the appellant could only sit for four hours a day and that she would continue to be off work until the arthroscopy was approved. A January 1998 state DOD report indicates that the appellant worked in a civilian capacity for the ANG with concurrent ANG membership as noted above. In July 2013, the appellant had a VA left knee examination with a physician. The physician diagnosed left knee medial meniscus tear status post meniscectomy with a 1989 onset. The appellant reported left knee pain beginning in 1987. She had a left medial meniscectomy in January 1989. Left knee physical findings were detailed. The physician furnished a positive medical opinion. She cited STRs noting the left knee medial meniscus tear occurring in service in 1989. In July 2019, the appellant reported that she sustained a left knee injury while working as a full time technician. She did not ever receive a line of duty (LOD) determination. She relied on private health coverage for treatment. She enclosed the medical records in her possession. She indicated that the enclosed physician's work excuse letter was made in lieu of a LOD report and submitted to her supervisor for documentation. She also enclosed a picture of the area where the injury occurred. For the following reasons, service connection for a left knee disability is not warranted. The appellant is competent to report about her left knee injury history and circumstances. Jandreau, 492 F.3d at 1377 n.4. However, her reports must be considered with the service department records. The Board finds that for any significant acute left knee injury occurring during an ACDUTRA or INACDUTRA period that there would be a corresponding LOD determination or similar documentation, instead of DOL processing. LOD administrative processing would be expected for ACDUTRA and INACDUTRA injuries. Molitor v. Shulkin, 28 Vet. App. 397, 410 (2017) ("The absence of evidence only tends to prove the nonexistence of a fact if the fact would ordinarily have been recorded"). The June 1989 Report of Medical Examination is the only reference to left knee disorder found within STRs. It does not include any indication that this left knee disorder was related to a ACDUTRA disease or injury or INACDUTRA injury. As to the June 1996 left knee injury, the contemporaneous records show that it was processed under the DOL as a workers' compensation injury. It is reasonable to infer the injury occurred in connection with civilian DOD employment from the administrative processing report. See id. Thus, the preponderance of the evidence weighs against a finding that the appellant sustained an acute left knee injury during ACDUTRA or INACDUTRA. The Board has also considered whether general exertive activity during ACDUTRA or INACDUTRA periods is related to her current left knee disability. This subject is a complex medical issue. The complex medical issue designation is appropriate because the appellant's ANG service history and alternative cause of exertive activities outside ACDUTRA and INACDUTRA periods leading to the left knee disability. Thus, identifying exertive or overuse injury incurred during various ACDUTRA or INACDUTRA periods as the cause for the left knee disability extends beyond a simple cause and effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Id.; 38 C.F.R. § 3.159(a)(1). The appellant's reports as to this relationship to INACDUTRA and ACDUTRA exertive injury are not competent. Id. The competent evidence is limited to the July 2013 VA medical opinion. It is apparent that the VA physician confused the 1989 Report of Medical Examination as an active duty service period as opposed to an ACDUTRA or INACDUTRA service period. See Acevedo, 25 Vet. App. at 294; 38 C.F.R. § 3.6. The Board does not find it probative to show a relationship to service since it is not premised on an accurate review of the appellant's active service history. Id. There is no additional evidence indicating the injury or events leading to the 1989 left knee surgery were incurred during ACDUTRA or INACDUTRA periods to warrant further investigation. For the above stated reasons, the preponderance of the evidence is against the claim for service connection for a left knee disability. The benefit-of-the-doubt doctrine is therefore not for application, and the claim for service connection for a left knee disability must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Lumbar spine disability STRs do not show any complaints or treatment for a back injury. March 1993 STRs include a physical examination confirming that the appellant's spine was clinically examined and deemed normal. In an accompanying Report of Medical History, the appellant denied having or ever having recurrent back pain. July 1997 private medical records showed that the appellant was under medical care for acute back strain and included July 1997 and August 1997 notes excusing her from work due to low back pain. In July 2013, the appellant had a VA spine examination with a physician. The physician assessed normal lumbar spine. The appellant reported that her back pain began in the ANG but did not receive a LOD determination. The pain was intermittent. She denied any surgical or brace history and had not missed work in the past 12 months for back pain. Clinical findings for the lumbar spine were detailed. The physician furnished a negative medical opinion. She stated that there was no evidence of a back disorder from STRs and the clinical evaluation for the back revealed normal findings. In her August 2013 NOD, the appellant reported that she performed frequent lifting activities as an ANG supply sergeant. For the following reasons, service connection for a lumbar spine disability is not warranted. The appellant asserts that the July 1997 private medical records show an in-service back injury or alternatively that her current back pain is related to ANG work as a supply sergeant. She is competent to report about her back injury history and circumstances. Jandreau, 492 F.3d at 1377 n.4. However, her reports must be weighed against the service department records. The Board again finds that for any significant acute back injury occurring during an ACDUTRA or INACDUTRA period that there would be a corresponding LOD determination or similar documentation. Molitor, 28 Vet. App. at 410 ("The absence of evidence only tends to prove the nonexistence of a fact if the fact would ordinarily have been recorded"). STRs and ANG records do not reference any back injury. The July 1997 work note is authored by a private physician and does not reference any ACDUTRA or INACDUTRA injury. The preponderance of the evidence weighs against a finding that the appellant sustained an acute back injury during ACDUTRA or INACDUTRA. The Board has considered whether the appellant's current back pain has a relationship to exertive injury during ACDUTRA or INACDUTRA periods. This subject is a complex medical issue. Jandreau, 492 F.3d at 1377 n.4. The complex medical issue designation is appropriate because the appellant's ANG service history and alternative of non-service activities outside ACDUTRA and INACDUTRA periods as the primary cause. Thus, identifying exertive or overuse injury incurred during various ACDUTRA or INACDUTRA periods as the cause for the current back pain extends beyond a simple cause and effect relationship that that is of the type that the courts have found to be beyond the competence of lay witnesses. Id.; 38 C.F.R. § 3.159(a)(1). The appellant's reports as to this relationship to INACDUTRA and ACDUTRA for current back pain are not competent. Id. The competent evidence on this issue is limited to the July 2013 VA medical opinion. It was based upon an examination of the appellant, a review of her treatment records, and consideration of her reported history. Reading the opinion as a whole and in the context of the evidence of record, the physician did not find sufficient evidence to link any reported back pain to ACDUTRA or INACDUTRA service. Her opinion is therefore entitled to some probative weight. See Monzingo, 26 Vet. App. at 106; Acevedo, 25 Vet. App. at 294. There is no conflicting medical opinion or competent evidence linking the appellant's back pain to ACDUTRA or INACDUTRA service. For the above stated reasons, the preponderance of the evidence is against the claim for service connection for a lumbar spine disability. The benefit-of-the-doubt doctrine is therefore not for application, and the claim for service connection for a lumbar spine disability must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Left eye disability Additional regulations pertain to this claim as noted below. For purposes of entitlement to benefits, the law provides that refractive errors of the eyes are congenital or developmental defects and are not a disease or injury within the meaning of applicable legislation. In the absence of superimposed disease or injury, service connection may not be allowed for refractive error of the eyes, including myopia, presbyopia, and astigmatism, even if visual acuity decreased in service, as this is not a disease or injury within the meaning of applicable legislation relating to service connection. 38 C.F.R. §§ 3.303(c), 4.9. Thus, VA regulations specifically prohibit service connection for refractive errors of the eyes unless such defect was subjected to a superimposed disease or injury which created additional disability. See VAOPGCPREC 82-90 (July 18, 1990); 55 Fed. Reg. 45711 (1990). Turning to the evidence, STRs from September 1977 showed that the appellant complained about left eye redness over the past week. She reported blurred vision lasting about five minutes on a daily basis, along with mild itching. The clinician appears to defer a diagnosis. In a November 1977 Report of Medical History, the appellant denied eye trouble. June 1989 and March 1993 physical examination reports showed that the appellant's eyes, ophthalmoscopic, pupils, and ocular motility were clinically evaluated and deemed to be normal. Refractive error was noted. A March 1993 Report of Medical History showed that the appellant denied having or ever having eye trouble but reported wearing glasses. In July 2013, the appellant had a VA eye examination with an optometrist. The appellant reported that she had blurred vision from working with computers since 1981 in service. She retired in 1998. Currently, she experienced eye redness and headaches. Ocular findings were detailed. The optometrist assessed right eye myopia compounded with myopic astigmia and left eye presbyopia. A retinal hole was also found for the right eye. The optometrist furnished a negative medical opinion. She stated that no eye condition was found in the medical records beyond refractive error. The right eye retinal hole was a new finding and unrelated to service. She reported the appellant had correctable vision throughout service and now. October 2019 VA optometry clinic records showed that the appellant presented for a diabetic eye examination. She had had laser surgery to repair the right eye retinal hole. Ocular findings were detailed. The optometrist assessed best corrective vision was 20/20 or better for each eye. No retinopathy was found. The optometrist issued an eyewear prescription and encouraged the appellant to work with her primary care provider to control her blood sugar. For the following reasons, service connection for an ocular disorder is not warranted. The appellant is competent to report about her ocular history and readily observable symptoms. Jandreau, 492 F.3d at 1377 n.4. She does not report a specific eye injury. Rather, she asserts that she developed ocular problems due to reading computer screens during ACDUTRA and INACDUTRA periods. See July 2013 VA examination report. The Board has considered whether the appellant's current non-refractive error ocular disorder has a relationship to the eye strain injury described by her during ACDUTRA or INACDUTRA periods. The question of whether any current ocular disorder is related to eye strain injury sustained during INACDUTRA and ACDUTRA periods is a complex medical issue. Jandreau, 492 F.3d at 1377 n.4. The complex medical issue designation is appropriate because the appellant's periodic ANG service history and alternative of non-service activities outside ACDUTRA and INACDUTRA periods or following ANG separation as the primary cause of the current ocular disorder. Thus, identifying eye strain injury as incurred during various ACDUTRA or INACDUTRA periods as the cause for the current non-refractive ocular disorder extends beyond a simple cause and effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Id.; 38 C.F.R. § 3.159(a)(1). The appellant's reports as to this relationship to INACDUTRA and ACDUTRA for any current ocular disorder are not competent. Id. The competent evidence on this issue is limited to the July 2013 VA medical opinion. It was based upon an ocular examination of the appellant, a review of her treatment records, and consideration of her reported history. Reading the opinion as a whole and in the context of the evidence of record, the optometrist did not find sufficient evidence to link the diagnosed retinal hole to ACDUTRA or INACDUTRA service. Her opinion is therefore entitled to some probative weight. See Monzingo, 26 Vet. App. at 106; Acevedo, 25 Vet. App. at 294. There is no conflicting medical opinion or competent evidence linking the July 2013 retinal hole or any other potentially compensable ocular disorder to ACDUTRA or INACDUTRA service. For the above stated reasons, the preponderance of the evidence is against the claim for service connection for an ocular disorder. The benefit-of-the-doubt doctrine is therefore not for application, and the claim for service connection for an ocular disorder must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. D. Simpson, 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.