Citation Nr: 21062482 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 13-17 455 DATE: October 7, 2021 ORDER An initial rating higher than 10 percent for right hip degenerative joint disease based on limitation of right hip flexion for the entire rating period is denied. An initial compensable rating for right hip limitation of extension from May 9, 2012 to March 19, 2019 is denied. An initial rating higher than 10 percent for right hip limitation of extension from March 19, 2019, forward, is denied. An initial rating of 20 percent, and no higher, for right hip limitation of abduction from May 9, 2012 to March 19, 2019 is granted. An initial rating higher than 20 percent for right hip limitation of abduction from March 19, 2019, forward, is denied. An initial rating higher than 10 percent for left hip degenerative joint disease based on limitation of left hip flexion from May 9, 2012 to March 1, 2021 is denied. An initial rating of 20 percent, and no higher, for left hip limitation of abduction from May 9, 2012 to March 19, 2019 is granted. An initial rating higher than 20 percent for left hip limitation of abduction from March 19, 2019 to March 1, 2021 is denied. An initial disability rating of 50 percent, and no higher, for total left hip replacement from March 1, 2021, forward, is granted. FINDINGS OF FACT 1. For the entire initial rating period from May 9, 2012, the right hip disability was manifested by arthritis with painful motion and right thigh flexion limited to 65 degrees or to a greater degree (i.e., noncompensable limitation of motion). 2. For the initial rating period from May 9, 2012 to March 19, 2019, right thigh extension was not limited to 5 degrees or more. 3. For the initial rating period from March 19, 2019, forward, right thigh extension ranged from normal (i.e., 0 degrees) to extension limited to 10 degrees. 4. For the initial rating period from May 9, 2012, forward, right hip adduction was limited so that the Veteran could not cross the legs and the right hip demonstrated a limitation of abduction to 10 degrees, adduction to 10 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees during a flare-up and/or after repetitive use due to pain and fatigue. 5. For the initial rating period from May 9, 2012 to March 1, 2021, the left hip disability was manifested by painful motion and left thigh flexion limited to 80 degrees or to a greater degree (i.e., noncompensable limitation of motion). 6. For the initial rating period from May 9, 2021 to March 1, 2021, left hip adduction was limited so that the Veteran could not cross the legs and the left hip demonstrated a limitation of abduction to 10 degrees, adduction to 10 degrees, external rotation to 20 degrees, and internal rotation to 10 degrees during a flare-up and/or after repetitive use due to pain and fatigue. 7. For the initial rating period from March 1, 2021, the total left hip replacement was manifested by moderately severe residuals of weakness, pain, or limitation of motion with pain and clicking in the left hip, pain, and weakness with walking and physical activity limited range of motion but only to a noncompensable degree, regular use of a cane for ambulation without need for constant use or any other assistive device such as crutches or a wheelchair, and an ability to cross the legs. CONCLUSIONS OF LAW 1. The criteria for an initial rating higher than 10 percent for right hip degenerative joint disease based on limitation of flexion have not been met or approximated for any period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5003. 2. The criteria for an initial compensable rating for right hip limitation of extension have not been met or approximated from May 9, 2012 to March 19, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5003-5251. 3. The criteria for an initial rating higher than 10 percent for right hip limitation of extension have not been met or approximated from March 19, 2019, forward. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5003-5251. 4. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial rating of 20 percent, and no higher, for right hip limitation of abduction have been met from May 9, 2012 to March 19, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5253. 5. The criteria for an initial rating higher than 20 percent for right hip limitation of abduction from March 19, 2019, forward, have not been met or approximated for any period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5253. 6. The criteria for an initial rating higher than 10 percent for the left hip degenerative joint disease based on limitation of flexion have not been met or approximated from May 9, 2012 to March 1, 2021. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5003. 7. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial rating of 20 percent, and no higher, for left hip limitation of abduction have been met from May 9, 2012 to March 19, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5253. 8. The criteria for an initial rating higher than 20 percent for left hip limitation of abduction from March 19, 2019 to March 1, 2021 (excluding a period of temporary total rating) have not been met or approximated for any period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5253. 9. Resolving reasonable doubt in the Veteran's favor, the criteria for an initial rating of 50 percent, and no higher, for total left hip replacement are met from March 1, 2021, forward. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5054. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from April 1975 to May 1975 and from January 1978 to July 1989. This matter is on appeal from May 2013 rating decision. The procedural history as described in the August 2020 Board decision is incorporated herein by reference. In August 2020, the Board denied an earlier effective date for the grant of a 50 percent rating for left elbow ankylosis and remanded the multiple initial rating issues involving the service-connected left and right hip disabilities, as well as the issue of service connection for reflux esophagitis, for updated VA treatment records, authorization to obtain private treatment records for reflux esophagitis, new VA examinations to determine the current severity of the right and left hip disabilities when he had not recently received a steroid injection, an addendum opinion addressing the etiology of reflux esophagitis, and readjudication of the appeals. Regarding the initial rating appeals, updated VA treatment records were obtained in August 2020, September 2020, and November 2020. In July 2021, a VA hips and thigh conditions examination was performed. In the portion of the July 2021 VA examination report designated for description of the history of the hip condition, the July 2021 VA examiner noted that hip injections had been performed in December 2018 and March 2019 with no mention of any additional steroid injections. This notation adequately showed that there had been no recent steroid injection at the time of the July 2021 VA examination. The July 2021 VA examination report also recorded range of motion findings on active and passive motion, on repetitive use, and with weight-bearing and non-weight-bearing. While the July 2021 VA examiner provided no estimates for range of motion in degrees, none was needed because the July 2021 VA examiner opined that the procured evidence did not suggest that left or right hip pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups. In July 2021, the AOJ readjudicated the appeals. For these reasons, the Board finds that there has been compliance with the prior remand directives. As a result of the ordered development, service connection for gastroesophageal reflux disease with reflux esophagitis was established with a 10 percent rating effective from November 29, 2014. See July 2021 rating decision. Because of the full grant of benefits sought on appeal, the issue of service connection for esophagitis is no longer before the Board. In a September 2021 letter, the attorney argued that the AOJ did not substantially comply with the prior remand directives because the July 2021 Supplemental Statement of the Case (SSOC) did not address the ameliorative effects of medication and did not provide adequate reasons and bases regarding findings for additional functional loss due to pain, weakness, fatigability, or incoordination either normally, during flares, or after repeated use over a period of time; however, the argument is unpersuasive. The AOJ referenced the July 2021 VA examination report and included relevant findings when explaining the bases for denying higher initial ratings for the left and right hip disabilities. Because the July 2021 VA examination adequately addressed that there had been no recent steroid injection and adequately addressed additional functional loss, including during flare-ups and after repeated use, there was no need for the AOJ to specifically address the questions raised by the attorney. Thus, the Board finds that the July 2021 SSOC was adequate and satisfied prior remand directives. Disability Rating Legal Authority Disability ratings are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. 1. An initial rating higher than 10 percent for right hip degenerative joint disease for the entire rating period is denied. For the entire initial rating period from May 9, 2012, right hip degenerative joint disease has been rated at 10 percent under DC 5252 for limitation of thigh flexion. Although the assigned DC was 5252, the use of DC 5252 was an incorrect designation because the right hip disability did not actually manifest to a compensable (to 10 percent) degree of limitation of thigh flexion. The 10 percent rating was assigned based on findings of right hip pain with noncompensable limitation of motion, which is the substantive criteria for a 10 percent rating for arthritis of a major painful joint under DC 5003. Under DC 5003, degenerative arthritis established by X-ray findings will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under DC 5252 (limitation of flexion of the thigh), a 10 percent rating is provided for flexion limited to 45 degrees; a 20 percent rating is provided for flexion limited to 30 degrees; a 30 percent rating is provided for flexion limited to 20 degrees; and a 40 percent rating is provided for flexion limited to 10 degrees. After review of all the lay and medical evidence of record, the Board finds that the evidence weighs against finding that the criteria for an initial rating higher than 10 percent under DC 5003 for right hip disability have been met or approximated for any period. During the time relevant to the initial rating period, the right hip disability was manifested by painful motion and right thigh flexion limited to 65 degrees or to a greater degree (i.e., noncompensable limitation of motion); therefore, an initial rating higher than 10 percent under DC 5003 or DC 5252 for the right hip disability is not warranted for any period. 2. An initial compensable rating for right hip limitation of extension from May 9, 2012 to March 19, 2019 is denied. For the entire initial rating period from May 9, 2012 to March 19, 2019, right hip limitation of extension is rated at 0 percent under DC 5251 for limitation of thigh extension. (Service connection was not established for right hip limitation of extension prior to March 19, 2019, so it is reasonably assumed that a noncompensable rating for limitation of right hip limitation of extension was assigned during the initial rating period from May 9, 2012 to March 19, 2019). Under DC 5251 (limitation of extension of the thigh), a maximum 10 percent rating is provided for extension limited to 5 degrees. After review of all the lay and medical evidence of record, the Board finds that the evidence weighs against finding that the criteria for an initial compensable rating under DC 5003-5251 for degenerative arthritis with residual limitation of right hip extension. During the time relevant to this portion of the initial rating period, there is no indication in the record that right thigh extension was limited to 5 degrees at any time during the period. As explained above, the July 2016 Memorandum Decision determined that the October 2012 VA examination for the hips was inadequate for rating purposes on the basis that it did not adequately address functional limitations during flare-ups. Later, in a May 2018 decision, the Board determined that the January 2018 VA examination also was inadequate for rating purposes because it did not adequately address functional limitations during flare-ups and did not comply with the requirements of Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). In the February 2020 rating decision, the AOJ apparently considered findings from the March 2019 VA examination when granting the 10 percent rating for right hip limitation of extension effective from March 19, 2019; however, the March 2019 VA examination report does not show that right thigh extension was limited to 5 degrees. Rather, it shows normal right hip extension (i.e., to 0 degrees). Nonetheless, the Board will not disturb the award of disability benefits for limitation of right hip extension for the portion of the rating period from March 19, 2019, forward. For the foregoing reasons, the Board finds that an initial compensable rating under DC 5251 for the left hip disability is not warranted for the period. 3. An initial rating higher than 10 percent for right hip limitation of extension from March 19, 2019, forward, is denied. For the entire initial rating period from March 19, 2019, forward, right hip limitation of extension is rated at 10 percent under the criteria at 38 C.F.R. § 4.71a, DC 5003-5251 for degenerative arthritis with residual limitation of thigh extension. Under DC 5251 (limitation of extension of the thigh), a maximum 10 percent rating is provided for extension limited to 5 degrees. After review of all the lay and medical evidence of record, the Board finds that the evidence weighs against finding that the criteria for an initial rating higher than 10 percent under DC 5003-5251 for degenerative arthritis with residual limitation of right thigh extension from March 19, 2019, forward. For this portion of the rating period, right thigh extension ranged from normal (i.e., 0 degrees) to limited to 10 degrees. A 10 percent rating is the maximum schedular rating available under DC 5251 for limitation of thigh extension; therefore, a higher rating for limitation of right thigh extension under DC 5251 is not available on a schedular basis. 4. An initial rating of 20 percent, and no higher, for right hip limitation of abduction from May 9, 2012 to March 19, 2019 is granted. 5. An initial rating higher than 20 percent for right hip limitation of abduction from March 19, 2019 to January 29, 2020 is denied. Limitation of right hip abduction is rated at 10 percent from May 9, 2012 to March 19, 2019, and at 20 percent thereafter, under the criteria at 38 C.F.R. § 4.71a, DC 5253 for impairment of the thigh. Under DC 5253, pertaining to impairment of the thigh, a 10 percent rating is provided for limitation of adduction of the thigh such that the legs cannot be crossed, or limitation of rotation such that it is not possible to toe out more than 15 degrees with the affected leg. A 20 percent rating is provided for limitation of abduction with motion lost beyond 10 degrees. After review of the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether the criteria for a rating of 10 percent under DC 5253 for the right hip disability have been met from May 9, 2012 to March 19, 2019. As explained above, the July 2016 Memorandum Decision determined that the October 2012 VA examination for the hips was inadequate for rating purposes on the basis that it did not adequately address functional limitations during flare-ups. Later, in a May 2018 decision, the Board determined that the January 2018 VA examination also was inadequate for rating purposes because it did not adequately address functional limitations during flare-ups and did not comply with the requirements of Sharp, 29 Vet. App. at 34-36. In the August 2020 decision, the Board similarly determined that the March 2019 VA examination was inadequate on the basis that left hip flexion and extension testing was not performed due to the Veteran's refusal due to reported pain and did not provide estimations in those ranges of motion. Nevertheless, the March 2019 VA examination performed range of motion testing for the right hip, and it appears to have been conducted during a flare-up period as evidenced by then-recent steroid injections, so the Board finds that the March 2019 VA examination report may be considered in rating right hip impairment under DC 5253. The March 2019 VA examination report showed that right hip adduction was limited so that the Veteran could not cross the legs and the right hip demonstrated a limitation of abduction to 10 degrees, adduction to 10 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees during a flare-up and/or after repetitive use due to pain and fatigue. Because the right hip disability demonstrated limitation of abduction of the thigh with motion lost beyond 10 degrees, the February 2020 rating decision awarded a 20 percent rating under DC 5253 effective from March 19, 2019. Thus, resolving reasonable doubt in the Veteran's favor, a higher initial rating of 20 percent under DC 5253 for the right hip disability based on thigh impairment is also warranted for the portion of the rating period from May 9, 2012 to March 19, 2019. Regarding the portion of the initial rating period from March 19, 2019, forward, a 20 percent rating is the maximum schedular rating available under DC 5253 for right thigh impairment; therefore, a higher rating for right thigh impairment is not available on a schedular basis. 6. An initial rating higher than 10 percent for left hip degenerative joint disease based on limitation of left hip flexion from May 9, 2012 to March 1, 2021 is denied. For the entire initial rating period from May 9, 2012 to March 1, 2021 (excluding a temporary total rating period from January 29, 2020 to March 1, 2021), left hip flexion is rated at 10 percent under DC 5252 for limitation of thigh flexion. Although the assigned DC was 5252, the use of DC 5252 was an incorrect designation because the left hip disability did not actually manifest to a compensable (to 10 percent) degree of limitation of thigh flexion. The 10 percent rating was assigned based on findings of left hip pain with noncompensable limitation of motion, which is the substantive criteria for a 10 percent rating for arthritis of a major painful joint under DC 5003. Under DC 5003, degenerative arthritis established by X-ray findings will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under DC 5252 (limitation of flexion of the thigh), a 10 percent rating is provided for flexion limited to 45 degrees; a 20 percent rating is provided for flexion limited to 30 degrees; a 30 percent rating is provided for flexion limited to 20 degrees; and a 40 percent rating is provided for flexion limited to 10 degrees. After review of all the lay and medical evidence of record, the Board finds that the evidence weighs against finding that the criteria for an initial rating higher than 10 percent under DC 5003 for left hip flexion have been met or approximated from May 9, 2012 to March 1, 2021. During the time relevant to the initial rating period, the left hip disability was manifested by painful motion and left thigh flexion limited to 80 degrees or to a greater degree (i.e., noncompensable limitation of motion); therefore, an initial rating higher than 10 percent under DC 5003 or DC 5252 for the left hip disability is not warranted for any period. 7. An initial rating of 20 percent, and no higher, for left hip limitation of abduction from May 9, 2012 to March 19, 2019 is granted. 8. An initial rating higher than 20 percent for left hip limitation of abduction from March 19, 2019 to January 29, 2020 is denied. For the initial rating period from May 9, 2012 to March 19, 2019, left hip abduction is rated as noncompensable (0 percent) under the criteria at 38 C.F.R. § 4.71a, DC 5253 for impairment of the thigh. Under DC 5253, pertaining to impairment of the thigh, a 10 percent rating is provided for limitation of adduction of the thigh such that the legs cannot be crossed, or limitation of rotation such that it is not possible to toe out more than 15 degrees with the affected leg. A 20 percent rating is provided for limitation of abduction with motion lost beyond 10 degrees. After review of the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether the criteria for a rating of 10 percent under DC 5253 for the left hip disability have been met from May 9, 2012 to March 19, 2019. As explained above, the July 2016 Memorandum Decision determined that the October 2012 VA examination for the hips was inadequate for rating purposes on the basis that it did not adequately address functional limitations during flare-ups. Later, in a May 2018 decision, the Board determined that the January 2018 VA examination also was inadequate for rating purposes because it did not adequately address functional limitations during flare-ups and did not comply with the requirements of Sharp at 34-36. In the August 2020 decision, the Board similarly determined that the March 2019 VA examination was inadequate on the basis that left hip flexion and extension testing was not performed due to the Veteran's refusal due to reported pain and did not provide estimations in those ranges of motion. Nevertheless, the March 2019 VA examination performed range of motion testing for left thigh abduction, adduction, and rotation and appears to have been conducted during a flare-up period as evidenced by then-recent steroid injections, so the Board finds that the March 2019 VA examination report may be considered in rating left hip impairment under DC 5253. The March 2019 VA examination report showed that left hip adduction was limited so that the Veteran could not cross the legs and the left hip demonstrated a limitation of abduction to 10 degrees, adduction to 10 degrees, external rotation to 20 degrees, and internal rotation to 10 degrees during a flare-up and/or after repetitive use due to pain and fatigue. Because the left hip disability demonstrated limitation of abduction of the thigh with motion lost beyond 10 degrees, the February 2020 rating decision awarded a 20 percent rating under DC 5253 effective from March 19, 2019. Thus, resolving reasonable doubt in the Veteran's favor, a higher initial rating of 20 percent under DC 5253 for the left hip disability based on thigh impairment is also warranted for the portion of the rating period from May 9, 2012 to March 19, 2019. Regarding the portion of the initial rating period from May 9, 2012 to March 1, 2021, a 20 percent rating is the maximum schedular rating available under DC 5253 for left thigh impairment; therefore, a higher rating for left thigh impairment is not available on a schedular basis. 9. An initial disability rating of 50 percent, and no higher, for total left hip replacement from March 1, 2021, forward, is granted. For the portion of the initial rating period from March 1, 2021, the left hip disability is rated at 30 percent under the criteria found at 38 C.F.R. § 4.71a, DC 5054 for hip resurfacing or replacement (prosthesis). Under DC 5054, a 30 percent rating is the minimum rating provided when is total replacement only. A 50 percent rating is provided when there are moderately severe residuals of weakness, pain, or limitation of motion. A 70 percent rating is provided when there is markedly severe residual weakness, pain, or limitation of motion following implantation of the prosthesis. A 90 percent rating is provided following implantation of prosthesis with painful motion or weakness such as to require the use of crutches. A 100 percent rating is provided for four months following implantation of a prosthesis or resurfacing and for prosthetic replacement of the head of the femur or of the acetabulum. After review of the lay and medical evidence of record, the Board finds that the evidence is in equipoise on the question of whether the criteria for an initial 50 rating under DC 5054 for the left hip disability have been met for the period. Treatment records show that the Veteran underwent a total hip replacement in January 2020. At the April 2021 VA examination, the VA examiner opined that there were moderately severe residuals of weakness, pain, or limitation of motion, which is the level of disability consistent with the 50 percent schedular rating criteria. In consideration of the foregoing, and resolving reasonable doubt in the Veteran's favor, a higher initial rating of 50 percent under DC 5054 for total left knee replacement is warranted for the portion of the rating period from March 1, 2021, forward. A rating higher than 50 percent under DC 5054 for the total left hip replacement is not warranted for any period. After the January 2020 left hip replacement and convalescence period, the left hip disability was manifested by pain and clicking in the left hip, pain, and weakness with walking and physical activity limited range of motion but only to a noncompensable degree, regular use of a cane for ambulation without need for constant use or any other assistive device such as crutches or a wheelchair, and ability to cross the legs. VA treatment records relevant to this portion of the rating period show a successful left hip arthroplasty and include no findings to indicate that the left hip replacement was manifested by markedly severe residual weakness, pain, or limitation of motion following implantations of the prosthesis. Such a disability picture is consistent with the schedular criteria for a 50 percent rating. Additionally, after considering left hip symptoms and functional impairment demonstrated by the left hip disability following replacement, the April 2021 VA examiner specifically opined that the left hip disability demonstrated moderately severe residuals with weakness, pain, or limitation of motion, which is the level of disability contemplated by the 50 percent schedular rating criteria. For these reasons, the Board finds that a rating higher than 50 percent under DC 5054 for the total left hip replacement residuals is not warranted for any period. The Board finds that neither the Veteran nor the record has raised the issue of an extraschedular rating for the initial rating appeals. See Thun v. Peake, 22 Vet. App. 111 (2008); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.