Citation Nr: 21063963 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 14-22 573 DATE: October 18, 2021 ORDER Entitlement to service connection for migraine headaches, to include as a neurobehavioral effect due to exposure to contaminated water at Camp Lejeune, is denied. Entitlement to service connection for an esophageal disorder, to include as due to exposure to contaminated water at Camp Lejeune and/or as due to the Veteran's service-connected right knee disorder, is denied. Entitlement to service connection for a stroke disorder or residuals thereof, to include as due to exposure to contaminated water at Camp Lejeune, is denied. REMANDED Entitlement to service connection for Wegener's granulomatosis, to include as a neurobehavioral effect due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to service connection for unspecified anxiety disorder, to include as a neurobehavioral effect due to exposure to contaminated water at Camp Lejeune, is remanded. Entitlement to an evaluation in excess of 20 percent for right knee patellofemoral disease with medial synovial plica, prior to April 1, 2021, is remanded. Entitlement to an evaluation in excess of 10 percent for right knee patellofemoral disease with medial synovial plica, since April 1, 2021, including whether the rating reduction for this disability, from 20 percent to 10 percent, effective April 1, 2021, was proper, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran's migraine headaches are not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease, to include as due to exposure to contaminated water at Camp Lejeune. 2. The preponderance of the evidence is against finding that the Veteran's esophageal disorder, diagnosed as gastrointestinal reflux disease (GERD), Barrett's esophagus, and esophageal strictures, began during active service, or is otherwise related to an in-service injury or disease, including as due to exposure to contaminated water at Camp Lejeune; or was secondary to the Veteran's service-connected right knee disability. 3. The preponderance of the evidence is against finding that the Veteran's strokes or residuals thereof began during active service, or are otherwise related to an in-service injury or disease, including as due to exposure to contaminated water at Camp Lejeune. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for migraine headaches, to include as a neurobehavioral disorder due to exposure to contaminated water at Camp Lejeune, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for an esophageal disorder, to include as due to exposure to contaminated water at Camp Lejeune, and/or due to his service-connected right knee disability, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 3. The criteria for entitlement to service connection for a stroke disorder or residuals thereof, to include as due to exposure to contaminated water at Camp Lejeune, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from June 1986 to December 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 2014 and October 2014 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2016, the Veteran testified before a Veterans Law Judge who is no longer with the Board. A transcript of this hearing is of record. In June 2021, the Veteran was informed of this fact and offered the opportunity to testify at a new hearing. No request for a new hearing has been received. See 38 C.F.R. § 20.700. In April 2018, the Board remanded this matter for additional evidentiary development. The RO subsequently obtained updated treatment records and a best available copy of the Veteran's service treatment and service personnel record files. Moreover, the RO has obtained new examinations, along with medical opinions, concerning the issues being adjudicated herein. Accordingly, the Board finds these actions to be in substantial compliance with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that substantial, rather than strict, compliance with remand directives is required). For the sake of clarity, the Board has listed the Veteran's claimed neurobehavioral disorders as three separate issues. Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). VA has acknowledged that persons residing or working at Camp Lejeune from August 1953 through December 1987 were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). See Veterans Benefits Administration (VBA) Fast Letter 11-03 (Revised) (January 28, 2013). In the early 1980s, it was discovered that two on-base water-supply systems were contaminated with volatile organic compounds (VOCs) trichloroethylene (TCE), a metal degreaser, and perchloroethylene (PCE), a dry-cleaning agent. Benzene, vinyl chloride, and other VOCs were also found to be contaminating the water-supply systems. See VBA Training Letter 11-03 (Revised) (November 29, 2011). Accordingly, VA now essentially presumes that, absent evidence to the contrary, benefits claimants who served at Camp Lejeune between 1953 and 1987 were potentially exposed to the range of chemicals that contaminated the water there. Id. at 6. Effective March 14, 2017, VA amended its adjudication regulations, 38 C.F.R. §§ 3.307 and 3.309, regarding presumptive service connection, adding certain diseases associated with contaminants present in the base water supply at Camp Lejeune. The final rule establishes that veterans who served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) during this period, and who have been diagnosed with any of eight associated diseases (adult leukemia, aplastic anemia and other myelodysplastic syndromes, bladder cancer, kidney cancer, liver cancer, multiple myeloma, Non-Hodgkin's lymphoma, and Parkinson's disease) are presumed to have incurred or aggravated the disease in service for purposes of entitlement to VA benefits. VA has also recognized a relationship between esophageal cancer and/or neurobehavioral effects and contaminated water at Camp Lejeune, at least for treatment purposes. See 38 C.F.R. § 17.400. Thus, service connection for these disabilities may be granted on a presumptive basis for purposes of treatment only. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2016); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for migraine headaches, to include as a neurobehavioral effect due to exposure to contaminated water at Camp Lejeune. The Veteran that he that he has migraine headaches related to his inservice exposure to contaminated water while stationed at Camp Lejeune. The Veteran has a current diagnosis of migraine headaches as evidenced by his VA examinations and treatment reports. Migraine headaches, as an organic disease of the nervous system, are an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the Veteran's migraine headaches are not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and are not noted in service with attributable continuity of symptomatology. Post service treatment records do not show complaints of headaches until January 2010, 10 years after his separation from service, and 9 years outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of headaches during and consistently since military service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of migraine headaches as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires knowledge of organic diseases of the nervous system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board gives more probative weight to competent medical evidence of record. The September 2020 VA examiner opined that the Veteran's migraine headaches were less likely than not incurred in or caused by his active service. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner also considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted that the Veteran had only acute headaches during service, and that he denied having headaches during service in June 1985 and June 1986, and post service in April 1990 and September 2005. The VA examiner further stated that the Veteran's first documented post service complaint of headaches was not until several years after his military service had ended. The May 2020 VA examiner opined that the Veteran's migraine headaches are less likely as not cause by or as a result of the Veteran's exposure to contaminated water while at Camp Lejeune. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner also considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted the lack of chronic migraine headaches having been shown during service, and the lack of any ongoing medical treatment for headaches for years thereafter. The VA examiner also cited medical literature suggesting that neurobehavioral effects in adults resulting from exposure to contaminated water at Camp Lejeune are unlikely to require treatment at a much later time period. The Board finds this opinion to be both adequate and probative, as it responded directly to the questions posed by the Board, contains a well-reasoned rationale, and had specific notations to the Veteran's claims file. While the Veteran is competent to report experiencing consistent symptoms of headaches since service, the Board finds the reports of continuity of symptomatology not credible. The Veteran's reports are internally inconsistent with his reports in contemporaneous treatment records, which show that he denied experiencing headaches during service in June 1985 and June 1986, and post-service in April 1990 and September 2005. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Further, while the Veteran asserts that the reported symptoms of headaches were manifestations of migraine headaches, he is not competent to determine that these symptoms were manifestations of migraine headaches specifically (as opposed any other type of headache) as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex. Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the preponderance of the evidence is against the Veteran's claim for service connection for migraine headaches, to include as a neurobehavioral effect due to exposure to contaminated water at Camp Lejeune. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for an esophageal disorder, to include as due to exposure to contaminated water at Camp Lejeune and/or as due to the Veteran's service-connected right knee disability. The Veteran contends that he developed an esophageal disorder due to his inservice exposure to contaminated water while at Camp Lejeune. Alternatively, the Veteran attributes this condition to the use of nonsteroidal anti-inflammatory (NSAID) drugs used to treat his service-connected right knee disability. The Board concludes that, while the Veteran has current diagnoses of GERD, Barrett's esophagus, and esophageal strictures, as evidenced by his post service treatment records, the preponderance of the evidence weighs against finding that the Veteran's esophageal disability began during service or is otherwise related to an in-service injury, event, or disease, to include as due to exposure to contaminated water at Camp Lejeune and/or as due to medications used in treating the Veteran's service-connected right knee disability. The September 2020 VA examiner opined that the Veteran's esophageal disorder, diagnosed as GERD, Barrett's esophagus, and esophageal stricture, are less likely than not incurred in or caused by his military service. In rendering this opinion, the VA examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner also considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted that there was no chronic esophageal disorder shown during service, or for years thereafter. The VA examiner also noted that the Veteran's post service treatment records do not show any findings of GERD, Barrett's esophagus, or esophageal strictures until several years after his separation from service; and that the Veteran's post service treatment records document findings of elevated body mass index scores indicating obesity and also alcohol consumption, which are risk factors for peptic stricture formation. The June 2020 VA examiner opined that the Veteran's esophageal disorder, including GERD, Barrett's esophagus, and esophageal strictures, are less likely as not caused by or as a result of the Veteran's exposure to contaminated water while at Camp Lejeune. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner also considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted that the Veteran is not shown to have a confirmed diagnosis of esophageal cancer. Moreover, the Veteran is shown to have several risk factors, including tobacco use, alcohol use, and obesity, which most likely caused his GERD, which subsequently promoted the development of his Barrett's esophagus. Finally, the VA examiner noted that it was highly unlikely that these conditions caused the Veteran's esophageal disabilities given the length of time from inservice exposure to development of these conditions. The March 2021 VA examiner opined that the Veteran's esophageal disorder, including GERD, Barrett's esophagus, and esophageal strictures, are less likely as not caused by or as a result of the Veteran's use of NSAID drugs to treat his service-connected right knee disability. In support of this opinion, the VA examiner noted that a review of medical literature failed to demonstrate a causal relationship between the Veteran use of NSAIDs and his esophageal disorder. Moreover, the VA examiner noted that the Veteran has multiple risk factors that can caused and/or aggravate his GERD, Barrett's esophagus, and esophageal strictures. Post service treatment records show the Veteran was not diagnosed with any esophageal disorder until the August 2008 diagnosis of esophageal stricture, over 8 after his separation from service. While the Veteran is competent to report having experienced symptoms of heartburn intermittently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a chronic esophageal disorder incurred during service or aggravated by his use of NSAIDs. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, it is outside the competence of Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Consequently, the Board gives more probative weight to the VA examiners' opinions in June 2020, September 2020, and March 2021. Accordingly, the preponderance of the evidence is against the Veteran's claim for service connection for esophageal disorder, to include as due to exposure to contaminated water at Camp Lejeune and/or as due to medications used in treating the Veteran's service-connected right knee disability. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert, 1 Vet. App. at 49. 3. Entitlement to service connection for a stroke disorder or residuals thereof, to include as due to exposure to contaminated water at Camp Lejeune. The Veteran contends that he had strokes in 2010 and 2012 due to his inservice exposure to contaminated water while at Camp Lejeune. The Board concludes that, while the Veteran has current residuals of stroke, as evidenced by his January 2010 MRI of the brain showing a 6 millimeter lesion in the right striatum which likely represents and area of subacute infarction, the preponderance of the evidence weighs against finding that the Veteran's strokes, or residuals thereof, began during service or are otherwise related to an in-service injury, event, or disease, to include as due to exposure to contaminated water at Camp Lejeune. The September 2020 VA examiner opined that the Veteran's stroke or residuals thereof are less likely than not incurred in or caused by his military service. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted that there was no evidence of a stroke shown during service or for more than two decades thereafter in 2010. The VA examiner also noted that multiple stroke risk factors are listed throughout the Veteran's post service treatment records, including a history of smoking, hypertension, and hyperlipidemia, and that these risk factors for stroke are more likely than not the cause of the Veteran's stokes, not his military service. The June 2020 VA examiner opined that the Veteran's strokes and/or residuals thereof, are less likely as not cause by or as a result of the Veteran's exposure to contaminated water while at Camp Lejeune. In rendering this opinion, the examiner considered the evidence of record, including the Veteran's statements, prior to forming this opinion. The examiner further considered the Veteran's prior physical examinations and treatment records, and also supported the opinion provided with a sufficient rationale. The VA examiner noted that a stroke is not listed as a condition having any association with exposure to contaminated water at Camp Lejeune. The VA examiner also noted that it was highly unlikely that the Veteran's stroke would be related to his inservice exposure contaminated water over two decades earlier. Post service treatment records show the Veteran was not treated for or diagnosed with a stroke until 2010, over two decades after his separation from service. While the Veteran is competent to report having experienced symptoms related to his eyesight and physical coordination since service, he has not made any such allegations in this case. Moreover, he is not competent to provide a diagnosis in this case or determine that any symptoms he has had were manifestations of a stroke. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiners' opinions in June 2020 and September 2020. Accordingly, the preponderance of the evidence is against the Veteran's claim for service connection for stroke or residuals thereof. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not for application. Gilbert, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for Wegener's granulomatosis, including as a neurobehavioral disorder due to exposure to contaminated water at Camp Lejeune. 2. Entitlement to service connection for unspecified anxiety disorder, including as a neurobehavioral disorder due to exposure to contaminated water at Camp Lejeune. The Veteran contends that that his Wegener's granulomatosis and unspecified anxiety disorder are neurobehavioral effects, related to his exposure to contaminated drinking water at Camp Lejeune. VA has recognized a relationship between neurobehavioral effects and contaminated water at Camp Lejeune, at least for treatment purposes. See 38 C.F.R. § 17.400. Although diagnosed with Wegener's granulomatosis and an unspecified anxiety disorder in an October 2020 VA examination for mental disorders, a medical opinion has not been obtained addressing whether these conditions constitute a neurobehavioral effect and/or whether either condition is related to the Veteran's military service. Moreover, the October 2020 VA examiner noted that further neurological/medical evaluations would be beneficial to address these issues. Given the presumptive relationship between neurobehavioral effects and contaminated water at Camp Lejeune, at least for treatment purposes, a VA examination and medical opinion is necessary to properly adjudicate these issues. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 3. Entitlement to an evaluation in excess of 20 percent for right knee patellofemoral disease with medial synovial plica, prior to April 1, 2021. 4. Entitlement to an evaluation in excess of 10 percent for right knee patellofemoral disease with medial synovial plica, since April 1, 2021, including whether the rating reduction for this disability, from 20 percent to 10 percent, effective April 1, 2021, was proper. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the proper evaluation of the Veteran's right knee patellofemoral disease with medial synovial plica. Specifically, the August 2020 VA examination of the right knee does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The August 2020 VA examination report does do not contain passive range of motion measurements for the right knee. Thus, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board also notes that regulations used in evaluating musculoskeletal system and muscle injuries have recently been amended. These amendments should be considered in readjudicating these issues. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5257). 5. Entitlement to a TDIU. Finally, because a decision on the remanded issues above could significantly impact a decision on the issue entitlement to TDIU, the issues are inextricably intertwined. A remand of the TDIU claim is also required. The matters are REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his right knee disability and claimed neurobehavioral effects, diagnosed as Wegener's granulomatosis and unspecified anxiety disorder. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Schedule the Veteran for a VA examination to identify any current neurobehavioral effects found, to include a determination as to whether the Veteran's current Wegener's granulomatosis and/or unspecified anxiety disorder constitutes a neurobehavioral effect. The VA examiner should also provide an opinion as to the likely etiology of the Veteran's Wegener's granulomatosis and unspecified anxiety disorder and any neurobehavioral effects identified. On review of the record, and acknowledging that the Veteran was exposed to contaminated water at Camp Lejeune during service, the VA examiner should: (a.) Identify all neurobehavioral effects the Veteran exhibits. (b) Provide an opinion as to whether the Veteran's current Wegener's granulomatosis and/or unspecified anxiety disorder constitute a neurobehavioral effect. (c.) Identify the likely etiology for each identified neurobehavioral effect. Specifically, is it at least as likely as not (a 50% or greater etiology) that it is etiologically related to his service, to include as due to exposure to contaminated water at Camp Lejeune? The examiner must acknowledge and discuss that VA recognizes, at least for treatment purposes, that there may be a relationship between neurobehavioral effects and expo (d.) Identify the likely etiology of the Veteran's Wegener's granulomatosis and unspecified anxiety disorder. Specifically, is it at least as likely as not (a 50% or greater etiology) that it is etiologically related to his service, to include as due to exposure to contaminated water at Camp Lejeune? (e.) If a neurobehavioral effect found is determined to be unrelated to the Veteran's service, to include as due to exposure to contaminated water therein, identify the etiology for the disability that is considered to be more likely (and explain why that is so). All opinions must include rationale; the rationale must include consideration of the Veteran's contentions in support of his claim. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right knee patellofemoral disease with medial synovial plica. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Following the above, the RO should readjudicate the issues remaining on appeal, with consideration as appropriate of recent amendments to the regulations used in evaluating musculoskeletal system and muscle injuries. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). If any benefit sought is not granted, the appellant and his representative are to be furnished an SSOC and given the requisite opportunity to respond before the case is returned to the Board. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. Yates, 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.