Citation Nr: 21066591 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 17-48 032 DATE: November 1, 2021 ORDER A rating in excess of 10 percent for degenerative arthritis of the lumbar spine is denied. Service connection for tinnitus is denied. Service connection for prostatitis is denied. Service connection for residuals of a head injury is denied. Service connection for hypertension is denied. Service connection for a disability manifested by myopia is denied. Service connection for obstructive sleep apnea (OSA) is denied. Service connection for human immunodeficiency virus (HIV) is denied. Service connection for gout is denied. FINDINGS OF FACT 1. The Veteran had active duty from May 1972 to May 1975 and from March 1976 to June 1977; he has 100 percent disabled based on unemployability since December 2014 and 100 percent on a schedular basis since February 2016. 2. A lumbar spine disability has been manifested by subjective complaints of pain that worsened with movement; objective findings include forward flexion to be, at worst, 85 degrees, the combined range of motion of the thoracolumbar spine to be, at worst, 235 degrees, muscle spasm not resulting in abnormal gait or abnormal spinal contour, and no intervertebral disc syndrome (IVDS). 3. Tinnitus was not shown in service, not shown to a compensable degree within one year of service, symptoms not continuous since service, and is not causally or etiologically related to service. 4. Prostatitis was not shown during service; the current prostatitis is not causally or etiologically related to service. 5. Residuals of a head injury have not been shown during the appeal period. 6. Hypertension was not shown in service, was not continuous since service, was not shown to a compensable degree within one year of separation from service, was not shown for many years after service, and is not causally or etiologically related to service. 7. An eye disorder for VA compensation purposes was not shown in service. The currently-diagnosed myopia, astigmatism, cataracts, and right eye corneal linear scar, are not causally or etiologically related to service, to include any injury or event therein. 8. OSA was not shown in service and is not causally or etiologically related to service. 9. HIV was not shown in service and is not causally or etiologically related to service. 10. Gout was not shown in service, was not shown to a compensable degree within one year of service, and symptoms of gout were not continuous since service; the current diagnosis of gout is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for degenerative arthritis of the lumbar spine have not been met. 38 U.S.C. §§ 1110, 1131, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 5242 (2021). 2. Tinnitus was not incurred during service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2021). 3. Prostatitis was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2021). 4. Residuals of a head injury was not incurred in service. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2021). 5. Hypertension was not incurred in service and may not be presumed to have been incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2021). 6. A bilateral eye disorder was not incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131, 1137, 5103, 5103A, 5107 (2021); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2021). 7. OSA was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2021). 8. HIV was not incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38C.F.R. §§3.159, 3.303 (2021). 9. Gout was not incurred in service and is not presumed to have been incurred in service. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In July 2019, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Increased Rating For a Lumbar Spine Disability Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The lumbar spine disability has been rated at 10 percent under DC 5242. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Specifically, the amended regulations clarify that DC 5243 is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; assign DC 5242 for all other disc diagnoses. No other changes were made to the rating criteria for the spine. Under the applicable rating criteria, a 20 percent rating is warranted when the objective medical evidence shows: forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees (20 percent); combined range of motion of the thoracolumbar spine not greater than 120 degrees (20 percent); muscle spasms or guarding that is severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis (20 percent); incapacitating episodes of IVDS having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months (20 percent). Turning to the medical evidence, a June 2015 VA examiner noted that the Veteran reported worsening pain with weather changes and sleeping at night. He indicated that it was difficult to sleep at night because of joint pain in his arms, feet, legs and ankles. He indicated experiencing flare-ups which impacted movement, climbing stairs and walking. Range of motion testing revealed forward flexion to 85 degrees with objective evidence of pain at 85 degrees. Extension was to 30 degrees or greater with objective evidence of pain at 30 degrees or greater. Right and left lateral flexion was to 30 degrees or greater each without objective evidence of pain. Right and left lateral rotation was to 30 degrees or greater each without objective evidence of pain. Repetitive use testing was accomplished and there was no additional loss of function or range of motion after three repetitions. There was functional loss/impairment of the thoracolumbar spine resulting in less movement than normal, excess fatigability, pain on movement. There was localized tenderness or pain to palpation for joints and/or soft tissue of the thoracolumbar spine (back) which is further described as lumbar tenderness to palpation. On examination, there was no guarding or muscle spasm. There was no atrophy or ankylosis. Sensory examination was normal. There were no signs or symptoms of radiculopathy. The examiner indicated that the Veteran did not have IVDS. There was evidence of pain on passive range of motion. There was no evidence of pain when the joint was used in non-weight bearing. The remaining medical evidence does not show more severe lumbar spine symptoms. Based on the above, the medical evidence does not support a rating in excess of 10 percent. In this regard, the June 2015 VA examination measured the forward flexion at 85 degrees at worst, and found the combined range of motion of the cervical spine to be 235 degrees at worst. Additionally, the Veteran consistently did not have muscle spasms or guarding. Finally, the examinations revealed no IVDS. Accordingly, the medical evidence does not support a rating in excess of 10 percent. The Board has also considered the Veteran's lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's lumbar spine disability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which a lumbar spine disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by these disabilities and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is denied. Service Connection Claims Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Tinnitus Turning to the evidence, tinnitus was diagnosed in the July 2019 VA Disability Benefits Questionnaire (DBQ). Therefore, the first element of direct service connection is met. As to an in-service incurrence, the service treatment records (STRs) do not show complaints, diagnoses, or treatment for tinnitus, nor do the military personnel records (MPRs) document specific instances of in-service noise exposure. Rather, the Veteran's military occupational specialty (MOS) was an information specialist for his first period of service and his primary specialty was a legal clerk and secondary specialty was a journalist for his second period of service. Nonetheless, he reported on his July 2019 VA DBQ that he has noise exposure during parachute jump training during service. A veteran is competent to report that which he perceives through the use of his senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). As to nexus, a July 2019 VA examiner concluded that it was less likely than not that tinnitus was caused by or a result of military noise exposure. The examiner noted that the Veteran's hearing was normal throughout service. Further, he reasoned that there was a low probability of noise exposure as a journalist. The examiner indicated that there were no reports of tinnitus in service. Further, the examiner explained that the Veteran denied tinnitus as defined in the Dauman and Tyler (1992) cited in the Tinnitus Handbook (Tyler) and he reported transient ear noise that occurs in the general population without auditory damage or pathology. The examiner noted that the Veteran described the course of the tinnitus as occurring about 2 times per week with a duration of 30-90 seconds. The examiner further noted that occasional brief transient tinnitus was often associated with middle ear muscle spasms and the episodes were characterized by a tightening of the ear drum causing a "loss of hearing" or fullness in the ear prior to the onset of a high pitch ringing. She further explained that there was no clinical evidence that connected these episodes with auditory abnormality, hearing loss, or medications and that this transient ear noise was not consistent with noise-induced tinnitus and was less likely than not related to military noise exposure. There is no contradictory medical opinion. As such, the medical evidence does not support a nexus between tinnitus and in-service noise exposure. Tinnitus is recognized by VA as a "chronic disease" under 38 C.F.R. § 3.309(a); therefore, the presumptive provisions of 38 C.F.R. §§ 3.303(b), 3.307, and 3.309 apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). However, service connection for tinnitus is not warranted based on a chronicity during service or a continuity of symptomatology after service. While the July 2019 examiner diagnosed tinnitus, the examiner found no complaints, diagnoses, or treatment for tinnitus in service or within one year of separation from service. Further, the evidence does not document any complaint of tinnitus until he filed his claim for service connection in January 2015. The medical evidence first documents complaints of tinnitus at the July 2019 VA examination. Therefore, tinnitus was not shown until 2015, at the earliest, with documentation beginning in 2019. In light of the above, the medical evidence does not support service connection for tinnitus based on continuity of symptomatology. In sum, the medical evidence weighs against the claim for service connection under any theory of entitlement. Prostatitis As to a current diagnosis, a July 2019 VA male reproductive system conditions DBQ report reflected a current diagnosis of prostatitis and urinary dysfunction. Therefore, a current disorder is shown. A review of the STRs does not reflect any complaints, findings, or diagnosis of prostatitis. While the Veteran's claims that prostatitis began in 1972, there is no evidence of prostatitis in service. Further, the STRs including April 1972, November 1972, April 1975, January 1976, and May 1977 examination reports found normal clinical evaluation of genitourinary system and findings were negative for urine infections, painful urination, and blood in urine. Therefore, prostatitis was not noted in his STRs and the second element of direct service connection in-service incurrence has not been met. To the extent that the Veteran asserts a medical nexus between his prostatitis and service, the July 2019 VA examiner opined that the Veteran's prostatitis was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that there was no evidence of prostatitis during service and the first post-service medical treatment note regarding prostatitis was "biopsy in 2006 positive for chronic prostatitis" which was 29 years after the end of service. This evidence weighs against a medical nexus. As such, the medical evidence does not support the claim. Residuals of a Head Injury The Veteran maintains that service connection is warranted for residuals of a head injury because it is related to service. Specifically, he alleges that he had a head injury in-service along with other injuries during a difficult jump in 1972 that caused his current disorder. The Veteran filed his claim for service connection for residuals of a head injury in January 2015. During the appeal period, residuals of a head injury have not been shown. Specifically, an August 2019 VA Traumatic Brain Injury (TBI) examination report stated that the Veteran did not have a diagnosis of TBI or any residuals of a TBI and there was no other medical evidence that showed he had a current diagnosis of TBI. The August 2019 VA examiner, a physiatrist, took a full history from the Veteran and reviewed the claims file. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran's medical record was silent with regards to head injury or instance of TBI. Further, the examiner noted that the Veteran's reported an in-service head injury along with other injuries during a difficult jump in 1972 however, at this time he had no further symptom that was probably related to TBI. The Board places significant probative value on the examination and clinical records. The examination was adequate for evaluation purposes. Although the Veteran reported that he had head injuries in 1972 in service, the examiner conducted a physical examination of the Veteran and reviewed the claims file and determined that he was not diagnosed with a TBI or residuals of a TBI. Therefore, the medical evidence of record does not reflect a current diagnosis of any TBI, and no such diagnosis has been rendered at any time during the pendency of this appeal. See McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Thus, the evidence weighs against a finding that he has a current diagnosis of residuals of a head injury. In sum, the examination report and clinical records are of great probative value and the medical evidence weighs against the claim. Hypertension As an initial matter, the Veteran has not asserted that hypertension is secondary to a service-connected disability; therefore, secondary service connection is not for application. However, as cardiovascular-renal diseases are chronic diseases under 38 C.F.R. §§ 3.307 and 3.309(a), service connection based on continuity of symptomatology will be considered. Additionally, direct service connection will be addressed. The Veteran has been diagnosed with hypertension. Specifically, a July 2019 VA DBQ reflected a diagnosis of hypertension. Therefore, a current disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the STRs are silent as to any complaints, treatment, or diagnosis of hypertension, or related complaints. Further, the heart and vascular systems were found to be clinically normal, and the Veteran explicitly denied that he presently or previously had high or low blood pressure in his April 1975 (blood pressure was 128/64) and May 1977 (blood pressure was 120/70) separation examinations. This suggests that hypertension was not noted in service. This is further support that hypertension was not shown in service. The STRs contain no in-service diagnoses, complaints, or treatments for hypertension. Therefore, the second element of direct service connection in-service incurrence has not been met and the medical evidence does not support hypertension on a direct basis. To the extent that the Veteran asserts a nexus between hypertension and service, the July 2019 VA examiner opined that hypertension was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the first mention of hypertension was December 2000 where the Veteran denied signs and symptoms of hypertension. The examiner noted that the Veteran was diagnosed with hypertension many years after the end of service. Further, none of the post-service treatment records establish a connection between service and hypertension. Therefore, the record does not support the claim based on medical nexus. Turning to the one-year presumption, hypertension did not manifest to a compensable degree within a year of separation from service. In a July 2007 treatment note, the Veteran was diagnosed with hypertension which is well outside the one-year legal presumption for certain chronic diseases such as hypertension. Next, the record does not establish continuity of symptomatology. As noted above, the evidence shows that the Veteran's symptoms began as early as 2007, more than 30 years after his separation from service. Therefore, hypertension was not shown until 2007, with documentation beginning at the same time. In light of the above, the medical evidence is against the claim for service connection based on continuity of symptomatology and the appeal is denied on this basis. In sum, the medical evidence does not show that the Veteran experienced symptoms of hypertension in-service, that it manifested within one year of the Veteran's separation from service, or that continuity of symptomatology existed. Accordingly, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Bilateral Eye Disorder Initially, the Veteran has been diagnosed with myopia, astigmatism, cataracts, and right eye corneal linear scar. As a current disorder has been shown, the first element of service connection has been met. The April 1972 Report of Medical History indicated that the Veteran had worn glasses and his physical examination for service entrance indicated that he had defective vision. His physical examination for service entrance stated that his eyes, ophthalmoscopic tests, pupils, and ocular motility were all normal. The STRs reflect a history of frontal headaches and decreased distance vision in May 1975. The April 1975 separation examination for his first period of service showed a normal clinical evaluation of his head, eyes, ophthalmoscopic tests, pupils, ocular motility, and neurologic tests. For the second period of service, the January 1976 Report of Medical History indicated that the Veteran had worn glasses. His physical examination for service entrance stated that his eyes, ophthalmoscopic tests, pupils, and ocular motility were all normal. The STRs reflect routine eye examinations and replacement corrective lenses and a diagnosis of myopia in May 1977. The May 1977 separation examination showed a normal clinical evaluation of his head, eyes, ophthalmoscopic tests, pupils, ocular motility, and neurologic tests. On the Report of Medical History, he indicated that he did not have eye trouble, neuritis, paralysis, epilepsy or fits, or periods of unconsciousness. Therefore, none of the current eye disorders were noted in the STRs. To the extent that the Veteran claims a vision defect such as astigmatism and myopia, these are not considered "diseases or injuries" within the meaning of applicable legislation and, hence, do not constitute disabilities for VA compensation purposes. See 38 C.F.R. §§ 3.303(c). As to the remaining vision-related claims (including the cataracts and right eye corneal linear scar), the evidence does not reflect an in-service incurrence or injury. This finding is supported by the fact that he sought treatment for a myriad of other medical complaints and underwent routine eye examinations, but never mentioned symptoms associated with cataracts or right eye corneal linear scar. Therefore, lay statements as to an in-service vision or an eye disorder are assigned less probative value. As the second element (in-service incurrence) is not demonstrated with respect to the remaining eye/vision claims, the appeal for service connection on these issues is denied. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred). To the extent that the Veteran asserts a medical nexus between service and current diagnosis, the July 2019 VA examiner opined that it was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner noted that the Veteran had myopia when he entered service and myopia and astigmatism were developmental errors of refraction unrelated to any in service event, disease or trauma. Further, the examiner explained that the Veteran's cataracts were age related and had no relationship to any in service events. He indicated that the Veteran's right eye corneal linear scar was an incidental finding with unknown history and there were no findings in the medical record of etiology of corneal linear scar. Moreover, there was no other VA or private medical opinion that alleged any etiological connection between service and the Veteran's current disability. As such, the third element is not met, the medical evidence weighs against finding a nexus and does not support service connection on a direct basis. Obstructive Sleep Apnea As to current diagnosis, the Veteran has been diagnosed with OSA. Specifically, the July 2019 VA examiner diagnosed OSA, excessive daytime sleepiness, exogenous obesity, contributory to obstructive sleep disorder syndrome. Further, an August 2019 sleep study diagnosed OSA, excessive daytime sleepiness, exogenous obesity, contributory to obstructive sleep disorder syndrome. Therefore, a current disorder has been shown and the first element of service connection has been met. As to in-service incurrence, a review of the STRs reveals that there were no complaints related to sleep apnea. Further, he was found to be neurologically normal and he asserted that he did not have frequent trouble sleeping in this he 1975 and May 1977 separation examinations. This suggests that sleep apnea was not noted in service. The STRs contain no in-service diagnoses, complaints, or treatment for sleep apnea. Therefore, the second element of direct service connection in-service incurrence has not been met. To the extent that the Veteran asserts a nexus between his sleep apnea and service, the July 2019 VA examiner opined that the Veteran's sleep apnea was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner indicated that the Veteran's exogenous obesity contributed to OSA. Therefore, the record does not support the claim based on medical nexus. In sum, the medical evidence does not show that the Veteran experienced symptoms of OSA in-service or established a medical nexus between his service and his current OSA. Therefore, the preponderance of the evidence is against the claim and there is no doubt to be otherwise resolved. As such, the appeal is denied. HIV Turning to the evidence, the first element of direct service connection a current disability is met. Specifically, the July 2019 HIV DBQ examiner and multiple medical treatment notes diagnosed HIV. As such, a current diagnosis has been shown and the first element of service connection has been met. As to an in-service incurrence, STRs are silent for any complaint of or treatment for HIV or symptoms attributed to it. The April 1975 and May 1977 separation examinations were silent for HIV. However, it is reasonable to assume that HIV was not recognized in the 1970s, the absence of in-service manifestations is not dispositive of the issue. To the extent the Veteran asserts a nexus between HIV and service, the medical evidence does not support such a contention. In this regard, the July 2019 VA examiner found that it was less likely than not that HIV was caused by service. The examiner reasoned that the Veteran was diagnosed with HIV in May 2008 many years after the end of service. VA and private treatment notes have been reviewed and are generally reflective of continuous treatment for HIV since initial diagnosis but offer no statements as to medical nexus. Therefore, the medical evidence does not support a nexus between current diagnosis of HIV and service. Gout Turning to the evidence, the first element of direct service connection a current disability is met. Specifically, the July 2019 DBQ examiner and multiple medical treatment notes diagnosed gout. As such, a current diagnosis has been shown and the first element of service connection has been met. As to in-service incurrence, STRs reflect no complaints related specifically to gout or symptoms attributed to it. The April 1975 and May 1977 separation examinations were silent for gout or any symptoms reasonably attributed to it. As such, the second element of service connection is not met for gout and the evidence does not support direct service connection. To the extent the Veteran asserts a nexus between his current disorder and service, the medical evidence does not support such a contention. In this regard, the July 2019 VA examiner found that it was less likely than not that gout was caused by service. The examiner noted that the first mention of gout in the medical records was in 2003, many years after the end of service. VA and private treatment notes have been reviewed and are generally reflective of continuous treatment for gout since initial diagnosis but offer no statements as to medical nexus. As a result, direct service connection is not warranted. Next, gout is a form of arthritis and presumptive service connection will be considered. However, the medical evidence does not show that gout was manifested to a compensable degree within one year of service or that symptoms were continuous since service. Of note, gout was not recorded or diagnosed until 2007, more than 32 years after separation from service. Therefore, the medical evidence does not support presumptive service connection. The Board has considered the Veteran's lay statements this his disorders were caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Grzeczkowicz 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.