Citation Nr: 21075863 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 19-36 736 DATE: December 21, 2021 ORDER Entitlement to service connection for degenerative arthritis of the lumbar spine is granted. Entitlement to service connection for right lower extremity radiculopathy, secondary to service-connected degenerative arthritis of the lumbar spine, on a causation basis, is granted. Entitlement to service connection for degenerative arthritis of the cervical spine is granted. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether the Veteran's degenerative arthritis of the lumbar spine is related to service. 2. The Veteran's right lower extremity radiculopathy is caused by his now service-connected degenerative arthritis of the lumbar spine. 3. The evidence is at least evenly balanced as to whether the Veteran's degenerative arthritis of the cervical spine is related to service. CONCLUSIONS OF LAW 1. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for degenerative arthritis of the lumbar spine have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for right lower extremity radiculopathy, secondary to service-connected degenerative arthritis of the lumbar spine on a causation basis, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for degenerative arthritis of the cervical spine have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Navy on active duty from July 1959 to May 1963. This case comes to the Board of Veterans Appeals (Board) from a January 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which, in relevant part, denied a petition to reopen a previously denied service connection claim for degenerative joint disease and service connection for osteoarthritis of the neck. This case has been before the Board multiple times, most recently in April 2021. The requested development has been completed to the extent possible, and the case has returned to the Board for review. 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, air, or space service. 38 U.S.C. § 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). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected; if a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required. Entitlement to service connection based on chronicity or continuity of symptomatology pursuant to 38 C.F.R. § 3.303(b) applies only when the disability for which the Veteran is claiming compensation is due to a disease enumerated on the list of chronic diseases in 38 U.S.C. § 1101(3) or 38 C.F.R. § 3.309(a), which includes arthritis or degenerative spine disease. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, such chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307(a), 3.309(a). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Lumbar spine disability Service treatment records (STRs) from May 1960 reflect that the Veteran sought treatment for back pain. The clinician diagnosed lumbar strain and included illegible comments. The Veteran received medication. April 1963 separation examination showed that the Veteran's spine was clinically examined and deemed normal. A one inch left lumbar scar was noted. November 2000 private medical records reported that the Veteran sought treatment for severe low back pain radiating to his right leg. The physician noted that the Veteran did not have any history for disk disease. Physical examination was unremarkable. The physician assessed lumbar disk syndrome with right sciatica and rule out herniated disk. October 2001 private medical records referenced that a magnetic resonance imaging (MRI) study, which confirmed degenerative lumbar disk disease. July 2009 VA primary care records showed that the Veteran had an initial consultation. The Veteran reported a history of chronic low back pain and osteoarthritis. Physical examination was unremarkable. The clinician assessed osteoarthritis and low back pain and issued medication. In August 2016, the Veteran stated that his low back problems started shortly after boot camp. He was assigned to a crash and salvage unit. He was ordered to pull long iron hooks back to their proper place on the runway after a jet had an emergency landing. The chains were huge and usually pulled back to their original location by tractors. However, the tractor equipment was broken, and the task had to be completed manually. It took a significant amount of time. The Veteran recalled developing low back pain and eventually falling on his knees. After the task was finished, he visited the sick bay. He was told to take pain relief medication and that he was stable. However, he had back and neck problems ever since then. He had taken a great deal of medication and wanted to avoid surgery. In September 2016, the Veteran's son furnished a statement in support of the claim. He reported that throughout his life his father, the Veteran, had severe back and neck problems. The Veteran informed him about that he sustained an in-service injury when he worked with an aircraft crash recovery unit. The Veteran also told him he did not seek medical attention in service due to his young age and fear of reprisal. In September 2016, the Veteran's wife also furnished a statement in support of the claim. She met the Veteran shortly after separation in July 1963. Throughout the time she had known him, he had severe back and neck problems. She recounted the same injury and medical treatment history as the son did in the above noted report. July 2017 VA treatment records showed that the Veteran reported initially injuring his back during military service. He had a low back pain treatment regimen. In his October 2017 notice of disagreement (NOD), the Veteran reported that his back injury plagued him his entire life by limiting his mobility and causing severe pain. He stated that Dr. W informed him it was more likely than not that his back pain was related to military injuries. In September 2019, the Veteran had a VA back examination with a nurse practitioner (NP). She diagnosed multilevel degenerative changes, lumbar spine. The Veteran reported injuring his back in 1960 during military service when he had to move a large heavy chain. He recalled a 'snapping' sensation. He had had back pain ever since then. He took pain medication. He occasionally had shooting pain to his right leg. Clinical findings for the lumbar spine were detailed. Radiculopathy was not found. The NP furnished a negative medical opinion. She noted the military injury reports and 1960 STRs showing treatment for lumbar strain. However, there were no other medical records until November 2000, over 35 years following service. She stated that there was lack of medical evidence to suggest a chronic back condition existed during military service. She assessed the military lumbar strain as self-limiting. In November 2019, the Veteran reported that he was initially injured in 1960. Later that year, he was transferred to a ship. He often visited the ship's sick bay for back pain. He received medication, but the nurse told him he would have learn to self-manage the pain. He stated that most of them he would not even sign in for sick bay treatment. He did not report his back injury at separation because the ship nurse's comments. He experienced back pain for many years and started taking prescription strength medication around 1999. In December 2020, the Veteran had a VA-contract examination with a NP. She diagnosed degenerative arthritis of the spine. She noted the Veteran's reports about an in-service back injury while lifting heavy chains and that he had ongoing back pain since then. Physical findings were detailed. Right lower extremity radiculopathy was noted. The NP furnished a negative medical opinion. She stated that the in-service back condition was acute. There was no evidence of a chronicity of care and the symptoms were subjective. She also stated that the diagnostic information were consistent with age-related degenerative changes and did not correlated with the lumbar strain incurred in service. In June 2021, another VA-contract medical opinion was obtained from a physician based upon review of the entire claims folder. He furnished a negative medical opinion. He stated that there was no evidence of an acute back condition in service and the separation examination was negative. He reported that it was highly unlikely a significant back condition would have gone unreported. He stated there was no evidence of a back condition until 2015. The degenerative spine disease was natural occurring and age appropriate at time of diagnosis. It was more likely that the spine degeneration was represented a naturally occurring, age appropriation condition. He cited medical evidence showing that half of male patients over age 50 have evidence of degenerative spine disease. In August 2021, the same physician issued an addendum to his June 2021 VA-contract medical opinion. He reviewed specific contentions by the Veteran. As to the Veteran's contention that he experienced back pain since service, the physician referenced his initial medical opinion and found that the medical evidence did not support the Veteran's reports. He rejected the reportedly positive medical opinion from Dr. W. as being based solely on the Veteran's self-reported history. As to the Veteran's reported fear of reprisal for seeking medical attention during service, the physician dismissed since it was unlikely to occur for a significant back injury and there would be no reprisal at separation. As to the Veteran's spouse and son's reports about frequent sick call visits, he dismissed it as not being supported by documentation. As to the spouse's report about longstanding back pain shortly after separation, he referenced his prior responses about such a condition not being supported by documented medical care. He stated that the pathophysiology is such that they developed due to normal aging. In the November 2021 brief, the representative challenged the June 2021 and August 2021 VA-contract medical opinions. He noted that following service the Veteran likely had to pay for any doctor visit and this was a factor for why he did not receive medical treatment for many years following service. The representative also asserted a Report of Medical History was always completed at separation and the document's absence indicated the STRs were incomplete. He observed that in general it was the military culture to avoid sick calls and that it in his experience it was difficult to receive an actual examination for any medical problems. He challenged the VA-contract physician's medical literature citations. He noted Centers for Disease Control (CDC) reports showing that significant younger age populations had arthritis. Furthermore, a VA publication reported arthritis as an occupational disease for Veterans. Another VA publication advised that osteoarthritis was more common in Veterans than the general population and exertive military activities may be a contributing factor for Veterans' increased risk of developing osteoarthritis. Another CDC report corroborated the VA's findings for increased osteoarthritis risk for Veterans. For the following reasons, service connection for degenerative arthritis of the lumbar spine is warranted. The disputed issue is whether there is a relationship between service and the currently diagnosed degenerative arthritis of the lumbar spine. The Veteran is competent to report about his physical activities in service and history of back pain since it is readily observable. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). He reports sustaining a back injury when he pulled an extremely heavy chain on a runway that was used to assist with emergency aircraft landings. He had experienced back pain ever since then. He visited sick call but was told there was no available treatment other than pain medication. He was afraid to further pursue treatment due to reprisal. STRs from May 1960 note lumbar strain and current imaging studies confirm lumbar spine degenerative disease. The separation examination included normal clinical findings, but as noted by the representative the accompanying medical history report is unavailable and it is possible the Veteran would have reported back pain. There is no other evidence affirmatively conflicting with the Veteran's and other lay reports that he had longstanding low back pain starting in service. The Veteran's reports are entitled to probative weight in showing a continuity of symptomatology for degenerative arthritis of the lumbar spine beginning in service. The VA and VA-contract medical opinions weigh against the claim. In essence, these clinicians reject the Veteran's reports about continuous low back pain symptoms beginning in service due to an absence of medical treatment and the age related nature of current degenerative arthritis of the lumbar spine. The June 2021 physician explained that he found it highly unlikely a significant back condition would have been unreported for decades. Although the VA and VA-contract clinicians implicitly make a negative credibility determination about continuous low back pain symptoms since service, the Board is responsible for the ultimate credibility determination. Miller v Wilkie, 32 Vet. App. 249, 259 (2020). In this case, rejecting the Veteran's symptom reports substantially relies on the supposition that an absence of medical treatment equates to nonexistence of symptoms. The representative provided several reasons why there are no reports of medical treatment for back pain during and after service. Additionally, the Board is not permitted to reject the Veteran's otherwise competent symptom reports solely on an absence of contemporaneous treatment. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The representative also challenged the age-related determination by the VA-contract physician. He identified arthritis studies by the CDC and VA that conflicted with the physician's determination that the Veteran's degenerative arthritis of the lumbar spine was simply an age-related disorder. His arguments present another limitation to the rationale from the VA and VA-contract medical opinions. With this background and the representative's arguments in particular, the Board does not find the VA and VA-contract medical opinions persuasive to weigh against a continuity of symptomatology for back pain. The Board could remand the claim for another medical opinion, but a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim"). For the foregoing reasons, the evidence of a relationship to service for degenerative arthritis of the lumbar spine is in a state of relative equipoise. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for degenerative arthritis of the lumbar spine is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; See Buchanan, 451 F.3d at 1335 (lay evidence may be sufficient in and of itself to substantiate a service connection claim). Right lower extremity lumbar radiculopathy While the Veteran has not filed a claim of service connection for lower extremity radiculopathy, the Court has indicated that such claims can be adjudicated by the Board even in the absence of explicit AOJ adjudication. Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) (38 C.F.R. § 3.155(d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal). As relevant, October 2018 VA treatment records indicate that the Veteran was treated for lumbar spine with radiculopathy affecting his right leg. The December 2020 VA-contract examination notes right lower extremity radiculopathy as part of the physical findings from the lumbar spine examination. While there is no clear and direct opinion that the Veteran's right lower extremity radiculopathy is caused by his now service-connected lumbar spine disability, the diagnoses noted above in the October 2018 VA treatment records and December 2020 VA-contract examination report in essence support the conclusion that he has current right lower extremity radiculopathy which is caused by his now service-connected lumbar spine disability. See also 38 C.F.R. § 4.71a, Diagnostic Code 5242, Note 1. For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's right lower extremity radiculopathy was caused by his service-connected lumbar spine disability. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right lower extremity radiculopathy, secondary to service-connected degenerative arthritis of the lumbar spine, on a causation basis, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Cervical spine disability STRs do not show any complaints or treatment regarding the cervical spine. The April 1963 separation examination showed that the Veteran's spine was clinically examined and deemed normal. The Report of Medical History is not of record. March 1990 private medical records reported that the Veteran had a history of cervical spine osteoarthritis. The clinician noted crepitus of the neck and pain on movement. February 1992 private medical records showed that the Veteran sought medical attention for migraine headaches and neck pain. He stated that in 1983 he was involved in an automobile accident and started having neck pain. He described neck pain radiating to his head. He had sharp pain with turning his head. With sudden turns, the neck pain would become so severe he would have to take medication and rest for several days. He denied parasthesia, numbness, bowel or bladder problems. Cervical spine physical evaluation was notable to for limitation of lateral bending. X-ray report of the cervical spine showed cervical disc disease at C5 and C6 and the physician maintained this as the diagnosis. February 1997 private medical records noted complaints about chronic neck pain. Physical evaluation revealed neck muscle pain and spasm. The clinician assessed degenerative osteoarthritis of the cervical spine. November 2000 private medical records reported that the Veteran had problems with degenerative disk disease in his neck. October 2004 private medical records mentioned that the Veteran had a history of cervical spine osteoarthritis and degenerative joint disease. Clinical evaluation showed tenderness to palpation in the posterior cervical neck muscles. The physician affirmed the previously established cervical spine diagnoses. July 2009 VA primary care records reflected that the Veteran visited the clinic to establish VA medical care. He had a history of osteoarthritis and low back pain. Physical examination was unremarkable. The clinician did not provide any assessment specific to the cervical spine. November 2015 VA cervical spine X-ray report confirmed degenerative changes. In August 2016, the Veteran stated that his low back problems started shortly after boot camp. He was assigned a crash and salvage unit. He was ordered to pull long iron hooks back to their proper place on the runway after a jet made an emergency landing. The chains were huge and usually pulled back to their original location by tractors. However, the tractor equipment was broken, and the task had to be done manually. It took a significant amount of time. The Veteran recalled developing low back pain and eventually falling on his knees. After the task was finished, he visited the sick bay. He was told to take pain relief medication and that he was stable. However, he had back and neck problems ever since then. He had taken a great deal of medication and wanted to avoid surgery. In September 2016, the Veteran's son furnished a statement in support of the claim. He reported that throughout his life his father, the Veteran, had severe back and neck problems. The Veteran informed him about the in-service injury while working with an aircraft crash recovery unit. He also told him that he did not seek medical attention in service due to his young age and fear of reprisal. In September 2016, the Veteran's wife also furnished a statement in support of the claim. She met the Veteran shortly after separation in July 1963. Throughout the time she had known him, he had had severe back and neck problems. She recounted the same injury and medical treatment history as the son did in his report. July 2017 private medical records showed that the Veteran was treated for muscle spasm of the back. He had a cervical spine computerized tomography (CT) scan. The indication was neck pain with right sided radiation. The impression was listed as degenerative changes and straightening of the cervical lordosis. In his October 2017 NOD, the Veteran reported that he recently had emergency treatment for severe back and neck pain in July 2017. He was released with pain medication, muscle relaxers and prescribed bed rest. He was going to follow up with VA clinicians. In December 2020, the Veteran had a VA-contract cervical spine examination with a NP. She diagnosed degenerative arthritis of the spine with a 2001 onset. The Veteran reported that in-service he "jerked" his neck while working with an aircraft crash recovery unit. He sought medical attention and received aspirin. He reported that over the years since military service, he had difficulty flexing his neck and neck pain. Physical findings for the cervical spine were detailed. Radiculopathy was not indicated. The NP reviewed the record and issued a negative medical opinion. She stated that any in-service neck injury was acute and there was no evidence of a chronicity of care. The symptoms were subjective. In June 2021, a VA-contract cervical spine medical opinion was obtained from a physician. He furnished a negative medical opinion. In pertinent part, he stated that there was no evidence of an acute neck condition in service and the separation examination was negative. He stated that it was highly unlikely a significant neck condition would have gone unreported. The first medical evidence for a neck condition is in 1983 and an abnormality was not found on X-ray. He reported that degenerative arthritis of the spine was a naturally occurring condition and age appropriate at time of diagnosis. He summarized that the first evidence for a neck condition was 20 years after service and it was highly unlikely an individual could have gone at least 20 years with an ongoing neck condition without manifestations requiring care. He concluded it was more likely than not that the Veteran cervical spine disorder was a naturally occurring, age-appropriate condition due to normal wear and tear and disc desiccation over time. In August 2021, the same physician issued an addendum to his June 2021 VA-contract medical opinion. He reviewed specific contentions by the Veteran. In pertinent part, the Veteran and lay statements from his son and wife indicate the Veteran had a fear of reprisal for seeking medical attention during service. The physician reported that it would appear highly unlikely that retribution would have been incurred for a significant neck condition. He observed that there would be no risk of reprisal at separation and a neck condition was not found or reported. As to the Veteran's spouse and son's reports about frequent sick call visits during service, he dismissed it as not being support by documentation since a sick call excursion would require documentation and medication would need to be logged. As to the spouse's report that she met the Veteran right after separation and he had severe neck problems ever since she knew him, the physician referenced his prior responses. He again noted the Veteran had neck care beginning in 1983 and the pathophysiology of degenerative disease of the cervical spine was such that it almost certainly were not present at separation and developed due to the normal aging process. In the November 2021 brief, the representative challenged the June 2021 and August 2021 VA-contract medical opinions. He noted that following service the Veteran likely had to pay for any doctor visit and this was a factor for why he did not receive medical treatment for many years following service. The representative asserted a Report of Medical History was always completed at separation, and the absence of this document indicated that the STRs were incomplete. He observed that in general it was the military culture to avoid sick calls and that it in his experience it was difficult to receive an actual examination for any medical problems. He challenged the VA-contract physician's medical literature citations. He noted CDC reports showing that significant younger age populations had arthritis. Furthermore, a VA publication reported arthritis as an occupational disease for Veterans. Another VA publication advised that osteoarthritis was more common in Veterans than the general population and exertive military activities may be a contributing factor for the increased risk of developing osteoarthritis. Another CDC report corroborated the VA's findings for increased osteoarthritis risk for Veterans. For the following reasons, service connection for degenerative arthritis of the cervical spine is warranted. The disputed issue is whether there is a relationship between service and the currently diagnosed degenerative arthritis of the cervical spine. The Veteran is competent to report about his physical activities in service and history of neck pain since it is readily observable. Jandreau, 492 F.3d at 1377 n.4. He reports sustaining an injury when he pulled an extremely heavy chain on a runway that was used to assist with emergency aircraft landings. He had experienced neck pain ever since then. He visited sick call but was told there was no available treatment other than pain medication. He was afraid to further pursue treatment due to reprisal. As noted by the representative, it was common not receive a thorough evaluation during service and avoid reporting medical problems. The separation examination included normal clinical findings for the spine. Again, as noted by the representative, the accompanying medical history report is unavailable, and it is possible the Veteran would have reported neck pain. The Veteran's spouse and son corroborate his reports about neck pain beginning in service. The only affirmative evidence conflicting with the reports that neck pain began in service comes from February 1992 private medical records, which suggest neck pain started with a post service vehicle accident. The entire circumstances of this report are limited. Given the multiple reports from the Veteran and his family, as well as the representative's arguments, the Board does not find it sufficiently persuasive to weigh against a finding that there had been continuous symptoms of neck pain since service. The lay reports are probative to show continuous symptoms since service for neck pain. The VA-contract medical opinions weigh against the claim. In essence, these clinicians reject the Veteran's reports about continuous neck pain symptoms beginning in service due to an absence of medical treatment and the age related nature of current cervical spine degenerative disease. The June 2021 physician explained that he found it highly unlikely a significant neck condition would have been unreported for decades. Although the VA-contract clinicians implicitly make a negative credibility determination about continuous neck pain symptoms since service, the Board is responsible for the ultimate credibility determination. Miller, 32 Vet. App. at 259. In this case, rejecting the Veteran's symptom reports substantially relies on the supposition that an absence of medical treatment equates to nonexistence of symptoms. The Board is not permitted to reject the Veteran's otherwise competent symptom reports solely on an absence of contemporaneous treatment. Buchanan, 451 F.3d at 1337. As the representative points out, the Veteran likely had difficulty accessing appropriate medical care during service and financial barriers in accessing healthcare following service. Then, the representative presented conflicting medical evidence regarding the determination that the Veteran's cervical spine degenerative disease was purely an age related phenomenon unrelated to service. With this background and the representative's arguments in particular, the Board does not find the VA-contract medical opinions persuasive to weigh against a finding that there were continuous symptoms since service for neck pain. The Board could remand the claim for another medical opinion, but a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews, 34 Vet. App. at 225 ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim"). For the foregoing reasons, the evidence as to a relationship to service for degenerative arthritis of the cervical spine is in a state of relative equipoise. See Buchanan, 451 F.3d at 1335 (lay evidence may be sufficient in and of itself to substantiate a service connection claim). As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for degenerative arthritis of the cervical spine is warranted. 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.