Citation Nr: 21007007 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 17-10 304 DATE: February 8, 2021 ORDER The application to reopen a claim of service connection for skin cancer is granted. The application to reopen a claim of service connection for psoriatic arthritis is granted. The application to reopen a claim of service connection for diabetes mellitus is granted. The application to reopen a claim of service connection for diabetic retinopathy is granted. The application to reopen a claim of service connection for erectile dysfunction is granted. Service connection for psoriasis is granted. Service connection for diabetes mellitus is granted. Service connection for psoriatic arthritis, as secondary to service-connected psoriasis, is granted. Service connection for diabetic retinopathy, as secondary to service-connected diabetes mellitus, is granted. REMANDED The issue of service connection for skin cancer is remanded. The issue of service connection for erectile dysfunction, as secondary to service-connected diabetes mellitus, is remanded. The issue of an initial compensable rating for residuals of a right thumb fracture (right thumb disability) is remanded. FINDINGS OF FACT 1. In a January 2008 rating decision, the RO denied service connection for skin cancer and psoriatic arthritis. The Veteran received notice of the decision, did not appeal this decision, and new and material evidence was not received within one year after it was issued. 2. Evidence received since the January 2008 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating the claims of service connection for skin cancer and psoriatic arthritis. 3. In a June 2014 rating decision, the RO continued and confirmed the previously denied claim of service connection for diabetes mellitus and denied service connection for diabetic retinopathy and erectile dysfunction. 4. Evidence received since the June 2014 rating decision relates to an unestablished fact and raises a reasonable possibility of substantiating the claims of service connection for diabetes mellitus, diabetic retinopathy, and erectile dysfunction. 5. The evidence is at least evenly balanced as to whether the Veteran’s psoriasis had its onset in service. 6. The evidence is at least evenly balanced as to whether the Veteran served on or near the perimeter of U-Tapao Royal Thai Air Force Bases (RTAFB) in Thailand during the Vietnam era. 7. The Veteran has been diagnosed as having diabetes mellitus. 8. The evidence is at least evenly balanced as to whether the Veteran’s psoriatic arthritis is caused by his service-connected psoriasis. 9. The evidence is at least evenly balanced as to whether the Veteran’s diabetic retinopathy is caused by his service-connected diabetes mellitus. CONCLUSIONS OF LAW 1. The January 2008 rating decision that denied service connection for skin cancer and psoriatic arthritis is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.302, 20.1103. 2. Since the January 2008 rating decision, new and material evidence has been received to reopen the claims of service connection for skin cancer and psoriatic arthritis. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The June 2014 rating decision that continued and confirmed the previously denied claim of service connection for diabetes mellitus and denied service connection for diabetic retinopathy and erectile dysfunction is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.302, 20.1103. 4. The criteria for service connection for psoriasis are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for diabetes mellitus are met. 38 U.S.C. §§ 1110, 1116, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e). 6. The criteria for service connection for psoriatic arthritis, as secondary to service-connected psoriasis, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for service connection for diabetic retinopathy, as secondary to service-connected diabetes mellitus, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1965 to July 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2015 and January 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In the June 2015 rating decision, the RO confirmed and continued the previously denied claims of service connection for diabetes mellitus, skin cancer, psoriatic arthritis, and diabetic retinopathy, and denied service connection for erectile dysfunction. In the January 2017 rating decision, the RO granted service connection for a right thumb disability and assigned a noncompensable rating, effective June 5, 2007. Regardless of whether the RO determined new and material evidence has been submitted to reopen the service connection claims on appeal, the Board must address the issues of the receipt of new and material evidence in the first instance because it determines the Board’s jurisdiction to reach the underlying claims and to adjudicate the claims de novo. See Jackson v. Principi, 265 F.3d 1366, 1369 (2001). In October 2020, the Veteran presented testimony before the Board. During the hearing, the Veteran’s request for the record to be held open for an additional 60 days to allow him to submit additional evidence was granted. The claim of service connection for psoriatic arthritis has been recharacterized to include the related diagnosis of psoriasis, in accordance with Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009). New and Material Evidence Generally, a claim that has been denied in a final unappealed rating decision may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). An exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, VA will reopen the claim and review it on the merits. The implementing regulation also provides that new and material evidence received prior to the expiration of the appeal period will be considered as having been filed in connection with the claim that was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the evidence is generally presumed. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held, however, that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented. Anglin v. West, 203 F.3d 1343, 1347 (2000). In deciding whether new and material evidence has been received, the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). 1. Whether new and material evidence has been received to reopen the claim of service connection for skin cancer. 2. Whether new and material evidence has been received to reopen the claim of service connection psoriatic arthritis. In the January 2008 rating decision, the RO denied service connection for skin cancer and psoriatic arthritis. The RO denied service connection for skin cancer on the basis that it did not occur during the Veteran’s military service or related to his military service. The RO denied service connection for psoriatic arthritis on the basis of no current diagnosis. Later that month, in a January 2008 notification letter, the Veteran received notice of the January 2008 rating decision. He did not appeal that decision and new and material evidence was not associated with the record within one year of its issuance. Accordingly, the January 2008 rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. In July 2015, the Veteran submitted applications to reopen his previously denied claims of service connection for skin cancer and psoriatic arthritis. Relevant evidence received after the January 2008 rating decision includes VA treatment records, private treatment records, a Mayo Clinic article on sun damage, internet articles regarding Thailand’s climate, and the October 2020 Board hearing transcript. Specifically, VA treatment records show a current diagnosis of psoriatic arthritis, actinic keratosis, and basal cell carcinoma. See, e.g., VA treatment record (September 2012); VA treatment record (May 2017) (problem list). Moreover, during the October 2020 Board hearing, the Veteran provided further details regarding his in-service excessive exposure to sun while stationed in Thailand. Also, the Veteran provided internet articles regarding Thailand’s environment and climate and a Mayo Clinic article that defined basal cell carcinoma and that it is caused by sun damage. In sum, the Veteran’s October 2020 testimony, treatment records, Mayo Clinic article, and the internet articles regarding Thailand’s climate were not previously considered in the last prior final denial and such evidence relate to unestablished facts necessary to substantiate the claims of service connection for skin cancer and psoriatic arthritis and raise a reasonable possibility of substantiating the claims. See Shade, 24 Vet. App. at 117. Therefore, the criteria for reopening the claims of service connection for skin cancer and psoriatic arthritis are met. 3. Whether new and material evidence has been received to reopen the claim of service connection for diabetes mellitus. In a June 2009, the RO denied service connection for diabetes mellitus on the basis that the Veteran was not exposed to an herbicide agent during his military service, and that it was not due to his military service. In a June 2014 rating decision, the RO continued to the deny the previously denied claim of service connection for diabetes mellitus, on the basis that new and material evidence had not been submitted since the prior final June 2009 rating decision. Later that month, in a June 2014 notification letter, the Veteran received notice of the June 2014 rating decision. He did not appeal that decision and new and material evidence was not associated with the record within one year of its issuance. Accordingly, the June 2014 rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. In July 2015, the Veteran submitted an application to reopen his previously denied claim of service connection for diabetes mellitus. Relevant evidence received after the June 2014 rating decision includes VA treatment records, private treatment records, and the October 2020 Board hearing transcript. Specifically, during the October 2020 Board hearing, the Veteran provided testimony regarding his in-service exposure to an herbicide agent. In particular, the Veteran provided specific details suggesting that he was in or near the perimeter at the U-Tapao Royal Thai Air Force Base in Thailand during the Vietnam era. The Veteran is presumed credible in his reports for the limited purpose of reopening the claim. Justus, 3 Vet. App. at 513. The Veteran’s testimony regarding his in-service exposure to an herbicide agent was not previously considered in the last prior final denial and such evidence relate to unestablished facts necessary to substantiate the claim and raise a reasonable possibility of substantiating the claim. See Shade, 24 Vet. App. at 117. Therefore, the criteria for reopening the claim of service connection for diabetes mellitus are met. 4. Whether new and material evidence has been received to reopen the claim of service connection for diabetic retinopathy. 5. Whether new and material evidence has been received to reopen the claim of service connection for erectile dysfunction. In a June 2014 rating decision, the RO denied service connection for diabetic retinopathy and erectile dysfunction on the basis that they were not caused or aggravated by a service-connected disability. The Veteran did not appeal the June 2014 rating decision and new and material evidence was not associated with the record within one year of its issuance. Accordingly, the June 2014 rating decision is final. See 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. In July 2015, the Veteran submitted applications to reopen his previously denied claims of service connection for diabetic retinopathy and erectile dysfunction. Relevant evidence received after the June 2014 rating decision includes VA treatment records, private treatment records, and the October 2020 Board hearing transcript. Specifically, during the October 2020 Board hearing, the Veteran provided testimony regarding his in-service exposure to an herbicide agent and, thus, suggesting that his diabetes mellitus was the result of his in-service exposure to an herbicide agent. Furthermore, the Veteran asserted that his diabetic retinopathy and erectile dysfunction were the result of his diabetes mellitus. In December 2020, the Veteran provided private treatment records that suggested that his diabetic retinopathy was the result of his diabetes mellitus. The Veteran’s testimony provided at the October 2020 Board hearing and the new private treatment records triggers VA’s duty to assist and thereby raises a reasonable possibility of substantiating the claims. Shade, 24 Vet. App. at 118 (VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement). Therefore, the criteria for reopening the claims of service connection for diabetic retinopathy and erectile dysfunction are met. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection requires competent evidence of (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). 1. Service connection for psoriasis. The Veteran claims that he has had psoriasis in and since service. See Board hearing transcript (January 2020). Specifically, during the Board hearing, the Veteran testified that during service he had patches of scaly, itchy, dry skin which was diagnosed as psoriasis, and that it was treated with creams in and since service. For the reasons below, service connection for psoriasis is warranted. VA treatment records show a current diagnosis of psoriasis. See, e.g., VA treatment record (May 2017). Thus, a current disability has been established. The Veteran’s service treatment records (STRs) show that he was treated on many occasions for a skin rash and/or hives that was treated with Benadryl and other treatments during service. See, e.g., VA treatment record (May 1968). Specifically, a May 1968 treatment record shows that the Veteran had an itchy rash on his body that was treated with Benadryl. A May 1968 STR reflects that the Veteran had hives on his body. Notably, a May 1968 STR appears to show a diagnosis of either pruritus or psoriasis. Post-service treatment records have only been obtained, at the earliest, since 2000. VA treatment records in 2000 show a diagnosis of psoriasis. Several VA treatment records reflect that the Veteran has had a history of psoriasis. An August 2016 VA treatment record notes that the Veteran reported scaly legions that had “been present for years.” In sum, the evidence of record, to include the Veteran’s STRs, suggest that his psoriasis may have had its onset during service. For example, during the Board hearing, the Veteran testified that during service, he had scaly, dry lesions that was diagnosed as psoriasis. Treatment records since 2000 reflect that the Veteran has had psoriasis for many years. Notably, the evidence of record suggest that the Veteran has had the similar skin symptoms in and since service. The Veteran, as a lay person, is competent to report skin symptoms in service and continuous skin symptoms since service. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir 2006) (holding lay evidence concerning continuity of symptoms after service, if credible, is ultimately competent, regardless of the lack of contemporaneous medical evidence). The Veteran’s statements, regarding skin symptoms in and since service are credible and consistent with the evidence of record. There is no medical evidence to the contrary. The evidence is therefore at least evenly balanced as to whether the Veteran’s psoriasis had its onset in service. As the reasonable doubt created by this approximate balance in the evidence must be resolved in favor of the Veteran, service connection for psoriasis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for diabetes mellitus. The Veteran contends that his diabetes mellitus is due to in-service exposure to an herbicide agent while stationed at U-Tapao AFB in Thailand. See Board hearing transcript (October 2020). Specifically, he asserts that he was in or near the U-Tapao AFB in Thailand perimeter during the Vietnam era, due to his military duties. Id. VA laws and regulations provide that if a veteran was exposed to an herbicide agent during service, certain listed diseases, including diabetes mellitus, is presumptively service connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). A veteran who “served in the Republic of Vietnam” between January 9, 1962, and May 7, 1975, is presumed to have been exposed during such service to an herbicide agent. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). VA now recognizes that tactical or tactical-like herbicides were used on the fenced-in perimeters of military bases in Thailand. VA has determined that exposure to herbicide agent will be conceded for veterans whose duties placed them at or near the perimeters of certain Thailand military bases, including U-Tapao, during the Vietnam era (February 28, 1961, to May 7, 1975), allowing for presumptive service connection of the diseases associated with herbicide exposure. VA based this determination of evidence contained on a declassified Vietnam era Department of Defense document titled “Project CHECO Southeast Asia Report: Base Defense in Thailand.” Specifically, if a veteran served as an Air Force security policeman, security patrol dog handler, member of the security police squadron, or otherwise near the base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence, herbicide exposure is to be conceded on a direct/fact-founds basis. In addition, if an Army veteran provides a statement that he was involved in perimeter duty, and there is additional credible evidence supporting such statement, herbicide agent exposure is also to be conceded on a direct/fact-founds basis. VA and private treatment records show a current diagnosis of diabetes mellitus. See, e.g., VA treatment record (March 2017). Therefore, a current disability has been established. The dispositive issue in this case is whether the Veteran’s military duties placed him at or near the perimeter of the U-Tapao AFB. In this case, the Veteran asserts that his barracks in Thailand were a few feet from the perimeter of the U-Tapao AFB. See Board hearing transcript (October 2020). The Veteran provided photographs illustrating the closeness of the location of his barracks to the perimeter of the U-Tapao AFB. He also reports that his military occupational specialty (MOS) was a mechanic/transporter and that he was assigned to the flight line, as he worked on airplane equipment on the flight line. He indicated that the airplanes were parked near or on the perimeter of the U-Tapao AFB. The Veteran has also provided photographs illustrating the location of airplanes at the U-Tapao AFB. Additionally, he asserts that he accompanied a military policeman for two nights and walked “the perimeter outside in the jungle with a dog”. The Veteran indicated that his commander of the base wanted the Veteran to be familiar with the perimeter; thus, he accompanied a military policeman along the perimeter. Id. Also, the Veteran stated that two or three times a week, he crossed the perimeter when he went outside the base to go to bars. Id. During the October 2020 Board hearing, the Veteran provided a photograph of his roommate standing against the base of the perimeter of the U-Tapao AFB. The Veteran’s service record shows that he served in U-Tapao AFB in Thailand from May 1967 to May 1968 in the aircraft maintenance squadron. Service records reflect that the Veteran was assigned to the support branch to operate tow tractors and aircrafts, and to perform duties on vehicles. A May 1968 service record indicates that the Veteran dispatched drivers and equipment as required by the flight line controllers. Furthermore, the May 1968 service records shows that the Veteran delivered various equipment from the support branch to the flight line. The Board finds that the Veteran’s statements, regarding his proximity to the perimeter of the U-Tapao AFB in Thailand during his Vietnam era service, credible. The Veteran’s photographs are consistent with his statements and service records; his photographs bolster his account of proximity to the perimeter of the U-Tapao AFB in Thailand. See Parseeya-Picchione v. McDonald, 28 Vet. App. 171, 176 (2016) (the Board must consider lay, historical, and archival evidence, in addition to service records, in determining whether there was service in Vietnam or exposure to herbicide agents elsewhere). The record is absent evidence against the Veteran’s account of proximity to the perimeter of the U-Tapao AFB in Thailand. After resolving any doubt in the Veteran’s favor, the Board finds that the Veteran served at the U-Tapao AFB in Thailand in or near the perimeter during the Vietnam era and he is, therefore, presumed exposed to an herbicide agent. As the Veteran has been diagnosed as having diabetes mellitus and this disability is presumed service connected in veterans who were exposed to an herbicide agent, service connection for diabetes is therefore warranted. 3. Service connection for psoriatic arthritis. Service connection is warranted for a disability proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b). For the following reasons, service connection for psoriatic arthritis, on a secondary basis, is warranted. VA treatment records show a current diagnosis of psoriatic arthritis. See, e.g., VA treatment record (September 2014). Psoriatic arthritis is defined as a type of arthritis linked with psoriasis. See Psoriatic Arthritis, JOHN HOPKINS MEDICINE (last visited February 5, 2021), https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/psoriatic-arthritis. As the Veteran’s service-connected disabilities include psoriasis and a current diagnosis of psoriatic arthritis has been shown, service connection for psoriatic arthritis, as secondary to service-connected psoriasis, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Service connection for diabetic retinopathy. The Veteran claims that his diabetic retinopathy is secondary to his service-connected diabetes mellitus. For the reasons below, service connection for diabetic retinopathy, on a secondary basis, is warranted. The Veteran’s private treatment record show multiple diagnoses of diabetes mellitus “with” diabetic retinopathy. See, e.g., private treatment record (August 2020). Although the private treatment records do not provide a rationale as to whether the Veteran’s diabetes mellitus caused his diabetic retinopathy, it is readily apparent that Veteran’s diabetic retinopathy is associated/the result of his diabetes mellitus. Accordingly, resolving any reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s diabetic retinopathy was caused by his service-connected diabetes mellitus. Therefore, service connection for diabetic retinopathy, as secondary to service-connected diabetes mellitus, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. The issue of service connection for skin cancer is remanded. The Veteran claims that his skin cancer is due to his military service. See Board hearing transcript (October 2020). Specifically, he attributes his skin cancer to excessive sun exposure when he was stationed in Thailand in the jungle for 12 hours a day. VA treatment records show actinic keratosis and basal cell carcinoma. See, e.g., VA treatment record (September 2012); VA treatment record (May 2017) (problem list). In December 2020, the Veteran’s attorney submitted a Mayo Clinic article that defined basal cell carcinoma; the article reflects that basal cell carcinoma is caused by sun damage. Also, the Veteran’s attorney provided internet articles regarding Thailand’s environment and climate. The Veteran has not been afforded a VA examination to determine the nature and etiology of his skin cancer. As the evidence indicated that the Veteran has been diagnosed as having skin cancer that may be associated with his military service, a remand is warranted to schedule the Veteran for a VA examination with a medical opinion. See 38 U.S.C. § 5103(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. The issue of service connection for erectile dysfunction, as secondary to service-connected diabetes mellitus, is remanded. The Veteran claims that his erectile dysfunction is secondary to his service-connected diabetes mellitus. There is no opinion of record that addresses whether the Veteran’s erectile dysfunction is caused or aggravated by his service-connected diabetes mellitus. Therefore, upon remand, a medical opinion should be obtained that addresses whether the Veteran’s erectile dysfunction is caused or aggravated by his service-connected diabetes mellitus. 3. The issue of an initial compensable rating for a right thumb disability is remanded. During the October 2020 Board hearing, the Veteran provided testimony suggesting that his right thumb disability symptoms had worsened since his last VA examination in April 2015. Specifically, he testified that he was unable to bend his thumb, unable to grip objects with his right hand, and that he frequently dropped objects due to his right thumb disability. Therefore, a remand is necessary to afford the Veteran a new VA examination to determine the current severity of his service-connected right thumb disability. See, e.g., Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (“Where the appellant complained of increased hearing loss two years after his last audiology examination, VA should have scheduled the appellant for another examination”). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination regarding his claim of service connection for skin cancer. The physician should first identify any skin cancer or residuals of skin cancer since the date of the Veteran’s reopened claim of service connection in July 2015. Then, the physician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin cancer or residuals of skin cancer is related to his military service, to include as due to in-service excessive sun exposure. The physician should address the Veteran’s submitted Mayo Clinic article and the internet articles regarding Thailand’s environment and climate. The physician must provide a rationale for the opinion. 2. Refer the claims file to a physician to address the Veteran’s claim of service connection for erectile dysfunction. The physician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s erectile dysfunction was (1) caused or (2) aggravated by his service-connected diabetes mellitus. The physician must provide a rationale for the opinion. 3. Schedule the Veteran for a VA examination to determine the current severity of his service-connected right thumb disability. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should examine the Veteran and provide findings in accordance with the currently applicable disability benefits questionnaire. All opinions must be supported by a detailed rationale. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Castillo, 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.