Citation Nr: 21007764 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 18-47 694 DATE: February 10, 2021 ORDER An initial compensable rating prior to August 26, 2016, and a compensable rating as of November 1, 2016, for ventral hernia condition, with scar (hereinafter, ventral hernia condition) is denied. A rating in excess of 10 percent peritoneal adhesions, abdominal laparotomy (hereinafter, peritoneal adhesions) is denied. An effective date prior to June 30, 2016, for the award of service connection for ventral hernia condition is denied. REMANDED Entitlement to a rating in excess of 10 percent for shell fragment wound, abdomen, located on the right side, Muscle Group XIX (hereinafter, SFW abdomen) is remanded. Entitlement to a rating in excess of 30 percent for shell fragment wound scar, right knee (hereinafter, SFW right knee) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (hereinafter, TDIU) is remanded. Entitlement to special monthly compensation (SMC) is remanded. FINDINGS OF FACT 1. Prior to August 26, 2016, the Veteran’s ventral hernia condition measured approximately eight centimeters by five centimeters, was reducible, and resulted in episodes of mild to moderate discomfort. 2. As of November 1, 2016, the Veteran’s ventral hernia condition was manifested by a healed, postoperative ventral hernia repair, without indication for a supporting belt, and five well-healed, laparoscopic surgical scars, each measuring two centimeters by .5 centimeters that were not painful or unstable and did not result in any disabling effects. 3. For the entire appeal period, the Veteran’s peritoneal adhesions were manifested by episodes of abdominal pain and cramping, without partial obstruction manifested by delayed motility of barium meal, colic distension, nausea, or vomiting, and a scar measuring approximately 38 centimeters by one centimeter that is not unstable or painful and did not result in any disabling effects. 4. The Veteran did not file a formal or informal claim for service connection for a ventral hernia condition prior to receipt of his intent to file on June 30, 2016, and entitlement to service connection for such disability did not arise until December 2, 2016. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating prior to August 26, 2016, and a compensable rating as of November 1, 2016, for ventral hernia condition have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, 4.118, Diagnostic Codes 7338, 7339, 7800-7805. 2. The criteria for a rating in excess of 10 percent for peritoneal adhesions have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.114, 4.118, Diagnostic Codes 7301, 7800-7805. 3. The criteria for an effective date prior to June 30, 2016, for the award of service connection for ventral hernia condition have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to October 1970. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in June 2016 and February 2017 by a Department of Veterans Affairs (VA) Regional Office. In the February 2017 rating decision, the Agency of Original Jurisdiction (AOJ) awarded a 100 percent rating for the Veteran’s ventral hernia from August 26, 2016, to November 1, 2016, based on a period of convalescence. Such award constitutes a full grant of the benefit sought on appeal for that period, and the Board has characterized the issue herein accordingly. In his April 2017 notice of disagreement, the Veteran raised the issues of entitlement to a TDIU and entitlement to SMC in connection with his increased rating claims, and he filed a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, in May 2017, alleging therein that his SFW abdomen rendered him unemployable. The AOJ has not adjudicated those issues; however, the Board has assumed jurisdiction over the matters as part and parcel of the issues on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). In June 2020, the Veteran’s representative withdrew his request for a Board hearing before a Veterans Law Judge. 38 C.F.R. § 20.704(e). Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. 1. Entitlement to an initial compensable rating prior to August 26, 2016, and a compensable rating as of November 1, 2016, for ventral hernia condition. The Veteran contends the severity of his ventral hernia condition warrants a higher rating than those currently assigned prior to August 26, 2016, and as of November 1, 2016. The appeal period commences on June 30, 2016, the effective date of the award of service connection. Such disability is rated under Diagnostic Code 7339, which pertains to postoperative ventral hernias. Under Diagnostic Code 7339, a noncompensable rating is assigned for wounds, postoperative, healed, no disability, no belt indicated. A 20 percent rating is warranted for a small postoperative ventral hernia, not well supported by a belt under ordinary conditions, or healed ventral hernia or postoperative wounds with weakening of abdominal wall and indication for a supporting belt. A 40 percent rating is assigned for a large postoperative ventral hernia, not well supported by a belt under ordinary conditions, and a 100 percent rating is assigned for massive, persistent, severe diastasis of recti muscles or extensive diffuse destruction or weakening of muscular and fascial support of abdominal wall so as to be inoperable. A May 2016 Peritoneal Adhesions Disability Benefits Questionnaire (DBQ) shows the Veteran had a ventral (abdominal wall) hernia located approximately three centimeters superior to the belly button. The hernia measured approximately eight centimeters by five centimeters, and the VA examiner noted such was reducible. The Veteran reported episodes of mild to moderate discomfort at the area of the hernia. As such evidence pre-dates the Veteran’s hernia operation, the Board finds his service-connected ventral hernia condition is most appropriately rated as analogous to a pre-operative inguinal hernia and, therefore, pursuant to Diagnostic Code 7338. In this regard, Diagnostic Code 7338 provides a noncompensable rating for a small, reducible hernia or one without true hernia protrusion, as well as a hernia that has not been operated on but is remediable. Based on the findings described above, therefore, the Board finds a rating in excess of the zero percent currently assigned is not warranted prior to August 26, 2016. A December 2016 Hernias DBQ is the only evidence of record relevant to the Veteran’s ventral hernia condition dated subsequent to his convalescence period ending on November 1, 2016. According to the DBQ, the VA examiner did not detect any current hernia on examination, but there was evidence of a healed, postoperative ventral hernia repair. In addition, there was no indication for a supporting belt and no other pertinent physical findings, complications, conditions, signs, or symptoms, to include a residual hernia, related to the Veteran’s ventral hernia condition. The remainder of the medical evidence dated during the relevant period is silent for any complaints, treatment, or diagnosis referable to a ventral hernia condition. Consequently, the Board finds a compensable rating is not warranted for the Veteran’s ventral hernia condition as of November 1, 2016, under Diagnostic Code 7339. 38 C.F.R. § 4.114. Furthermore, although the December 2016 DBQ shows the Veteran had five well-healed, laparoscopic surgical scars throughout the abdominal area, such measured only two centimeters by .5 centimeters and were not painful or unstable. Thus, a higher and/or separate rating is not warranted pursuant to the Schedule of Ratings – Skin under 38 C.F.R. § 4.118. Here, the Board acknowledges the Veteran’s competent lay statements regarding his observable symptomatology, to include discomfort. For the purpose of assigning a higher and/or separate rating, however, the Board affords greater probative value to the medical findings as reported by the VA examiners, who, with specialized medical training, considered the Veteran’s reported symptoms and conducted physical examination of the Veteran. Consequently, the Board finds a compensable rating for his ventral hernia condition is not warranted for the appeal periods prior to August 26, 2016, and as of November 1, 2016. 38 C.F.R. §§ 4.114, 4.118, Diagnostic Codes 7338, 7339, 7800-7805. 2. Entitlement to a rating in excess of 10 percent for peritoneal adhesions. The appeal period before the Board stems from the Veteran’s intent to file a claim received on June 30, 2016, plus the one year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Veteran asserts the severity of his peritoneal adhesions warrants a rating in excess of 10 percent. Such disability is rated under Diagnostic Code 7301, which pertains to adhesions of the peritoneum. The Note to Diagnostic Code 7301 directs that ratings for adhesions will be considered when there is history of operative or other traumatic or infectious (intraabdominal) process, and at least two of the following: disturbance of motility, actual partial obstruction, reflex disturbances, presence of pain. Diagnostic Code 7301 provides a zero percent rating for a disability deemed mild in nature and a 10 percent rating for a disability determined to be moderate in nature, as manifested by pulling pain on attempting work or aggravated by movements of the body, or occasional episodes of colic pain, nausea, constipation (perhaps alternating with diarrhea) or abdominal distension. A 30 percent rating is provided for a moderately severe disability, with partial obstruction manifested by delayed motility of barium meal and less frequent and less prolonged episodes of pain. A 50 percent rating is assigned for a severe disability manifested by definite partial obstruction shown by X-ray, with frequent and prolonged episodes of severe colic distension, nausea or vomiting, following severe peritonitis, ruptured appendix, perforated ulcer, or operation with drainage. In May 2016, the Veteran underwent VA examination of his peritoneal adhesions. Therein, he described persistent episodes of abdominal pain and cramping. He denied any residual problems such as bowel obstructions or abdominal conditions necessitating hospitalization or surgical treatment. The VA examiner found the Veteran’s abdominal condition had been stable, and he did not have a history of operative or infectious process. The Veteran’s disability had not been manifested by severe peritonitis, a ruptured appendix, or a perforated ulcer, although he had undergone an operation with drainage. Notably, the VA examiner attributed only pain to the Veteran’s peritoneal adhesions and determined that he did not have delayed motility of barium meal, partial or complete bowel obstruction, reflex disturbances, nausea, vomiting, abdominal distension, or constipation. With respect to the latter symptom, however, the Board notes the VA examination report indicates the Veteran was taking continuous medication specifically prescribed for constipation. Nevertheless, the VA examiner found the overall severity of the manifestations of the Veteran’s peritoneal adhesions was best described as mild, based on his reports of intermittent episodes of abdominal pain and cramping, especially with physical exertion and after eating greasy or spicy foods. Additionally, the VA examiner determined the Veteran’s service-connected peritoneal adhesions did not impact his ability to work. A December 2016 VA examination report repeats the findings that the Veteran did not have a history of operative or infectious process, severe peritonitis, a ruptured appendix, or a perforated ulcer. In fact, the VA examiner determined the Veteran did not have a current diagnosis of peritoneal adhesions, although he did have pain associated with peritoneal adhesions. Notably, the VA examiner found the Veteran did not have delayed motility of barium meal, partial or complete bowel obstruction, reflex disturbances, nausea, vomiting, abdominal distension, or constipation associated with peritoneal adhesions. However, the VA examiner again reported the Veteran’s use of continuous medication prescribed for constipation. As in May 2016, the VA examiner described the severity of the Veteran’s manifestations as mild based on his reports of intermittent episodes of abdominal pain with cramping, especially upon physical exertion or after eating greasy or spicy foods. However, in December 2016 the Veteran reported that such episodes had essentially resolved following his ventral hernia repair surgery. Further, the VA examiner found the Veteran’s condition had been stable and did not impact his ability to work. Based on the foregoing, the Board finds the evidence does not reflect symptomatology so as to warrant a higher rating for the Veteran’s peritoneal adhesions at any time during the appeal period. Considering the directives under Diagnostic Code 7301, the record does not demonstrate associated symptomatology such as partial obstruction manifested by delayed motility of barium meal, colic distension, nausea, or vomiting. With respect to a skin disability, the May 2016 and December 2016 VA examination reports show the Veteran had a scar in the midline abdominal area associated with his abdominal laparotomy that measured 38 centimeters by one centimeter. The scar was not described as painful or unstable. Based on these findings, a higher and/or separate rating is not warranted pursuant to the Schedule of Ratings – Skin under 38 C.F.R. § 4.118. Again, the Board acknowledges the Veteran’s competent lay statements regarding his observable symptomatology, to particularly include pain and cramping, and notes that the currently assigned 10 percent rating was specifically awarded on the basis of such symptoms. For the purpose of assigning a higher and/or separate rating, however, the Board affords greater probative value to the medical findings as reported by the VA examiners, who, with specialized medical training, considered the Veteran’s reported symptoms and conducted physical examination of the Veteran. Consequently, even considering the Veteran’s self-reported symptomatology, the Board finds a rating in excess of 10 percent for peritoneal adhesions is not warranted at any time during the appeal period. 38 C.F.R. §§ 4.114, 4.118, Diagnostic Codes 7301, 7800-7805. Other Considerations The Board has also considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran’s service-connected ventral hernia condition and/or peritoneal adhesions; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning additional staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the claims decided herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Earlier Effective Date Pertinent to the instant case, the effective date for a grant of service connection is the day after separation from service or day entitlement arose, if a claim is received within one year of separation from service, otherwise the date of receipt of claim, or the day entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). A claim for VA benefits, whether formal or informal, must be in writing and must identify the benefit sought. 38 U.S.C. § 5101; 38 C.F.R. §§ 3.1(p), 3.151, 3.155; Rodriguez v. West, 189 F.3d 1351 (Fed. Cir. 1999); Lalonde v. West, 12 Vet. App. 377 (1999). Prior to March 24, 2015, any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, was considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). While the VA should broadly interpret submissions from a veteran, it is not required to conjure up claims not specifically raised. Brannon v. West, 12 Vet. App. 32 (1998); Talbert v. Brown, 7 Vet. App. 352, 356-57 (1995). As of March 24, 2015, VA no longer recognizes informal claims. In this regard, as of such date, a claimant, or certain other individuals as specified in section 3.155(b), may indicate a claimant’s intent to file a claim for benefits by submitting an intent to file a claim to VA. 38 C.F.R. § 3.155(b). An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form prescribed by the Secretary. If VA receives a complete application form prescribed by the Secretary, as defined in 38 C.F.R. § 3.160(a), appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date of the intent to file a claim was received. 38 C.F.R. § 3.155(b). The “intent to file” is a term of art defined by VA regulation, which can only be submitted in certain formats. Specifically, an intent to file a claim can be submitted in one of the following three ways: i. A saved electronic application (as specified in section 3.155(b)(1)(i)). ii. A written intent on prescribed intent to file a claim form. The submission to an AOJ of a signed and dated intent to file a claim, on the form prescribed by the Secretary for that purpose, will be accepted as an intent to file a claim; iii. Oral intent communicated to a designated VA personnel and recorded in writing, as further specified in 38 C.F.R. § 3.155(b)(1)(iii). If an intent to file a claim is not submitted in the form required by 38 C.F.R. § 3.155(b)(1), as described above, or a complete claim is not filed within one year of the receipt of the intent to file a claim, VA will not take further action unless a new claim or a new intent to file a claim is received. 38 C.F.R. § 3.155(b)(4). To implement the “intent to file” provisions, VA introduced a new form, VA Form 21-0966, Intent to File a Claim for Compensation and/or Pension Benefits (VA Form 21-0966). 79 Fed. Reg. at 57,664. As explained in VA’s comments to the published final rule, this represents a standardized method of filing an informal claim which would be submitted in a format more amenable to efficient processing, while still allowing veterans to receive favorable effective date treatment similar to that available under the “informal claim” provisions. Id. at 57,665. It also achieves the standardization of the claims process by requiring that all claims or initiation of claims be filed on a VA-prescribed form. Id. In addition to the above, under current regulations, when a claimant, or other qualified individual as specified in section 3.155(a), “indicates a desire to file for benefits under the laws administered by VA, by a communication or action... that does not meet the standards of a complete claim,” this is considered a request for an application form for benefits under § 3.150(a). Upon receipt of such a communication or action, the Secretary shall notify the claimant and the claimant’s representative, if any, of the information necessary to complete the application form or form prescribed by the Secretary. 38 C.F.R. § 3.155(a). 3. Entitlement to an effective date prior to June 30, 2016, for the award of service connection for ventral hernia condition. In the February 2017 rating decision, the AOJ awarded service connection for the Veteran’s ventral hernia condition as of June 30, 2016. According to the rating decision, such was based on the date VA received the Veteran’s intent to file a claim, as a completed application was received within one year of such. The Veteran, as relevant, disagreed with the propriety of the effective date assigned therein but has not offered any specific argument as to why he believes an earlier effective date for such award is warranted. Here, the Board finds it cannot construe any document as a formal or informal claim for service connection for a ventral hernia condition prior to March 24, 2015. Despite an extensive record, to include correspondence and informal and formal claims received prior to such date, the evidence does not include a reference to a ventral hernia condition or contain a communication indicating an intent to apply for service connection for such a disability. During the period from March 24, 2015, to June 30, 2016, the only reference to a hernia condition is found in the Veteran’s notice of disagreement received on June 28, 2016, which was filed in connection with the June 2016 rating decision. Therein, the Veteran indicated his area of disagreement was “Other” with respect to the issue of a hernia next to his surgery scar. Notably, the June 2016 rating decision adjudicated only the issue of entitlement to an increased rating for SFW right knee. Additionally, the Board finds the Veteran’s statements regarding his hernia on the June 28, 2016, notice of disagreement do not meet the criteria for consideration as an “intent to file” a claim as such were not submitted in one of the forms required by 38 C.F.R. § 3.155(b)(1). Further, neither the Veteran nor his representative have identified a written statement or claim, either informal or formal, supposedly submitted prior to June 30, 2016. The Board finds that there is likewise no general statement of intent to seek benefits coupled with a reasonably identifiable in-service medical diagnosis in the Veteran’s service treatment records that may constitute an earlier claim for benefits. Sellers v. Wilkie, 30 Vet. App. 157 (2018). In this regard, the Board notes the ventral hernia for which the AOJ awarded service connection was not diagnosed until approximately 2014, many years after service. Furthermore, upon review of his earlier filings, the Board finds that such did not identify specific medical records that contained a reasonably ascertainable diagnosis of a ventral hernia so that such submission may constitute an informal claim for benefits. Shea v. Wilkie, 926 F.3d 1362 (Fed. Cir. 2019). Even assuming a prior submission may be considered an earlier claim for service connection, entitlement did not arise until a December 2, 2016, VA examination when the examiner opined that the Veteran’s hernia was likely secondary to his in-service abdominal surgery. Consequently, an effective date prior to June 30, 2016, the date of receipt of the Veteran’s intent to file a claim, for the award of service connection for ventral hernia condition is not warranted. There is no doubt to be resolved, and the appeal for an earlier effective date for the award of service connection must be denied. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. § 3.400. REASONS FOR REMAND 1. Entitlement to a rating in excess of 10 percent for SFW abdomen is remanded. 2. Entitlement to a rating in excess of 30 percent for SFW right knee is remanded. In connection with his increased rating claims for his service-connected SFW abdomen and SFW right knee, the Veteran underwent VA examination in May 2016 and December 2016. Notably, the VA examiner discussed both disabilities simultaneously in the examination reports without identifying the manifestations specifically attributable to each disability. For example, the VA examiner stated on both examination reports that the Veteran had entrance and exit scars that were small or linear, indicating a short track of missile through muscle tissue, as well as entrance and exit scars indicating the track of a missile through one or more muscle groups; however, the VA examiner did not identify the associated disability for either. Likewise, the VA examiner reported there was some loss of deep fascia but did not attribute such symptom to a particular disability. As the rating criteria specifically contemplate such findings, the Board finds it imperative that clarification be obtained prior to re-adjudication of the increased rating claims. Moreover, in a June 2020 written correspondence, the Veteran’s representative asserts a separate rating is warranted for orthopedic impairment associated with his service-connected SFW right knee. Given such allegations, the Board finds additional, appropriate examination is warranted to determine the nature and severity of all manifestations associated with the Veteran’s SFW right knee and SFW abdomen. Consequently, a remand is necessary for examination and opinions addressing such matters. 3. Entitlement to a TDIU is remanded. 4. Entitlement to SMC is remanded. As noted above, the Veteran contends his service-connected SFW abdomen renders him unemployable. Additionally, he has raised the issue of entitlement to SMC in connection with the increased rating claim for SFW abdomen. As a result, the development and readjudication of the increased rating claim remanded herein could impact the Veteran’s eligibility for and entitlement to a TDIU and SMC and, thus, adjudication of the latter issues must be deferred pending the outcome of the former. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Furthermore, the Board notes the AOJ sent the Veteran correspondence in May 2017 requesting that he provide the addresses of his previous employers, to which he has not yet responded. Upon remand, therefore, the Veteran should be given the opportunity to supplement his claims, to include a completed application for entitlement to SMC. The matters are REMANDED for the following actions: 1. Request that the Veteran complete an addendum to his VA Form 21-8940 that lists his complete employment history, to include addresses for all of his previous employers, as well as the proper form for his claim for entitlement to SMC. Complete any associated development for the latter accordingly. 2. After receiving a response from the Veteran in connection with the directive in the above paragraph, contact the Veteran’s former employers and request that they complete and return VA Form 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits, detailing the dates of the Veteran’s employment and the reasons that he stopped working. 3. Afford the Veteran a VA muscle examination to determine the current nature and severity of his service-connected SFW abdomen and SFW right knee. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. The examiner should describe the current nature and severity of all manifestations of the Veteran’s SFW abdomen and SFW right knee and the resulting functional impairment of such disabilities. The examiner(s) should specifically identify to which disability each symptom/manifestation is attributable (i.e., abdomen and/or right knee). In this regard, the examiner is asked to review the examination reports dated in May 2016 and December 2016 and address any information that may conflict with the current findings. A rationale should be provided for any opinion offered. 4. Afford the Veteran an appropriate VA orthopedic examination to determine the current nature and severity of any right knee disability associated with his service-connected SFW right knee. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests and studies should be accomplished. The examiner should describe the current nature and severity of all orthopedic manifestations of the Veteran’s SFW right knee and the resulting functional impairment of such disability. A rationale should be provided for any opinion offered. K. STANTON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.