Citation Nr: 21008962 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-32 885 DATE: February 18, 2021 ORDER Service connection for a right shoulder disorder is granted. Service connection for heart palpitations, to include as due to an undiagnosed illness or a medically unexplained chronic multi symptom illness (MUCMI), is denied. Service connection for a fatigue disorder, to include as due to an undiagnosed illness or a MUCMI, is denied. Service connection for shortness of breath, to include as due to an undiagnosed illness or a MUCMI, is denied. FINDINGS OF FACT 1. Resolving any doubt in the Veteran’s favor, his current right shoulder disorder originated in service. 2. The probative evidence indicates that the Veteran does not have a current diagnosis of any heart condition that manifests with heart palpitations; his claimed heart palpitations are not a sign or symptom of an undiagnosed illness or a MUCMI, or otherwise related to service. 3. The probative evidence indicates that the Veteran does not have a current diagnosis of any fatigue disorder, his claimed fatigue is not a sign or symptom of an undiagnosed illness or a MUCMI, or otherwise related to service. 4. The probative evidence indicates that the Veteran does not have a current diagnosis of any respiratory condition that manifests with shortness of breath, and that his claimed shortness of breath is not a sign or symptom of an undiagnosed illness or a MUCMI, or otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disorder have been approximated. 38 U.S.C. §§ 1110, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.309. 2. The criteria for service connection for heart palpitations have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317, 3.326 (a). 3. The criteria for service connection for a fatigue disorder have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317, 3.326 (a). 4. The criteria for service connection for shortness of breath have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317, 3.326 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Marine Corps from March 1987 to February 1993. In November 2017, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge. The undersigned noted the issues on appeal and engaged in a colloquy with the Veteran toward substantiation of the claims. See Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010). A copy of the hearing transcript is associated with the claims file. In January 2020, the Board of Veterans’ Appeals (Board) remanded this matter for additional VA examinations to determine whether the Veteran has cardiac, respiratory or fatigue symptoms as a result of an undiagnosed illness or MUCMI. The Veteran was afforded the appropriate VA examinations in March 2020. Review of the completed development reveals that substantial compliance with the remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998). The January 2020 Board decision also denied service connection for a right shoulder disorder and a headaches disorder. The Veteran appealed the specified denials to the United States Court of Appeals for Veterans’ Claims (Court). In October 2020, the Court approved a Joint Motion for Partial Remand (JMR), which directed the Board to further explain the reasons and bases for denying service connection for a right shoulder disorder. In particular, the Board was ordered to assess the weight and probative value of the Veteran’s allegations regarding continuous right shoulder pain since service. Additionally, the Court dismissed the Veteran’s appeal of the January 2020 denial of service connection for headaches and that issue is no longer before the Board. Service Connection Service connection may be granted for current disability arising from disease or injury incurred or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain disorders, listed as “chronic” in 38 C.F.R. § 3.309 (a) and 38 C.F.R. § 3.303 (b), are capable of service connection based on a continuity of symptomatology without respect to an established causal nexus to service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Arthritis is among the chronic diseases listed under 38 C.F.R. § 3.309 (a). Therefore, the presumptive service connection provisions based on “chronic” in-service symptoms and “continuous” post-service symptoms under 38 C.F.R. § 3.303 (b) apply to the Veteran’s claim of service connection for degenerative arthritis of the right shoulder. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 38 C.F.R. § 3.303 (b). Where a veteran served ninety days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Additionally, Persian Gulf Veterans with qualifying chronic disabilities that manifest to a degree of 10 percent or more before December 31, 2021, may be entitled to service connection on a presumptive basis. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a). A “qualifying chronic disability” is one that cannot be attributed to any known clinical diagnosis by history, physical examination, or laboratory tests. 38 C.F.R. § 3.317 (a). Qualifying chronic disabilities, including those that result from (1) an undiagnosed illness, (2) a medically unexplained chronic multi symptom illness (MUCMI) (such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders) that is defined by a cluster of signs or symptoms, or (3) any diagnosed illness that the Secretary determines in regulations, warrant a presumption of service connection. 38 U.S.C. § 1117; 38 C.F.R. § 3.317 (a). A MUCMI is a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317 (a). Signs and symptoms of an undiagnosed illness or MUCMI include, but are not limited to, fatigue, unexplained rashes or other dermatological signs or symptoms, headaches, muscle pain, joint pain, neurological signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. See 38 U.S.C. § 1117 (g); 38 C.F.R. § 3.317 (b). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). It is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Service connection for a right shoulder disorder. The Veteran contends his current right shoulder degenerative joint disease (DJD) is related to service. Service connection is presently in effect for DJD of the left shoulder. In an August 1987 service treatment record (STR), the Veteran reported experiencing “sharp” right shoulder pain in the previous three days. The attending clinician indicated the Veteran had no tenderness, his shoulders were symmetrical, and he had full range of motion (ROM). The clinician diagnosed the Veteran with mild painful acromioclavicular (AC) syndrome. In a November 1992 STR, the Veteran reported experiencing right shoulder pain for approximately four to six months. He denied specific trauma and the attending clinician indicated there were no obvious signs of trauma, deformities, swelling, or crepitus. The Veteran had full ROM but reported slight tenderness. The clinician diagnosed the Veteran with tendonitis of the right shoulder. At the October 2013 VA shoulder and arm examination, the Veteran reported injuring his right shoulder in service and having residual soreness when lifting or physically exerting the shoulder joint. He did not recall the circumstances of the injury but believed he was placed on a profile or light duty for a short period. The VA examiner noted that X-rays revealed possible evidence of posttraumatic and/or degenerative changes in the left shoulder, but not the right. Despite these findings, the Veteran reported his right shoulder caused him more pain than his left. The October 2013 VA examiner opined that the Veteran’s right shoulder symptoms were more likely recurrent, isolated, individual repeated injuries to his right shoulder, and not likely related to any in-service event or injury. However, the examiner did not explain the medical bases for these conclusions. A January 2018 non-VA radiological report indicated the Veteran had post-traumatic subluxation of the acromiohumeral joint, DJD of the AC joint, and post-traumatic arthritis of the glenohumeral joint. The examiner indicated no fractures, pathologies or severe dislocations were present in X-ray imaging. The examiner also noted there may be diminished joint space in the glenohumeral joint, which could be attributed to degenerative arthritis, calcium pyrophosphate dehydrate crystal disease (CPPD), and post-traumatic arthritis. Of those causes, the examiner opined that post-traumatic arthritis seemed most likely due to the Veteran’s “history and other radiological findings.” The examiner did not give further detail as to what history or radiological findings he relied upon in rendering his opinion. The Veteran was afforded an additional VA shoulder examination in June 2019 pursuant to the April 2018 Board remand. The examiner indicated that X-rays taken in 2019 showed mild degenerative changes of both shoulder joints, with no progression of the conditions from 2013 to 2019. The June 2019 examiner opined that the Veteran’s mild right shoulder DJD was most likely caused by the Veteran’s genetics, age, lifestyle and a lifetime of wear and tear. The examiner acknowledged the August 1987 STR indicating “painful AC syndrome,” but stated there was no further evidence of a chronic right shoulder condition. However, the examiner failed to account for the fact that the Veteran reported continued right shoulder pain from service separation to the present. Additionally, the examiner did not explain why the right shoulder tendonitis diagnosed in service is unrelated to the Veteran’s current arthritis. The evidence is in approximate balance regarding the cause of the Veteran’s current right shoulder disorder. As indicated above, the 2019 VA opinion did not fully explain the conclusion that the Veteran’s current arthritis was unrelated to his continuous right shoulder pain, which he has credibly reported since service. The January 2018 non-VA opinion linked the Veteran’s current shoulder condition with trauma in service but did not specify which evidence it used in reaching that conclusion. The Board will resolve any doubt in favor of the Veteran and grant the claim. 38 U.S.C. § 5107 (b); Gilbert, supra. 2. Service connection for heart palpitations, including as due to an undiagnosed illness or a MUCMI. The Veteran asserts that he began experiencing heart palpitations shortly after his Gulf War service. He contends that these palpitations are directly related to service, or, alternatively, are a manifestation of an undiagnosed illness or MUCMI. At the November 2017 Board hearing, the Veteran testified that he began experiencing shortness of breath and a heart-racing sensation after (but not during) his deployment to Southwest Asia. He stated that these palpitations occurred about twice per week. The Veteran reported he was unsure what caused the palpitations and denied that they were stress related. He reported his heart was routinely evaluated as normal by his primary care doctor based on echocardiogram testing. STRs and VA treatment records are silent for any complaints of or treatment for heart palpitations. The Veteran has consistently reported that he never mentioned having heart palpitations to any medical provider before filing a claim for compensation in June 2012. A June 2013 VA echocardiogram indicated the Veteran had a “mild increase in pulmonary artery systolic pressure,” but otherwise his heart was normal. At the October 2013 VA examination, the Veteran reported having brief episodes where he could feel his heart beating or thumping in an unusual fashion. He reported associated symptoms including difficulty breathing and lightheadedness but denied discomfort during these episodes. The Veteran reported that these episodes began about two years after entering service. The VA examiner noted the Veteran’s symptoms were vague, poorly characterized, and difficult for the Veteran to describe. Upon physical examination, the Veteran had a normal heart rate and heart rhythm. Chest X-rays and an electrocardiogram (ECG) revealed normal findings. The examiner noted the Veteran’s echocardiogram was unremarkable and there were otherwise no cardiac abnormalities. Based on this evidence, the VA examiner concluded the Veteran did not have a cardiac condition related to environmental exposure during his military service. At the June 2019 VA cardiac disorders examination, the Veteran reported he began having heart palpitations “a couple [of] years” after he joined the Marines, in about 1989. He reported having spontaneous and fleeting episodes of an “unusual” heartbeat, although he denied chest pain during these episodes. He speculated that his palpitations may be related to his shortness of breath/respiratory distress. The Veteran reported having these episodes about twice per year, and the examiner noted the Veteran previously reported having these episodes twice per week at the 2017 Board hearing. The Veteran reported having an active lifestyle and cycling about 70-80 miles per week with no unusual or unexpected symptoms. He stated his palpitations are not associated with any activity, exertion, or body position. The Veteran continued to deny mentioning palpitations to any medical provider in the 30 years prior to filing his claim for compensation. The VA examiner indicated the Veteran had not had a myocardial infarction (heart attack), congestive heart failure, arrhythmia (irregular heartbeat), or a valve condition. Upon physical examination, the Veteran demonstrated normal heart rate; heart sounds; and normal heart rhythm with no murmurs, rubs, or gallop. The June 2019 VA examiner noted that the Veteran admitted his claimed heart palpitations have no clinical significance or symptomatology and no impact on his health or functioning, apart from his awareness of what seems to be a pounding heart. The examiner further noted that a cardiac rhythm disturbance had never been clinically documented and, functionally, the Veteran has good cardiac performance and stamina with his active lifestyle and vigorous exercise regimen without any cardio-pulmonary symptoms during exercise. Based on this evidence, the examiner opined it is less likely than not that the Veteran has arrythmia or palpitations related to his military service. The Veteran was afforded an additional VA examination in March 2020 pursuant to the January 2020 Board remand. The VA examiner noted the Veteran was well developed, well-nourished and in no acute distress, with no signs of malaise. Upon physical examination, the Veteran continued to have normal heart rhythm and heart sounds. The examiner noted that an ECG revealed a sinus rhythm with occasional supraventricular premature complexes, low QRS voltage in chest leads, and abnormal rhythm. However, the examiner indicated the Veteran did not have arrythmia. Chest X-rays indicated the Veteran’s heart and lungs were within normal limits, and an echocardiogram revealed normal wall motion and thickness. Based on these tests and a review of the Veteran’s medical history, the VA examiner opined there were no findings, signs or symptoms to support a diagnosis of any cardiac disorder. The VA examiner further stated there was no indication of a [diagnosed?] illness for which no etiology (cause) was established, and no signs or symptoms that may represent an undiagnosed illness or a MUCMI. The preponderance of the evidence is against finding service connection for heart palpitations, or any other cardiac disorder. Three VA examiners have indicated the Veteran’s mild and brief episodes of an irregular heartbeat are not symptoms of a cardiac disease or any other disorder. ECG and echocardiogram testing have not revealed arrythmias, cardiac disorders, or clinically significant abnormalities. Without a current a disability, there can be no claim for service connection. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (“Congress specifically limits entitlement to service-connected disease or injury to cases where such incidents have resulted in a disability. In absence of proof of a present disability there can be no valid claim.”). While the Veteran is competent to report observable symptoms such as a pounding heart, he is not competent to diagnose himself with a complex cardiac condition. See Jandreau, supra. Additionally, no competent medical provider has opined that the Veteran’s claimed palpitations are a sign or symptom of an undiagnosed illness or a MUCMI. As indicated above, the Veteran was afforded an opportunity to submit medical evidence substantiating his claim but did not do so. As the probative medical evidence indicates that the Veteran’s claimed palpitations do not have clinical significance, are not related to an undiagnosed illness or MUCMI, or otherwise related to his military service, the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 3. Service connection for a fatigue disorder, including as due to an undiagnosed illness or a MUCMI. The Veteran reports experiencing fatigue symptoms since service. He contends these symptoms are directly related to service or are a sign or symptom of an undiagnosed illness or MUCMI. At the November 2017 hearing, the Veteran reported that he began experiencing headaches and fatigue immediately after he deployed to Southwest Asia, although currently these symptoms have improved somewhat. STRs and VA treatment records are silent for any complaints of or treatment for heart palpitations. The Veteran reports he did not mention fatigue symptoms to any medical provider before filing this claim in June 2012. At the June 2019 VA chronic fatigue syndrome (CFS) examination, the Veteran reported experiencing fatigue, difficulty falling and staying asleep, and never feeling refreshed or rested after sleep. He stated these symptoms began in service and have remained constant. He denied being diagnosed with CFS and stated he had not previously mentioned his symptoms to any caregiver. The Veteran indicated his fatigue symptoms did not interfere with his job performance. The VA examiner noted the Veteran has an active lifestyle and routinely bicycled 50-80 miles per week. The examiner indicated the Veteran’s sleep pattern was consistent with depression, noted the Veteran’s recent divorce, and opined that the Veteran appeared clinically depressed. Based on this evidence, the VA examiner concluded the Veteran did not meet diagnostic criteria for CFS. The examiner indicated the Veteran’s fatigue could be related to depression and/or possible sleep apnea, noting the Veteran’s neck length. At the March 2020 VA CFS examination, the Veteran reported general tiredness and lack of restfulness. The VA examiner noted the Veteran was unable to recall or describe when these symptoms began. The Veteran indicated he did not know what CFS is, stating he “just thought [he] was tired.” The VA examiner concluded the Veteran did not meet any diagnostic criteria for CFS and indicated there were no findings, signs or symptoms to support a diagnosis of any fatigue disorder. In the March 2020 VA Gulf War examination report, the examiner indicated the Veteran had no additional signs or symptoms that may represent an undiagnosed illness or MUCMI. The preponderance of the evidence is against finding direct service connection for a fatigue disorder. Recent VA examinations have not indicated a diagnosis of CFS or any other fatigue disorder. Generally, without a diagnosis of a current disability, there can be no claim for service connection. See Brammer, supra. While the Veteran is competent to report observable symptoms such as fatigue and headaches, he is not competent to diagnose himself with a fatigue disorder. See Jandreau, supra. Additionally, no competent medical provider has opined that the Veteran’s claimed fatigue symptoms are a sign or symptom of an undiagnosed illness or a MUCMI. The probative medical evidence indicates the Veteran’s fatigue symptoms are likely related to non-service-connected sleep difficulties and/or depression, both conditions with known pathophysiology and cause. As the evidence does not indicate that the Veteran’s claimed fatigue symptoms have resulted in a diagnosis, are related to an undiagnosed illness or MUCMI, or are otherwise related to his military service, the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 4. Service connection for shortness of breath, including as due to an undiagnosed illness or a MUCMI. The Veteran reports that he has had episodes of shortness of breath and difficulty breathing since his Gulf War service. He contends these respiratory issues are directly related to service or are a sign or symptom of an undiagnosed illness or MUCMI. At the November 2017 hearing, the Veteran reported having episodes of shortness of breath, often at the same time as his heart palpitations. He indicated that he had respiratory symptoms since his deployment but did not report these symptoms to a medical provider until after filing this claim. STRs records do not reference shortness of breath or other respiratory symptoms or diagnoses. The Veteran has stated that he did not report these symptoms to any medical provider before filing this claim. At the 2013 VA examination, the Veteran reported experiencing episodes of shortness of breath and heart palpitations. He indicated these episodes lasted about 5-10 minutes and occurred about twice per month. He denied coughing, wheezing, or vertigo associated with these symptoms. The VA examiner noted that pulmonary function testing (PFT) was unremarkable and that the Veteran’s claimed symptoms did not indicate a diagnosis of any respiratory disorder. The VA examiner stated the Veteran’s reports were subjective and there were no objective findings of any abnormality. At the June 2019 VA examination, the Veteran reported his shortness of breath was not related to exertion or stress and described the sensation as being “aware” of his breathing. He reported the respiratory episodes lasted about 2-3 minutes and occurred 1-2 times per month. The VA examiner noted the Veteran’s high level of physical activity, often bicycling for 50-80 mile-rides 2-3 times per week without any respiratory difficulty. The examiner noted the Veteran denied ever having asthma, cough, or chest pain, and the Veteran’s PFT was normal in a 2013 VA examination. Based on this evidence, the examiner concluded it was less likely than not that the Veteran had any current respiratory condition related to unknown environmental factors during military service; the Veteran had no respiratory condition at all. The examiner noted there was no documentation of respiratory symptoms in the Veteran’s STRs or VA records. The examiner stated it was significant that, in several clinic visits between the 2013 and 2019 VA examinations, the Veteran consistently denied having shortness of breath. The VA examiner reiterated that the Veteran is highly active, exercises frequently without respiratory problems, and has no functional impairment due to his claimed shortness of breath. The report of the March 2020 VA respiratory examination continued to indicate that the Veteran’s lungs and breathing are clinically normal. A chest X-ray revealed the lungs were expanded and clear with no abnormalities. The examiner conducted PFT and noted the Veteran was at risk for COPD, however this finding did not result in a diagnosis of any respiratory disorder. The May 2020 VA examiner continued to find the Veteran’s claimed respiratory episodes are not a sign or symptom of an undiagnosed illness or MUCMI. The preponderance of the evidence is against finding direct service connection for shortness of breath or any other respiratory disorder. Three VA examiners have found the Veteran’s lungs to be healthy and normal, and PFT and other clinical testing have not indicated any lung abnormalities. Without a current disability, there can be no claim for service connection. See Brammer, supra. Although the Veteran is competent to report observable symptoms such as shortness of breath, he is not competent to diagnose himself with a complex respiratory disorder or opine as to its cause. See Jandreau, supra. Additionally, no competent medical provider has opined that the Veteran’s claimed respiratory episodes are a sign or symptom of an undiagnosed illness or a MUCMI. The Veteran was afforded the opportunity to submit additional evidence in support of his claim but did not do so. As the probative medical evidence indicates the Veteran’s shortness of breath has not resulted in a diagnosis, is not related to an undiagnosed illness or MUCMI, or otherwise related to his military service, the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hiaasen 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.