Citation Nr: 21011585 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 05-22 515 DATE: March 2, 2021 ORDER Service connection for a peripheral nerve disorder of the bilateral upper extremities, to include peripheral neuropathy and carpal tunnel syndrome, as due to herbicide exposure or secondary to a low back disability is denied. Service connection for a peripheral nerve disorder of the bilateral lower extremities, to include peripheral neuropathy, as due to herbicide exposure or secondary to a low back disability is denied. Eligibility for assistance in acquiring specially adapted housing is denied. Eligibility for a special home adaptation grant is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of peripheral neuropathy of the bilateral upper extremities. 2. There is no probative evidence to show that the Veteran’s current carpal tunnel syndrome of the bilateral upper extremities is related to an event, injury, or disease in service, to include his presumed exposure to Agent Orange; manifested within one year of separation from service, or otherwise had a continuity of symptomatology since service, or is secondary to a service-connected disability. 3. There is no probative evidence to show that the Veteran’s peripheral neuropathy of the bilateral lower extremities is related to an event, injury, or disease in service, to include his presumed exposure to Agent Orange; manifested within one year of separation from service, or otherwise had a continuity of symptomatology since service, or is secondary to a service-connected disability. 4. The Veteran does not have a disability rated as permanent and total due to the loss or loss of use of both upper extremities or loss or loss of use of both of his lower extremities, one lower extremity together with the residuals of organic disease or injury, or one lower extremity together with one upper extremity, any of which preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; nor does he have service-connected amyotrophic lateral sclerosis, full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk, or loss of use of one lower extremity with blindness in both eyes that results in only having light perception. 5. The Veteran does not have a permanent and total service-connected disability which includes the anatomical loss or loss of use of both hands, or that is due to burn injuries or residuals of an inhalational injury, nor does he have a service-connected disability due to blindness in both eyes, with corrected central visual acuity of 20/200 or less in the better eye. CONCLUSIONS OF LAW 1. The criteria for service connection for carpal tunnel syndrome of the bilateral upper extremities have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5103, 5107; 38 C.F.R. §§ 3.303, 3.307. 3.309, 3.310. 2. The criteria for service connection for peripheral neuropathy of the bilateral lower extremities have not been met. 38 U.S.C. §§ 1110, 1116, 1131, 5103, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 3. The criteria for eligibility for assistance in acquiring specially adapted housing have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809. 4. The criteria for eligibility for a special home adaption grant have not been met. 38 U.S.C. §§ 2101, 5107; 38 C.F.R. §§ 3.102, 3.809a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The January 2009 Board decision that denied the service connection claims for disabilities related to the hands, feet, and back is final. The Veteran filed his petition to reopen his service connection claims in April 2017. In September 2020 the Board found that new and materia evidence had been received and reopened the service connection claims for peripheral neuropathy of the bilateral upper and lower extremities. As the petition to reopen was filed in April 2017, the appeal period commences April 2017. The Board remanded the matter in September 2020 for additional development. The Board finds that the remand directives have been substantially complied with and therefore will proceed with the appeal. Stegall v. West, 11 Vet. App. 268. The Veteran served on active duty in the United States Navy from November 1967 to September 1971. Service Connection Legal Criteria Establishing service connection generally requires (1) evidence of a presently existing disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)); Hickson v. West, 12 Vet. App. 247, 253 (1999). Service connection may also be established on a secondary basis when a disability is shown to be proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). For certain chronic diseases, such as other organic diseases of the nervous system, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. That presumption is rebuttable by probative evidence to the contrary. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection when the requirements for application of the presumption are not met. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Other organic diseases of the nervous system include peripheral neuropathy and carpal tunnel syndrome. In addition, service connection for certain disabilities may be presumed for those exposed to particular herbicide agents. Veterans exposed to Agent Orange or other listed herbicide agents are presumed service-connected for certain conditions even if there is no record of such disease during service. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). For VA purposes, neuropathy associated with herbicide agent exposure includes early-onset peripheral neuropathy. 38 C.F.R. § 3.309(e) (emphasis added). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Evidence The Veteran’s November 1967 enlistment examination shows that he was healthy upon entrance. A March 1968 service treatment record shows infection and injury to the right foot from coal. October 1968 service treatment records document pain, tenderness in left lower leg and complaints of pain in left lower leg. Edema and redness were shown as well as a history of the Veteran hitting his left leg. The diagnosis was listed as cellulitis. Service treatment records, to include the August 1971 separation examination, do not indicate any complaints of or treatment for symptoms related to peripheral neuropathy or carpal tunnel syndrome (CTS). During the October 2017 VA Back Conditions Disability Benefits Questionnaire (DBQ), the examiner concluded that the Veteran did not have a diagnosis of radiculopathy. During the November 2019 VA Back Conditions DBQ, the examiner concluded that the Veteran did not have a diagnosis of radiculopathy. During the June 2020 VA Back Conditions DBQ, the examiner concluded that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. During the December 2020 VA Peripheral Nerves Conditions DBQ, the examiner concluded that the Veteran did not have a diagnosis of peripheral neuropathy of the bilateral upper extremities. The Veteran was diagnosed with carpal tunnel syndrome (CTS) of the bilateral upper extremities and peripheral neuropathy of the bilateral lower extremities. The VA examiner opined that the Veteran’s carpal tunnel syndrome (CTS) of the bilateral upper extremities was less likely than not incurred in service, within a year of service, or is otherwise related to service or herbicide exposure. The examiner indicated there is no evidence that the Veteran had CTS or symptoms suggestive of CTS while in service or due to an event, illness, or exposure while in service. Nor did the Veteran have CTS within one year of service that likely resulted in, or predisposed him to, the development of CTS. The examiner further noted that although the Veteran may be credible in that he feels what he is contending is the truth, he could not recall the result of using wrist splints three years prior, so his memory may not be entirely reliable for events and symptoms that occurred almost 50 years ago. In regard to herbicide exposure, the updates issued by the National Academy of Sciences in 2014 and 2018 do not recognize herbicide exposure as a cause of CTS. Lastly, CTS is brought on by compression of the median nerve as it travels through the carpal tunnel. It is medically implausible that chemical exposure would cause this localized neural compression and chemical exposure is not medically recognized as a cause of CTS. The VA examiner also opined that the Veteran’s carpal tunnel syndrome of the bilateral upper extremities was less likely than not proximately due to or the result of the low back disability. The lumbar nerves supply the lower extremities and the neck/cervical spine nerves supply the upper extremities. Thus, a lower back/lumbar spine disability, degenerative arthritis, and degenerative disc disease can never result in the neural symptoms involving the upper extremities. Further, CTS is brought on by compression of the median nerve as it travels through the carpal tunnel of the wrist. “Thus, it is not medically implausible [sic] that a lower back condition or spinal condition of any kind, cervical, or lumbar would cause this localized neural compression and lower back/lumbar spine and neck/cervical spine conditions are not medically recognized as cause of CTS.” It is less likely than not that the Veteran’s carpal tunnel syndrome of the bilateral upper extremities was aggravated beyond its normal progression by the low back disability, because there is no means for those conditions to cause aggravation. Neither condition can plausibly cause the localized neural compression at the wrist that characterizes CTS and lower back/lumbar spine and neck/cervical spine conditions are not medically recognized as causes of CTS and thus cannot aggravate it beyond its natural progression. The VA examiner also opined that the peripheral neuropathy of the bilateral lower extremities was less likely than not incurred in service or within a year of service or is otherwise related to service or related to the presumed in-service herbicide exposure. There is no evidence that the Veteran had peripheral neuropathy, symptoms suggestive of peripheral neuropathy, or a condition, event, injury, illness, exposure or circumstance in service or within one year of service likely to result in or predisposed to development of peripheral neuropathy. A detailed Social Security disability exam in 2004 did not document any symptoms or exam findings suggestive of peripheral neuropathy. The examiner noted that the Veteran’s memory may not be entirely reliable for events and symptoms that occurred almost 50 years ago. Therefore, the examination of records and reliance on objective documentation is important. In terms of herbicide exposure, the examiner found no evidence that peripheral neuropathy began during or within one year of service. “Based on a finding of the National Academy of Sciences Engineering, and Medicine in its report Veterans and Agency Orange: Update 1996’ that there is limited/suggestive evidence that neuropathy of acute or subacute onset may be associated with herbicide (TCDD, COIs) exposure, early onset peripheral neuropathy occurring within one year of exposure was made a presumptive condition qualifying for service connection.” That same publication indicated there was inadequate/insufficient evidence linking late onset peripheral neuropathy with herbicide exposure. One study cited in the National Academy of Science report found there was no increased prevalence of peripheral neuropathy several years after an incident of accidental heavy exposure. The report concluded that “If TCDD is associated with the development of transient acute and subacute peripheral neuropathy, the disorder would become evident shortly after exposure, therefore, there is no evidence that new cases that develop long after service in Vietnam are associated with herbicide exposure that occurred there.” According to experts “The most rigorously conducted studies argued against a relationship between TCDD or herbicides and chronic persistent neuropathy” and “despite intensive investigation, a specific cause of a chronic peripheral neuropathy may not be found in between 20 and 50 percent of cases…. making it impossible to ascribe such neuropathies to exposure to a possible neurotoxin when that exposure occurred years earlier and was not continuing.” The examiner noted that more recent studies have similarly found that the prevalence of polyneuropathy in the general middle-aged and elderly population is at least 4%, increased with age and almost half were idiopathic. No additional studies have found a relationship between past herbicide exposure and peripheral neuropathy that began years after exposure. Specifically, the latest update issued by the National Academy of Sciences in 2014 concluded that while an early onset (within one year of exposure) neuropathy may become chronic, “the committee concludes that the evidence reviewed here does not support an association between exposure to COIs and the development of delayed-onset chronic neuropathy.” The conclusion was “there is inadequate or insufficient evidence to determine whether there is an association between exposure to the COIs and delayed-onset chronic neuropathy.” A 2018 update to the 2014 report did not change the previous conclusions regarding neuropathy. Therefore, as the Veteran’s neuropathy began many years after herbicide exposure it remains less likely than not that the peripheral neuropathy of the bilateral lower extremities is etiologically related to service, to particularly include presumed exposure to herbicides. The VA examiner opined that the peripheral neuropathy of the bilateral lower extremities was less likely than not proximately due to or the result of the service-connected low back disabilities. Peripheral neuropathy affects multiple small distal nerves rather than spinal nerves and low back disability cannot plausibly affect those multiple small nerve endings and therefore are not medically recognized cause of peripheral neuropathy. Further, the examiner pointed to the Veteran’s treating provider who indicated his neuropathy was idiopathic, meaning there was no apparent cause. The examiner also noted that though early diabetic neuropathy was initially suspected, the only mildly abnormal glucose did not support that consideration. It is less likely than not than not that the peripheral neuropathy of the bilateral lower extremities was aggravated beyond its normal progression by the low back disability because there is no means for those conditions to cause aggravation. Neither condition can plausibly affect the multiple small nerve endings that develop pathology in peripheral neuropathy and therefore neither is a medically recognized cause of peripheral neuropathy. A condition that does not cause peripheral neuropathy cannot aggravate it beyond its natural progression. Contentions The Veteran contends that he has peripheral neuropathy of the bilateral upper and bilateral lower extremities due to his herbicide exposure or secondary to his service-connected low back disability. Carpal tunnel syndrome of the bilateral upper extremities The record shows a current diagnosis carpal tunnel syndrome (CTS) of the bilateral upper extremities. In the January 2009 Board decision, the Board conceded exposure to Agent Orange. The question before the Board is whether the Veteran’s CTS is related to his military service, his presumed in-service exposure to herbicide agent, or secondary to his service-connected low back disability. The probative evidence of record illustrates that the Veteran’s CTS is not related to service or his service-connected disabilities. The Board acknowledges the Veteran’s opinion that his CTS is due to his exposure to Agent Orange and or his low back disability. As a lay person, he does not have the education, training, or experience to diagnose a peripheral nerve condition or opine as to the etiology of any current related disability. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376 (2007) (lay persons not competent to diagnose conditions such as cancer). “Competent medical evidence” is evidence that is provided by a person qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. 38 C.F.R. § § 3.159(a); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Additionally, the only medical opinions of record conclude that the Veteran’s CTS is not related to military service, exposure to herbicide agent, or secondary to his low back disability. The VA examiner performed an in-person examination of the Veteran, noted and accounted for his reporting, and reviewed the file. The examiner provided very detailed and thorough rationale. There is no competent opinion to the contrary. These medical opinions far outweigh the Veteran’s contentions. Further, the earliest dated record post-separation in the file to show a diagnosis of neuropathy of the upper extremities, is dated October 2002, over three decades following his September 1971 separation. The Board acknowledges that there is a private treatment record wherein the Veteran reports having a diagnosis of neuropathy as early as 2000. As shown above, the probative evidence of record shows that there is no diagnosis of neuropathy of the bilateral upper extremities. Also, even if taking the Veteran’s reports as credible and his belief of having neuropathy as early as 2000 highlights symptoms consistent with CTS, it is still over 28 years post separation. Therefore, service connection for CTS of the upper extremities is not warranted on a direct theory of entitlement, even when considering his presumed exposure to herbicide agents; nor is service connection warranted on a secondary theory of entitlement. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. As the preponderance of the evidence is against these claims, the benefit of the doubt doctrine is not for application. See U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. at 54-56 (1990). Peripheral neuropathy of the bilateral lower extremities The record shows a current diagnosis peripheral neuropathy of the bilateral lower extremities. As stated above, exposure to Agent Orange has been conceded. The question before the Board is whether the Veteran’s peripheral neuropathy is related to his military service, his presumed in- service exposure to herbicide agent, or secondary to his service-connected low back disability. The probative evidence of record illustrates that the Veteran’s peripheral neuropathy is not related to service or secondary to his service-connected disabilities. The Board recognizes the service treatment record that shows a wound to the right foot. However, there is nothing in the record to indicate a claim for the right foot and the record does not show, nor has the Veteran contended, that this in-service injury is related to his peripheral neuropathy of the right lower extremity. The Board also recognizes the service treatment records that show pain in the left lower leg, edema, and a diagnosis of cellulitis. However, there is nothing in the record to indicate a claim for cellulitis. Additionally, the record does not show, nor has the Veteran contended, that his in-service diagnosis of cellulitis is related to his peripheral neuropathy of the left lower extremity The Board acknowledges the Veteran’s opinion that his peripheral neuropathy is due to his exposure to Agent Orange and or his low back disability. As a lay person, he does not have the education, training, or experience to diagnose a peripheral nerve condition or opine as to the etiology of any current related disability. Additionally, there is only one medical opinion of record and the VA examiner concluded that the Veteran’s peripheral neuropathy is not related to military service, exposure to herbicide agent, or secondary to his low back disability. The examiner performed an in-person examination of the Veteran, noted and accounted for his reporting, and reviewed the file. The examiner provided very detailed and thorough rationale. There is no competent opinion to the contrary. These medical opinions far outweigh the Veteran’s contentions. Additionally, the earliest dated record post separation in the file to indicate a diagnosis of neuropathy of the lower extremities, is dated October 2002, over three decades post his September 1971 separation. The Board acknowledges that there is a private treatment record wherein the Veteran reports having a diagnosis of neuropathy as early as 2000. However, even if taking the Veteran’s reports as credible and his belief of having neuropathy as early as 2000, this is still over 28 years post separation. Therefore, service connection for peripheral neuropathy of the lower extremities is not warranted on a direct theory of entitlement, even when considering his presumed exposure to herbicide agents, nor is service connection warranted on a secondary theory of entitlement. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. As the preponderance of the evidence is against these claims, the benefit of the doubt doctrine is not for application. Acquisition and Adaptation of Housing Evidence During the October 2017 VA Back Conditions DBQ the examiner noted the assistive devices the Veteran used. He occasionally used a back belt for his back. During the November 2019 VA Back Conditions DBQ, the examiner noted the assistive devices the Veteran used. He used a brace regularly and a cane occasionally. He uses the back brace when he is lifting, and uses the cane to help with his knees and to help him walk when his symptoms worsen. During the June 2020 VA Back Conditions DBQ, the examiner concluded that the Veteran did not use any assistive devices as a normal mode of locomotion. During the December 2020 VA Peripheral Nerves Conditions DBQ, the examiner noted that the only assistive device the Veteran used was a lift belt. He would use the lift belt occasionally when lifting 25 to 30-pounds, repetitively to prevent back pain. He does not use any assistive devices for his bilateral upper or lower extremities. Special Adapted Housing Specially adapted housing under is available to a veteran who has a permanent and total service-connected disability. This permanent and total service-connected disability must either be amyotrophic lateral sclerosis rated as 100 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8017 or must be due to: (1) the loss or loss of use of both lower extremities, such as to preclude locomotion without the use of the aid of braces, crutches, canes, or a wheelchair; (2) blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; (3) the loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the use of the aid of braces, crutches, canes, or a wheelchair; (4) the loss or loss of use one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the use of the aid of braces, crutches, canes, or a wheelchair; (5) the loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow; or (6) full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk. 38 U.S.C. § 2101(a); 38 C.F.R. § 3.809(a), (b), (d). Specially adapted housing may also be available to a veteran who served on or after September 11, 2001, who has a permanent disability that was incurred during such service, and which results in loss or loss of use of one or more extremities which so affects the functions of balance or propulsion as to preclude ambulating without the aids of braces, crutches, canes, or a wheelchair. See 38 U.S.C. § 2101(a)(2)(C). As the Veteran’s active service concluded prior to September 11, 2001, this provision is inapplicable. The phrase “preclude locomotion” is defined as the necessity for regular and constant use of a wheelchair, braces, crutches or canes as a normal mode of locomotion, although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). The Veteran is service connected for the following disabilities: posttraumatic stress disorder (PTSD) rated at 70 percent, status-post left knee replacement rated at 30 percent, left shoulder rotator cuff tendonitis with degenerative arthritis rated at 20 percent, right shoulder rotator cuff tendonitis with degenerative arthritis rated at 20 percent, low back disability rated at 20 percent, pilonidal cystectomy residuals rated at 10 percent, degenerative joint disease of the left knee rated at 10 percent, degenerative joint disease of the right knee rated at 10 percent, tinnitus rated at 10 percent, and right index finger cut residuals rated as noncompensable. He has a combined disability rating of 90 percent. He is also in receipt of total disability rating based on individual unemployability (TDIU) rating with an effective date of August 5, 2004. He is also in receipt of S-1 special monthly compensation. As he has been granted a TDIU, the first prerequisite has been met, a permanent and total service-connected disability. The question before the Board is whether the permanent and total service-connected disability meets the necessary criteria for eligibility for a certificate of entitlement to specially adapted housing. When considering the evidence of record under the aforementioned law and regulation, the Board finds that a preponderance of the evidence is against the Veteran’s claim for eligibility for specially adapted housing. Despite meeting the requisite of a permanent and total service-connected disability, he does not meet the regulatory requirement that the disability be rated as permanent and total as due to one of the combinations of functional impairments enumerated under §3.809(b) or (d). Even assuming, without deciding, that the Veteran’s service-connected disabilities alone are of such severity as to preclude locomotion without an ambulatory aid, the evidence demonstrates that such functional impairment would result from degenerative arthritis of the knees and degenerative joint and disc disease of the low back. These disabilities do not qualify for specially adapted housing, as there is no service-connected lower extremity disability, and therefore, no permanent loss or loss of use of both lower extremities. In fact, the evidence shows that the Veteran does not require the use of any ambulatory aids or that his service-connected disabilities precludes locomotion. Additionally, the most recent examination highlights that the Veteran does not use a brace, a cane, or a walker. In fact, he lifts heavy items and will use the assistive device of a back belt to provide extra support when lifting. All of the examinations of record, that fall within the appeal period, all illustrate that any use of an assistive device by the Veteran was used occasionally or regularly. There is no service-connected disability that results in the loss or loss of use of one lower extremity. The Veteran is not service connected for any disability specific to the lower extremity, such as neuropathy, radiculopathy, or spinal injury. As such, he is ineligible for specially adapted housing under §3.809(b)(2). It is neither shown, nor has the Veteran asserted, that his service-connected disabilities involve blindness, an organic disease, burn injuries, or amyotrophic lateral sclerosis. Similarly, a service-connected disability is not shown or alleged to have resulted in loss of use of either upper extremity that precludes use of the arms at or above the elbows. Thus, a clear preponderance of the evidence demonstrates that the Veteran has not experienced the loss of use of both upper extremities, both lower extremities, or one lower extremity along with one upper extremity. As such, the Veteran does not have a permanent and total disability due to the any of the enumerated conditions required under 38 C.F.R. §§ 3.809. He is therefore ineligible for specially adapted housing. Special Home Adaptation If entitlement to specially adapted housing is not established, a veteran may qualify for a grant for necessary special home adaptations if he has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard correcting lens or a limitation in fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees (such a disability need not be permanent and total in nature); a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contracture(s) with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contracture(s) of one or more extremities or the truck; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)). 38 C.F.R. § 3.809a(b). As discussed in greater detail above, the Board finds that the weight of the evidence demonstrates that although the Veteran is service connected for his shoulders, he retains complete use of his hands. As such, there is not the anatomical loss or loss of use of both hands. Additionally, his service-connected disabilities do not include burn injuries, an inhalation injury, or loss of vision. Ultimately, the Veteran does not have a permanent and total disability due to the any of the enumerated conditions under 38 C.F.R. §§ 3.809a. He is therefore ineligible for a special home adaptation grant. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes 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.