Citation Nr: 21013060 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 18-01 774 DATE: March 8, 2021 ORDER From June 12, 2014, entitlement to a separate disability rating of 10 percent for slight left knee instability is granted. Entitlement to a compensable rating for left knee strain, limitation of extension is denied. Entitlement to a disability rating in excess of 10 percent prior to November 19, 2020 and in excess of 30 percent thereafter for left knee sprain, limitation of flexion is denied. Entitlement to a disability rating of 20 percent, but no higher, for a left ankle sprain with osteoarthritis is granted. FINDINGS OF FACT 1. From June 12, 2014, the Veteran’s left knee disability has resulted in slight instability requiring use of a cane and/or brace for ambulation. 2. The Veteran’s left knee disability has not resulted in limitation of extension to an endpoint greater than 5 degrees. 3. Prior to November 19, 2020, the Veteran’s left knee disability did not result in limitation of flexion to an endpoint under 60 degrees; from November 19, 2020, the Veteran’s left knee disability resulted in limitation of flexion to an endpoint under 15 degrees. 4. The Veteran’s left ankle disability has manifested with pain, instability, and reduced muscle strength resulting in marked limited motion and additional functional impairment. CONCLUSIONS OF LAW 1. From June 12, 2014, the criteria for entitlement to a separate disability rating of 10 percent for slight left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.71a, Diagnostic Code (DC) 5257. 2. The criteria for entitlement to a compensable rating for left knee strain, limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.71a, DC 5261. 3. The criteria for entitlement to a disability rating in excess of 10 percent prior to November 19, 2020 and in excess of 30 percent thereafter for left knee sprain, limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.71a, DC 5260. 4. The criteria for entitlement to a disability rating of 20 percent, but no higher, for a left ankle sprain with osteoarthritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.40, 4.45, 4.71a, DCs 5010-5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1979 to July 1983, with additional period of active duty for training from July 1978 to October 1978. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). A May 2019 Board decision, in pertinent part, denied entitlement to increased disability ratings for left knee and left ankle disabilities. The Veteran appealed the decision to the United States Court of Veterans Appeals for Veterans Claims (Court). In April 2020, the Court granted the parties Joint Motion for Remand (JMR), which vacated the Board’s decision to deny increased disability ratings for the Veteran’s left knee and ankle disabilities, finding the Board did not provide an adequate reasons and bases and relied on inadequate VA musculoskeletal examinations. In September 2020, the Board remanded the claims for further development in accordance with the parties’ JMR. Such development has been completed. Increased Ratings When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Additional separate disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability.  38 C.F.R. § 4.14; see Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Effective February 7, 2021, the schedule for rating disabilities of the musculoskeletal system has been revised. See 85 Fed. Reg. 76453 (Nov. 30, 2020). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that the Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable diagnostic codes to the period on or after the effective dates of the new diagnostic codes if the prior versions were in effect during the pendency of the appeal, as is the case here. Therefore, the Board may evaluate the Veteran’s claims for increased disability ratings for his left knee and ankle under both earlier and current diagnostic codes, as of their effective dates, in order to determine which version would afford the Veteran the highest rating. 1. From June 12, 2014, entitlement to a separate disability rating of 10 percent for slight left knee instability is granted. 2. Entitlement to a compensable rating for left knee strain, limitation of extension is denied. 3. Entitlement to a disability rating in excess of 10 percent prior to November 19, 2020 and in excess of 30 percent thereafter for left knee sprain, limitation of flexion is denied. The Veteran seeks an increased rating for his left knee disability. The Veteran’s left knee is currently rated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5260 for limitation of flexion as 10 percent disabling until November 19, 2020 and 30 percent disabling thereafter and under DC 5261 for limitation of extension as noncompensable. Normal range of motion of the knee is to 0 degrees (full extension) and to 140 degrees (full flexion).  38 C.F.R. § 4.71a, Part II.   When flexion of the knee is limited to 45 degrees, a 10 percent rating may be assigned.  When flexion is limited to 30 degrees, a 20 percent evaluation may be assigned.  A 30 percent rating may be assigned when flexion of the leg is limited to 15 degrees.  38 C.F.R. § 4.71a, DC 5260.   When extension of the knee is limited to 10 degrees, a 10 percent evaluation may be assigned. When extension is limited to 15 degrees, a 20 percent evaluation may be assigned. When limited to 20 degrees, a 30 percent rating may be assigned. When extension is limited to 30 degrees, a 40 percent evaluation is assignable.  A 50 percent evaluation may be assigned when extension of the leg is limited to 45 degrees.  38 C.F.R. § 4.71a, DC 5261.   Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (DC 5260), limitation of extension (DC 5261), lateral instability or recurrent subluxation (DC 5257), and meniscal conditions (DC 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). Slight recurrent subluxation or lateral instability warrants a 10 percent evaluation. A 20 percent rating requires moderate recurrent subluxation or lateral instability.  A 30 percent rating requires severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The Board notes that the terms “mild,” “moderate,” and “severe” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are “equitable and just.”  38 C.F.R. § 4.6. Here, the Board finds an increased disability rating is not warranted under DCs 5260 and 5261, but a separate disability rating is warranted for slight left knee instability under DC 5257 from the date the Veteran first complained of left knee instability on the record. The Veteran underwent VA knee examinations in June 2014, June 2015, December 2015, April 2017, September 2020, and November 2020. At the June 2014 examination, the examiner diagnosed the Veteran with a left knee strain dating back to 1979 and observed painful motion with a flexion end point of 95 degrees and an extension endpoint of 5 degrees. Repetitive use testing resulting in the same range of motion measurements. Loss of range of motion was not estimated during a potential flare up, but the Veteran described them as pain and swelling with cold, rainy weather and going up and down stairs. The Veteran also complained of his left knee giving out and exhibited slightly reduced muscle strength on extension, although objective stability testing was normal. The examiner noted the Veteran used a cane daily for walking and knee pain. At the June 2015 examination, the examiner did not issue a diagnosis, address, or obtain measurements regarding the Veteran’s left knee. Treatment records from August 2015 note pain in the Veteran’s right knee and left ankle, but not his left knee. At the December 2015 examination, the examiner observed the Veteran to sit with his left knee in extension and noted the Veteran complained of pain sitting, getting up from sitting, and trying to stoop. The examiner diagnosed the Veteran with partial ankylosis of the left knee and observed painful motion with a flexion endpoint of 60 degrees and an extension endpoint of 20 degrees. The examiner elaborated that the limited ankylosis diagnosis represented to the Veteran’s limited motion as he showed on this examination. However, the examiner further explained the Veteran actively resisted and actively prevented the examiner from attempting any extension beyond that point. Treatment records from January 2016 note stable pain in the Veteran’s right knee and left ankle, but did not mention pain in the Veteran’s left knee. At the April 2017 examination, the examiner diagnosed the Veteran with left knee strain and observed painful motion with a flexion endpoint of 115 degrees and an extension endpoint of 0 degrees. The Veteran complained of flare ups precipitated by standing and walking and that his knee gives out. However, the examiner did not address potential range of motion loss following repetitive use over time or during a flare up, explaining that any estimation of range of motion loss would have to resort to mere speculation. Joint stability tests indicated a stable left knee, but the Veteran was observed to occasionally use a brace and regularly use a cane for his left knee. No ankylosis was noted and the Veteran exhibited full strength in his left knee. At the September 2020 examination, the Veteran complained of difficulty going up and down stairs and with prolonged standing and walking. The examiner diagnosed the Veteran with a left knee sprain and observed painful motion with a flexion endpoint of 95 degrees and an extension endpoint of 0 degrees. The Veteran chose not to undergo repetitive use testing consisting of three repetitions for fear of pain. The Veteran reported flare ups consisting of daily pain qualified as 10 on a 10-point scale with moving around. However, based on the Veteran’s statements, the examiner noted that pain, weakness, and fatigue caused the Veteran functional loss over time and estimated the functional loss would result in left knee flexion to an endpoint of 90 degrees and an extension endpoint to 0 degrees. Similar estimations were given for functional loss during flare ups. Instability testing was normal, but it was noted that the Veteran constantly wears a brace and uses a cane. Again, no ankylosis was noted, but the Veteran did exhibit slightly reduced left knee strength. At the November 2020 examination, the Veteran reported flare ups from bending and walking, describing walking as “difficult.” The examiner diagnosed the Veteran with a left knee sprain and observed painful motion with initial ranges of motion measured as flexion to an endpoint of 26 degrees and an extension to an endpoint of 0 degrees. Following three repetitions, the Veteran’s flexion range of motion degrees to an endpoint of 13 degrees. He maintained full extension. The examiner estimated the Veteran’s ranges of motion to be flexion to an endpoint of 13 degrees and extension to an endpoint of 0 degrees following repetitive use over time and during flare ups. Passive range of motion testing revealed left knee flexion to an endpoint of 11 degrees and extension to an endpoint of 0 degrees. No ankylosis was noted; however, a history of recurrent subluxation was noted. Based on the foregoing, the Board finds that increased disability ratings for left knee limitation of flexion and limitation of extension are not warranted. First, from November 19, 2020, the Veteran is in receipt of the maximum rating based on limitation of flexion under DC 5260, thus, an increased schedular rating for left knee limitation of flexion from November 19, 2020 is denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Prior to November 19, 2020, the Veteran would have had to exhibit reduced flexion to an endpoint of 30 degrees to receive a rating in excess of his currently assigned 10 percent disability rating. However, prior to November 19, 2020, the Veteran, at worst, exhibited limitation of flexion to 90 degrees. Thus, a rating in excess of 10 percent prior to November 19, 2020 and a rating in excess of 30 percent for limitation of flexion under DC 5260 is denied. Second, the Veteran is currently assigned a noncompensable rating for left knee limitation of extension under DC 5261 and the Board finds that a higher rating is not warranted. For a compensable rating under DC 5261, the Veteran must have exhibited limitation of extension in excess of 5 degrees. However, at worst during the entire period on appeal, the Veteran exhibited limitation of extension to 5 degrees. DC 5261 qualifies limitation of extension to 5 degrees as noncompensable. Thus, a compensable rating for limitation of extension under DC 5261 is denied. The Board acknowledges the December 2015 examiner noted an extension endpoint of 20 degrees, limited ankylosis, and greatly reduced muscle strength in the Veteran’ left knee. However, because the examiner noted the Veteran did not fully cooperate with the examination, the Board has assigned less probative weight to this examination than the other examinations of record. Notes of pain in the Veteran’s right knee and left ankle, but not left knee shortly before and shortly after the December 2015 examination also weigh against ascribing probative weight to the degree of pain, reduced motion, and reduced muscle strength noted at this examination. The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). A higher or separate rating is not available under DCs 5256, 5258, 5259, 5262, 5263 as the evidence of record indicates the Veteran does not have ankylosis of the left knee, dislocated semilunar cartilage with frequent episodes of locking pain and effusion, symptomatic removal of the semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. However, the Board finds a sufficient basis to award a 10 percent rating under DC 5257 for left knee instability. He is competent to report such symptoms. This rating is assigned due to the Veteran’s consistent subjective reports of left knee instability and giving out since his June 2014 examination. Notably, the Veteran has used a brace and cane to assist with ambulation and the November 2020 examination confirms a history of recurrent subluxation. This evidence supports the assignment of a compensable rating for instability. See English v. Wilkie, 30 Vet. App. 347 (2018). A higher rating is not warranted as objective medical evidence, which is probative, fails to establish clinical findings of recurrent subluxation or lateral instability on examination. In sum, the Board finds the preponderance of the evidence is against the Veteran’s increased rating claims for left knee limitation of flexion and limitation of extension. The Veteran’s noted functional loss (i.e., difficulty walking, getting up from sitting down, going up and down stairs, etc.) is encompassed by his current ratings for limited motion. See Thompson, 815 F.3d at 785. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. However, a separate 10 percent rating for slight left knee instability is warranted. 4. Entitlement to a disability rating of 20 percent, but no higher, for a left ankle sprain with osteoarthritis is granted. The Veteran seeks an increased rating for his left ankle disability. The Veteran is currently rated under 38 C.F.R. § 4.71a, DC 5010-5271 for moderate limitation of motion. The Board finds an increased rating is warranted. Under DC 5271, a 10 percent evaluation is warranted for “moderate” limitation of motion of an ankle. A 20 percent evaluation is warranted for “marked” limitation of motion of an ankle. Evaluations greater than 20 percent are warranted for ankylosis. See 38 C.F.R. § 4.71a, DCs 5270 and 5272. The words “moderate” and “marked” are not defined in the rating schedule; rather, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. Normal ranges of ankle motions are 0 to 20 degrees for dorsiflexion and 0 to 45 degrees for plantar flexion. See 38 C.F.R. § 4.71, Plate II. The Veteran underwent VA ankle examinations in June 2014, June 2015, December 2015, April 2017, December 2018, September 2020, and November 2020. At the June 2014 examination, the Veteran reported flare ups manifested by pain and swelling with prolonged walking, standing, and rainy weather. The examiner diagnosed the Veteran with a left ankle sprain dating back to 1980 and degenerative arthritis and observed plantar flexion to 20 degrees, where pain began, and dorsiflexion to 10 degrees, where pain began. Repetitive use testing resulted in the same ranges of motion. Ranges of motion were not estimated for after repetitive use over time nor during flare ups. The examiner recorded reduced muscle strength and the anterior drawer and talar tilt tests revealed laxity in the Veteran’s left ankle. No ankylosis was noted, nor additional conditions such as malunion of os calcis or astragalus. In March 2015, the Veteran sought treatment for left ankle pain through a VA emergency department. He stated he had recently fallen at home and reported needing a cane to walk. At the June 2015 examination, the Veteran reported no flare ups, but problems with walking or standing for long periods of time. The examiner observed dorsiflexion to an endpoint of 10 degrees and plantar flexion to an endpoint of 40 degrees. The examiner noted that this range of motion contributed to functional loss in that it made it difficult for the Veteran to climb stairs. The examiner estimated that three repetitions would not result in additional functional loss, indicated there would be at least some functional loss with repetitive use over time, but concluded any specific estimate would be require speculation. The examiner did not address flare ups. The examiner observed pain on palpation and pain on weight bearing. The Veteran left ankle strength was reduced. No ankylosis was noted nor was instability; however, the examiner recorded the Veteran as constantly requiring a brace and cane for his left ankle arthritis. In October 2015, the Veteran sought treatment through an emergency department and was diagnosed with chronic pain in his left ankle. At the December 2015 examination, the Veteran complained of ankle pain and functional loss. He explained that he was not able to walk a full block because of ankle pain and that when standing he experiences left ankle pain which forces him to sit down, although he did not describe how long he could stand before needing to sit. The examiner diagnosed the Veteran with posterior tibial tendonitis and ununited medial malleolar fracture and observed painful motion with dorsiflexion to an endpoint of 5 degrees and plantar flexion to an endpoint of 20 degrees. The examiner noted that he could not assess change in motion with repetition on the left because of resistance from the Veteran and did not estimate function loss during a flare up. The examiner was also unable to conduct left ankle strength and stability testing because the Veteran resisted and refused. At the April 2017 examination, the Veteran reported pain and arthritis, that his ankle “aches.” He noted the regular use of a lace up ankle brace and reported flare ups from standing and use. The examiner observed the Veteran’s left ankle dorsiflexion to an endpoint of 10 degrees and plantar flexion to an endpoint of 25 degrees, but noted the decreased range of motion did not contribute to functional loss. The Veteran exhibited tenderness on palpation, but full strength in his left ankle. Instability was shown by the talar tilt test and the examiner noted regular use of a brace and cane. No ankylosis was noted. Potential range of motion lost following repetitive use over time or during a flare up was not addressed. The examiner explained that any estimation would be based on speculation. At the December 2018 examination, the Veteran reported left ankle pain with prolonged standing, walking, or climbing stairs. He was observed to regularly wear a brace and was noted to have intermittent swelling at the site of his original injury. The examiner recorded the Veteran’s dorsiflexion to an endpoint of 10 degrees and plantar flexion to an endpoint of 30 degrees. The examiner noted pain on examination, but that it did not result in functional loss. The Veteran exhibited pain with weight bearing and localized tenderness to palpation. The Veteran was able to perform three repetitions without any resulting functional loss. The examiner estimated that repetitive use over time would result in functional loss, but was unable to estimate the resulting range of motion loss. Regarding flare ups, the examiner explained that the Veteran “does not have flare ups per se, but rather has a predictable increase in pain with activity.” No ankylosis was noted, nor instability. However, the Veteran reported regular use of a left ankle brace and that without it, the ankle can feel like it is going to give out after walking or standing for too long. In April 2019, the Veteran sought treatment through an emergency department for left ankle pain. He arrived ambulatory with chronic left ankle pain, worse in the previous three days. He reported pain as 10 on a 10-point scale. He also reported the use of a brace, but was noted not to be wearing it. VA treatment records from July 2019 note the Veteran experienced chronic swelling around the ankle that was not new. At the September 2020 examination, the Veteran reported sharp pain in his left ankle and difficulty standing or walking for prolonged periods of time. He alleged an inability to exercise. For example, walk around a track. The Veteran also reported constantly wearing a brace to help support the ankle, and a cane for ambulation. The examiner observed the Veteran’s dorsiflexion to an endpoint of 10 degrees and plantar flexion to an endpoint of 20 degrees. There was no loss of range of motion following three repetitions. The examination was not conducted immediately after repetitive use over time or during flare ups, but the examiner estimated that the resulting range of motion loss would be dorsiflexion to 5 degrees and plantar flexion to 15 degrees for both scenarios. The Veteran exhibited slightly reduced left ankle strength. At the November 2020 examination, the Veteran reported a sharp, needle like pain in his left ankle when he stands or turns—“hurts to stand on it,” he explained. He reported constantly wearing a brace. The examiner observed the Veteran’s left ankle dorsiflexion to an endpoint of 19 degrees and plantar flexion to an endpoint of 30 degrees. The examiner observed pain, but noted it did not cause functional loss. After three repetitions, the Veteran’s left ankle dorsiflexion was measured to an endpoint of 18 degrees and plantar flexion to an endpoint of 30 degrees. The examiner estimated repetitive use over time and flare ups to result in the same ranges of motion. The Veteran exhibited full left ankle strength and no ankylosis. Passive range of motion tests revealed dorsiflexion to an endpoint of 20 degrees and plantar flexion to an endpoint of 18 degrees. Based on the foregoing, a 20 percent rating, which is the maximum schedular rating under DC 5271, is assigned for “marked” limitation of motion. The evidence of record demonstrates that the Veteran has had limited motion in his left ankle and has reported pain which, at the beginning of the period on appeal, worsened with prolonged walking or simply standing, and has progressed to restricting the Veteran’s ability to walk at all. For example, he recently reported the inability to even walk around a track. He has consistently worn a lace up brace to support his left ankle. His left ankle has exhibited reduced strength and laxity. Based on objective evidence showing his left ankle’s range of motion has primarily been limited to about half of the normal range, as well as the Veteran’s subjective complaints of pain and functional limitations, a 20 percent rating is warranted. The Veteran is not entitled to a rating in excess of 20 percent. A 20 percent rating is the maximum schedular rating under DC 5271. The Board has considered other potentially applicable diagnostic codes. DC 5010 does not offer a higher rating. There is also no evidence of impairment of the tibia and fibula, ankylosis of the subastragalar or tarsal joint, malunion of the os calcis or astragalus, or astragalectomy. See 38 C.F.R. § 4.71a, DCs 5262, 5272, 5273, and 5274. Thus, there are no other diagnostic codes that are potentially applicable that would provide for a higher or separate rating for the Veteran’s left ankle disability. Resolving doubt in the Veteran’s favor, a 20 percent rating, but no higher, is warranted for a left ankle sprain with osteoarthritis. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante, Associate 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.