Citation Nr: 21013875 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-39 407 DATE: March 10, 2021 ORDER An initial 70 percent disability rating for service-connected posttraumatic stress disorder (PTSD) prior to September 17, 2019, is granted. A disability rating in excess of 70 percent for service-connected PTSD, from September 17, 2019, is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU), prior to September 17, 2019, is remanded. FINDINGS OF FACT 1. The evidence is at least evenly balanced as to whether prior to September 17, 2019, the Veteran’s PTSD symptoms and overall impairment more nearly approximated occupational and social impairment with deficiencies in most areas; however, they have not more nearly approximated total occupational and social impairment. 2. From September 17, 2019, the Veteran’s PTSD results in deficiencies in most areas, but not total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for a 70 percent disability rating for service-connected PTSD, prior to September 17, 2019, have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for a disability rating greater than 70 percent for service-connected PTSD, from September 17, 2019, have not been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1969 to January 1971. This appeal comes before the Board of Veterans’ Appeals (Board) from September 2011 and January 2012 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The September 2011 rating decision granted service connection for PTSD and assigned a 10 percent disability rating, effective June 28, 2011. The Veteran’s notice of disagreement (NOD) was received in October 2011. The RO issued the statement of the case (SOC) in January 2012 which granted an initial 30 percent disability rating for PTSD which was effectuated by a February 2012 rating decision. The January 2012 rating decision denied entitlement to TDIU. The Veteran’s NOD was received in February 2012 where he stated that he disagreed with the assigned initial 30 percent disability rating for his service-connected PTSD and the denial of TDIU. The RO issued the SOC in May 2012 and in June 2012 the Veteran again stated that he disagreed with the currently assigned rating for his PTSD and the denial of TDIU. A July 2012 VA letter indicates that the VA accepted the Veteran’s June 2012 lay statement in lieu of a VA Form 9, substantive Board appeal. In December 2018 the Board remanded the case to the RO for further development and adjudicative action. During the pendency of the appeal, the RO issued a rating decision in May 2020 granting an increased rating for the service-connected PTSD to 70 percent, effective from September 17, 2019, and granting TDIU, effective from September 17, 2019. The Board acknowledges that the Veteran agreed to withdraw his appeal seeking an increased rating for his PTSD and entitlement to TDIU in September 2012, followed by a request to re-open in August 2013. See September 2012 and August 2013 VA Forms 21-4138, Statements in Support of Claim. As previously noted in the December 2018 Board remand, the Board finds that the Veteran did not fully understand the consequences of withdrawal, as he subsequently clarified that he did not wish to withdraw his appeal, but was awaiting other evidence to submit for his appeal. See October 2013 VA 21-4138, Statement in Support of Claim. Thus, the Veteran’s prior withdrawal of his issues on appeal cannot be characterized now as “done with a full understanding of the consequences of such action on the part of the Veteran,” and accordingly, the Board will assume jurisdiction over the June 2011 claim. See Warren v. McDonald, 28 Vet. App. 214, 218 (2016) (citing DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011)). Increased Disability Ratings Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Separate diagnostic codes identify the various disabilities. It is necessary to rate the disability from the point of view of the Veteran working or seeking work, 38 C.F.R. § 4.2, and to resolve any reasonable doubt regarding the extent of the disability in the Veteran's favor. 38 C.F.R. § 4.3. If there is a question as to which disability rating to apply to the Veteran's disability, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the Veteran's entire history is reviewed when assigning a disability rating, 38 C.F.R. § 4.1, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). However, where the Veteran is appealing the initial assignment of a disability rating, the severity of the disability is to be considered during the entire period from the initial assignment of the disability rating to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). Additionally, in determining the present level of a disability for any increased rating claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In other words, where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of staged ratings would be necessary. It is possible for a Veteran to have separate and distinct manifestations from the same injury that would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); 38 C.F.R. § 4.14. 1. Entitlement to a disability rating greater than 30 percent for service-connected PTSD prior to September 17, 2019. 2. Entitlement to a disability rating greater than 70 percent for service-connected PTSD from September 17, 2019. The Veteran asserts that his service-connected PTSD is more disabling than reflected by the respective 30 and 70 percent disability ratings. Service connection for PTSD was established by rating action dated in September 2011 at which time an initial 10 percent disability rating was assigned effective as of June 28, 2011. In October 2011, the Veteran’s NOD was received. By rating action dated in February 2012, the RO determined that the service-connected PTSD warranted a 30 percent disability rating, effective as of June 28, 2011, the date of receipt of his initial claim for service connection. In May 2020, the RO assigned a 70 percent disability rating for the PTSD, effective as of September 17, 2019. The Veteran’s service-connected PTSD is rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. This disability is rated under the General Rating Formula for Mental Disorders, which provides as follows: A 100 percent disability rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. A 70 percent disability rating is warranted when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 50 percent disability rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 30 percent disability rating is assigned for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment; mild memory loss (such as forgetting names, directions, recent events). The symptoms recited in the criteria in the rating schedule for evaluating mental disorders are “not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating.” Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In adjudicating a claim for an increased disability rating, the adjudicator must consider all symptoms of a claimant’s service-connected mental condition that affect the level of occupational or social impairment. Id. at 443. Effective August 4, 2014, VA amended the regulations regarding the evaluation of mental disorders by removing outdated references to the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The amendments replace those references with references to the recently updated Fifth Edition (DSM-V). As the Veteran’s claim was received prior to August 4, 2014, but had not yet been certified to the Board, the DSM-IV is applicable to this case. However, according to the new DSM-V, clinicians do not typically assess Global Assessment of Functioning (GAF) scores. The DSM-V introduction states that it was recommended that the GAF be dropped from DSM-V for several reasons, including its conceptual lack of clarity (i.e., including symptoms, suicide risk, and disabilities in its descriptors) and questionable psychometrics in routine practice. In reviewing the evidence of record, the Board will consider any assigned GAF score; however, the Board is cognizant that GAF scores are not, in and of themselves, the dispositive element in rating a disability. Rather, GAF scores must be considered in light of the actual symptoms of the Veteran’s disorder, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126 (a). The GAF is a scale reflecting psychological, social, and occupational functioning on a hypothetical continuum of mental health illness. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing DSM-IV). According to the DSM-IV, which VA had adopted pursuant to 38 C.F.R. §§ 4.125 and 4.130, a GAF score of 41 to 50 is reflective of serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF score ranging from 51 to 60 reflect more moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). A GAF of 61 to 70 is defined as some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. The Veteran was afforded an initial VA examination for his PTSD in August 2011. The Veteran was diagnosed with PTSD under the DSM IV and his symptomatology was characterized as resulting in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported that he has been divorced for 23 years. He stated that he tried dating afterwards but “it went downhill.” The Veteran reported that he has not seen his children in years and has never seen his two grandchildren. The Veteran reported living in a small town and going to the tavern daily but not drinking alcohol. He stated that he enjoys hunting and shooting at beer cans. The Veteran reported driving a truck for a farming company for the past 23 years and enjoying this job. The Veteran reported experiencing nightmares 2 to 3 times a year. He reported experiencing external or internal reminders of the traumatic event and physiological reactions 2 to 3 times a week. He stated that he makes efforts to avoid thoughts, feelings or memories of trauma nearly every day. He has restricted affect some of the time. The Veteran has some estrangement and makes efforts to avoid places, situations or people some of the time. The Veteran reported chronic sleep impairment for many years and reported only sleeping 3.5 to 4 hours a night on average. He reported feeling irritable most of the time. The Veteran reported hypervigilance a little bit of the time and stated that he experienced exaggerated startle response 1 to 2 times per week. Despite these statements and the VA examiner’s own findings regarding the Veteran meeting the DSM IV criteria for PTSD, the examiner did not check any of the boxes for symptoms that apply to the Veteran’s PTSD and provided no explanation for failing to mark that the Veteran experienced any PTSD symptoms. The Veteran underwent a private psychological evaluation in June 2012. The Veteran was described as a reliable historian. The private psychologist recounted the Veteran’s childhood history and family life as well as his service in Vietnam and the traumatic experiences he encountered there. The Veteran reported that after service, he worked various manual labor jobs and driving jobs before becoming a beekeeper for a time. The Veteran eventually quit his job as a beekeeper and became a truck driver for an agricultural company for many years. The Veteran reported significant difficulty interacting with his boss which eventually led to his boss telling him to quit or be fired. The Veteran quit a week prior to this evaluation. The private psychologist stated that the Veteran appeared to be extremely oppositional and generally embittered and hostile in all situations including that of his family. The psychologist stated that the Veteran was in fact an outsider in virtually every social situation because of his drinking and the relatively miserable way he came across to other people. The Veteran reported moving to the small town where he currently lives about 13 years ago. He stated that he felt he was able to “turn over a new leaf” but that recently he has been having considerable difficulty with his anxiety, fear, anger, and other negative attitudes and moods and feels that his symptoms are worsening. The Veteran stated that this worsening of symptoms is why he had to quit his job. He reported that he sleeps terribly and wakes up after about one hour of sleep and has difficulty getting back to sleep for several hours. He stated that he is almost afraid to go to sleep because he experiences nightmares that are so frightening that when he does wake up he is perspiring regardless of how cool the room is. The Veteran reported that his nightmares have become much more frequent and more intense in the past 2 to 3 years. He reported feeling fatigued all the time. The Veteran stated that he experienced very terrifying flashbacks which are especially bad when he is hunting with other people. He stated that such flashbacks are accompanied by panic attacks. The Veteran endorsed passive suicidal ideation. He endorsed difficulty with intimacy and pursuing romantic relationships. The psychologist noted that the Veteran appeared capable of attending to daily routines and habits with at least a fair attention to detail but also noted that the Veteran appears to becoming more and more of a recluse and has stopped attending many of the meetings and service clubs that he used to. The Veteran stated that he won't even go into a bar for a soft drink anymore. During the mental status evaluation, the Veteran was noted as having circumstantial but generally normal conversation and thought patterns. His speech was noted as rapid and the Veteran was noted to have poor eye contact which the psychologist viewed as indicative of problems with verbal expression and that the Veteran is not a very social individual. His mood was described as variable but with pervasive anxiety fueled by fear during flashbacks. His affect was described as indicative of his general withdrawal and detachment from others despite desiring closer relationships. His mental content was described as preoccupied with his friends who did not return from Vietnam. The Veteran was described as compulsive but not delusional or paranoid. The Veteran was fully oriented but had some difficulty with being slow to answer questions and correctly stating what the day was. The Veteran was noted as having an extremely poor fund of general information. The Veteran’s immediate recall ability was described as extremely poor and the Veteran became severely frustrated and irritable during such testing. His concentration was assessed as poor. Insight and judgment were described as fair. In conclusion, the private psychologist stated that “the general manner in which the Veteran is accepted by the positive feelings of a small village in Nebraska is still no substitute for the fact that he has very few friends and does not do much for recreation except occasionally fish and maybe hunt once in a while.” The psychologist noted that even these recreational activities require an extreme amount of psychosocial energy from him and so he is becoming more and more comfortable in staying in his room and doing virtually nothing. The private psychologist further noted that the Veteran experiences severe insomnia which leads to a lack of energy and that, during the two-hour evaluation, the Veteran demonstrated a startle reflex whenever the psychologist’s phone would ring. The psychologist concluded that the Veteran suffers from severe emotional difficulties with stress and irritability and described his difficulty with social adaptation as severe. A VA examination report dated in February 2014 confirms the Veteran’s diagnosis of PTSD. The Veteran reported having a best friend who he occasionally goes hunting and to auctions with. The level of occupational and social impairment was described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Symptoms that applied to the Veteran’s diagnosis included anxiety and chronic sleep impairment. During an April 2014 Decision Review Officer (DRO) hearing, the Veteran testified that he entertained suicidal ideation; had problems with concentration and memory; experienced anxiety and bouts of depression; experienced chronic sleep impairment and severe irritability; and felt the need to protect himself with firearms. See April 2014 DRO Hearing Transcript pgs. 10-12. Moreover, a witness testified that he was afraid the Veteran might hurt himself. See id at 11. A VA examination report dated in May 2015 noted the Veteran’s diagnosis of PTSD. The Veteran reported that he and his best friend are no longer friends. He reported being frustrated with people at the VFW. The level of occupational and social impairment was described as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. Symptoms that applied to the Veteran’s diagnosis included anxiety and chronic sleep impairment. The Veteran most recently underwent a VA examination for PTSD in September 2019. The examiner confirmed that the Veteran meets the full criteria for PTSD. The Veteran reported that he has had no contact with his ex-wife and has no relationship with his youngest son. He reported having a conflicted relationship with his sister and stated that they rarely speak. He stated that he has two ex-military friends who he visits with weekly. The Veteran continues to be retired since 2012 after driving a fuel truck for a COOP for 25 years. He reported that he was isolated and worked solo most of his life. The Veteran denied any mental health treatment, including psychotherapy or medications ever. The examiner noted that he continues to meet criteria for PTSD, but has had no treatment or hospitalizations. The Veteran reported that his small town is very far from the closest VA. He denied active suicidal ideas, intent or plan but has passive suicidal ideas and reported thinking of death often. The level of occupational and social impairment was described as occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Symptoms that applied to the Veteran’s diagnosis included anxiety, suspiciousness, panic attacks that occur weekly or less often, panic attacks more than once a week, chronic sleep impairment, mild memory loss, impairment of short- and long-term memory, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a work like setting, inability to establish and maintain relationships, suicidal ideation, and impaired impulse control such as unprovoked irritability with periods of violence. More specifically, the VA examiner stated that the Veteran’s PTSD symptoms include intolerance for being around others (the Veteran’s fuel truck driving job was isolated and no direct involvement with co-workers and rarely with supervisors, but now he is unable to drive truck due to prosthetic left knee/leg); impulsive anger with throwing things/yelling; poor concentration; dissociative and memory symptoms, and frequent panic symptoms when in public/around people often. The examiner stated that the Veteran's chronic insomnia is related to the PTSD and disrupts his cognitive skills, concentration, and irritability. The examiner also stated that the Veteran's poor interpersonal skills and ability to tolerate others is supported by his lack of a relationship and his conflicted relationships for 15 years with 1 son that has been improving since 2010, no relationship with one son, and chronically estranged relationship with his ex-wife. The overall evidence of record has demonstrated that the Veteran has consistently experienced anxiety with panic attacks occurring more than once a week, sleep disturbance, nightmares, insomnia, hypervigilance and suspiciousness, irritability, avoidant behavior, intrusive thoughts, impaired memory, poor concentration, impaired impulse control, and disturbances of motivation and mood. He has also endorsed passive suicidal ideation. In order to meet the criteria for a 70 percent disability rating, the Veteran’s disability would have to be manifested primarily by occupational and social impairment, with deficiencies in most areas due to symptoms such as suicidal ideation; obsessional rituals; intermittently illogical speech; near-continuous panic or depression; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; and an inability to establish and maintain effective relationships. In this regard, the Veteran has exhibited suicidal ideation, impaired impulse control, difficulty in adapting to stressful circumstances, and an inability establishing and maintaining effective relationships. Although he did not exhibit all of the symptomatology consistent with a 70 percent disability rating, resolving all doubt in favor of the Veteran, the Board finds that overall, his disability picture prior to September 17, 2019 meets the criteria for a 70 percent disability rating and does not significantly differ from the symptomatology revealed during his September 2019 VA examination which formed the basis for his current 70 percent disability rating from September 17, 2019. See Mauerhan, 16 Vet. App. at 442. The Board has additionally reviewed the evidence to determine if a disability rating in excess of 70 percent may be assigned. A 100 percent disability rating for PTSD requires symptoms more nearly approximating total occupational and social impairment. The preponderance of the evidence of record demonstrates that the Veteran is not entitled to a 100 percent disability rating prior to September 17, 2019, as the evidence does not show symptoms and overall impairment more nearly approximating total occupational and social impairment before then. In sum, considering all applicable rating criteria, the Board finds that the level of impairment presented by the Veteran’s service-connected PTSD over the course of this appeal prior to September 17, 2019, warrants a 70 percent disability rating, and no higher. Accordingly, the Board finds that the overall disability picture most closely approximates the criteria for a 70 percent disability rating prior to September 17, 2019. Consideration has been given to additional staged ratings since the date of the Veteran’s claim (i.e., different percentage ratings for different periods of time). See Fenderson, 12 Vet. App. at 119. There, however, appears to be no identifiable period of time since the date of claim during which an additional staged rating for the PTSD would be warranted. Having carefully considered the evidence of record from September 17, 2019, the Board finds that the preponderance of the evidence of record demonstrates that the Veteran is not entitled to a 100 percent disability rating as the evidence does not show that the symptoms or overall level of impairment more nearly approximate total occupational and social impairment. The September 2019 VA examination reflects that the Veteran’s PTSD has not caused gross impairment in thought processes or communication; persistent delusions or hallucinations; gross inappropriate behavior; persistent danger of hurting self or others; or disorientation to time or place. Moreover, the Veteran has reported that he maintains a good relationship with two ex-military friends who he visits weekly. Thus, total (italics added for emphasis) impairment is not demonstrated. In sum, considering all applicable rating criteria, the Board finds that the level of impairment presented by the Veteran’s service-connected PTSD over the course of this period on appeal warrants the currently assigned 70 percent disability rating, and no higher. For the foregoing reasons, the Board finds that the criteria for the next higher 100 percent disability rating have not been met. The Board has considered the statements of the Veteran as to the extent of his current symptoms. He is certainly competent to report that his symptoms are worse. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, in evaluating a claim for an increased schedular rating, VA must consider the factors as enumerated in the rating criteria discussed above, which in part involves the examination of clinical data gathered by competent medical professionals. The Board finds that the preponderance of the evidence is against the assignment of a disability in excess of 70 percent for PTSD, and the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to TDIU prior to September 17, 2019 is remanded. The RO last adjudicated the issue of entitlement to a TDIU prior to September 17, 2019 in a June 2015 supplemental statement of the case (SSOC). Since that time, the Veteran has undergone additional VA examinations for his service-connected disabilities. The issue of entitlement to a TDIU prior to September 17, 2019 was not readjudicated following these examinations. Further, VA Medical Center progress notes from May to December 2015, from September 2016 to December 2017 and from December 2018 to September 2019 have been associated with the claims file since the June 2015 SSOC. A May 2020 Deferred Rating memorandum indicates that the RO was deferring adjudication of the issue of TDIU prior to September 17, 2019 until development could be completed regarding the Veteran’s work history. In this regard, VA sent several letters requesting information from AG Valley Coop, the Veteran’s reported most recent employer, but to date has received no response. The Veteran did not submit a waiver of review by the Agency of Original Jurisdiction (AOJ). Therefore, the issue of entitlement to a TDIU must be readjudicated before the Board decides the appeal. Accordingly, the case is REMANDED for the following action: Readjudicate the issue of entitlement to a TDIU for the period prior to September 17, 2019. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then return the claim to the Board. Carole R. Kammel Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Modesto, Victor 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.