Citation Nr: 21021366 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 20-18 579 DATE: April 12, 2021 ORDER Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to June 26, 2017 is denied. Entitlement to an increased 50 percent rating, but no higher, for PTSD from June 26, 2017 is granted, subject to controlling regulations governing the payment of monetary awards. FINDING OF FACT 1. Prior to June 26, 2017, the Veteran’s PTSD was manifested by symptoms productive of impairment no greater than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; occupational and social impairment with reduced reliability and productivity due to PTSD symptoms was not shown. 2. From June 26, 2017, the Veteran’s service-connected PTSD has been manifested by symptoms that more closely approximate functional impairment comparable to no worse than occupational and social impairment with reduced reliability and productivity; symptoms productive of occupational and social impairment with deficiencies in most areas is not shown. CONCLUSION OF LAW 1. Prior to June 26, 2017, the criteria for an initial rating in excess of 30 percent rating for PTSD are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code (Code) 9411. 2. Resolving all reasonable doubt in favor of the Veteran, from June 26, 2017, the criteria for a 50 percent rating, but no higher, for PTSD have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1966 to March 1970, including service in the Republic of Vietnam. His decorations include the Distinguished Flying Cross. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a September 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA) which granted service connection and assigned an initial 30 percent rating for PTSD from January 13, 2014, the date of receipt of the Veteran’s claim for service connection. In this regard, it is noted that a November 2015 communication from the Veteran’s representative expressed disagreement with the September 2015 rating decision for PTSD. In a December 2015 letter, the RO acknowledged his disagreement with the September 2015 rating decision and requested he notify VA within 60 days of his choice to either have a Decision Review Officer (DRO) review his appeal or follow the traditional appeal process, if no response was received, he was advised his case would be reviewed under the traditional review process. Although a timely January 2016 response reflects the Veteran’s election to have his case reviewed by a DRO; the record does not show further review of this appeal by the RO. Thereafter, a June 2017 communication requests an increased rating for PTSD and VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, listing his PTSD claim was received in October 2017. Accordingly, a November 2017 rating decision denied the claim for an increased rating for PTSD and, in response to a March 2018 VA Form 21-0958, Notice of Disagreement (NOD) with the November 2017 rating decision, the Veteran was provided a Statement of the Case (SOC) in March 2020. Although the Veteran did not file a NOD via VA Form 21-0958 within one year of the of the September 2015 rating decision, review of the record shows the Veteran was advised that his disagreement with the initial 30 percent rating assigned in the September 2015 rating decision was accepted by the AOJ. Accordingly, the Board will consider whether an initial rating in excess of 30 percent for PTSD is warranted at any time since receipt of his January 13, 2015 claim for service connection. In August 2018, the Veteran testified at a hearing before a DRO at the RO. In January 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of both hearings is of record. On the record during his Board hearing, the Veteran waived RO consideration of any additional evidence added to his file. Increased Rating Disability ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of the Veteran’s symptoms increased sometime prior to the date of the examination reports. 1. PTSD The Veteran is currently in receipt of a 30 percent rating for PTSD, rated under 38 C.F.R. § 4.130, Code 9411, for the entire appeal period. As explained above, he is appealing the original assignment of a disability evaluation following the award of service connection; thus, the entire appeal period since receipt of his January 13, 2015 claim for service connection is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). All psychiatric disabilities, including PTSD, are rated under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130, Code 9411. A 30 percent rating is warranted 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). This may be due to such symptoms as: depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; and/or mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation is warranted where there is occupational and social impairment with reduced reliability and productivity. This may be 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; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is assignable for 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 work like setting); inability to establish and maintain effective relationships. A rating of 100 percent is assignable for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly 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. When evaluating a mental disorder, consideration shall be given to the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The evaluation will be based on all the evidence of record that bears on occupational and social impairment rather than solely on an examiner’s assessment of the level of disability at the moment of examination. It is the responsibility of the rating specialist to interpret reports of examinations in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. When determining the appropriate disability evaluation to assign, the Board’s primary consideration is a Veteran’s symptoms, but it must also make findings as to how those symptoms impact a Veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436 (2002). Because the use of the term “such as” in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442; see also Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). Under the General Formula, the Board must conduct a “holistic analysis” that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). As previously stated, the Veteran’s service-connected PTSD is rated 30 percent for the entire appeal period since receipt of his January 13, 2015 claim for service connection. After reviewing the pertinent evidence of record, the Board finds the medical evidence of record warrants a rating of 50 percent (but no higher) from June 26, 2017. Prior to June 26, 2017 An April 2015 report of social and industrial survey notes the Veteran married in 1967 and his marriage was going well, he reported falling “asleep at the drop of a hat” and waking up after sleeping a couple of hours “but he did not endorse the symptom of nightmares.” On mental status examination, the Veteran “admitted to guilt, but denied hopelessness, depression, and worthlessness.” He also denied hallucinations and suicidal ideation. The Veteran had periods of dissociation but there were logical connections between his thoughts. Long-term memory was much better than short-term memory and his judgment and insight were intact for safety and self-care. He reported feeling irritable (but denied anger problems) and overly alert. He also denied problems with concentration. He reported he is “a very optimistic person,” had “a lot to live for” and had “a good family.” The examiner noted the Veteran traveled with his wife a great deal, they socialize and, although he reported the only thing he cannot do is “go back to the wall,” he had already been once. He reported feeling he fits into his community and society as a whole. A May 2015 VA initial PTSD examination report includes the examiner’s assessment, based on examination and interview of the Veteran and review of his claims file, that “a mental condition has been diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.” The examination report notes the Veteran had a close relationship with one of his sisters, had been married for 48 years, had one adult son and had a close relationship with his family. He also reported close relationships with “a few friends,” one of whom is a fellow veteran that the Veteran served with. The Veteran reported having retired 13 years earlier, after 30 years working as an air traffic controller. For rating purposes, the Veteran’s PTSD symptoms were anxiety and chronic sleep impairment. On examination, the Veteran spoke rapidly and his mood was anxious. He was observed to be alert and oriented, neatly dressed and groomed, his thought process was logical and oriented, memory and concentration were intact, judgment was good, there were no indications of hallucinations or delusions and he denied suicidal/homicidal thoughts or plans. In a June 2015 statement, the Veteran’s spouse reported he experiences “frequent nightmares involving gunfire and frightening situations.” He wakes clutching and protecting her and sometimes rushes to the window to check for danger. She also reported he “talks in his sleep about flying, gunfire and wartime incidents which still disturb him.” He worries about potential danger to his family and “has been in tears at times,” feeling he has not taught his son adequate survival skills. Treatment records from the Vet Center note the Veteran had reported “sadness” and expressed a desire to be treated by a combat veteran. A June 2015 report notes the Veteran had been contacted to ascertain whether he wanted to follow-up with a Vietnam combat veteran for counseling; the Veteran declined because “he was heading off to Florida, etc. for the next few months, but might consider it in the fall when he returns.” There is no record of subsequent Vet Center treatment. In a November 2015 statement, the Veteran reported that “[b]oth the stressful memory triggers of the past and the ongoing, potentially dangerous medical issues impact [his and his] wife’s daily lives. [His] sleep patterns have worsened and [he has] frequent nightmares. [He is] increasingly uneasy in crowds and [he feels] an ongoing potential danger, both actual and medical.” A similar statement in support of these assertions was also provided by the Veteran’s spouse. An April 2016 VA psychiatry note shows the Veteran underwent a “Problem Focused Brief Consultation” during which his history was reviewed, a brief review of symptoms was completed and the Veteran was interviewed. The examiner noted the Veteran had been diagnosed with and assigned a 30 percent disability rating for PTSD but felt “no need to seek out psychiatric services.” He reported wanting to purchase a weapon for his spouse for target shooting but having difficulty doing so because of an “incorrect report” of having received psychiatric treatment (he “had never been in psychiatric treatment at any time in the past.”) He reported he was “without current symptoms related to his past traumas,” was “functioning at his baseline” and requested a letter to assist him on obtaining a target shooting weapon. Mental status examination was unremarkable (his mood was euthymic and overall condition was “grossly intact.”) The impression/assessment was PTSD, mild by history. Pursuant to the Veteran’s request, he was provided a letter indicating his current psychological stability and absence of suicidal or homicidal tendencies. No treatment was indicated or recommended. A subsequent November 2016 treatment report shows a negative PTSD screen. The Board notes that it has reviewed all the lay and medical evidence of record prior to June 26, 2017, to include VA treatment records. Such evidence does not show additional symptoms or occupational and social impairment beyond that discussed above. Again, having reviewed all the evidence of record, lay and medical, the Board finds that, for the period on appeal prior to June 26, 2017, the Veteran’s PTSD symptomatology approximated no greater than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. As discussed above, while the April 2015 report of social and industrial survey notes periods of dissociation, there was no impairment in thinking, he reported he is a very optimistic person and felt he fits into his community and society as a whole. Although the May 2015 VA examination report notes PTSD symptoms of anxiety and sleep impairment, the Vet Center records note sadness and statements from the Veteran and his spouse note symptoms of sleep impairment, worry about his family, stress triggered by his health concerns and increasing discomfort in crowds; the frequency and severity of these symptoms prior to June 26, 2017 does not meet the criteria for a rating in excess of 30 percent. Moreover, the assessment provided by the May 2015 examiner is that “a mental condition has been diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication;” the criteria for a zero percent rating under the General Formula. Similarly, when the Veteran sought VA psychiatric consultation in April 2016 because the “incorrect report” of having received psychiatric treatment was causing difficulty in his effort to purchase a weapon for target shooting for his wife, he reported he was “without current symptoms related to his past traumas,” the assessment was mild PTSD by history and he was provided a letter indicating his current psychological stability. The evidence overall during the rating period prior to June 26, 2017 shows the Veteran has primarily manifested mental health symptoms of a severity, frequency, and/or duration commonly associated with no more than the 30 percent rating criteria. In sum, review of all the evidence of record supports a finding that the severity, frequency, and duration of the symptoms of the service connected PTSD did not result in more than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks during the rating period prior to June 26, 2017. Accordingly, as the criteria for an evaluation in excess of 30 percent for PTSD for the appeal period prior to June 26, 2017 are not met, entitlement to an initial rating in excess of 30 percent for PTSD prior to June 26, 2017 is denied. From June 26, 2017 A June 26, 2017 statement requesting an increased rating for the Veteran’s PTSD notes the Veteran “continues to have mood swings, memory concerns and difficulty with rational thinking.” An October 2017 VA PTSD examination report includes the assessment, based on examination and interview of the Veteran and review of his claims file, that the Veteran’s PTSD results 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. As noted in the May 2015 examination report, the Veteran remained close to his family and few friends; however, he reported difficulty interacting people, even his friends, who were not in the military because they do not understand what he experienced while in Vietnam. Even though he presents with a social demeanor, the Veteran reported feeling detached from people who have not served in the military. The Veteran reported he was getting a service dog to help with his PTSD symptoms. The examiner noted that the Veteran “tended to minimize his symptoms throughout the evaluation.” On examination, the PTSD diagnostic criteria included irritable behavior and angry outbursts (with little or no provocation), hypervigilance, problems with concentration and sleep disturbance. For VA rating purposes, the Veteran’s PTSD symptoms were depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss (such as forgetting names, directions or recent events) and difficulty in establishing and maintaining effective work and social relationships. The Veteran was alert and oriented, his mood was euthymic, there was no thought disturbance, hallucinations, delusions or suicidal and homicidal ideation. He reported feeling more distressed because his (service-connected) soft tissue sarcoma seemed to be getting worse and “increases the trauma from Vietnam.” The examiner noted that the Veteran “has learned to mask his emotional reaction to traumatic situations” and “although on the surface he appears social and adjusted, in reality, he is haunted by his experiences in Vietnam” and is “getting a service dog to help him overcome some of his everyday fears.” The examiner concluded that “the Veteran’s PTSD has increased since his last evaluation.” During his August 2018 DRO hearing, the Veteran testified that stress from the soft tissue sarcoma was “weighing on his mind” and he had gotten a therapy dog “which helps more than” he felt like talking about. A January 2019 VA PTSD examination report notes that the Veteran’s multiple health “conditions, particularly the history of malignant soft tissue sarcoma, result in symptoms of anxiety and depression. This is the etiology of the diagnosed Adjustment Disorder with Mixed Anxiety and Depressed Mood.” After examination and interview of the Veteran and review of his claims file, the examiner noted that the Veteran’s PTSD results 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 examiner noted “few changes in psychosocial functioning” since the October 2017 VA examination. The Veteran reported intermittent episodes of depressed mood and irritability and a “great deal of ongoing anxiety and worry about his health conditions and prognosis for the future.” The examiner noted, overall, the Veteran “describes a moderate level of impairment in social and occupational functioning at the current time” and there “are no changes in occupational functioning since the previous evaluation.” For VA rating purposes, the Veteran’s PTSD symptoms were depressed mood, anxiety, chronic sleep impairment and flattened affect (“affect appeared mildly restricted”). The Veteran denied suicidal ideation and noted “he did not understand why a person would ever commit suicide after working so hard to stay alive during war.” VA treatment records include a September 2018 report of mental health assessment (the Veteran self-referred after recommendation from “his VSO/DRO” in connection with his appeal) which notes the Veteran reported “some impairment in recent memory” and “some irregularity in sleep patterns.” The assessment was PTSD, rule out adjustment disorder with mixed anxiety and depressed mood and rule out depressive disorder due to medical condition. There records also include a December 2020 primary care provider note which shows psychological evaluation was positive for depression. The Veteran’s March 2020 VA Form 9, Appeal to Board of Veteran’s Appeals, notes the Veteran’s history of treatment for numerous cancerous growths and includes the statement that “the potential for any new growth is a serious concern which increases his anxiety and depression.” The Veteran’s January 2021 Board hearing transcript (and a statement from his representative submitted the same day) reflects his increased stress from anticipating future surgeries (and increased risk from anesthesia and age) related to his service-connected soft tissue sarcoma. In addition, the Veteran’s spouse testified as to his increasing isolation and avoidance behavior (he despises going into crowds, doesn’t mingle well with people and is guarded.) The Board notes that it has reviewed all the lay and medical evidence of record since June 26, 2017, to include VA treatment records. Such evidence does not show additional symptoms or occupational and social impairment beyond that discussed above. Affording the Veteran the benefit of the doubt, the Board finds that throughout the appeal since June 26, 2017, his PTSD symptoms most nearly approximated the criteria for a 50 percent rating. The statement received on June 26, 2017, noting his mood swings, memory concerns and difficulty with rational thinking, suggests an increase in his mental health symptoms which is subsequently confirmed on October 2017 VA PTSD examination. Specifically, the examination report notes that the Veteran “has learned to mask his emotional reaction to traumatic situations” and “although on the surface he appears social and adjusted, in reality, he is haunted by his experiences in Vietnam.” The examiner concluded that “the Veteran’s PTSD has increased since his last evaluation.” While the October 2017 examination report notes PTSD symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment and mild memory loss (such as forgetting names, directions or recent events), which are contemplated in the criteria for a 30 percent rating; it is also noted that the Veteran’s PTSD resulted in difficulty in establishing and maintaining effective work and social relationships, a criteria contemplated in the next higher 50 percent rating. In addition, the January 2019 VA PTSD examination report includes diagnoses of PTSD as well as Adjustment Disorder with Mixed Anxiety and Depressed Mood as a result of the Veteran’s health “conditions, particularly the history of malignant soft tissue sarcoma” and the finding that there “are no changes in occupational functioning since the previous evaluation.” The October 2017 examination report also includes a finding of flattened effect, a symptom contemplated in the criteria for a 50 percent rating. Although the October 2017 and January 2019 VA examination reports show an assessment of the level of occupation and social impairment as occupational and social impairment due to mild or transient symptoms, the criteria for a 10 percent rating; the Board finds that the record since June 26, 2017 reflects that the Veteran reported increased severity and frequency of mental health symptoms, including flattened effect and difficulty establishing and maintaining work and social relationships, and this increased symptomatology is confirmed by October 2017 and January 2019 VA examination reports. As such, during the appeal period since June 26, 2017, he likely experienced occupational and social impairment with reduced reliability and productivity. Accordingly, the Board finds the frequency and severity of the symptoms more closely approximate the criteria for an increased 50 percent rating. However, although the Veteran has argued that his PTSD should be rated 70 percent disabling, the preponderance of the evidence is against a finding that symptoms associated with a 70 percent rating have been shown at any time during appeal period and it is not argued otherwise. Specifically, there is no suggestion that illogical, obscure, or irrelevant speech, near-continuous panic or depression affecting independent, appropriate or effective function, impaired impulse control such as unprovoked irritability with periods of violence, obsessional rituals interfering with routing activities, spatial disorientation, neglect of personal appearance and hygiene, or an inability to establish and maintain effective relationships were experienced by the Veteran during the relevant period. The Veteran has consistently denied suicidal ideation. While the Board acknowledges that the Veteran has difficulty adapting to stressful circumstances associated with his health problems, including service-connected soft tissue sarcoma; on the whole, the Veteran’s symptoms more nearly approximate reduced reliability and productivity and not reduced reliability and productivity in most areas, such as work, family relations, judgment, thinking or mood. Although the evidence shows impairment in the Veteran’s ability to establish and maintain effective relationships, he has maintained social relationships with some friends and has described a close relationship with his wife and family throughout the appeal period. There is no evidence he has been unable to maintain effective relationships. In addition, there is no evidence during the appeal period of gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives, or own occupation, or own name. Thus, the frequency, duration and severity of his mental health symptomatology does not more nearly approximates the criteria for a 70 percent (or 100 percent) disability rating. As indicated, the Board has considered the lay assertions in support of the Veteran’s claim. Indeed, the Veteran and his spouse are competent to report on that as to which they have personal knowledge, such as occupational difficulties as well as social and marital problems. However, without the appropriate medical training and expertise, the Veteran and his spouse are not competent to provide a probative, persuasive opinion as to the severity of his psychiatric disability in relation to the applicable rating criteria. A medically complex matter such as this requires expertise in clinical psychology or psychiatry, which neither the Veteran nor his spouse possess. In contrast, the VA examiners are experts in clinical psychology/psychiatry. Their assessments considered the Veteran’s subjective complaints, social and occupational history, and the results of the objective mental status evaluations in determining the overall severity of his psychiatric disability. Thus, the VA examinations and VA treatment record findings are of greater probative value. Accordingly, after conducting a holistic analysis and considering all associated symptoms, the Board finds that the severity, frequency, and duration of the Veteran’s mental health symptoms more closely approximate the symptoms contemplated by the 30 percent rating assigned prior to June 26, 2017 and, resolving reasonable doubt in his favor, an increased 50 percent rating from that date. The Board also finds that the Veteran’s symptoms throughout the appeal period have been less severe, less frequent, and shorter in duration than those contemplated by a 70 percent (or 100 percent) rating. The Board has considered the Veteran’s claim for an increased rating of his service connected PTSD and decided entitlement based on the evidence. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claim. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kshama Hughes 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.