Citation Nr: 21024112 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 17-55 034 DATE: April 22, 2021 ORDER The application to reopen the claim of entitlement to service connection for leg injury is granted. The application to reopen the claim of entitlement to service connection for chest injury is granted. Entitlement to service connection for left leg disability is granted. Entitlement to service connection for chest wall strain is granted. Entitlement to an initial 10 percent rating, but no higher, for scar, puncture wound left lower leg, located on the upper tibial region of the left leg is granted, subject to controlling regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. In a January 1979 rating decision, the RO denied service connection for leg injury. The Veteran did not appeal that decision, and new and material evidence was not received within one year of its issuance. 2. The evidence received since the final January 1979 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for leg injury and raises a reasonable possibility of substantiating the claim. 3. In a November 2008 rating decision, the RO denied entitlement to service connection for chest injury. The Veteran did not perfect an appeal within the applicable time period, nor was new and material evidence received within one year of issuance of that decision. 4. The evidence received since the final November 2008 rating decision relates to an unestablished fact necessary to substantiate the claim of service connection for chest injury and raises a reasonable possibility of substantiating the claim. 5. The evidence is at least evenly balanced as to whether the Veteran’s current left leg disability is related to an injury suffered during a period of active duty for training (ACDUTRA). 6. The Veteran's chest disability is related to an injury suffered during a period of ACDUTRA. 7. The Veteran’s left leg scar more nearly approximates one scar that is painful or unstable. CONCLUSIONS OF LAW 1. The January 1979 rating decision denying service connection for leg injury is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 2. New and material evidence has been received to warrant reopening the claim of service connection for leg injury. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The November 2008 rating decision denying service connection for chest injury is final. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.104, 20.302, 20.1103. 4. New and material evidence has been received to warrant reopening the claim of service connection for chest injury. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 5. The criteria for service connection for left leg disability have been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.1, 3.6, 3.303. 6. The criteria for service connection for chest wall strain have been met. 38 U.S.C. §§ 101, 1131; 38 C.F.R. §§ 3.1, 3.6, 3.303. 7. The criteria for an initial 10 percent rating, but no higher, for scar, puncture wound left lower leg, located on the upper tibial region of the left leg have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, Diagnostic Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty service with the National Guard from July 1975 to November 1975, including a period of ACDUTRA from May 13, 1978 to May 27, 1978. This case comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which granted entitlement to service connection for scar, puncture wound left lower leg, located on the upper tibial region, and assigned a noncompensable rating effective November 27, 2015. The RO reopened the claim of entitlement to service connection for left leg injury and denied the claim on the merits. The RO also denied reopening the claim of entitlement to service connection for chest injury. The Veteran disagreed with RO’s determinations. In February 2016, the RO granted service connection for scar, puncture wound, lower left leg and assigned a noncompensable rating. The Veteran timely appealed the initial rating assigned. A SOC was issued in September 2017 addressing the above matters. In the September 2017 SOC, the RO reopened the claim of entitlement to service connection for chest injury and denied the claim on the merits. The Veteran timely appealed. With regard to the applications to reopen, the Board has a jurisdictional responsibility to consider whether it was proper for a claim to be reopened, regardless of whether the RO granted or denied an application to reopen. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). In June 2020, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. At the June 2020 Board hearing, the Veteran offered testimony on the issue of entitlement to an effective date earlier than November 15, 2008 for the grant of service connection of tinnitus. The Board notes that in a November 2008 rating decision, the RO, inter alia, granted entitlement to service connection for tinnitus, and assigned a 10 percent rating effective November 15, 2008. In March 2009, the Veteran disagreed with the effective date assigned, and the RO issued a SOC in September 2009. The Veteran submitted a substantive appeal (VA Form 9) in February 2010. In March 2010, the RO notified the Veteran that he had one year from that date of notification of the rating decision, or 60 days from the date of the SOC, therefore, his February 2010 VA Form 9 was untimely. Although informed of his right to appeal this decision, the Veteran did not appeal. The decision assigning an effective date of November 15, 2008 thus became final. 38 U.S.C. § 7105(d) (2002); 38 C.F.R. §§ 20.202, 20.1103 (2008). Thus, the Board cannot address the issue of entitlement to an earlier effective date for the grant of service connection for tinnitus. See Rudd v. Nicholson, 20 Vet. App. 296 (2006) (VA claimants may not properly file, and VA has no authority to adjudicate, a freestanding claim for an earlier effective date in an attempt to overcome the finality of an unappealed VA decision). The only way to challenge the effective date of the grant of service connection for tinnitus is through an allegation of clear and unmistakable error and as that issue has not been adjudicated by the agency of original jurisdiction, the Board cannot address it. Jarrell v. Nicholson, 20 Vet. App. 326, 334 (2006) (en banc) (assertion of CUE in an RO decision must first be presented to and decided by the RO before the Board has jurisdiction to decide the matter). New and Material Evidence In general, decisions of the RO that are not appealed in the prescribed time period are final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1100, 20.1103. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. New evidence means evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Generally, a veteran for VA benefits purposes is a person who served in the active military, naval, or air service, and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C. § 101(2); 38 C.F.R. § 3.1(d). Active military, naval, or air service is defined by VA law and regulations. Active military, naval, or air service includes active duty and any period of ACDUTRA during which the individual concerned was disabled from a disease or injury incurred in the line of duty. See 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a). Active military, naval, or air service also includes any period of inactive duty training INACDUTRA during which the individual concerned was disabled from an injury incurred in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. Id. Accordingly, service connection may be granted for disability resulting from disease or injury incurred in, or aggravated, while performing ACDUTRA, from injury incurred or aggravated while performing INACDUTRA, or from myocardial infarction or cardiac arrest while performing INACDUTRA. Id. In this case, the Veteran has achieved veteran status by virtue of his DD Form 214 that confirms he had active duty service. Thus, his qualifying as a veteran, with active military, naval, or air service for disability benefits for a disability resulting from injury or disease incurred during service from July 1975 to November 1975 is not in question. For service connection to be granted for any disability resulting from injury or disease incurred during the remainder of his service, specifically from May 13, 1978 to May 27, 1978, it must be shown that the claimed disability first manifested during this verified period of ACDUTRA. Here, the Veteran served on ACDUTRA from May 13, 1978 to May 27, 1978. The Veteran has been granted service connection scar, puncture wound left lower leg, located on the upper tibial region based on this period of ACDUTRA and thus established his veteran status. Hill v. McDonald, 28 Vet. App. 243, 252 (2016) (“once a claimant has achieved veteran status for a single disability incurred or aggravated during a period of ACDUTRA, that status applies to all disabilities claimed to have been incurred or aggravated during that period of ACDUTRA”). He contends that his left leg and chest injuries incurred contemporaneously with service-connected scar disability in a motor vehicle accident (MVA) during the period of ACDUTRA. 1. Left Leg As set forth above, in a January 1979 rating decision, the RO denied service connection for leg injury, finding no evidence a current leg injury occurred in or was caused by service. The Veteran was notified of his appellate rights in January 1979 letter. He did not appeal the RO's determination and no new and material evidence was received within a year of the issuance of the rating decision. He does not contend otherwise. Thus, the RO's January 1979 rating decision is final and not subject to revision on the same factual basis. 38 U.S.C. § 7105(c); 38. C.F.R. §§ 3.104, 20.302, 20.1103. In this appeal, the Veteran seeks to reopen his claim of service connection for leg injury. As noted above, despite the finality of a prior adverse decision, a claim will be reopened, and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C. § 5108 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final rating decision in January 1979. That evidence includes a January 2016 VA examination, at which the Veteran reported that he injured his left leg in a jeep accident in 1978 during active service. The examiner opined that the residual scar would be directly related to the claimed service injury. The record also includes August 2017 and October 2020 VA clinical records showing complaints and treatment for chronic leg pain. Additionally, at his June 2020 Board hearing, the Veteran testified that he injured his left leg in service and have continued to experience symptoms since service. Given the basis for the prior denial of the claim, and presuming the credibility of this evidence, the Board finds that this additional evidence relates to unestablished facts necessary to substantiate the claim of service connection for leg injury and raises a reasonable possibility of substantiating the claim; therefore, the claim is reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Turning to the merits in this case, the Veteran contends that his left leg disability resulted from a jeep accident during the period of ACDUTRA. As discussed in detail above, the Veteran has been granted service connection scar, puncture wound left lower leg, located on the upper tibial region based on this period of ACDUTRA and thus established his veteran status. In this case, the evidence of record indicates a current left leg disability. For example, a January 2016 VA examination report shows a diagnosis of puncture wound left lower leg, resolved. Although the examiner indicated that the Veteran’s left leg condition had resolved, the Veteran is competent to report his observable symptoms, and there is no evidence of record which suggests the Veteran lacks credibility. See Jandreau, 492 F. 3d at 1377, n. 4. Moreover, the Court in McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) held that the presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board’s adjudication of the claim. Additionally, VA clinical records dated in August 2017 and October 2020 reflects complaints and treatment for chronic left leg pain. Thus, the first element of service connection has been met. The evidence of record also indicates that the in-service injury requirement has been met. The Veteran’s service treatment records (STRs) shows he was involved in a motor vehicle accident and sustained a cut to his left leg in the line of duty during a period of ACDUTRA on May 23, 1978. He received a suture to left leg-upper tibia region inner aspect. The Veteran’s personnel records include a May 23, 1978 sworn statement by the Veteran reporting that he injured his left leg and chest in a motor vehicle accident. Also included was a May 23, 1978 sworn statement by a soldier who witnessed the Veteran’s reported injuries during their motor vehicle accident. At his June 2020 Board hearing, the Veteran testified that he experienced left leg symptoms in service, and he has continued to experience left leg symptoms since service. The Veteran’s competent and credible statements, STRs, and personnel records are sufficient to meet the second element of the service connection claim. The next issue is whether the third element of a nexus has been met. In January 2016, the Veteran was afforded a VA examination. The examiner opined that the Veteran’s knee condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner’s rationale was a review of this veteran’s STRs does indicate that he was seen and treated for a knee injury while on active duty for which he received 3 stitches. The examiner noted that many of this veteran’s STRs are illegible, but it does not appear that he was seen or treated at any later date for a knee problem. The examiner further noted that review of his CPRS records, likewise, did not reveal that he has sought treatment for a knee problem/condition. The examiner concluded, that however, the residual scar would be directly related to the claimed service injury. In this case, the Board finds the January 2016 opinion that the Veteran’s knee disability is not related to service of no probative value. Specifically, the examiner failed to provide an opinion with supporting rationale as to whether the Veteran’s claimed left leg disability is related to his military service. The examiner failed to address the STR showing suture to left leg-upper tibia region inner aspect injury resulting from a motor vehicle accident during a period of ACDUTRA. Moreover, the examiner failed to consider competent and credible evidence of the Veteran’s report of the onset of his left leg symptoms in service, and the continuation of those symptoms in the years since service. Given the lack of an adequate medical opinion, there is no contrary evidence of record. While the Board could remand the case for an additional medical opinion, such action could be construed as a request for another opinion could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible. 38 C.F.R. § 3.304(c) (The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination); Gardner-Dickson v. Wilkie, No. 19-4765, 2020 U.S. App. Vet. Claims LEXIS 1927 (Panel Order), at *20 (denying petition for a writ of mandamus challenging a remand, but agreeing with the petitioner that it would not be permissible for VA to undertake... additional development if a purpose was to obtain evidence against an appellant’s case.’ (citing Mariano v. Principi, 17 Vet. App. 305, 312 (2003) and Hart v. Mansfield, 21 Vet. App. 505, 508 (2007)). The above evidence is sufficient to decide the claim. There is competent evidence of current left leg disability, left leg symptoms during active duty, and a relationship between the two as shown by the Veteran’s competent, credible statements, which are consistent with the service and post service treatment records. Moreover, there is no other evidence that attributes the Veteran’s current left leg disability to any other cause. Based on the evidence of record, and resolving reasonable doubt in his favor, the Board finds that the Veteran currently has left leg disability that were incurred during a period of ACDUTRA. Thus, service connection for left leg disability is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Chest As set forth above, in a November 2008 rating decision, the RO denied service connection for chest injury, finding no evidence a current chest injury occurred in or was caused by service. Although the Veteran appealed and a statement of the case was issued in September 2009, the Veteran did not perfect an appeal of the RO's determination, and no new and material evidence was received prior to the appellate decision. Thus, the RO's November 2008 rating decision is final and not subject to revision on the same factual basis. 38 U.S.C. § 7105(c); 38. C.F.R. §§ 3.104, 20.302, 20.1103. In this appeal, the Veteran seeks to reopen his claim of service connection for chest injury. As noted above, despite the finality of a prior adverse decision, a claim will be reopened, and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C. § 5108 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final rating decision in November 2008. That evidence includes a March 2017 VA examination report showing a diagnosis of chest wall strain. The evidence also includes a September 2020 letter from private Dr. J.F., who opined that the Veteran’s chest wall pain is at least as likely as not caused by his jeep accident on active duty. Given the basis for the prior denial of the claim, and presuming the credibility of this evidence, the Board finds that this additional evidence relates to unestablished facts necessary to substantiate the claim of service connection for chest injury and raises a reasonable possibility of substantiating the claim; therefore, the claim is reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Turning to the merits in this case, the Veteran contends that his chest disability resulted from a motor vehicle accident during the period of ACDUTRA. As set forth above, veteran status has been established during his period of ACDUTRA. In this case, the evidence of record indicates a current chest disability. Specifically, a March 2017 VA examination report shows a diagnosis of chest wall strain. Thus, the first element of service connection has been met. The evidence of record also indicates that the in-service injury requirement has been met. The Veteran’s STRs shows he sustained injuries in a motor vehicle accident in the line of duty during a period of ACDUTRA on May 23, 1978. The Veteran’s personnel records include a May 23, 1978 sworn statement by the Veteran reporting that he injured his left leg and chest in a motor vehicle accident. Also included was a May 23, 1978 sworn statement by a soldier who witnessed the Veteran’s reported injuries during their motor vehicle accident. At his June 2020 Board hearing, the Veteran testified that he experienced chest symptoms in service, and he has continued to experience chest symptoms since service. The Veteran’s competent and credible statements, STRs, and personnel records are sufficient to meet the second element of the service connection claim. The next issue is whether the third element of a nexus has been met. In a March 2017 VA examination report, the examiner opined that the Veteran’s chest disability was less likely as not incurred in or caused by the claimed in-service injury, event or illness. The examiner’s rationale was the Veteran reports in 1978, he was involved in a jeep accident that caused injury to his left leg and chest. Notes he hit the steering wheel with his chest. The examiner indicated that review of VBMS notes shows the Veteran was denied service connection in the past for his chest wall injury noting no treatment complaints or diagnosis of a chest injury is shown in the STRs. The examiner noted that in the STRs, a chest x-ray was found from October 1978 that was read as normal. Also, sworn statements made by the veteran and another veteran note to a chest injury. The examiner further noted that she did not locate emergency room records from the accident or a separation exam to review. Chest x-ray from 2016 and sternum views from 2017 are both read as normal, no evidence of fracture. The examiner stated that although there are sworn statements in the STRs, there remains a lack of medical evidence to suggest an ongoing chest wall condition since military service. The examiner further stated she did not locate any other records in the STRs to determine the injury remained during his active duty time, making the examiner assume the condition was self-limiting. The examiner noted there is a 30+ year time lapse since the injury in 1978 to the present. In a September 2020 letter, private Dr. M.F. opined that the Veteran’s chest wall pain is at least as likely as not caused by his jeep accident on active duty. Dr. M.F. explained that the Veteran hit his chest at the time of impact in the jeep accident as seatbelts were not worn. The Veteran has had continuous chest pain and tenderness. Dr. M.F. noted the Veteran cannot hold anything against his chest due to pain. Dr. M.F. further noted that a very deep breath causes chest wall pain. The Board finds the March 2017 VA opinion that the Veteran’s chest disability is not related to service is of no probative value. The examiner failed to consider the Veteran's competent and credible lay statements, which include his assertion of chest symptoms in service, and the continuation of symptoms in the years since service. Private Dr. M.F. opined that the Veteran's chest disability is at least as likely as not caused by his jeep accident while on active duty. Dr. M.F. thoroughly explained the reasons for his conclusions based on an accurate characterization of the evidence, his opinion is entitled to substantial probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). For the foregoing reasons, the current diagnosis, the Veteran's competent and credible lay statements, and the private opinion indicating that the Veteran's chest disability is related to an injury during a period of ACDUTRA, provide a sufficient basis to grant service connection for chest disability. Thus, service connection for chest wall strain is warranted. 3. Scar The Veteran contends that a a higher initial rating of 10 percent is warranted based on the painful nature of his left leg scar. See June 2020 Hearing Transcript. The Veteran’s left leg scar is currently rated as noncompensable under 38 C.F.R. § 4.118, Diagnostic Code 7802. The regulations pertaining to rating skin disabilities were revised, effective August 13, 2018. Claims, such as this, pending prior to the effective date will be considered under both old and new rating criteria, and whichever criteria are more favorable to the Veteran will be applied. Relevant to scar evaluation, the new regulation revises the rating criteria for DC 7801 and DC 7802, while DC 7800, 7804 and 7805 remain unchanged. See 83 Fed. Reg. 32,592 (July 13, 2018) (codified at 38 C.F.R. § 4.118). Prior to August 13, 2018, Diagnostic Code 7802 provided rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear. 38 C.F.R. § 4.118, Diagnostic Code 7802. The amended version is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802 (August 13, 2018). Both versions state that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater. The Veteran was afforded a VA examination in January 2016. He exhibited one superficial non-linear scar measuring 2-centimeter-long and 1 centimeter wide on upper tibial region left leg. The scar was not painful or unstable. At his June 2020 Board hearing, the Veteran testified that his scar hurts and described it as being painful. In this case, the Veteran’s superficial non-linear left leg scar is not of an area 144 square inches or greater. As such, a compensable rating is not available under either version of Diagnostic Code 7802. However, the Board finds that a 10 percent rating is warranted under Diagnostic Code 7804. Diagnostic Code 7804 provides a 10 percent rating for one or two scars that are unstable or painful on examination. Here, the Veteran has reported a painful left leg scar. The Veteran, as a layperson, is competent to report on matters observed or within his personal knowledge, to include symptoms such as scar pain. See 38 C.F.R. § 3.159 (a)(2); Jandreau, 492 F.3d at 1376-77. Therefore, the evidence is at least evenly balanced as to whether the Veteran’s left leg scar more closely approximates one scar that is painful or unstable under Diagnostic Code 7804. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, a 10 percent rating for left leg scar under Diagnostic Code 7804 is warranted during the entire claim period. The Board also finds, however, that a rating higher than 10 percent is not warranted at any time during the claim period. Specifically, the evidence of record does not reflect, and the Veteran does not contend, that his left leg scar more nearly approximates three or more scars that are unstable or painful, thus a rating higher than 10 percent for the Veteran’s left leg scar is not warranted under DC 7804. There is also no evidence or argument that there are symptoms that more nearly approximate the criteria for a higher rating under any other potentially applicable diagnostic code. The Veteran’s scarring does not involve the head, face, or neck so as to warrant consideration under Diagnostic Code 7800. The scar area is not at least 6 square inches (39 square centimeters) so as to warrant a rating under Diagnostic Code 7801. Overall, the Board finds that as the Veteran’s left leg scar more nearly approximate one scar that is painful or unstable, entitlement to a 10 percent rating, but no higher, under Diagnostic Code 7804 is warranted during the entire claim period. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Walker, 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.