Citation Nr: 21024441 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 12-31 965 DATE: April 22, 2021 ORDER Entitlement to an initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) prior to April 29, 2015, for substitution purposes, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a total disability rating based on individual unemployability (TDIU), for substitution purposes, is granted, effective from November 30, 2012, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. Prior to April 29, 2015, the Veteran’s PTSD has been productive of symptoms that most nearly approximate severe symptomatology resulting in occupational and social impairment with deficiencies in most areas, but not total social and occupational impairment. 2. Resolving reasonable doubt in the Veteran’s favor, the most probative evidence of record demonstrates that the Veteran service-connected disabilities, particularly his PTSD, rendered him incapable of securing and following a substantially gainful employment consistent with his education background and work history, from November 30, 2012. CONCLUSIONS OF LAW 1. Prior to April 29, 2015, the criteria for an initial 70 percent rating, but not higher, for PTSD, have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, Diagnostic Code 9411. 2. The criteria for entitlement to a total disability rating based on individual unemployability (TDIU) have been met. 38 U.S.C. §§ 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.340, 3.341, 4.16, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran has recognized Philippine Guerilla Service from December 1944 to April 1945. These matters come before the Board of Veterans’ Appeals (Board) based on the appeal of a May 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Manila, the Republic of the Philippines. The record reflects that the Veteran died in January 2021. The appellant is the Veteran's surviving spouse. In March 11, 2021, the appellant, through her attorney, requested to be substituted as the claimant in the Veteran's claims pending at the time of his death. This request for substitution was granted by the RO in a March 26, 2021, correspondence. Therefore, 38 U.S.C. § 5121A and implementing regulation 38 C.F.R. § 3.1010 are applicable, and the appellant's claim is not one for accrued benefits, but remains the Veteran's original claim, into which she is substituted. Adjudicative History In a September 2014 decision, the Board granted an initial rating increase from 30 percent to 50 percent for PTSD but denied a rating in excess of 50 percent. In this decision, the Board remanded the issue of entitlement to a TDIU, which was raised on the record, for additional development. The Veteran appealed the Board’s decision to the U.S. Court of Appeals for Veterans Claims (Court). In an April 2015 Order, the Court granted a Joint Motion for Remand (JMR) and remanded the issue of entitlement to an initial rating in excess of 50 percent for PTSD to the Board for action consistent with the JMR. In May 2015, the RO increased the Veteran’s rating for PTSD to 70 percent from April 29, 2015. These issues were subsequently remanded by the Board for further development in July 2015, and subsequently, in an October 2017 decision, the Board denied the Veteran’s claims for higher ratings for an initial rating in excess of 50 percent prior to April 29, 2015 and an initial rating in excess of 70 percent from April 29, 2015, for PTSD. The Veteran appealed the Board’s October 2017 decision to the Court, and in a July 2018 Order, pursuant to the parties JMR, the Court remanded these issues to the Board for action consistent with the JMR. In January 2019, the Board issued a decision denying the Veteran’s appeal for several claims, including for higher ratings for an initial rating in excess of 50 percent prior to April 29, 2015, an initial rating in excess of 70 percent from April 29, 2015, both for PTSD, and for entitlement to TDIU, which was later vacated due to the Veteran’s appointment of a new attorney the notice of which was scanned into the Veteran’s electronic file after the issuance of the decision. Subsequently, in March 2020, the Board, among other actions, denied the Veteran's appeal seeking an evaluation in excess of 50 percent for service-connected PTSD prior to April 29, 2015, and entitlement to TDIU. The Veteran appealed these portions of the Board's March 2020 decision to the United States Court of Appeals for Veterans Claims (Court). While the matter was pending before the Court, in November 2020, the Veteran’s attorney and a representative of VA’s Office of General Counsel filed a Joint Motion for Partial Remand (JMPR). In a November 2020 Order, the Court vacated these portions of the Board’s March 2020 decision and remanded the matters for readjudication in light of the parties' agreements in the JMPR The Board notes that the JMPR reflects that the Veteran did not challenge the part of the Board’s decision that denied an initial rating in excess of 70 percent for PTSD from April 29, 2015, and as such this decision will only discuss the appeal in excess of 50 percent for PTSD prior to April 29, 2015 and entitlement to TDIU. Increased Rating for PTSD Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. Any reasonable doubt regarding a degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's service-connected PTSD has been evaluated under 38 C.F.R. § 4.130, DC 9411. However, the actual criteria for rating the Veteran's disability are set forth in a General Rating Formula for evaluating psychiatric disabilities other than eating disorders. 38 C.F.R. § 4.130. Under that code, a 50 percent rating is provided when there is 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. Id. A 70 percent rating is provided 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 a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130. A 100 percent rating is provided 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 of the veteran 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. 38 C.F.R. § 4.130. The symptoms associated with the rating criteria are not intended to constitute exhaustive lists, but rather 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 (2002). A Veteran may only qualify for a disability rating under 38 C.F.R. § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration that result in the levels of occupational and social impairment provided. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). To adequately evaluate and assign the appropriate disability rating to the Veteran’s service-connected psychiatric disability, the Board must analyze the evidence as a whole and the enumerated factors listed in 38 C.F.R. § 4.130. Mauerhan, 16 Vet. App. at 436. The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5), effective for VA rating purposes as of August 2014, does not utilize the GAF scores. The Veteran’s GAF scores of 45 and 50 were assigned during the appeal period. The APA determined that the GAF score had limited usefulness in the assessment of the level of mental health disability, and therefore, it was removed from the DSM-5; noting that problems included a lack of conceptual clarity and doubtful value of GAF psychometrics in clinical practice. 79 Fed. Reg. 45,093, 45,097 (Aug. 4, 2014). 1. Entitlement to an initial rating of 70 percent, but no higher, is granted for posttraumatic stress disorder (PTSD) prior to April 29, 2015, for substitution purposes. The record reflects that the Veteran was first diagnosed with PTSD in October 2010, and he subsequently applied for service connection for PTSD which was granted in a May 2011 rating decision at 30 percent, and subsequently increased to 50 percent, prior to April 29, 2015, which the Veteran is currently appealing. Based upon further review of the specific evidence of record discussed below, the Board finds that an increase in an initial PTSD rating evaluation from 50 percent to 70 percent, but no higher, prior to April 29, 2015, is warranted. At the Veteran’s initial VA mental health assessment, conducted in November 2010, the Veteran reported the following symptoms: intrusive thoughts, nightmares, flashbacks, physical reactions to reminders of trauma, avoidance behaviors, difficulty remembering important aspects of trauma, loss of interest in significant activities, difficulty sleeping, difficulty concentrating, irritability and anger, guardedness, an exaggerated startle response, feelings of emptiness and depression, boredom, dysphoria, isolating behaviors, and a lack of energy. It was also noted that the Veteran endorsed feeling helpless, worthless, and hopeless. The Veteran reported that he retired from his full time position as a security guard in 2008 and subsequently spent most of his leisure time watching television; that he had a “very good” relationship with his family, and he had been happily married to his wife since 1947. Although, the VA psychologist noted that the Veteran did not endorse delusions or homicidal or suicidal ideation, the psychologist acknowledged that the Veteran’s mood was depressed, and his affect was appropriate to his mood. The Veteran was diagnosed with PTSD and major depressive disorder, and the examiner assigned a GAF score of 45. The Veteran was subsequently provided a VA psychiatric examination in March 2011. During this examination, the Veteran reported the following symptoms: nightmares, daydreams of traumatic events, difficulty sleeping, recurrent and intrusive distressing recollections and dreams, intense psychological distress and physiological reactivity upon exposure to internal or external cues, a sense of a foreshortened future, avoidance behaviors, diminished interest in significant activities, suspiciousness, hypervigilance, and some visual hallucinations, though they were not persistent. The Veteran also reported irritability and outbursts of anger, but that he had learned how to control himself during these outbursts. The Veteran further noted that he had a few friends though not many, and still enjoyed some activities, including watching television, playing ping pong, and going to the movies. The VA examiner noted his observations that the Veteran was neatly groomed and appropriately dressed, cooperative, friendly, attentive, polite, alert, and fully oriented. The examiner also reported that the Veteran’s mood was anxious, and he appeared intense, but his affect was appropriate, though restricted. The Veteran’s speech, thought processes, and thought content were reported to be unremarkable. Further, that the Veteran did not endorse delusions, obsessive or ritualistic behaviors, panic attacks, or homicidal or suicidal ideation. The examiner assigned a GAF score of 50. From May 2011 to October 2011, the Veteran was seen on a regular basis at VA for treatment of his PTSD. During these visits, the Veteran reported the following symptoms: depression, emotional numbness, feelings of nervousness and apprehension when recalling traumatic experiences, avoidance behaviors, difficulty sleeping with persistent insomnia, loss of interest in significant activities, isolation behaviors, anger and irritability, and recurrent intrusive thoughts, memories, and nightmares, occasionally awakening startled and disoriented. The Veteran denied feelings of hopelessness and worthlessness, psychotic symptoms, obsessive rituals, panic attacks, difficulty with motivation, and homicidal and suicidal ideation. In October 2013, the Veteran testified at a hearing, presided over by a DRO. The Veteran’s granddaughter attending the hearing to assist in translation and testimony. The Veteran testified at the hearing that he had been experiencing the following symptoms: flashbacks, nightmares, feelings of sadness, and difficulty sleeping, reporting that he only got approximately three hours of sleep at a time before awakening. Further, that he sometimes does not want to get out of bed and felt tired with life. However, the Veteran also testified that although he preferred to stay at his home, he does have some friends, and occasionally invited his neighbors over for a visit. The Veteran’s granddaughter also testified that the Veteran sometimes awakened looking startled or as though he was having a seizure, noting that he would sometimes shout as though he was afraid of some unknown threat. She also noted that she had observe the Veteran displaying behaviors of hypervigilance, such as, frequently locking doors and windows and that the Veteran had told her that he did not want to live anymore (suicidal ideation). The Veteran was provided another VA examination in March 2014. During this examination, the examiner reported that the Veteran endorsed the following symptoms: recurrent involuntary and intrusive distressing memories and dreams, intense or prolonged psychological distress and physiological reactions to internal or external cues, avoidance behaviors, persistent and exaggerated negative beliefs, persistent negative emotional state, diminished interest in significant activities, feelings of detachment or estrangement from others, irritable behavior and angry outburst, exaggerated startle response, difficulty concentrating, sleep disturbances and difficulty sleeping, and anxiety. VA treatment records from October 2014 document that the Veteran expressed suicidal ideation with no intent or plan. Specifically, that he knew it was not a good idea to kill himself because he needed to care for his family. The examiner noted that the Veteran was a low risk of self-harm, and that he was fully oriented with normal thought processes and speech and appropriate grooming. However, psychologically, the Veteran appeared depressed and tearful during this appointment, and his insight and judgment were noted to be fair with no evidence of psychotic processes. The Board also acknowledges the private examination, conducted in December 2019, that retrospectively commented on the Veteran’s symptomatology as far back as 2008. After a review of the file and an interview with the Veteran and the Veteran’s granddaughter, the psychiatrist, Dr. M. C. opined that among other factors, the Veteran has been “totally disabled” by his PTSD since at least 2008, when he stopped working because he could no longer “manage appropriate and reasonable interactions in a work environment on a consistent basis.” Further, that the Veteran’s severe PTSD symptoms predated his major vascular neurocognitive disorder diagnosis, which subsequently contributed to his (nonservice-connected) stroke in 2012. Dr. M.C. then went on to note that the Veteran experienced the following symptoms, likely with an onset prior to 2008: severe social isolation, profoundly impaired interpersonal relationships, dissociative episodes, intrusive memories, exaggerated startle response, recklessness, negative thinking, difficulty experiencing positive emotions, frequent flashbacks, nightmares insomnia, loss of focus, difficulty concentrating, anger, and volatile outbursts. The examiner also opined that these symptoms were severe and worsening over time since the Veteran’s active service. As such, the Board notes that there are differing opinions of record by the medical experts regarding the level of severity of the Veteran’s PTSD symptoms prior to April 29, 2015. After taking a holistic view of the frequency, severity, and duration of the Veteran’s PTSD disability, upon further review and in an action consistent with the November 2020 JMPR, the Board finds that the impairment due to the Veteran’s PTSD, approximated the schedular criteria for a rating of 70 percent prior to April 29, 2015. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). In so finding, the Board notes that the evidence shows that the Veteran suffered from a spectrum of symptoms ranging from anxiety, anger, irritability, intrusive thoughts, sleep impairment, recurring suicidal ideations and significant disturbances of motivation and mood. Thus, resolving all reasonable doubt in the Veteran’s favor, the Board finds that the evidence supports a 70 percent rating, but no higher, for the Veteran’s PTSD prior to April 29, 2015. Higher PTSD Rating Consideration of 100 percent The Board further finds that a 100 percent rating is not warranted prior to April 29, 2015, as the Veteran’s PTSD did not result in total social impairment prior to April 29, 2015. Indeed, the Veteran has acknowledged that he still enjoyed some social activities, including watching television, playing ping pong, and going to the movies, and by his on testimony (DRO Hearing October 2013), that he sometimes socializes with his neighbors, including taking a trip to Las Vegas together. During this period, the Veteran has also consistently reported a good relationship with his immediate family, including his wife, child, and grandchildren. These reports affirmatively oppose the notion of total social impairment. Although Dr. M. C. found the Veteran to be totally disabled due his PTSD, this was occupationally based, and did not state that this was inclusive of a finding of total social impairment. Further, observations by the various examiners revealed that the Veteran was considered fully oriented with normal speech and thought processes and appropriate grooming. The Board also finds that at no point during the period on appeal was the Veteran’s PTSD manifested by such symptoms in support of the next highest rating of 100 percent - such as, gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, disorientation to time or place, or memory loss for names of close relatives, or his own name, or an overall level of symptomatology supportive of a higher than 70 percent rating. Therefore, the preponderance of the evidence is against a finding that the Veteran’s PTSD disability more nearly approximates total occupational and social impairment. 2. Entitlement to a total disability rating based on individual unemployability (TDIU), for substitution purposes, is granted. The Board notes that this claim was raised by the record in conjunction with the Veteran’s increased rating claim for PTSD, pursuant to Rice, in the Board’s September 2014 decision. The Court has held that a request for a total disability rating based on individual unemployability is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). In this regard, a total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341. If the schedular rating is less than total, a total disability evaluation can be assigned based on individual unemployability if the Veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disability, provided that the Veteran has one service-connected disability rated at 60 percent or higher; or two or more service-connected disabilities, with one disability rated at 40 percent or higher and the combined rating is 70 percent or higher. The existence or degree of non-service-connected disabilities will be disregarded if the above-stated percentage requirements are met and the evaluator determines that the Veteran's service-connected disabilities render him incapable of substantial gainful employment. 38 C.F.R. § 4.16 (a). All Veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service-connected disability shall be rated totally disabled. 38 C.F.R. § 4.16 (b). In cases where the schedular criteria are not met, an extraschedular rating is for consideration. 38 C.F.R. § 3.321. The central inquiry is, "whether the Veteran's service-connected disabilities alone are of sufficient severity to produce unemployability." Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). Neither nonservice-connected disabilities nor advancing age may be considered in the determination. 38 C.F.R. §§ 3.341, 4.19; Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). For the Veteran to prevail on his TDIU claim, it is necessary that the record reflect some factor which takes his case outside the norm of other such Veterans. 38 C.F.R. §§ 4.1, 4.15. The sole fact that the Veteran is unemployed or has difficulty obtaining employment is not enough. The assignment of a rating evaluation is itself recognition of industrial impairment. With the above criteria in mind, the record shows that the Veteran was in receipt of a 50 percent disability rating for his PTSD from November 30, 2010, and a combined 60 percent disability rating as of the same date, which means that he did not meet the schedular criteria for TDIU at the time of his appeal. However, in granting the Veteran’s an increased rating of claim to 70 percent, prior to April 29, 2015, the Veteran has now met the schedular criteria for TDIU, as of November 30, 2012, the date of he was granted service connection for PTSD. The Veteran reported that he last worked (part-time) in August 2011, following his full-time job as an armed (and unarmed) security guard in 2009, stating that he became too disabled to work on November 2010. See, June 2016 VA 21-8940 Veterans Application for Increased Compensation Based on Unemployability. The Veteran’s reports that following his discharge from service in April 1945, the Veteran obtained a Bachelor of Arts degree in political science; that he taught high school part-time for two years and worked in government service and community development in the Republic of the Philippines for 25 years before moving to the United States in 1992 where he worked as a security guard until 2009. The Board notes that the Veteran did not initially meet the TDIU schedular criteria until April 29, 2015, when his PTSD rating was increased to 50 percent. However, in the decision above, the Veteran’s increased rating claim for PTSD has been granted to reflect a PTSD rating of 70 percent prior to April 29, 2015. Consequently, the Veteran has now met the TDIU schedular criteria as of November 30, 2012, the effective date of his underlying service-connection claim for PTSD. For the reasons discussed below, the Board finds that entitlement to TDIU, effective November 30, 2012, is warranted. First, the Board notes that a VA examiner in April 2015 acknowledged that the Veteran was totally socially and occupationally impaired, but also reported that only 10 percent of the Veteran’s symptomatology could be attributed to his service-connected PTSD, and that the remainder of his total and social impairment was due his nonservice-connected major neuro cognitive disorder related to 2012 stroke. However, the examiner did not provide concrete facts and supporting medical literature regarding how he made such a distinction. Thus, the Board finds that aspect of the VA examiner’s report inadequate. Furthermore, in both its July 2018 and November 2020 findings, the Court specifically noted that the VA medical opinions of record did not specifically address how the nature of the Veteran’s PTSD disability impacted his employability, and whether the Veteran is unemployable due solely to his service-connected disabilities. The Board further notes that notwithstanding the April 29, 2015, VA examiner’s opinion attributing only 10 percent unemployability to his PTSD symptoms, this examiner reported that the Veteran’s symptoms included poor short term memory, suspiciousness of others/authority, which the Veteran testified was a primary basis why he could not continue to work, first on a fulltime basis in 2008, and eventually, not even on a parttime basis in 2009. See, 2013 DRO Hearing Transcript. To this issue, the Board notes that the evidence of record includes a private opinion by psychiatrist, Dr. M.C, previously referenced, in which he opined that the Veteran’s PTSD disability rendered him “totally disabled,” citing to specific manifestations of his PTSD symptoms, such as his verbally threatening behavior, angry outbursts, inconsistent performance of his job requirements, and difficulty coping with complex functions. In addition, because of the Veteran’s PTSD severe symptoms, the Veteran could no longer “manage appropriate and reasonable interactions in a work environment on a consistent basis.” See, December 2019 Medical Treatment Record - Non-Government Facility. There is also evidence of record that reflects that the Veteran’s service-connected bilateral hearing loss, which was at 30 percent, effective July 15, 2016, causes “clinically significant distress or impairment in social, occupational or other important areas of functioning,” notwithstanding an April 2016 VA examiner’s opinion that the Veteran’s hearing loss and tinnitus impairment would not him totally occupationally impaired so long as visual cues, face-to-face communication, and amplification devices are implemented. See, May 2015 CAPRI Records. All other VA opinions of record did not directly address the Veteran’s unemployability with regards to his service-connected disabilities, instead just noting that the Veteran is retired, which of itself and the Veteran’s age is not relevant to the question of whether such disabilities would have rendered him incapable of securing and following a substantially gainful occupation. In determining whether a veteran is unemployable for VA purposes, consideration may be given to the veteran’s level of education, special training, and previous work experience, but not to age or any impairment caused by nonservice-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. A veteran need not show 100 percent unemployability in order to be entitled to a TDIU rating. Roberson v. Principi, 251F.3d1378, 1385 (Fed. Cir. 2001) In reviewing these records, the Board finds Dr. M.C.’s opinion that the Veteran was “totally disabled” by his PTSD since 2008 to be the most persuasive opinion of record with regards to whether the Veteran’s PTSD would have rendered his unemployable. Consequently, the collective evidence, both positive and negative, as to whether the Veteran’s service-connected disabilities, and specifically his PTSD, rendered him incapable of securing and following a substantially gainful occupation (38 C.F.R. § 4.16 (b)) on November 30, 2012, is at least in equipoise. Accordingly, resolving all doubt in the Veteran’s favor, the Board finds that entitlement to TDIU, effective November 30, 2012, is warranted, and as a result, the appellant’s claim is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Rice v. Shinseki, 22 Vet. App. 447 (2009). 38 C.F.R. §§ 3.102, 3.340, 4.15. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.B. King, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.