Citation Nr: 21025996 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 06-27 446 DATE: April 29, 2021 ORDER Service connection for a left acoustic neuroma is denied. Service connection for a bilateral shoulder disability, to include injury residuals and rotator cuff tears, is denied. Service connection for a chronic muscle disability is denied. Service connection for squamous cell carcinoma, to include as due to herbicides, asbestos, and chemical exposure, is denied. REMANDED Service connection for a left eye disability, to include narrow angle glaucoma, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a left acoustic neuroma began during active service or is otherwise related to an in-service injury. 2. The preponderance of the evidence is against finding that the Veteran’s bilateral shoulder disability began during active service or is otherwise related to an in-service injury. 3. The preponderance of the evidence is against a finding that the Veteran has had a muscle disability at any time during or approximate to the pendency of the claim. 4. The preponderance of the evidence is against finding that the Veteran’s squamous cell carcinoma began during active service or is otherwise related to his military service, to include as due to any herbicides, asbestos, and/or chemical exposure therein. CONCLUSIONS OF LAW 1. The criteria for service connection for a left acoustic neuroma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a bilateral shoulder disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a muscle disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for squamous cell carcinoma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1960 to January 1962. These matters stem from a February 2005 claim for service connection and were before the Board in January 2010, May 2013, October 2014, February 2018 and most recently in October 2019. One reason that the case has been remanded so many times is because the claims file is incomplete. In the February 2018 Remand, the Board noted that it appeared the available evidence obtainable in the case was of record and that further efforts at reconstructing the Veteran’s claims file would be of little use. Nevertheless, in October 2019, the Board indicated that it was not clear what notice the Veteran had received regarding the missing portions of his claims file. Also, he was offered an additional opportunity to supplement the file with any copies of documents he may have had in his possession. In a January 2020 letter, the RO invited the Veteran to submit any missing documents in his possession and explained that some portions of his claims file were missing, including documents from 2005. The Veteran did not submit any additional documents. Accordingly, the Board finds that all attempts to supplement the incomplete file have been made, such that the Board may proceed with adjudication. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Initially, the Board notes that the Veteran and the record have explored the possibility that his left ear condition (acoustic neuroma) and squamous cell carcinoma may be the result of exposure to herbicide agents. Specifically, he has discussed his time sailing in the Pacific and suggested that he may have been exposed abroad. In addition, at his July 2013 VA examination, the Veteran asserted that he had “brown water exposure” to herbicide agents which would suggest that the Veteran was claiming that he was sailing in or around Vietnam. He also told a July 2013 VA examiner that he was on board a “blue water” ship during the Vietnam war. In the October 2019 Remand, the Board directed that the RO obtain appropriate records to ascertain as best as possible the location of the vessel the Veteran was stationed aboard, with particular attention to any assignment of the ship to the waters surrounding the Republic of Vietnam. The RO subsequently obtained a military history report in April 2020, which shows that the Veteran did not have any Vietnam-era service. The RO sent the Veteran a letter in January 2020 asking him to supply information on how his military duties exposed him to herbicide agents—specifically whether he physically served in the Republic of Vietnam, its inland waterways, or in the eligible offshore waters between January 9, 1962 and May 7, 1975, or whether his job in service exposed him to herbicide agents. The letter explained to the Veteran that he could submit statements from persons who knew of his exposure, or information on the ship on which he was stationed, including the timeframe, location, and unit information. The Veteran did not respond, and the RO sent a follow-up letter on August 20, 2020, again asking the Veteran to submit information explaining how his military duties exposed him to herbicide agents. Over the course of the 16-year appeal period, the Veteran has not submitted information about the location of his ship. The Board has reviewed his service records and notes that he served on the U.S.S. Chemung, which is not a vessel listed on VA’s list of Navy ships associated with service in Vietnam and exposure to herbicide agents. Moreover, to the extent that the Veteran may be asserting that he was in the brown waters in Vietnam during the final days of his active service, service records show that he was stationed with the Pacific Reserve Fleet in San Diego, California until his separation. Given the foregoing, the Board concludes that the Veteran’s reports of “brown water” and “blue water” service in Vietnam are not credible. The competent and credible evidence of record does not show that the Veteran served in Vietnam. Service records show that he served on a Navy ship that is not associated with service in Vietnam and exposure to herbicide agents. Accordingly, the Board concludes that the Veteran did not have Vietnam service such that exposure to herbicide agents can be conceded. Alternatively, the Veteran has stated that he was exposed to herbicide agents while at the San Diego Naval Station. Specifically, he has stated that he was assigned to take care of ships and the base facility, and that included weed control by means of spraying. He has not demonstrated any actual knowledge of the presence of herbicide agents on or around the vessel on which he was working. The Veteran has never provided more than bare assertions that he may have been exposed to herbicide agents onboard a ship, and his assertions amount to no more than speculation. Therefore, the Board must also conclude that the evidence does not support a finding that the Veteran was exposed to herbicide agents during any other part of his active service. Lastly, the Board notes that the Veteran has asserted that the disabilities for which he seeks service connection and that are addressed in this decision may be in part due to a physical and sexual assault in service. The Board wishes to make clear that, in adjudicating the claims herein, it does not doubt that the assault occurred in the manner the Veteran describes and resulted in lasting, mental distress. Indeed, the Veteran is in receipt of service connection for posttraumatic stress disorder and depressive disorder, which a VA examiner concluded were due to his in-service military sexual trauma (MST). In denying the claims herein, the Board has relied on medical assessments from trained medical providers who have examined the medical evidence and rendered their conclusions. 1. Service connection for an acoustic neuroma. The Veteran seeks service connection for an acoustic neuroma. He contends that the disability was incurred during a sexual assault in service while aboard the U.S.S. Chemung. Specifically, he has testified that he sustained a head injury during the course of the assault that gave rise to the neuroma. The Board concludes that, while the Veteran has a diagnosis of a left acoustic neuroma, the preponderance of the evidence weighs against finding that the such began during service or is otherwise related to the claimed in-service injury. Private treatment records show that the Veteran was diagnosed with a left acoustic neuroma in approximately 2000 and has undergone biannual magnetic resonance imaging (MRI) to assess its growth. He underwent a VA examination in July 2013. The examiner noted the 2000 diagnosis but opined that the disability was less likely than not incurred in or caused by the claimed in-service injury. By way of rationale, the examiner acknowledged the Veteran’s reports of having been injured during an assault in service but noted that it was unlikely that a neuroma would onset 40 years after injury. Moreover, the examiner explained that acoustic neuromas had a genetic link to neurofibromatosis type II as well as an idiopathic cause, but that there was no link to trauma. Finally, the examiner noted that there was no medical evidence in the record to substantiate that the acoustic neuroma onset during active service. The Veteran underwent another VA examination in June 2019. A different examiner offered a negative nexus opinion similar to the July 2013 opinion—namely, that acoustic neuromas had a genetic component and were not linked to either trauma or herbicide exposure. Taken together, the July 2013 and June 2019 VA examiners’ opinions establish that the Veteran’s acoustic neuroma is less likely than not related to an in-service injury, event, or disease, including any trauma sustained during the Veteran’s in-service assault. Notably, both VA examiners explained that acoustic neuromas had a genetic component or were idiopathic in nature but were not linked to trauma or herbicide exposure. The examiners’ opinions are probative because they are based on an accurate medical history and provide explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Notably, there is no medical opinion evidence contrary to the findings of the VA examiners. The Veteran believes that his left acoustic neuroma is related to an in-service injury. While the Veteran is competent to report the symptoms that he presently experiences, he is not competent to determine that an acoustic neuroma is related to either trauma or herbicide exposure. The issue is medically complex, requiring knowledge of complicated neurological testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA opinions of record. For these reasons, the preponderance of the evidence is against the claim of entitlement to service connection for a left acoustic neuroma. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Service connection for a bilateral shoulder disability. The Veteran also seeks service connection for a bilateral shoulder disability that he contends stems from his personal assault in service in 1960. He has also asserted that he injured his shoulder during an explosion in a small skiff used to transport personnel from ship to shore while stationed in the South China Sea. See June 2019 VA examination. It is not in dispute that the Veteran has multiple shoulder disabilities; indeed, he has been diagnosed during the course of the appeal period with rotator cuff tendonitis, rotator cuff tear, and acromioclavicular (AC) joint osteoarthritis. The first post-service evidence of a shoulder condition is a May 2002 treatment note indicating that the Veteran had fallen and hurt his right shoulder while playing with his granddaughter. At that time, the Veteran noted that he had originally hurt his shoulder after falling in his shop. A June 2002 MRI of the shoulder showed moderate hypertrophic changes involving the AC joint with thinning of the underlying rotator cuff tissues. There appeared to be a complete tear of the rotator cuff with retraction and atrophy of the musculature suggesting an older injury. A January 2003 X-ray of the left shoulder showed left shoulder rotator cuff syndrome, and the it was noted that the alignment was anatomic with degenerative change commensurate with the Veteran’s age. At his March 2009 Board hearing, the Veteran testified that he believed his rotator cuff injury stemmed from being physically assaulted in service and that he had experienced problems with his shoulder ever since service. He underwent a VA shoulder examination in July 2013. The examiner noted diagnoses of right rotator cuff tear and left rotator cuff tear tendinopathy with partial tear. The examiner opined that the bilateral shoulder condition was less likely as not incurred in or caused by any incident of service. The examiner acknowledged the Veteran’s reports of having been assaulted and hurting his shoulder but not receiving any treatment during service. The examiner further noted that the Veteran’s occupation was that of an automobile and light truck mechanic for 40 years following separation from service, and that he also worked as a volunteer fireman for many years. Both of the Veteran’s post-service occupations, the examiner noted, were strenuous and exacting on his muscles and joints, and it was not until 2002 that the Veteran was diagnosed with rotator cuff injuries. The examiner noted that there were no complaints of shoulder injuries in the intervening years between separation from service and the rotator cuff diagnoses. Therefore, the examiner opined that it was just as likely that the Veteran incurred his shoulder injuries during his time as an auto mechanic; but the examiner noted that without any medical documentation, it was impossible to ascertain an in-service injury or shoulder injury connected to an in-service injury. A December 2013 VA treatment note reflects that the Veteran sought treatment for shoulder pain, telling his provider that he injured it that year when he fell off a fire truck. The Veteran underwent another VA examination in June 2019. He told the examiner that he was sexually assaulted and beaten while on a ship in service in July 1960. He said he was not treated in sick bay, did not report the incident, and did not seek any treatment after he was transferred to shore duty. In a corresponding opinion, the examiner opined that the shoulder condition was less likely than not incurred in or caused by the claimed in-service event. By way of rationale, the examiner similarly opined that the Veteran’s post-service occupations of automobile mechanic for 40 years and volunteer fireman were strenuous and could have contributed to his current shoulder injuries. The Veteran was scheduled for another VA examination in February 2021 after the Board asked a VA examiner to discuss the relevance of a June 2002 MRI indicating an “older” shoulder injury. The examiner noted diagnoses of rotator cuff tendonitis, rotator cuff tear (right), glenohumeral joint osteoarthritis, and AC joint osteoarthritis. He told the provider that he specifically did not seek any treatment for his shoulder conditions based on a mistrust of medical personnel. The examiner noted that the Veteran had substantial shoulder conditions, but that there were no service records available such that there was any evidence to link his current shoulder problems to the claimed in-service incidents. The examiner noted that the Veteran had a vigorous, active lifestyle in the years after active duty, including a career in heavy equipment and auto mechanics, which the examiner remarked was somewhat inconsistent with the extent of shoulder compromise observed on examination. There was also documentation, the examiner noted, of a fall off a fire truck in 2013 and two falls off fire trucks in 2016. The examiner acknowledged that the right shoulder rotator cuff tear document in 2002 had features of chronicity, suggesting that the injury likely occurred before 2002. However, the examiner stated that it was not possible to more accurately date the injury without speculation, and that the Veteran could have injured his shoulder at any point between separation from service in 1962 and the diagnosis of right rotator cuff tear in 2002—circumstances that, in the examiner’s view, did not satisfy a “more likely than not” link to active duty. Based on the foregoing, the Board finds that the preponderance of the evidence is against a finding that the Veteran’s bilateral shoulder disabilities were incurred in service. Taken together, the July 2013, June 2019, and February 2021 VA opinions establish that, even in consideration of a 2002 MRI finding of an “older” shoulder injury, it was more likely that his rigorous career as an auto mechanic and volunteer fireman contributed to his shoulder disabilities. Indeed, the most recent VA examiner stated that it was not “more likely than not” that the conditions were related to service. The Board finds that taken together, the examiners’ opinions are probative, insofar as they were based on an accurate medical history and provided clear and concise explanations. More, they considered the Veteran’s reports of having sustained his shoulder injuries in service. Nieves, 22 Vet. App. at 304. There is no medical opinion evidence that is contrary to the findings of the VA examiners. The Veteran believes that his bilateral shoulder conditions are related to service. While the Board does not doubt the Veteran’s reports of being assaulted in service, and recognizing that the Veteran is certainly competent to report the symptoms that he presently experiences, he is not competent to opine on a nexus between his shoulder conditions and service. The issue is medically complex, requiring knowledge of the inner workings of the musculoskeletal system. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, supra; see also Kahana, supra. Consequently, the Board gives more probative weight to the VA opinions of record. For these reasons, the preponderance of the evidence is against the claim of entitlement to service connection for a bilateral shoulder disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. 3. Service connection for a muscle disability, to include muscle and tissue injury residuals. The Veteran contended in his February 2005 claim for service connection that he had muscle and/or tissue damage, “origin of disease unknown.” The Board concludes that the Veteran does not have any current standalone muscle conditions and has not had any at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, the evidence of record does not show that the Veteran has experienced any manifestations of any muscle condition productive of a functional impairment in earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Notably, at his March 2009 Board hearing, the Veteran expressed that he believed his shoulder and muscle symptomatology were essentially the same. See Transcript at p. 18. He described a torn rotator cuff but did not indicate that he had any separate and distinct muscle injuries. The Veteran underwent a VA muscle examination in July 2013. The examiner noted a diagnosis of bilateral trapezius muscle strain. The Veteran told the examiner that he had pain in his upper back and neck muscles, and the examiner identified that the pain was in the extrinsic muscles of the shoulder girdle: trapezius, levator scapulae, serratus magnus. The examiner opined that the claimed condition was less likely than not incurred in or caused by service. The examiner indicated a review of the entire file and considered the Veteran’s reports of having injured his shoulder/upper back area in the context of his in-service MST. The examiner also noted that the Veteran was an automobile and light truck mechanic for 40 years following separation from service, and served as a volunteer fireman for many years, both of which, the examiner opined were strenuous and exacting on the Veteran’s muscle and joints. The examiner added that the Veteran had never been diagnosed, until the date of the examination, with an upper back muscle injury and had never been treated for complaints of upper back muscle pain. The Veteran underwent another VA muscle injuries examination in June 2019. The examiner reported the 2013 diagnosis of bilateral trapezius muscle strain and offered the exact same opinion as that offered in July 2013. The Veteran was afforded another muscle injuries examination in February 2021. The examiner indicated a review of the file but noted that some records were not available. Upon physical examination, the examiner stated that there was no diagnosed muscle injury. By way of clarification, the examiner noted that the Veteran did have significant bilateral shoulder problems, including bilateral shoulder and AC joint osteoarthritis, a complete right rotator cuff tear, and left rotator cuff tendonitis. The examiner addressed the prior examiners’ diagnosis of bilateral trapezius muscle strain, however, the examiner clarified that the current examination findings did not suggest a trapezius injury such as abnormal or asymmetrical trapezius appearance, contour, or palpation abnormalities. Rather, shoulder weakness was documented, which was to be expected with the Veteran’s significant bilateral shoulder joint damage. The examiner added that it was his opinion that there was no identifiable muscle or trapezius condition, and that the symptoms of shoulder weakness and local tenderness were actually due to his various shoulder conditions. The Board has reviewed VA treatment records dated throughout the appeal period which show treatment for the Veteran’s shoulder conditions but do not contain a noted diagnosis of a separate, standalone, muscle condition. In reviewing the pertinent medical evidence as outlined above, the Board concludes that there is no standalone muscle injury disability. In this regard, the Board affords high probative value to the February 2021 VA examination. That opinion provider explained, in clear medical terms, why the evidence did not support the prior diagnosis in the file of “bilateral trapezius muscle strain,” insofar as there were no physical markings of a trapezius muscle strain. Rather, the examiner opined that the symptomatology was attributable to the Veteran’s very significant shoulder issues. Notably, the Veteran himself testified that he was not aware of a standalone muscle injury; rather, he felt that his shoulder and muscle claims stemmed from the same symptomatology. See March 2009 Board Hearing Transcript. VA treatment records show treatment for the Veteran’s diagnosed shoulder conditions, but do not show any diagnosis of a muscle injury disability separate and distinct from muscle pain related to his shoulder disabilities. For these reasons, the preponderance of the evidence is against the claim of entitlement to service connection for a chronic muscle disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. 4. Service connection for squamous cell carcinoma, to include as due to herbicides, asbestos, and chemical exposure. Finally, the Veteran asserts that his diagnosed squamous cell carcinoma is related to service, to specifically include exposure to herbicides, asbestos, and chemicals. As noted above, the Board has found that the Veteran’s statements regarding exposure to herbicide agents are not credible. Private medical evidence shows that the Veteran was first diagnosed with skin cancer in May 1995. At his August 2007 DRO hearing, he testified that he was exposed to chemicals in the course of his duties with the Pacific Reserve Fleet in 1961, where he “took care of mold … and that sort of thing,” which subjected him to chemicals. He explained that he did not know if there was any specific herbicide involved, but rather that the substance was used for “defoliage.” He also testified that he had asbestos exposure. He underwent a skin conditions examination in July 2013, where it was noted that he had malignant melanoma. The examiner opined that after a review of all the medical records, the Veteran’s verbal history, and a physical examination, it was less likely as not that any skin cancer was caused by active service, to include any claimed in-service herbicide, asbestos, or chemical exposure therein. The examiner noted that the Veteran was diagnosed with a squamous cell carcinoma in 1995. The examiner specifically noted that exposure to asbestos could cause squamous cell carcinoma of the lung, but not of the skin. Moreover, the carcinoma originated 33 years after service and grew aggressively, according to medical records. For an aggressive skin cancer to have occurred so long after service, the examiner noted, it is less likely to have been incurred in service. In a June 2019 VA opinion, an examiner opined that the Veteran’s skin cancer was less likely as not related to service because it was diagnosed in 1995, did not have onset during active service, and was not subject to presumptive service connection. It was noted that the condition had completely resolved and no longer required any kind of treatment. While the Board finds that the June 2019 VA opinion is less probative, as the examiner did not supplement the opinion with a medical rationale, the Board does find that the July 2013 opinion is highly probative, insofar as the examiner explained that exposure to asbestos could cause lung cancer, but not skin cancer and more, that the aggressiveness of the cancer found in 1995 made it less likely than not that it was related to any exposure from 35 years earlier. The Board has also already found that the Veteran’s reports of herbicide exposure are not credible. There is no medical opinion evidence that is contrary to the findings of the VA examiners. The Veteran believes that his resolved skin cancer is related to service. As previously noted, the Veteran is not competent to opine on a nexus between a complicated medical condition—such as skin cancer—and active service, as such is medically complex, requiring interpretation of diagnostic testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, supra; see also Kahana, supra. Consequently, the Board gives more probative weight to the July 2013 VA opinion of record. For these reasons, the preponderance of the evidence is against the claim of entitlement to service connection for squamous cell carcinoma. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND The Veteran contends that his left eye disability, diagnosed as narrow angle glaucoma and cataracts, stems from his personal assault in service. He has also asserted that the condition may be related to a gunnery incident in service. He has indicated that he started having vision loss in service and that it progressively worsened until the point at which his left eye was removed in 1996. The Veteran has undergone two VA examinations for his left eye during the course of the appeal. In July 2013, a VA optometrist opined that the Veteran’s left eye conditions were related to his acoustic neuroma, without any medical explanation for why it was unrelated to the beating the Veteran sustained in service. Then, the same examiner offered an additional opinion in June 2019, wherein she again stated that some medical records documented the cause of vision loss in the left eye to be a result of acoustic neuroma, but that she was unable to determine a probability given the absence of records for a period of 37 years as well as the very limited clinical examination she was able to perform of the left eye given the presence of mature cataracts that prevented an evaluation of any ocular structures behind it. The question that the Board is seeking to answer, which no VA examiner has yet answered, is whether any of the Veteran’s diagnosed left eye conditions could have developed (a likelihood of 50 percent or greater) from having sustained a physical and sexual assault in service during which the Veteran describes having sustained a left-sided head injury. The matter is REMANDED for the following action: 1. Return the claims file to the VA optometrist who authored the July 2013 and June 2019 opinions, or if unavailable, a VA clinician with similar expertise in optometry/ophthalmology. Given the prior VA examiner’s assessment that physical examination of the left eye was essentially impossible given the presence of mature cataracts, physical examination is not necessary. After a thorough review of the claims file, the examiner is asked to respond to the following: - Is it at least as likely as not (50 percent or greater probability) that any of the Veteran’s diagnosed left eye conditions—including end stage glaucoma and mature cataracts—onset in or were caused by the Veteran’s active service, to specifically include a head injury sustained during the course of a physical/sexual assault? The examiner should accept as true that he was the victim of a physical and sexual assault. - In providing the requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability(ies), this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability(ies) is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 2. Thereafter, readjudicate the issue on appeal. James Springer Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Polly Johnson, 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.