Citation Nr: 21030192 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 18-22 945A DATE: May 18, 2021 ORDER A rating of more than 10 percent for right knee degenerative joint disease (DJD) status-post lateral meniscectomy, rated under diagnostic codes 5010 and 5260, since December 18, 2013, is denied. A rating of 20 percent for moderate right knee instability, rated under diagnostic code 5257, since December 18, 2013, is granted. A rating of 20 percent for right knee locking and effusion, rated under diagnostic code 5258, since December 18, 2013, is granted. A rating of more than 10 percent for right hip DJD, rated under diagnostic code 5252, since December 18, 2013, is denied. A compensable rating for right hip limitation of extension, rated under diagnostic code 5251, since December 18, 2013, is denied. A compensable rating for right hip limitation of abduction, rated under diagnostic code 5253, since December 18, 2013, is denied. A total rating for compensation purposes based on individual unemployability due to service-connected disabilities (TDIU) since August 11, 2017, is granted. FINDINGS OF FACT 1. Since December 18, 2013, the Veteran's right knee disorder caused pain after meniscectomy, DJD, flexion to 110 degrees, extension to 0 degrees, pain, flare-ups, instability, tenderness on palpation, weakness, stiffness, lack of endurance, incoordination, crepitus, locking, effusion, difficulty walking, and required the use of a brace and a cane. 2. Since December 18, 2013, the Veteran's right hip disorder caused DJD, flexion to 70 degrees, extension to 10 degrees, abduction to 20 degrees, adduction to 20 degrees, adduction not limited such that the Veteran could not cross his legs, rotation not limited such that he could not toe-out more than 15 degrees, external rotation to 30 degrees, internal rotation to 15 degrees, pain, less movement than normal, difficulty sitting, difficulty standing, difficulty weight-bearing, difficulty climbing stairs, and required the use of a cane. 3. The Veteran's service-connected disabilities prevent him from securing or following a substantially gainful occupation since August 11, 2017. CONCLUSIONS OF LAW 1. The criteria for a rating of more than 10 percent since December 18, 2013, for right knee DJD status-post lateral meniscectomy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5260. 2. The criteria for a rating of 20 percent since December 18, 2013, for moderate right knee instability have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 3. The criteria for a rating of 20 percent since December 18, 2013, for right knee locking and effusion have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5258. 4. The criteria for a rating of more than 10 percent since December 18, 2013, for right hip DJD with limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5252. 5. The criteria for a compensable rating since December 18, 2013, for right hip limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5251. 6. The criteria for a compensable rating since December 18, 2013, for right hip limitation of abduction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5010, 5253. 7. The criteria for a TDIU since August 11, 2017, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.326(a), 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from July 1967 to July 1969. He served in the Republic of Vietnam. On his May 2018 VA Form 9, the Veteran requested a videoconference hearing. The hearing was scheduled for October 2019, and an August 2019 notice letter informed the Veteran of the time, place, and location of the hearing. The Veteran failed to appear for the scheduled hearing and did not provide good cause or otherwise request the hearing be postponed or rescheduled. Therefore, Board will proceed as if the request for the hearing has been withdrawn. 38 C.F.R. § 20.704(d). In January 2020, the Board remanded the appeals of increased ratings for the right knee and right hip disorders for the Veteran to undergo VA examinations compliant with DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995) and Sharp v. Shulkin, 29 Vet. App. 26, 34-35 (2017). The VA examinations were scheduled, but the Veteran failed to appear. The Veteran's current address is unclear. In June 2019, an updated address was obtained for the Veteran. However, correspondence to that address was returned as undeliverable. In December 2020, the VA obtained another address for the Veteran confirmed through utility listing, vehicle, a credit bureau, and his Driver's license. However, correspondence to that address has been returned as undeliverable as well. Thus, all three addresses the VA had for the Veteran do not appear to be valid. A remand to obtain an additional address so that a new examination could be scheduled would be futile. VA has taken multiple steps to determine the Veteran's current address and has been unable to do so. The Veteran has a duty to keep VA apprised of his current address. Jones v. West, 12 Vet. App. 98 (1998). VA is not required to "turn up heaven and earth to find him." Hyson v. Brown, 5 Vet. App. 262, 265 (1993). "If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). VA has the discretion to determine when additional information is needed to adjudicate a claim. The Veteran is expected to cooperate in the efforts to adjudicate his claim for service connection. His failure to do so subjects him to the risk of an adverse adjudication based on an incomplete and underdeveloped record. Kowalski v. Nicholson, 19 Vet. App. 171 180-181 (2005). Therefore, the Board will proceed to adjudicate the claims based on the evidence of record. Increased Ratings Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. 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. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca, 8 Vet. App. at 202; see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in §§ 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under §§ 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Furthermore, in Sharp, 29 Vet. App. at 26, the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. The regulations governing the rating of musculoskeletal disorders were amended effective February 7, 2021. The previous versions of the rating criteria were more favorable to the Veteran. For those disorders whose rating criteria have changed, the Board will proceed to rate the disorders under the rating criteria in effect prior to February 7, 2021. Traumatic arthritis is to be rated as degenerative arthritis. 38 C.F.R. § 4.71a, Diagnostic Code 5010. Degenerative arthritis, established by X-ray, will be rated on the basis of limitation of motion under the appropriate diagnostic criteria for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted for X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups; a 20 percent rating is warranted if there are also occasional incapacitating exacerbations. Note (1) states: The 20 percent and 10 percent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2) states: The 20 percent and 10 percent ratings based on X ray findings, above, will not be utilized in rating conditions listed under diagnostic codes 5013 to 5024, inclusive. 38 C.F.R. § 4.71a, Diagnostic Code 5003. 1. Entitlement to an increased rating since December 18, 2013, for right knee disorder, currently rated as 10 percent for DJD status-post lateral meniscectomy. The Veteran's right knee DJD is currently rated as 10 percent under diagnostic code 5010 5260. Diagnostic Code 5257 provides ratings for recurrent subluxation or lateral instability. Slight disability warrants a 10 percent rating and a moderate disability warrants a 20 percent rating. Severe disability warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 provides that a 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Diagnostic Code 5259 provides that a 10 percent rating is warranted for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Diagnostic Code 5260 provides ratings based on limitation of flexion of the leg. Limitation of flexion to 60 degrees warrants a noncompensable rating. Limitation of flexion to 45 degrees warrants a 10 percent rating. Flexion limited to 30 degrees warrants a 20 percent rating. Flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Diagnostic Code 5261 provides ratings based on limitation of the extension of the leg. Limitation of extension to 5 degrees warrants a noncompensable rating. Extension limited to 10 degrees warrants a 10 percent rating. Extension limited to 15 degrees warrants a 20 percent rating. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. There is no indication that the Veteran has any other knee symptoms so the Board will not discuss other knee-related diagnostic criteria. In a January 2014 statement, the Veteran reported he had additional damage to his right knee since he was last examined. He stated that he had deterioration to the extent that it was bone on bone, and had difficulty walking. In November 2014, the Veteran was afforded a VA examination. The examination report states that the Veteran was a poor historian and possibly had memory loss due to a concussion a few years prior. The Veteran was diagnosed with right knee meniscal tear with lateral meniscectomy with residual scar and DJD. The Veteran reported no flare-ups but that he had constant pain, weakness, and stiffness. On examination, he had right knee flexion to 140 degrees or greater with pain and extension to 0 degrees. He was able to perform repetitive-use testing with no additional limitation in range of motion of the knee. There was functional loss/impairment described as pain on movement and interference with sitting, standing, and weight bearing. The examiner noted that pain and weakness could significantly limit functional ability when the joint was used repeatedly over a period of time. The examiner was unable to describe this in terms of degrees as the Veteran was unable to replicate the estimated limitation at the time of examination. There was no tenderness or pain to palpation. There was no instability found and no recurrent patellar subluxation/dislocation. He had a meniscectomy in 1969 with residuals described as pain, weakness, and stiffness. He had arthritis confirmed by X-ray study. In August 2017, the Veteran was afforded another VA examination. The Veteran reported chronic constant aching to throbbing pain in the right knee that had worsened. He reported flare-ups described as constant aching and stiffness with cold weather. He reported functional loss/impairment described as the inability to stand or walk for long periods and required a cane for ambulation. On examination, he had flexion to 120 degrees and extension to 0 degrees. Range of motion itself did not contribute to a functional loss. Pain was noted on examination on rest/non movement. There was evidence of localized tenderness or pain at the anterior/medial/lateral described as moderate due to arthritis. There was evidence of pain with weight-bearing and objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with flexion to 110 and extension to 0. Pain caused this functional loss. Pain, weakness, lack of endurance caused functional loss after repeated use over a period of time. The examiner was unable to describe this in term of range of motion as the assessment was based on the Veteran's subjective report of functionality after repetitive use over time. Pain, weakness, lack of endurance, and incoordination significantly limited functional ability with flare ups. The examiner was unable to describe this in terms of range of motion as the assessment was based on the Veteran's subjective report of functionality during flare-ups. The Veteran had instability of station, disturbance of locomotion, interference with standing, and an inability to stand or walk for extended periods of time. There was no ankylosis or joint instability. In 1969, the Veteran had a lateral meniscectomy. He reported that he used a brace and cane regularly for his right knee arthritis. VA treatment records throughout the period on appeal indicate complaints of knee pain, crepitus, locking, and mild effusion. Since December 18, 2013, the Veteran's right knee disorder caused post meniscectomy symptoms, DJD, flexion to 110 degrees, extension to 0 degrees, pain, flare-ups, instability, tenderness on palpation, weakness, stiffness, lack of endurance, incoordination, crepitus, locking, effusion, difficulty standing, difficulty walking, and required the use of a brace and a cane. Given these symptoms, the Board finds that a 20 percent rating for moderate instability is warranted under diagnostic code 5257. A 20 percent rating is also warranted under diagnostic code 5258 for episodes of locking and effusion. 38 C.F.R. § 4.7. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In making these determinations, the Board has considered, along with the schedular criteria, the Veteran's functional loss due to pain. 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 206-207. A 30 percent rating is not warranted for instability because no medical provider, nor the Veteran, ever described the instability as severe. A 10 percent rating is not warranted under diagnostic code 5259 for symptoms following a meniscectomy because the Veteran's meniscus symptoms will be rated under 5258, which provides for a higher rating and is, therefore, more favorable to the Veteran. Rating under both 5258 and 5259 would constitute pyramiding and, therefore, ratings under both disorders cannot be granted. During the period on appeal, the Veteran's limitation of flexion and limitation of extension indicate noncompensable ratings under diagnostic codes 5260 and 5261. Therefore, the 10 percent rating under diagnostic code 5010 continues to be appropriate due to the diagnosed arthritis. The Board is aware that the VA examination reports were previously determined by the Board to be inadequate. However, as noted above, VA has attempted to schedule the Veteran for new examinations but has been unable to locate him. Therefore, the Board had no choice but to use the information in the inadequate examination reports to decide the Veteran's appeal and to determine the appropriate ratings for his right knee disorder. 2. Entitlement to an increased rating since December 18, 2013, for right hip disorder, currently rated as 10 percent for DJD, and noncompensable for limitation of extension and limitation of abduction. The Veteran's service-connected right hip DJD is rated as 10 percent disabling under diagnostic code 5010-5252. Additionally, his right hip abduction and right hip extension are rated as noncompensable under diagnostic codes 5010-5253 and 5010-5251, respectively. Diagnostic code 5251 provides a 10 percent rating for limitation of extension of the thigh to 5 degrees. This is the only compensable rating under 38 C.F.R. § 4.71a, Diagnostic Code 5251. Diagnostic code 5252 provides a 10 percent disability rating for flexion of the thigh that is limited to 45 degrees; a 20 percent rating for flexion of the thigh that is limited to 30 degrees; a 30 percent rating for flexion of the thigh that is limited to 20 degrees; and a 40 percent rating for flexion of the thigh that is limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Diagnostic code 5253 provides rating for impairment of the thigh based on limitation of abduction, limitation of adduction, or limitation of rotation. A 10 percent rating will be assigned for limitation of rotation where the individual cannot toe-out more than 15 degrees on the affected leg, or for limitation of adduction where the individual cannot cross the legs. A 20 percent rating will be assigned for limitation of abduction where there is motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. The factual background in this case does not reasonably raise the possible applicability of the additional hip diagnostic codes under 5250 (ankylosis), 5254 (flail joint), or 5255 (femur, impairment). 38 C.F.R. § 4.71a, Diagnostic Codes 5250, 5254, 5255. Further discussion of these hip diagnostic codes is not warranted. In November 2014, the Veteran was afforded a VA examination. The Veteran denied any hip condition; although the examiner noted that he was a poor historian and may have some dementia due to a concussion he had a few years prior. The examiner reported that the Veteran had difficulty concentrating during the interview due to his memory impairment and could not properly answer most questions. The examiner noted that per the Veteran's treatment records, he had an X-ray study performed of his right hip in 2010 that showed DJD. Additionally, the Veteran did not report flare ups, but did report constant pain. On examination, he had flexion to 100 degrees with pain and extension to 30 degrees with pain. Abduction was not lost beyond 10 degrees. Adduction was not limited such that the Veteran could not cross his legs. Rotation was not limited such that he could not toe-out more than 15 degrees. Right hip external and internal rotation were normal with no objective evidence of painful motion. Right hip adduction and abduction was normal with no objective evidence of painful motion. The Veteran was not able to perform repetitive-use testing with three repetitions. He could not be properly evaluated for his range of motion because he could not lay down on the examination due to his dizziness. The Veteran had functional loss/impairment described as less movement than normal, pain on movement, and interference with sitting, standing, and/or weight bearing. Pain significantly limited functional ability when the joint was used repeatedly over a period of time. This could not be expressed in terms of the degrees because the Veteran was unable to replicate the estimated limitation at the time of the examination. There was no localized tenderness or pain to palpation. There was no ankylosis, malunion or union of femur, flail hip joint, or leg length discrepancy. He did not use any assistive devices. In his December 2014 NOD, the Veteran reported that his right hip had increased in severity and has worsened since his last evaluation. In August 2017, the Veteran was afforded a VA examination. He reported that his right hip disability had worsened, and that he had constant sharp to aching pain. He did not report flare-ups. He reported functional loss/impairment described as the inability to stand or walk for long periods, and that he required a cane for ambulation. On examination, he had flexion to 70 degrees, extension to 10 degrees, abduction to 20 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 15 degrees. Adduction was not limited such that the Veteran could not cross his legs. Range of motion contributed to functional loss described as limited ability to climb stairs. Pain was noted on examination on rest/non-movement. There was objective evidence of pain at the anterior and lateral described as moderate and due to arthritis. There was evidence of pain with weight-bearing. There was no objective evidence of crepitus. The Veteran was able to perform repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. Pain and lack of endurance significantly limited functional ability with repeated use over a period of time. The examiner was unable to describe this in terms of range of motion. He reported that the assessment was based on the Veteran's subjective report of functionality after repetitive use over time. The Veteran reported disturbance of locomotion and interference with standing. He did not have muscle atrophy and there was no ankylosis. There was no malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The Veteran used a cane regularly for his right hip. VA treatment records were reviewed in connection with the claim which did not reveal any further complaints from the Veteran. Since December 18, 2013, the Veteran's right hip disorder caused DJD, flexion to 70 degrees, extension to 10 degrees, abduction to 20 degrees, adduction to 20 degrees, adduction not limited such that the Veteran could not cross his legs, rotation not limited such that he could not toe-out more than 15 degrees, external rotation to 30 degrees, internal rotation to 15 degrees, pain, less movement than normal, difficulty sitting, difficulty standing, difficulty weight-bearing, difficulty climbing stairs, and required the use of a cane. The current 10 percent rating for DJD was assigned based on painful motion. This is appropriate, as a compensable rating is warranted for joint pain pursuant to 38 C.F.R. § 4.59 for orthopedic disabilities rated under diagnostic codes containing a compensable rating, and the criteria for such a rating can be satisfied with lay and other non-medical evidence. See Sowers v. McDonald, 27 Vet. App. 472, 480 (2016); Petitti v. McDonald, 27 Vet. App. 415, 428-29 (2015). However, the evidence does not reflect additional loss of motion warranting a higher rating under diagnostic codes 5252 or 5251, even considering the factors in 38 C.F.R. §§ 4.40 and 4.45, including flare-ups. Given the range of motion findings and the lack of flare-ups, or other motion including repetitive motion, it cannot be said that range of motion would more nearly approximate the flexion limited to 30 degrees required for a 20 percent rating under diagnostic code 5252. For similar reasons, there is no basis for a compensable rating based on limitation of extension, which did not more nearly approximate extension limited to 5 degrees required for a compensable rating under diagnostic code 5251. Finally, the Board finds that an increased disability rating of 10 percent is not warranted for adduction under diagnostic code 5253. Neither the November 2014 or the August 2017 VA examination reports found that adduction was limited such that the Veteran could not cross his legs and/or that he had limitation of rotation such that he could not toe-out more than 15 degrees. Therefore, a compensable disability rating under diagnostic code 5253 is not warranted. For these reasons, an increased disability rating of more than 10 percent is not warranted under diagnostic code 5252; a compensable disability rating is not warranted under diagnostic code 5251; and a compensable disability rating is not warranted under diagnostic code 5253. In making these determinations, the Board has considered, along with the schedular criteria, the Veteran's functional loss due to pain. 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 206-207. The Board is aware that the VA examination reports were previously determined by the Board to be inadequate. However, as noted above, VA has attempted to schedule the Veteran for new examinations but has been unable to locate him. Therefore, the Board had no choice but to use the information in the inadequate examination reports to decide the Veteran's appeal and to determine the appropriate ratings for his right hip disorder. 3. Entitlement to TDIU since August 11, 2017. The appeal period for the increased ratings currently on appeal began on December 18, 2013. TDIU was granted effective that date. However, TDIU was terminated effective August 11, 2017, the date the Veteran reached a 100 percent combined rating. The Board must consider, however, whether TDIU would be warranted after that date because the rating for each of the Veteran's service-connected disabilities is less than total. TDIU may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one such disability, that disability must be ratable at 60 percent or more. If there are two or more disabilities, there must be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Since August 11, 2017, the Veteran has met the schedular criteria for TDIU. There is no evidence that, since August 11, 2017, any of the Veteran's disabilities on its own prevented him from securing or following a substantially gainful occupation. However, the combined effects of the Veteran's disabilities since that date have so done. Therefore, the Board finds that TDIU is warranted since August 11, 2017. Jacqueline E. Miller Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laroche, N. 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.