Citation Nr: 21032318 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 17-65 294 DATE: May 26, 2021 ORDER Service connection for bilateral hearing loss is denied. Service connection for a right hip disability is denied. Service connection for a skin condition is denied. A rating in excess of 50 percent for other specified trauma and stressor related disorder is denied. REMANDED Service connection for type 2 diabetes mellitus is remanded. Service connection for erectile dysfunction, to include as due to diabetes and/or secondary to a service-connected disability is remanded. Service connection for malignant melanoma is remanded. Service connection for amputation of two toes, to include as due to malignant melanoma is remanded. Service connection for sleep apnea, to include as secondary to a service-connected disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had bilateral hearing loss for VA purposes at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a right hip disability at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence of record is against finding that the Veteran has had a skin condition (other than malignant melanoma) at any time during or approximate to the pendency of the claim. 4. The severity, frequency, and duration of the Veteran's other specified trauma and stressor related disorder symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right hip disability have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a skin condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for a rating in excess of 50 percent for other specified trauma and stressor related disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, had active service from August 1984 to December 1984 and from September 2004 to November 2005. In November 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. The Board previously considered this appeal in March 2020, and remanded these issues for additional development. After the development was completed, the case returned to the Board for further appellate review. Subsequently, a February 2021 rating decision granted service connection for COPD. As this represents a full grant of the benefits sought, the issue is no longer on appeal. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether a veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997. In Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that the Board has an inherent fact-finding ability. Id. at 1076. The United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007). 1. Service connection for bilateral hearing loss. The Veteran contends that he developed bilateral hearing loss due to service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. VA considers normal hearing to be from 0 to 20 decibels. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). Additionally, for the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The April 2017 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of decreased hearing acuity, he did not have a diagnosis of bilateral hearing loss for VA purposes. A September 2019 VA audiology consultation shows the Veteran had normal bilateral hearing except for one frequency in the left ear, which at 4,000 Hertz showed 35 decibels. Nonetheless, this still does not meet the hearing loss criteria for VA purposes. While the Veteran believes he has a current diagnosis of bilateral hearing loss, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. After a full review of the record, the weight of the evidence demonstrates that the Veteran does not have a current diagnosis of bilateral hearing loss and has not had one 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). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for a right hip disability. The Veteran asserts that he has a current right hip disability related to an injury he incurred during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of a right hip disability and has not had one 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). The January 2021 VA examiner evaluated the Veteran and determined that, while he experienced subjective symptoms of pain in his lower right hip area, he did not have a diagnosis of a right hip disability. Further, despite treatment from May 2015 to October 2020, VA treatment records do not contain a diagnosis of a right hip disability. While the Veteran believes he has a current diagnosis of a right hip disability, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In addition, VA's definition of a disability refers to the functional impairment of earning capacity, not the underlying cause of said disability; therefore, pain or other symptomatology that reaches the level of functional impairment of a veteran's earning capacity may qualify as a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1363-64 (Fed. Cir. 2018); 38 U.S.C. § 1110. However, the Veteran does not contend, and the evidence of record does not indicate, with respect to his right hip, the existence of any pain or symptoms resulting in the functional impairment during the period on appeal. Consequently, the Board gives more probative weight to the competent medical evidence. As the Veteran does not have a current disability of the right hip, to include symptoms resulting in functional impairment, service connection is not warranted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). 3. Service connection for a skin condition. The Veteran contends that he has a skin condition related to service, to include as due to his diabetes. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Veteran testified before the undersigned in November 2019. He endorsed "extremely itchy" skin on his arms and legs that started after he began taking metformin to treat his diabetes. The January 2021 VA examiner evaluated the Veteran and determined that he did not have a diagnosis of a skin condition other than melanoma, which is addressed separately in this appeal. The Veteran did not endorse any itchy skin during his VA examinations. Further, despite consistent treatment from 2008 to the present, VA treatment records do not contain a diagnosis of a separate skin condition apart from melanoma and the Veteran denied any skin issues during VA treatment. While the Veteran believes he has a current diagnosis of a skin condition, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. After a full review of the record, the weight of the evidence demonstrates that the Veteran does not have a current diagnosis of a skin condition (other than melanoma) and has not had one 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). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. A rating in excess of 50 percent for other specified trauma and stressor related disorder. The Veteran asserts that his psychiatric disability, diagnosed as other specified trauma and stressor related disorder, warrants a higher rating than 50 percent. Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate Diagnostic Codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. § 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where, as here, the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations during the course of the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999). Additionally, the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). After a full review of the record, and as discussed below, the Board concludes that an initial rating in excess of 50 percent for other specified trauma and stressor related disorder is not warranted. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 70 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a 50 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 50 percent rating. A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. VA and private treatment records, the March 2017 and September 2020 VA examinations, and the Veteran's lay statements show that the Veteran's other specified trauma and stressor related disorder was manifested by symptoms associated with a 50 percent rating (depressed mood, irritability, chronic sleep impairment, flattened affect, disturbances in motivation and mood, and difficulty in establishing and maintaining effective work and social relationships), and no symptoms associated with a 70 or 100 percent rating. He did not have other symptoms that are not listed with a specific rating. The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 50 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 70 percent rating. See 38 C.F.R. § 4.126. The Board also finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 50 percent rating. Mental status examinations in VA treatment records and the March 2017 and September 2020 VA examinations indicate that the Veteran had experienced occupational and social impairment with reduced reliability and productivity. During the March 2017 VA examination, the Veteran endorsed recurrent and traumatic dreams related to the deployment trauma resulting in chronic sleep disruptions, as well as depressive mood symptoms, and avoidance behaviors. He reported a positive and cohesive family system with limited supports outside of his family noting he prefers to isolate and does not engage in social activities outside of family events. There was no evidence of tangential thought process, loose associations, or psychotic symptoms including auditory/visual hallucinations, paranoid ideation or ideas of reference. He denied suicidal or homicidal ideation including plan, intent, preparatory behaviors, or attempts (failed, aborted, or interrupted). During the September 2020 VA examination, the Veteran had moved into a new home and continued to have a loving and supportive relationship within in a close and cohesive family structure. He expressed interest in gardening, house chores, and traveling since he sold his restaurant and retired in 2017. The VA examiner reported that medical records indicated he was able to keep superficial business-like relationship with his employees and customers and enjoyed working in that industry until he retired. The VA examiner found that the record of evidence supports an absence of increased impairment due to his psychiatric symptoms. The evidence overall does not demonstrate the level of impairment associated with a 70 percent rating. As noted above, the Veteran's symptoms were either contemplated by or more consistent with a 50 percent rating. Further, after reviewing the Veteran's medical records, the March 2017 and September 2020 VA examiner (the same examiner conducted both examinations) assessed that the Veteran's symptoms effected his functioning in a work environment by causing decreases in his work efficiency and ability to perform occupational tasks during periods of significant stress and that he related the challenges he experienced with maintaining consistent and reliable work (reported at that time as no work activity for about two years from 2015 to 2017) were "due to physical pain and limited range of subsequent to his shoulder injury." The Board has considered the Veteran's statements of record that a higher disability rating is warranted for his psychiatric disorder. The Veteran is competent to report symptomatology relating to his psychiatric disorder because this requires only personal knowledge as it comes to him through his senses. Layno, 6 Vet. App. at 470. He is not, however, competent to identify a specific level of disability relating such to the appropriate DCs. The Board finds that the question of the severity of his psychiatric disorder is medically complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). To the extent that the Veteran alleges greater severity, the Board finds that the probative value of his allegations is outweighed by the aforementioned examiner's findings. Competent evidence concerning the nature and extent of the Veteran's disability has been provided by the VA examiner during the current appeal and provided relevant medical findings in conjunction with the examinations. In this regard, the medical findings (as provided in the examination reports) directly address the evaluation criteria for this disability. Based on the foregoing, the Board concludes that a rating in excess of 50 percent for other specified trauma and stressor related disorder is not warranted for the period on appeal. All evidence has been considered and there is no doubt to be resolved. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND 1. Service connection for type 2 diabetes mellitus is remanded. 2. Service connection for erectile dysfunction, to include as due to diabetes and/or secondary to a service-connected disability is remanded. The February 2021 VA contract addendum opinion is inadequate to the extent the examiner's opinion is based on speculation or an absence of contrary evidence. As a result, the Board cannot make a fully-informed decision on the issue of diabetes until an adequate medical opinion is obtained. The issue of entitlement to service connection for erectile dysfunction cannot be adjudicated until service connection for diabetes is addressed because they are intertwined. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). 3. Service connection for malignant melanoma is remanded. 4. Service connection for amputation of two toes, to include as due to malignant melanoma is remanded. The February 2021 VA contract addendum opinion is inadequate to the extent the examiner's opinion is based on speculation or an absence of contrary evidence. As a result, the Board cannot make a fully-informed decision on the issue of malignant melanoma until an adequate medical opinion is obtained. The issue of entitlement to service connection for amputation of two toes cannot be adjudicated until service connection for malignant melanoma is addressed because they are intertwined. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). 5. Service connection for sleep apnea is remanded. The Board cannot make a fully-informed decision on the issue of sleep apnea because no VA examiner has adequately opined whether sleep apnea is proximately caused or aggravated by a service-connected disability. 6. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities. The Board notes that the issue of entitlement to a total disability rating based on individual unemployability cannot be adjudicated until the service connection issues are addressed because they are intertwined. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's diabetes. The examiner must opine on the following: (a.) Whether it is at least as likely as not related to service, to include whether the Veteran's symptoms during service (to include excessive thirst and fatigue) were related to his subsequent diagnosis for diabetes. (b.) Whether it is at least as likely as not proximately due to a service-connected disability. (c.) Whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. (d.) whether any service-connected disability/ disabilities caused the Veteran to become obese or aggravated the Veteran's obesity, and if so, whether the obesity or aggravation of obesity resulting from a service-connected disability was a substantial factor in causing diabetes such that the diabetes would not have occurred but for the obesity caused or aggravated by a service-connected disability. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's erectile dysfunction. The examiner must opine on the following: (a.) Whether it is at least as likely as not proximately due to a service-connected disability. (b.) Whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. 3. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's malignant melanoma. The examiner must opine on the following: (a.) Whether it is at least as likely as not related to service, to include sun exposure in Iraq. 4. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's amputation of two toes. The examiner must opine on the following: (a.) Whether it is at least as likely as not proximately due to a service-connected disability. (b.) Whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. 5. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's sleep apnea. The examiner must opine on the following: (a.) Whether it is at least as likely as not related to service, to include whether the Veteran's symptoms during service were related to his subsequent diagnosis for sleep apnea. (b.) Whether it is at least as likely as not proximately due to a service-connected disability. (c.) Whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. (d.) whether any service-connected disability/ disabilities caused the Veteran to become obese or aggravated the Veteran's obesity, and if so, whether the obesity or aggravation of obesity resulting from a service-connected disability was a substantial factor in causing sleep apnea such that the sleep apnea would not have occurred but for the obesity caused or aggravated by a service-connected disability. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Connally, 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.