Citation Nr: 21041116 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-53 370 DATE: July 8, 2021 ORDER Beginning May 30, 2013, entitlement to a disability rating of 70 percent for posttraumatic stress disorder and adjustment disorder with anxiety and depressed mood due to service-connected combat injuries (hereinafter "PTSD") is granted. Beginning May 30, 2013, entitlement to a total disability rating based upon individual unemployability (TDIU) is granted. Beginning September 16, 2015, entitlement to special monthly compensation (SMC) at the housebound rate is granted. FINDINGS OF FACT 1. Beginning May 30, 2013, the Veteran's PTSD symptoms more nearly approximated occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 2. Beginning May 30, 2013, the evidence is in equipoise as to whether the Veteran has been rendered unable to maintain gainful employment due to his PTSD. 3. Beginning September 16, 2015, the Veteran has a service-connected disability rated as total (PTSD), and his other service-connected disabilities are rated as at least 60 percent disabling. CONCLUSIONS OF LAW 1. Beginning May 30, 2013, the criteria for a disability rating of 70 percent for PTSD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.400(o)(2), 4.1, 4.3, 4.7, 4.130, Diagnostic Code (DC) 9411. 2. Beginning May 30, 2013, the criteria for a TDIU are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.340, 3.341, 3.400, 4.16. 3. Beginning September 16, 2015, the criteria for SMC at the housebound rate are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from March 1968 to March 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In decisions dated December 2018 and April 2020, the Board remanded the matter for additional development. In argument submitted December 2020, the Veteran, through his representative, specifically requested a 70 percent disability rating for PTSD. Although a claimant will generally be presumed to be seeking the maximum benefit allowed by law and regulation, such a claimant may "limit a claim or appeal to the issue of entitlement to a particular disability rating which is less than the maximum disability rating allowed by law" via "clearly expressed intent to limit the appeal to entitlement to a specific disability rating for the service-connected condition." AB v. Brown, 6 Vet. App. 35, 39 (1993). Here, the Board finds that the Veteran, through his representative, explicitly limited his appeal to a 70 percent disability rating for PTSD. As such, the Board finds it need not address entitlement to a disability rating in excess of 70 percent for PTSD. The Board observes that additional VA treatment records were received since the RO's adjudication in an August 2020 Supplemental Statement of the Case (SSOC), without a waiver of initial RO consideration. See Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012, Public Law No. 112-154, 126 Stat. 1165 (amending 38 U.S.C. § 7105 to provide that if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests agency of original jurisdiction (AOJ) consideration). However, since the Board is granting the full benefits sought herein, there is no prejudice to the Veteran in proceeding with this adjudication. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the appellant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 1. Entitlement to a disability rating in excess of 50 percent for PTSD Disability evaluations are determined by comparing a veteran's present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the veteran. 38 C.F.R. § 4.3. The veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). 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 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. at 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The criteria for rating psychiatric disabilities, other than eating disorders, are set forth in the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. Under the General Rating Formula, a 30 percent rating is warranted for occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of an inability to perform occupational tasks (although generally functioning satisfactorily with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). Id. A 50 percent rating is warranted for 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 warranted if the evidence establishes there is 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 work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating (total occupational and social impairment) is warranted 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; memory loss for names of close relatives, own occupation, or own name. Id. Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the DSM-IV and replace them with references to the updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction on or after August 4, 2014. Id. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In this matter, the RO certified the Veteran's appeal to the Board after August 4, 2014; therefore, the PTSD claim is governed by DSM-5 and the GAF scores are not relevant for consideration. See Golden v. Shulkin, 29 Vet. App. 221, 225-26 (2018) (holding that the Board errs when it uses GAF scores to assign a psychiatric rating in cases where DSM-5 applies). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). The use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to 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). Thus, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442. Nevertheless, all ratings in the General Rating Formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran's impairment must be "due to" those symptoms; a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. The Board recognizes that the Court in Mauerhan, 16 Vet. App. 436, stated that the symptoms listed in VA's General Rating Formula is not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. However, the Court further indicated that without those examples, differentiating between rating evaluations would be extremely ambiguous. In this matter, the Veteran is currently in receipt of PTSD disability ratings of 30 percent from December 29, 2010 and 50 percent from January 22, 2014. He asserts that a disability rating of 70 percent is warranted for PTSD, and that the 70 percent rating should be assigned prior to the date his claim for increase was received (January 22, 2014), based on a factually ascertainable increase in severity of his PTSD within the year prior to his claim. On review, the Board finds that the evidence is at least in equipoise as to whether the manifestations of the Veteran's PTSD more nearly approximate occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. First, the evidence reveals that the Veteran has experienced suicidal ideation. In a May 2013 VA mental health initial evaluation note, the Veteran endorsed occasional suicidal ideation without plan or intent, stating, "I just have thoughts it should be my time to die." In a March 2016 private PTSD Disability Benefits Questionnaire (DBQ), the Veteran's treating psychiatrist, Dr. J.L., indicated that the Veteran's symptoms included suicidal ideation. Additionally, in a March 2020 VA mental health nursing note, the Veteran reported that he had had thoughts that he would be better off dead or of hurting himself in some way on several days during the two weeks prior. Second, in a March 2016 private PTSD DBQ, and in the September 2016 VA PTSD examination report, the examiners determined that the Veteran had symptoms of near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively. Third, the Veteran has exhibited impaired impulse control. The Veteran endorsed anger and irritability in VA treatment records dated May 2013 to June 2020, and in an August 2013 VA mental health note, he reported that his anger has impaired most of his interpersonal relationships. In the September 2016 VA PTSD examination report, the VA examiner determined that the Veteran's symptoms included impaired impulse control, such as unprovoked irritability with periods of violence. In a January 2017 lay statement, the Veteran's spouse reported that the Veteran lost his job in 2008, explaining that his coworkers "couldn't work with him anymore, because his anger was so out of hand," and that in a subsequent part-time job, the Veteran "still had problems with anger, even though he only worked with two guys...I think he would get in an argument at least twice a week at this job." Fourth, in a March 2016 private PTSD DBQ, and in the September 2016 and April 2019 VA PTSD examination reports, the Veteran was found to have difficulty in adapting to stressful circumstances, including work or a worklike setting. In a January 2017 lay statement, the Veteran reported an inability to handle everyday stress. He wrote, "Since at least 2013, I think that I have been able to manage my symptoms better. I can do this because I am not working. I keep my own schedule and manage my problems as they come up. If I do too much in a day or change my plans too much, I get really irritated and anxious." In a January 2017 lay statement, the Veteran's spouse wrote, "I have observed that he can handle his anger and stress better since he stopped working. He is by himself all [the] time now, so he doesn't get angry as much. I think the freedom to do things at his own pace and schedule his day lowers his stress, which lowers his anger. I think he still has a flare up at least once a month. If he was forced to return to work, he could not handle it." Fifth, the evidence demonstrates some degree of difficulty in establishing and maintaining effective work and social relationships. In a September 2013 VA mental health note, the provider noted that the Veteran "reports problems with a long hx of difficulty with interacting with others. This has caused impairment in work throughout his life. He reports problems with impaired relationships due to these sx...Wife reports the pt does okay when he is working by himself but has problems when working with others. Discord with others occurs, and this has been a longstanding problem." In a March 2016 private PTSD DBQ, the Veteran's treating psychiatrist, Dr. J.L., noted that the Veteran's symptoms included an inability to establish and maintain effective relationships. After resolution of all reasonable doubt in the Veteran's favor, the Board concludes that the lay and medical evidence demonstrates that the Veteran's PTSD has resulted in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, as the rating criteria specifically contemplate the Veteran's symptoms of suicidal ideation, near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively, impaired impulse control, difficulty in adapting to stressful circumstances, and some degree of difficulty in establishing and maintaining effective work and social relationships. As discussed previously, the Board need not address entitlement to a disability rating in excess of 70 for PTSD since the Veteran expressly limited his appeal to entitlement to a 70 percent rating for PTSD. In addition, the Board finds that there was a factually ascertainable increase in severity in the Veteran's PTSD within 1 year prior to the date the Veteran's increased rating claim was received (January 24, 2014), so as to warrant an earlier effective date under 38 C.F.R. § 3.400(o)(2). In a VA mental health initial evaluation note dated May 30, 2013, the Veteran reported avoiding people, not doing well in crowds, having problems with his anger getting out of control, and insomnia with nightmares 2 to 3 times per week. Additionally, the Veteran endorsed occasional suicidal ideation without plan or intent, stating, "I just have thoughts it should be my time to die." The symptoms reported in the May 30, 2013 VA mental health initial evaluation note represent a factually ascertainable increase in severity in the Veteran's PTSD, particularly considering his endorsement of suicidal ideation. Based on the foregoing, the Board finds that May 30, 2013 is the earliest possible effective date for the award of a 70 percent disability rating for PTSD. For these reasons, the Board finds that a disability rating of 70 percent for PTSD is warranted effective May 30, 2013. The appeal is therefore granted. 2. Entitlement to a TDIU The Veteran is currently in receipt of a TDIU effective January 22, 2014. However, he asserts that a TDIU is warranted prior to that date. It is the established policy of VA that all veterans who are unable to secure and maintain substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16. A finding of total disability is appropriate "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(a)(1). Controlling laws provide that a TDIU may be assigned when a veteran has one service-connected disability rated at 60 percent or more, or two or more service-connected disabilities where at least one disability is rated at 40 percent or more and the combined rating is at least 70 percent. 38 C.F.R. § 4.16(a). The record must also show that the service-connected disabilities alone result in such impairment of mind or body that the average person would be precluded from securing or maintaining a substantially gainful occupation. Id. See 38 U.S.C. § 1155. Here, during the timeframe relevant to the period on appeal, the Veteran is in receipt of the following ratings for his service-connected disabilities: PTSD (70 percent from May 30, 2013, as granted herein); duodenal ulcer with residuals of punji stick injury (rated as 40 percent disabling from November 1, 1979 and 60 percent disabling from September 16, 2015); perianal ulcer (rated as 10 percent disabling from August 25, 2006); residuals of 5th metacarpal fracture (rated as 0 percent disabling from April 1, 1971); and abdomen scars (rated as 0 percent disabling from July 31, 2006). Therefore, the Veteran has met the schedular requirement for a TDIU under 38 C.F.R. § 4.16(a) since May 30, 2013. The remaining question is whether the Veteran's service-connected disabilities preclude the Veteran from securing and following a substantially gainful occupation. The fact that a veteran is unemployed or has difficulty finding employment does not alone warrant assignment of a TDIU, as a high rating itself establishes that his disability makes it difficult for him to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he is incapable "of performing the physical and mental acts required" to be employed. Id. at 363. Thus, the central question is whether a veteran's service-connected disabilities alone are of sufficient severity to produce unemployability, and not whether a veteran could find employment. Id. Consideration may be given to a veteran's education, training, and special work experience, but not to his age or to impairment caused by nonservice-connected disabilities. See 38 C.F.R. §§ 3.341, 4.16, 4.19. To determine whether a TDIU is warranted, the Board must consider all evidence of record to determine the earliest date as of which, within the one year prior to the filing of an informal or formal claim for TDIU, an increase in disability is ascertainable. See Servello v. Derwinski, 3 Vet. App. 196, 198-200 (1992). After careful consideration of the record and resolution of all reasonable doubt in favor of the Veteran, the Board finds that the Veteran is unemployable by reason of his service-connected PTSD. Specifically, the Board finds that the Veteran would not have been able to maintain any type of employment that was relevant to his educational background and work experience. In this regard, the Board notes that in Ray v. Wilkie, the Court defined the term "unable to secure and follow a substantially gainful occupation" in § 4.16(b) to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the veteran's history, education, skill, and training, whether the veteran has the physical ability to perform the type of activities required by the occupation at issue, and whether the veteran has the mental ability to perform the activities required by the occupation at issue. See Ray v. Wilkie, 31 Vet. App. 58 (2019). As to the economic component of a substantially gainful occupation, the Board finds that the Veteran has been unemployed since 2009. See VA 21-8940 Veterans Applications for Increased Compensation Based on Unemployability dated September 2015 and May 2019. The Board acknowledges that in the September 2016 VA PTSD examination report, the VA examiner wrote, "for the past seven years the patient has managed his own small cattle ranch. He generally does well at work as he has few interactions with others." However, when asked to clarify the nature of any self-employment, the Veteran, through his representative, explained that he does not operate a cattle ranch; rather, he owns 16 cows, 1 bull, and currently has 10 calves that will be sold, he considers this more of a hobby, and that his family "will sell the calves but with losses and expenses, they don't have 'earnings.'" See May 2019 Third Party Correspondence. The Veteran further explained that "his son does most of the work of taking care of the cattle. [The Veteran] tries to complete a few tasks on the farm and with the cattle but this amounts to part-time work at the most and does not result in substantially gainful income." Thus, with resolution of all reasonable doubt in his favor, the Board finds that the Veteran did not work in a gainful capacity at any point during the period on appeal. As to the non-economic component of a substantially gainful occupation, the Veteran's work history was as a carpenter, truck driver, and in air conditioning duct installation and repair. See VA examination reports dated June 2014, September 2016, and April 2019; VA 21-8940 Veterans Applications for Increased Compensation Based on Unemployability dated January 2011, September 2015, and May 2019. The Veteran's former occupations required skills such as the ability to establish and maintain effective relationships with colleagues and the ability to adapt to stressful circumstances. See January 2017 lay statement from Veteran's spouse. These skills were severely impacted by the Veteran's service-connected PTSD and its associated symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, flattened affect, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. See VA examination reports dated June 2014, September 2016, and April 2019; March 2016 private PTSD DBQ. Significantly, in a June 2017 private vocational assessment, C.E., a vocational expert, opined, "it is more likely than not that [the Veteran] was completely disabled from the workforce due to his service-connected PTSD alone beginning in 2013. The combination of symptoms resulted in an inability to attend to basic work functions and resulted in him being unable to maintain a substantially gainful occupation from 2013 to the present." The Board affords great probative value to C.E.'s vocational assessment given her review of pertinent medical records, interview of the Veteran, consideration of his education and work history, and her expertise as a vocational consultant. Based on the foregoing, the Board finds that a TDIU predicated on unemployability stemming from the Veteran's service-connected PTSD is warranted since May 30, 2013. 3. Entitlement to SMC SMC at the housebound rate is payable where a veteran has a single service-connected disability rated as 100 percent and: (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems; or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s). This requirement is met when a veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises, or if institutionalized, to the ward or clinical areas and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 C.F.R. § 3.350(i). A TDIU rating can satisfy the need for a rating of 100 percent if it can be sustained by a single disability. Buie, 24 Vet. App. at 250-51. Herein, the Veteran is awarded a TDIU based solely on his service-connected PTSD beginning May 30, 2013. The Veteran also has additional service-connected disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability (PTSD) and involving different anatomical segments or bodily systems. During the period on appeal, apart from his disability rating for PTSD, the Veteran is also in receipt of the following disability ratings: duodenal ulcer with residuals of punji stick injury (rated as 40 percent disabling from November 1, 1979 and 60 percent disabling from September 16, 2015); perianal ulcer (rated as 10 percent disabling from August 25, 2006); residuals of 5th metacarpal fracture (rated as 0 percent disabling from April 1, 1971); and abdomen scars (rated as 0 percent disabling from July 31, 2006). Effective September 16, 2015, these additional service-connected disabilities combine to a rating of 60 percent and are separate and distinct from the Veteran's PTSD, as they involve different anatomical segments or bodily systems. Accordingly, as the Veteran has a single service-connected disability rated as total (PTSD), and he has additional service-connected disabilities that are independently rated as at least 60 percent disabling, the criteria for SMC at the housebound rate are met beginning September 16, 2015. 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, 369-70 (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). S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. M. Gill, 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.