Citation Nr: 22016703 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 05-02 689 DATE: March 23, 2022 ORDER The application to reopen the previously denied claim of entitlement to service connection for a ganglion cyst on the right wrist is granted. The application to reopen the previously denied claim of entitlement to service connection for a prostate condition, to include prostate cancer and prostatitis, is granted. The application to reopen the previously denied claim of entitlement to service connection for left leg nerve damage is granted. REMANDED The issue of entitlement to service connection for a ganglion cyst on the right wrist is remanded. The issue of entitlement to service connection for neurological disability of the right upper extremity is remanded. The issue of entitlement to service connection for a prostate condition, to include prostate cancer and prostatitis, is remanded. The issue of entitlement to service connection for left leg nerve damage is remanded. The issue of entitlement to service connection for numbness in three toes is remanded. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) due to the service-connected disabilities is remanded. FINDINGS OF FACT 1. A May 1996 rating decision denied the Veteran's claim for service connection for a ganglion cyst on the right wrist and prostatitis. The Veteran did not file a timely notice of disagreement (NOD) and, as such, the decision became final. 2. Evidence presented since the May 1996 rating decision relates to unestablished facts necessary to substantiate the Veteran's claims of entitlement to service connection for a ganglion cyst on the right wrist and a prostate condition. 3. A July 1995 rating decision denied the Veteran's claim for service connection for left leg nerve damage. The Veteran did not file a timely notice of disagreement (NOD) and, as such, the decision became final. 4. Evidence presented since the July 1995 rating decision relates to unestablished facts necessary to substantiate the Veteran's claim of entitlement to service connection for left leg nerve damage. CONCLUSIONS OF LAW 1. The May 1996 rating decision that denied the Veteran's claim for entitlement to service connection for a ganglion cyst on the right wrist is final; new and material evidence has been received to reopen the claim for entitlement to service connection for service connection for a ganglion cyst on the right wrist. 38 U.S.C. §§ 5108; 7105; 38 C.F.R. § 3.156(a). 2. The May 1996 rating decision that denied the Veteran's claim for entitlement to service connection for prostatitis is final; new and material evidence has been received to reopen the claim for entitlement to service connection for service connection for a prostate condition, to include prostate cancer and prostatitis. 38 U.S.C. §§ 5108; 7105; 38 C.F.R. § 3.156(a). 3. The July 1995 rating decision that denied the Veteran's claim for entitlement to service connection for left leg nerve damage is final; new and material evidence has been received to reopen the claim for entitlement to service connection for service connection for left leg nerve damage. 38 U.S.C. §§ 5108; 7105; 38 C.F.R. § 3.156(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran was a member of the Massachusetts Army National Guard. He had a period of active duty from June 1977 to October 1977 and July 1991 to August 1991. These matters are on appeal from February 2004, April 2014, and June 2015 decisions by the Department of Veterans Affairs (VA) Regional Office (RO). The claim for service connection for neuropathy of the right hand was previously remanded by the Board of Veterans' Appeals (Board) in August 2009. A March 2012 Board decision denied entitlement to service connection for neuropathy of the right hand. The Veteran appealed the March 2012 Board decision to the U.S. Court of Appeals for Veterans Claims (Court). Following a January 2013 Joint Motion for Partial Remand (JMPR), the Court vacated the Board's decision regarding the neuropathy of the right hand and remanded the claim to the Board. In October 2013, the Board remanded the claim to the Agency of Original Jurisdiction (AOJ). In a June 2014 decision, the Board again denied entitlement to service connection for neuropathy of the right hand. In December 2015, the Veteran and the Secretary of Veterans Affairs (the Parties) filed a JMR regarding the Board's June 2014 denial of the neuropathy of the right hand. This JMR contained a drafting error in the language, which resulted in the purpose of the remand being inaccurately described. As a result, on January 11, 2016, the Court issued an order that the Parties, within 14 days after the date of its order, file a Substitute JMR. On January 19, 2016, the Parties filed a Substitute JMR which responded to the Court's order and corrected the error in the previous motion. In February 2016, the Court granted the substitute JMR of the Parties, vacated the June 2014 Board decision regarding the neuropathy of the right hand, and remanded that matter to the Board. In April 2017, March 2021, and August 2021, the Board remanded all of the claims currently on appeal to the AOJ. The Board expanded the issue of entitlement to service connection for neuropathy of the right hand to entitlement to service connection for a neurological disability of the right upper extremity. The Board also added the TDIU issue to the appeal under Rice v. Shinseki, 22 Vet. App. 447 (2009). During the pendency of this appeal, the Veteran requested a hearing before a Veterans Law Judge (VLJ) of the Board. See February 2015 VA Form 9. However, before he could be scheduled for a hearing, in correspondence dated in May 2016, the Veteran withdrew his request for a hearing. See 38 C.F.R. § 20.702(e) (a request for a hearing may be withdrawn by the appellant at any time before the date of the hearing). In a January 2022 rating decision, the RO awarded entitlement to service connection for pruritic rash with seborrheic and eczematous dermatitis (claimed as folliculitis and skin condition) and assigned a noncompensable rating effective March 6, 2007. In an October 7, 2021 rating decision, the RO awarded service connection for degenerative disc disease other than intervertebral disc syndrome and assigned an evaluation of 20 percent effective November 27, 2013. As such, these issues have been resolved and are no longer on appeal before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. The application to reopen the previously denied claim of entitlement to service connection for a ganglion cyst on the right wrist and a prostate condition, to include prostate cancer and prostatitis The Veteran seeks entitlement to service connection for a ganglion cyst on the right wrist. Generally, if a claim of entitlement to service connection has been previously denied and that decision has become final, the claim can be reopened and reconsidered only if new and material evidence is presented with respect to that claim. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § § 3.156(a). The threshold to reopen a claim is low. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). For the purposes of evaluating a request to reopen a previously denied claim, the credibility of new evidence will be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Veteran's claim for entitlement to service connection for a ganglion cyst on the right wrist was denied in a May 1996 rating decision based on the RO's finding that the condition neither occurred in nor was caused by service. The Veteran's claim for entitlement to service connection for prostatitis was denied in a May 1996 rating decision based on the RO's finding that the condition neither occurred in nor was caused by service. The Veteran did not file a timely NOD. Thus, the May 1996 rating decision became final. 38 C.F.R. §§ 19.52, 20.1103. Since May 1996, new evidence has been added to the claims file, which is material to the Veteran's claims. In regard to the Veteran's claim for entitlement to service connection for ganglion cyst of the right wrist, the new and material evidence includes medical records showing a diagnosis of a ganglion cyst on the right wrist, an October 2020 and September 2021 VA examinations, and a May 2021 and December 2021 VA medical opinions. In regard to the Veteran's claim for entitlement to service connection for a prostate condition, the new and material evidence includes a diagnosis of prostate cancer, May 2021 and December 2021 VA medical opinions, and October 2020 and September 2021 VA examinations. Accordingly, the Veteran's claims for entitlement to service connection for a ganglion cyst on the right wrist and a prostate condition, to include prostate cancer and prostatitis, is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). 2. The application to reopen the previously denied claim of entitlement to service connection for left leg nerve damage The Veteran's claim for entitlement to service connection for left leg nerve damage was denied in a July 1995 rating decision based on the RO's finding that the Veteran did not have a current diagnosis of left leg nerve damage. The Veteran did not file a timely NOD. Thus, the July 1995 rating decision became final. 38 C.F.R. §§ 19.52, 20.1103. Since July 1995, new evidence has been added to the claims file, which is material to the Veteran's claim, to include a medical record showing a diagnosis of nondiabetic neuropathy, May 2021 and December 2021 VA medical opinions, and a September 2021 VA examination. Accordingly, the Veteran's claim for service connection for left leg nerve damage is reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). REASONS FOR REMAND 1. Service connection for ganglion cyst on the right wrist The Veteran contends that his ganglion cyst on the right wrist is secondary to his service-connected burn scars on the right arm. See May 2014 Appellant's Post-Remand Brief; September 2003 VA examination. The Veteran also asserts that his ganglion cyst on the right wrist is associated with his mood disorder. See April 2015 notice of disagreement; November 2013 statement in support of claim. The Veteran stated that the onset of his disability was while on active duty and that this was not adequately acknowledged by the VA. See February 2022 Appellant's Post-Remand Brief. An April 1994 private treatment record shows a diagnosis of ganglion cyst on the right arm for one year. A February 1996 VA treatment records shows surgery for a of ganglion right wrist and a March 1996 VA treatment record shows follow up treatment, at which time the Veteran experienced numbness of the right wrist. A VA medical examination was conducted in October 2020. The examination report noted a diagnosis of ganglion cyst in 1996. The Veteran reported that his condition had progressed and that he had intermittent pain to the right wrist. He reported flareups and that stated that it affected lifting and grasping. The examiner determined that the Veteran's condition was less likely than not incurred in or caused by his service as she found no evidence that the Veteran was treated for this condition while in service or immediately after separation from service. The examiner also determined that the Veteran's ganglion cyst was less likely than not due to the Veteran's mental condition as there was no definitive medical literature to support a correlation between the two conditions. An additional VA medical opinion was obtained in May 2021 based on a review of the records. A different VA clinician determined that the Veteran's right wrist ganglion cyst was less likely than not incurred in or caused by his service. Her rationale was that the Veteran's subjective narrative history submitted more than 20 years after separation from military service did not constitute a medical diagnosis or fact. She also stated it was less likely than not the Veteran's right wrist ganglion cyst was caused by depressive disorder with anxiety or burn scars of the right arm, right thigh, and abdomen. Her rationale was that there was no pathophysiological correlation between right wrist ganglion cyst and depressive disorder with anxiety or burn scars of the right arm, right thigh, and abdomen. Additionally, she found that the Veteran's depression condition and scars did not aggravate the Veteran's right wrist ganglion cyst. In an August 2021 decision, the Board determined that the rationale provided by the May 2021 clinician was inadequate as her opinion regarding direct service connection did not address the Veteran's lay assertions that he suffered from said disabilities during his active duty service that they had continued to the present day. In regard to secondary service connection, the Board determined that further rationale, aside from "no pathophysiological correlation," was necessary. In compliance with the August 2021 Board remand directives, a VA examination was obtained in September 2021. The September 2021 VA examiner determined, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995 and performing physical exam, that it was less likely than not that the Veteran's ganglion cyst of the right wrist was related to his service as there were no medical records indicating complaints of a right wrist injury such as trauma or tendon or joint injury, which are known to cause ganglion cyst formation. The examiner also provided a negative nexus opinion in regard to secondary service connection. She noted that, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, and performing a physical examination, it was less likely than not that the Veteran's ganglion cyst of the right wrist is proximately due or the result of the service connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there is no medical pathophysiologic relationship between the "hypertension". She stated that there are no records showing a relationship between ganglion cyst of the right wrist and the service-connected burn scars of the right arm, right thigh, and abdomen. She also stated that the condition was also not aggravated by his service-connected depressive disorder and burn scars. She noted that after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, and performing a physical examination, it was less likely than not that the Veteran's ganglion cyst of the right wrist was aggravated beyond its natural progression by the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there are no medical pathophysiologic relationships between the ganglion cyst of the right wrist and service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen, nor any records indicating such a relationship exists. An addendum opinion was provided in December 2021 to obtain clarification from the September 2021 VA examiner regarding her opinion. In the addendum opinion, the examiner stated that, after performing physical examination and reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, and service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991, as well as the Board Remand letter and the Veteran's lay assertions, it was less likely than not that the Veteran's ganglion cyst of the right wrist was related to military service. She noted that the record failed to show a relationship between any wrist complaints or complaints while in service, nor did it show any progressive or continuation of such complaints while in service, or treatment of any of these complaints after service. In regard to secondary service connection, the December 2021 addendum opinion asked the examiner to clarify how hypertension fit into her rationale in the September 2021 opinion. She stated that, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991 as well as Board Remand letter and Veteran's lay assertions, and performing physical exam, it was less likely than not that the Veteran's ganglion cyst of the right wrist is proximately due or the result of the service connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there are no medical pathophysiologic relationship between the ganglion cyst of the right wrist. Furthermore, she determined that there were no records showing a relationship between ganglion cyst of the right wrist and the service-connected burn scars of the right arm, right thigh, and abdomen. The Board finds that the September 2021 and December 2021 opinions are inadequate for adjudication purposes. Specifically, the September 2021 VA examination report and the December 2021 VA addendum opinion only mention review of the records medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991; the Board Remand letter; and the Veteran's lay assertions. Pursuant to the August 2021 Board remand directives, the entire claims file must be reviewed by a VA clinician prior to rendering an opinion regarding service connection. Further, the VA clinician did not specifically address the Veteran's contention that the onset of his disability was during active duty, as directed by the August 2021 Board remand. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand. Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that there has not been substantial compliance with the prior August 2021 Board remand directives. Accordingly, the Board must remand the matter again. On remand, a medical opinion is warranted, after a full review of the claims file, to determine whether the Veteran's condition is related to his service or his service-connected unspecified depressive disorder with anxiety and burn scars. The examiner must consider the Veteran's contention that the onset of his disability was while on active duty. In ordering remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the clinician on remand consider the Veteran's own description of the history of his ganglion cyst on the right wrist. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). 2. Service connection for a neurological disability of the right upper extremity The Veteran contends that the onset of his disability was while on active duty, and that this was not adequately acknowledged by VA. See February 2022 Appellant's Post-Remand Brief. The Veteran also asserts that his neurological disability of the right upper extremity is secondary to his right arm burns. See July 2013 Brief. At an October 2008 VA examination, he reported nerve damage from the scar which caused numbness and tingling in the medial aspect of the elbow and moves to the mid hand digits 4-5 intervals. The Veteran has been diagnosed with neuropathy, right cubital tunnel syndrome, and right upper extremity carpel tunnel. See September 2003 VA treatment record; December 2008 VA examination; February 2010 VA treatment record. An April 2003 VA treatment record shows that the Veteran reported neuropathic sensation at his burn sites. A September 2003 VA scars examination noted that the Veteran complained of neurological problems secondary to his burn injuries. The examination report noted that the Veteran took Neurontin for pain, which was related to his cervical radiculopathy, but that the order also stated it was for "neuropathies related to burn injury." A December 2008 VA examiner diagnosed mild right cubital tunnel syndrome due to repetitive motion injury and found that there was insufficient evidence of a medical connection between second degree burn of the right arm and right cubital tunnel syndrome. Her rationale was that the area of the old burn had no anatomic connection to the ulnar nerve and that his cubital tunnel is located at the back of his elbow near his medial epicondyle. She also stated that second degree burns do not cause nerve damage; and that cubital tunnel syndrome is usually a repetitive motion injury. A March 2014 VA examination for peripheral nerve conditions showed a diagnosis of right cubital tunnel syndrome. The Veteran reported right hand numbness beginning in approximately 2006, with an EMG/NCS in 2008 which showed right cubital tunnel syndrome, and ongoing symptoms since then. The examiner provided a negative nexus opinion regarding direct service connection. The examiner also determined that it was less likely than not that the Veteran's right-hand neuropathy (right cubital tunnel syndrome) was caused or aggravated in whole or in part by a service-connected disability, to include second degree burn scar on the right arm. Another VA examination was conducted in October 2020. The examiner diagnosed right carpal tunnel syndrome and right elbow cubital tunnel syndrome. She provided a negative nexus opinion regarding direct service connection and secondary service connection. She stated that there was no evidence within the available records to support that peripheral nerve disorder of the upper right extremity, to include cubital tunnel syndrome of the right hand, was incurred in service. She also stated that the peripheral nerve disorder(s) was less likely than not due to or aggravated by the Veteran's burn scars or unspecific depressive disorder as there was no medical correlation between the disease processes. She stated that carpal tunnel syndrome is caused by pressure on the median nerve. She noted that cubital tunnel syndrome may occur with excessive bending, pulling, reaching, lifting, or leaning on the elbow; arthritis; bone spurs; and previous fractures or dislocations of the elbow. In March 2021, the Board determined that the October 2020 medical opinion regarding direct service connection was inadequate and ordered a new VA medical opinion. In May 2021, a VA clinician also provided negative nexus opinions regarding direct service connection for right cubital tunnel syndrome and carpal tunnel syndrome and regarding whether right cubital tunnel syndrome and/or carpal tunnel syndrome was secondary to depressive disorder or burn scars. In August 2021, Board determined that the October 2020 medical opinion regarding direct service connection was inadequate. As such, a new VA examination was obtained in December 2021. The December 2021 VA examiner determined it was less likely than not that a right upper extremity cubital tunnel syndrome / right upper extremity carpal tunnel syndrome (to include incomplete paralysis of the ulnar nerve) was related to service. Her rationale was that the submitted medical records did not contain any documentation of a right upper extremity cubital tunnel syndrome / right upper extremity carpal tunnel syndrome during military service from 7-25-1991 to 8-8-1991 and from 6-3-1977 to 10-6-1977. The examiner specifically considered the Veteran's lay assertions that he suffered from the disabilities during his active-duty training. However, she determined that subjective narrative history did not constitute a medical fact. She stated that medical assessments/ diagnoses/ treatments regarding neurological symptoms referring to the right upper extremity were not included in the submitted medical records. She further noted that neurological evaluations in the 1990s reported cervical spine injury that manifested with tingling and numbness of the bilateral hands due to a cervical spine condition for which the claimant sought medical treatment, however, this was not related to right cubital/ carpal tunnel syndrome. The December 2021 VA clinician also provided a negative nexus in regard to whether the Veteran's right upper extremity cubital tunnel syndrome/ carpal tunnel syndrome (to include incomplete paralysis of the ulnar nerve) was aggravated by his service-connected unspecific depressive disorder with anxiety and/or service-connected burn scars of the right arm, thigh, and abdomen. The December 2021 VA medical opinion did not address whether the Veteran's neurological disability of the right upper extremity was at least as likely as not caused by the Veteran's service-connected unspecified depressive disorder with anxiety and/or burn scars of the right arm, thigh, and abdomen, as required by the August 2021 Board remand. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand. Stegall v. West, 11 Vet. App. 268 (1998). As the December 2021 VA medical opinion did not address whether the Veteran's cubital tunnel syndrome and carpal tunnel syndrome are least as likely as not proximately due to the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen, the Board finds that there has not been substantial compliance with the prior August 2021 Board remand directives. Accordingly, the Board must remand the matter again. On remand, a medical opinion is warranted, after a full review of the claims file, to determine whether the Veteran's condition is related to his service or his service-connected unspecified depressive disorder with anxiety and burn scars. The examiner must consider the Veteran's contention that the onset of his disability was while on active duty. Additionally, the examiner must specifically comment on 1) April 2003 VA treatment record showing that the Veteran reported neuropathic sensation at his burn sites and 2) the September 2003 VA scars examination showing that the Veteran complained of neurological problems secondary to his burn injuries and that the Veteran took Neurontin, on which the order stated it was for "neuropathies related to burn injury." 3. Service connection for a prostate condition, to include prostate cancer and prostatitis In light of the Veteran's diagnosis of prostate cancer and prostatitis during the appeal period, the Board has recharacterized the Veteran's claim as entitlement to service connection for a prostate condition, to include prostate cancer and prostatitis. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran contends that his prostate cancer is associated with his mood disorder. See April 2015 notice of disagreement; December 2013 correspondence and statement in support of claim. The Veteran also asserts that his disability is not due to a family history, but rather had its onset while in service, persisting until manifesting, warranting service connection. See February 2022 Appellant's Pos-Remand Brief. A September 1977 service treatment record shows complaints of discharge with burning on urination. The Veteran was diagnosed with prostatitis in January 1993. See February 1993, April 1993, February 1994, March 1994, and March 1995 private treatment records; June 1994 VA General Medical Examination; July 1996 VA treatment record. A March 2006 VA treatment record noted an elevated prostate-specific antigen (PSA) since April 2005. A VA examination was provided in October 2020. The examiner diagnosed prostate cancer with a 2006 date of diagnosis. The Veteran reported that in 2006, his PSA levels were elevated, and he had a prostate biopsy which showed cancer. He underwent radiation for treatment. He contended that his condition had stayed the same with onset and his symptom is urinary frequency. The examiner noted that the Veteran's treatment for prostate cancer was completed, and that he was currently in watchful waiting status. He noted radiation therapy and androgen deprivation therapy (hormonal therapy) in 2007. The examiner determined that the Veteran's prostate cancer was less likely than not incurred in or caused by his service, as he found that there were no records to show that the Veteran complained of or was treated for this condition in service. The examiner also determined that the Veteran's prostate cancer was less likely than not proximately due to or the result of his service-connected mental condition as there was no definitive medical literature to support a correlation between unspecified mood disorder with anxiety and his prostate cancer. In May 2021, a VA medical opinion was obtained based on a review of the records. The clinician determined that the Veteran's prostate cancer was in remission. He found that it was less likely than not that the Veteran's prostate cancer was incurred from June 3, 1977 to October 6, 1977 as he determined that the medical records did not contain documentation of prostate cancer during that time and found that the Veteran's subjective narrative history submitted more than 20 years after separation from service did not constitute a medical diagnosis or fact. In regard to secondary service connection, the clinician determined that it was less likely than not that the Veteran's prostate cancer was caused or aggravated by a depressive disorder with anxiety or burn scars of the right arm, right thigh, and abdomen as there was no pathophysiological correlation between prostate cancer and a depressive disorder with anxiety or burn scars of the right arm, right thigh, and abdomen. In August 2021, the Board determined that the May 2021 VA examiner's rationale was inadequate for rating purposes. As such, a VA examination was obtained in September 2021. The September 2021 VA examiner noted that, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995 and performing physical exam, that it was less likely as not that the Veteran's prostate cancer began during active service or manifested within one year after discharge from service, or was noted during service with continuity of the same symptomatology since service. The examiner stated that records indicated a fluctuating PSA level with the first notation being 1/25/96 and that the Veteran also had several diagnoses of prostatitis, which can elevate PSA levels as well. She stated that the prostate biopsy, which was performed on 8/01/2007, several years after the Veteran's discharge from service, showed a "high grade prostatic intraepithelial neoplasm", which is a precursor to prostate cancer with studies showing carcinoma will develop in most patients with prostatic intraepithelial neoplasm within 10 years. The biopsy pathology report also noted a Gleason score of 6, meaning these types of prostate tumors grow slowly and in a majority of cases, never cause a problem, but do require monitoring. Therefore, she concluded that it was less likely than not that the Veteran's prostate cancer began during active service or manifested within one year after discharge from service or was noted during service with continuity of the same symptomatology since service due to the known natural course of this particular type of prostate cancer. In regard to secondary service connection, the September 2021 VA examiner found, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, and performing physical exam, it was less likely as not that the Veteran's prostate cancer was proximately due to the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there are no medical pathophysiologic relationship between the two conditions. Furthermore, she stated there were no records showing a relationship between prostate cancer and the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen. Additionally, in regard to aggravation she determined, it was less likely as not that the Veteran's prostate cancer was secondary to or aggravated beyond its natural progression by the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there is no medical pathophysiological relationship between the two conditions. In December 2021, the RO requested an addendum opinion from the September 2021 VA examiner in order to address the Veteran's lay assertions that he suffered from this disability during active service. In a December 2021 addendum opinion, the examiner stated that, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995 and service dates of June 26, 1977- October 26, 1977 and July 25, 1991 - August 8, 1991 as well as BVA Remand letter and Veteran's lay assertions, and performing physical exam, she found that it was less likely as not that the Veteran's prostate cancer began during active service or manifested within one year after discharge from service, or was noted during service with continuity of the same symptomatology since service. She noted that records indicated a fluctuating PSA level with first notation being 1/25/96 and that the Veteran also had several diagnoses of prostatitis, which can elevate PSA levels as well. She noted that the prostate biopsy, which was performed on 8/01/2007, several years after the Veteran's discharge from service, showed a "high grade prostatic intraepithelial neoplasm", which is a precursor to prostate cancer with studies showing carcinoma will develop in most patients with prostatic intraepithelial neoplasm within 10 years. She stated that the biopsy pathology report also noted a Gleason score of 6, meaning these types of prostate tumors grow slowly and in a majority of cases, never cause a problem, but do require monitoring. She also noted that the records indicate the Veteran has a family history of prostate cancer, which doubles his chance of developing prostate cancer himself and that the records failed to indicate a known exposure to any carcinogenic believed to cause prostate cancer. She therefore concluded that it was less likely than not that the Veteran's prostate cancer began during active service or manifested within one year after discharge from service or was noted during service with continuity of the same symptomatology since service due to the known natural course of this particular type of prostate cancer. The Board finds that the opinions provided by the VA examiner in the September 2021 VA examination report and the December 2021 addendum opinion are inadequate for adjudication purposes and that a new VA examination in warranted. The September 2021 VA examination report and the December 2021 VA addendum opinion only mention review of the records medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991; the Board Remand letter; and the Veteran's lay assertions. Pursuant to the August 2021 Board remand directives, the entire claims file must be reviewed by a VA clinician prior to rendering an opinion regarding service connection. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand. Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that there has not been substantial compliance with the prior August 2021 Board remand directives. Accordingly, the Board must remand the matter again. On remand, a medical opinion is warranted, after a full review of the claims file, to determine whether any prostate condition is related to the Veteran's service or his service-connected unspecified depressive disorder with anxiety and burn scars. The examiner must consider the Veteran's contention that the onset of his disability was while on active duty and the September 1977 service treatment record showing complaints of discharge with burning on urination. 4. Service connection for left leg nerve damage and numbness in three toes The Veteran contends that the onset of his left leg nerve damage and numbness in three toes was while on active duty was not adequately acknowledged by VA prior to final adjudication, albeit warranting service connection. See February 2022 Appellant's Post-Remand Brief. In regard to the left leg, in June 2008, the Veteran reported that he experienced pain and swelling since the time of his active duty ankle injury. In April 2015, the Veteran asserted that his left leg nerve damage is associated with his mood disorder. See April 2015 notice of disagreement. In regard to his toes, the Veteran contended that he experienced pain and numbness of three toes on his left foot during his service. See November 2013 statement in support of claim. The Veteran also stated that his numbness in three toes was associated with his mood disorder. See April 2015 notice of disagreement. An August 10, 1977 service treatment record shows that the Veteran had pain on the left leg and that his small toes felt numb. A September 14, 1977 service treatment record also shows a complaint of numbness in the left toes and a possible circulation problem was noted. In January 1993, the Veteran reported pain radiating down both legs. See January 1993 private treatment record. At the June 1994 medical examination, the Veteran reported radiating pain from his back to his left thigh and knee with tingling and numbness in his left leg previously. The Veteran contended that his back injury with left leg nerve damage was aggravated in service. In March 1995, the Veteran also complained of pain in his low back and intermittently into his left leg with numbness of the three middle toes. See September 1995 private treatment record. In June 2003, the Veteran reported pain and numbness in his left leg for the prior two years. See June 2003 private treatment record. An April 2015 VA treatment record shows pain both heels with paresthesias, known neuropathy and noted that it is not diabetic. An October 2018 VA podiatry consult shows a diagnosis of non-diabetic neuropathy. In October 2019, the Veteran reported the emergence of foot neuropathy. See October 2019 VA mental disorders examination. However, an October 2020 VA examination showed that the Veteran's lower extremity nerves were normal. In May 2021, a VA medical opinion was obtained. The clinician provided a negative nexus regarding direct service connection for a left leg neurological disability based on her finding that the submitted medical records did not contain documentation of a left leg neurological disability during military service. She also determined it was less likely than not that a left leg neurological disability was caused by depressive disorder with anxiety and/or burn scars of the right arm, thigh, and abdomen as there was no pathophysiological correlation between these conditions. The examiner acknowledged that there was an August 1977 medical record stating "left tibia pain;" however, she determined that this represented a left shin splint, not a neurological disorder. She also stated that the claimant's subjective history submitted more than 20 years after separation from military service does not constitute medical diagnosis/ fact. In regard to numbness of the toes, the clinician determined that it is less likely than not that a numbness of toes condition was aggravated by a depressive disorder with anxiety and/or burn scars of the right arm, right thigh, and abdomen. Her rationale was that there was pathophysiological correlation between numbness of toes condition and a depressive disorder with anxiety and/ or burn scars of the right arm, right thigh, and abdomen In August 2021, the Board determined that the May 2021 VA medical opinions were inadequate and remanded the claim to obtain a new VA examination. As such, a VA examination was conducted in September 2021. In regard to direct service connection, the September 2021 VA examiner determined, after performing physical exam and reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, it was less likely than not the Veteran's left leg neurological disorder is related to military service. She stated that the records failed to show a relationship between any back complaints while in service and numbness in left leg/toes. However, she did not address the August 10, 1977 service treatment record showing that the Veteran had pain on the left leg and that his small toes felt numb or the September 14, 1977 service treatment record showing a complaint of numbness in the left toes and a possible circulation problem. In regard to secondary service connection, the September 2021 VA examiner stated, after performing physical exam and reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, it is less likely than not the Veteran's left leg neurological disorder is proximately due to the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there is no medical pathophysiologic relationship between the two conditions. Furthermore, she determined that there were no records showing a relationship between the left leg neurological disorder and the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen. The examiner did not address numbness of the toes in this opinion. In regard to aggravation, the September 2021 VA examiner stated, after reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995 it was less likely as not that the Veteran's left leg neurological disorder, to include numbness of the toes, was aggravated beyond its natural progression by the service-connected unspecified depressive disorder with anxiety and/or the service-connected burn scars of the right arm, right thigh, and abdomen as there is no medical pathophysiological relationship between the two conditions. A December 2021 addendum opinion was obtained for further clarification from the September 2021 VA examiner. In the December 2021 opinion, the examiner stated that, after performing physical exam and reviewing medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, and service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991 as well as BVA Remand letter and Veteran's lay assertions, it was less likely than not the Veteran's left leg neurological disorder is related to military service. She noted that the records failed to show a relationship between any back complaints or numbness in left leg/toes while in service nor did they show any progressive or continuation of these complaints while in service, or treatment of any of these complaints after service. The Board finds that the opinions provided in the September 2021 VA examination report and the December 2021 addendum opinion are inadequate for adjudication purposes. As such, another VA medical opinion is warranted. Specifically, the September 2021 VA examination report and the December 2021 VA addendum opinion only mentioned review of the records medical records dated 08/10/1977, 08/12/1977, 09/18/1977, 09/28/1977, 08/02/1981, 08/04/1981, 08/07/1981, 06/27/1982, 03/04/1992, 09/14/1992, 09/15/1993, 01/10/1994, 03/01/1995, 03/27/1995, 04/13/1995, service dates of June 26, 1977 to October 26, 1977 and July 25, 1991 to August 8, 1991; the Board Remand letter; and the Veteran's lay assertions. Pursuant to the August 2021 Board remand directives, the entire claims file must be reviewed by a VA clinician prior to rendering an opinion regarding service connection. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand. Stegall v. West, 11 Vet. App. 268 (1998). The Board finds that there has not been substantial compliance with the prior August 2021 Board remand directives. Accordingly, the Board must remand the matter again. On remand, a medical opinion is warranted, after a full review of the claims file, to determine whether the Veteran's left leg nerve damage and numbness in three toes is related to his service or his service-connected unspecified depressive disorder with anxiety and burn scars. The examiner must consider the Veteran's contention that the onset of his disability was while on active duty. The examiner must also acknowledge and consider the August 10, 1977 service treatment record showing that the Veteran had pain on the left leg and that his small toes felt numb and the September 14, 1977 service treatment record showing numbness in the left toes and a possible circulation problem. Further, in an October 2021 rating decision, service connection was awarded for degenerative disc disease, effective November 27, 2013. As the evidence shows that the Veteran's left leg nerve damage and numbness in three toes may be related to his service-connected degenerative disc disease, VA medical opinions are warranted to consider whether the Veteran's left leg nerve damage and numbness in three toes were caused or aggravated by his degenerative disc disease. 5. TDIU The Veteran contends that his service-connected disabilities of depressive disorder and neuropathies related to his burn injury prevent him from securing or following any substantially gainful occupation. See January 2005 VA Form 21-8940; February 2022 Appellant's Post-Remand Brief. He reported that he last worked in 1993 when he was forced to leave work due to a neck injury. The Veteran's claim for entitlement to TDIU is inextricably intertwined with the pending claim service connection claims. Thus, a decision by the Board on the Veteran's TDIU claim would, at this point, be premature. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim.). The matters are REMANDED for the following action: 1. Forward the Veteran's claims file to an appropriate VA clinician to provide a medical opinion regarding the nature and etiology of his ganglion cyst on the right wrist. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. The clinician must then address the following: a.) whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's ganglion cyst on the right wrist had its onset in, was caused by, or is otherwise related to service. b.) whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's ganglion cyst on the right wrist was caused by the Veteran's service-connected burn scars. c.) whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's ganglion cyst on the right wrist was aggravated by the Veteran's service-connected burn scars. d.) whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's ganglion cyst on the right wrist was caused by the Veteran's service-connected unspecified depressive disorder with anxiety. e.) whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's ganglion cyst on the right wrist was aggravated by the Veteran's service-connected unspecified depressive disorder with anxiety. For the purpose of providing the opinions requested, please consider the Veteran's contentions that onset of his disability was while on active duty; and state whether a nexus between the Veteran's ganglion cyst on the right wrist and his service is medically consistent with the Veteran's contention. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 2. Forward the Veteran's claims file to an appropriate VA clinician to provide a medical opinion regarding the nature and etiology of his neurological disability of the right upper extremity. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. The clinician must then address the following: a.) Diagnose all neurological disabilities of the right upper extremity during the appeal period. Please acknowledge the records showing diagnoses of neuropathy, right cubital tunnel syndrome, and right upper extremity carpel tunnel. b.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any disability diagnosed in part (a) had its onset in, was caused by, or is otherwise related to service. c.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the any disability diagnosed in part (a) was caused by the Veteran's service-connected burn scars. d.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any disability diagnosed in part (a) was aggravated by the Veteran's service-connected burn scars. e.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any disability diagnosed in part (a) was caused by the Veteran's service-connected unspecified depressive disorder with anxiety. f.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any disability diagnosed in part (a) was aggravated by the Veteran's service-connected unspecified depressive disorder with anxiety. For the purpose of providing the opinions requested, please consider the Veteran's contentions that onset of his disability was while on active duty; and state whether a nexus between the Veteran's neurological disability of the right upper extremity and his service is medically consistent with the Veteran's contention. The examiner must also specifically acknowledge and consider: 1) the April 2003 VA treatment record showing that the Veteran reported neuropathic sensation at his burn sites and 2) the September 2003 VA scars examination showing that the Veteran complained of neurological problems secondary to his burn injuries and that the Veteran took Neurontin, which the order stated was for "neuropathies related to burn injury." (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 3. Forward the Veteran's claims file to an appropriate VA clinician to provide a medical opinion regarding the nature and etiology of his prostate condition(s), to include prostate cancer and prostatitis. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. The clinician must then address the following: a.) Diagnose all prostate conditions during the appeal period, to include prostate cancer and prostatitis. b.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) had its onset in, was caused by, or is otherwise related to service. For the purpose of providing the opinion requested, please consider the Veteran's contentions that onset of his disability was while on active duty; and state whether a nexus between the Veteran's prostate condition and his service is medically consistent with the Veteran's contention. Please acknowledge and consider the September 1977 service treatment record showing complaints of discharge with burning on urination. c.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was caused by the Veteran's service-connected burn scars. d.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was aggravated by the Veteran's service-connected burn scars. e.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's any condition diagnosed in part (a) was caused by the Veteran's service-connected unspecified depressive disorder with anxiety. f.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was aggravated by the Veteran's service-connected unspecified depressive disorder with anxiety. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. 4. Forward the Veteran's claims file to an appropriate VA clinician to provide a medical opinion regarding the nature and etiology of his left leg nerve damage and numbness in three toes. The entire claims file should be made available to and be reviewed by the clinician in conjunction with this request. The clinician must then address the following: a.) Diagnose all conditions manifested by left leg nerve damage and numbness in three toes during the appeal period. b.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) had its onset in, was caused by, or is otherwise related to service. For the purpose of providing the opinion requested, please consider the Veteran's contentions that onset of his disability was while on active duty; and state whether a nexus between the Veteran's left leg nerve damage and/or numbness in three toes and his service is medically consistent with the Veteran's contention. Please acknowledge and consider the August 10, 1977 service treatment record showing that the Veteran had pain on the left leg and that his small toes felt numb and the September 14, 1977 service treatment record showing a complaint of numbness in the left toes and a possible circulation problem. c.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was caused by the Veteran's service-connected burn scars. d.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was aggravated by the Veteran's service-connected burn scars. e.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was caused by the Veteran's service-connected unspecified depressive disorder with anxiety. f.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was aggravated by the Veteran's service-connected unspecified depressive disorder with anxiety. g.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was caused by the Veteran's service-connected degenerative disc disease. h.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that any condition diagnosed in part (a) was aggravated by the Veteran's service-connected degenerative disc disease. Please acknowledge and consider: 1) the Veteran's report at the June 1994 medical examination that he had radiating pain from his back to his left thigh and knee with tingling and numbness in his left leg previously and that his back injury with left leg nerve damage was aggravated by his service; and 2) the Veteran's complaint of pain in his low back and intermittently into his left leg with numbness of the three middle toes in March 1995. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Samuelson, 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.