Citation Nr: 22017198 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 09-37 410A DATE: March 24, 2022 ORDER Entitlement to an initial evaluation in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to October 5, 2000, is denied. FINDINGS OF FACT 1. Prior to February 2, 1988, the evidence does not show that the Veteran's ability to establish or maintain effective or favorable relationships with people was substantially impaired, or that by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in severe industrial impairment. 2. For the period from February 2, 1988, to November 7, 1996, the evidence does not show that the Veteran's ability to establish or maintain effective or favorable relationships with people was considerably impaired, or that by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in considerable industrial impairment. 3. For the period from November 7, 1996, to October 5, 2000, the evidence does not show that the Veteran's PTSD was productive of occupational and social impairment with reduced reliability and productivity. CONCLUSION OF LAW The criteria for an initial evaluation in excess of 30 percent for PTSD prior to October 5, 2000, have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.21, 4.129 (1972), 4.130 (2022), 4.132 (1972), 4.132 (1988), Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from December 1970 to October 1971. She had subsequent service in the United States Army Reserve with a period of active duty for training from January 1992 to April 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In that rating decision, the RO effectuated a December 2007 Board decision that assigned an earlier effective date of August 17, 1977, for the grant of service connection for PTSD. The AOJ assigned a 30 percent evaluation for the period from August 17, 1977, to October 5, 2000. A 100 percent evaluation was assigned from October 5, 2000. The Veteran appealed the initial 30 percent evaluation assigned for the period from August 17, 1977, to October 5, 2000. In February 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. The Board remanded the case for further development in August 2018 and May 2021. The case has since been returned to the Board for appellate review. Law and Analysis In the August 2018 remand, the Board noted that, during the February 2018 hearing, the Veteran stated that she was treated for PTSD at the Milwaukee VA Medical Center (VAMC) from 1977 to 2000. The Board found that the records had not been associated with the record and directed the AOJ to obtain any outstanding VA treatment records, to specifically include any records from the Milwaukee VAMC dated from 1977 to 2000. Thereafter, in April 2020 correspondence, the agency of original jurisdiction (AOJ) informed the Veteran that her pre-2005 VA treatment records from the Milwaukee VAMC had been requested. The AOJ noted that the Milwaukee VAMC responded stating that the information had been disclosed. However, in the May 2021 remand, the Board found that a review of the record showed a single VA outpatient treatment record dated in August 1996 from the Milwaukee VAMC, which did not pertain to the disability on appeal. Thus, the Board remanded the case again and directed the AOJ to make further attempts to obtain the records. In June 2021 and August 2021, the AOJ submitted requests for any outstanding records. In September 2021, the Milwaukee VAMC responded that all of the records that were available and scanned in November 2019, but it appears that the only record uploaded into the Veteran's claims file was an August 1996 VA neurology consultation report, which is not pertinent to the claim on appeal. Given the efforts made and the responses received, the Board finds that the AOJ substantially complied with the Board's remand directives and that any further attempts would be futile. Stegall v. West, 11 Vet. App. 268, 271 (1998). See also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial compliance would be required, not strict compliance). Neither the Veteran nor her representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir.2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Fenderson, 12 Vet. App. at 126-27. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307, 37312 (Fed. Cir. Dec. 17, 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other). In the February 2008 rating decision on appeal, the AOJ effectuated a December 2007 Board decision that assigned an earlier effective date of August 17, 1977, for the grant of service connection for PTSD. The AOJ assigned a 30 percent evaluation for the period from August 17, 1977, to October 5, 2000. A 100 percent evaluation was assigned from October 5, 2000. The Veteran appealed the initial 30 percent evaluation and has contended that she warrants a 100 percent evaluation since August 17, 1977. The Board notes that PTSD was not an established psychiatric diagnosis in 1977 (see the Diagnostic and Statistical Manual of the American Psychiatric Association, 2d edition (DSM-II) (1968), which was in effect in August 1977). Indeed, VA did not adopt the PTSD nomenclature until 1980. See Fed. Reg. 26,326 (1980) (The diagnosis of PTSD under Diagnostic Code 9411 was added to the rating schedule, effective April 11, 1980, the date of approval of the regulatory amendment by the Administrator of VA.) Thus, prior to that date the rating criteria did not state whether PTSD is a psychotic disorder, organic brain disorder, psychoneurotic disorder, or a psychophysiologic disorder. However, when PTSD was formally added in April 1980, it was included as a psychoneurotic disorder. Id. As such, the Board will apply the General Formula for Rating Psychoneurotic Disorders. For the period prior to April 1980 when Diagnostic Code 9411 governing PTSD did not exist, the Board will rate by analogy to Diagnostic Code 9400, governing anxiety reaction or anxiety neuroses. 38 C.F.R. § 4.27. The Board notes that the applicable rating criteria has changed over the rating period. Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enactment of the new rule. VAOPGCPREC 07-03. However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The schedular criteria for mental disorders that were in effect at the beginning of the rating period at issue in this appeal were amended effective April 11, 1980 (as discussed above where the diagnosis of PTSD under Diagnostic Code 9411 was added to the rating schedule), February 3, 1988, and November 7, 1996. The criteria from the November 1996 General Rating Formula for Mental Disorders is currently in effect. See 61 Fed. Reg. 52695 (October 8, 1996) (amending the sections of the VA schedule for rating mental disorders); see also 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders) (2022). As such, the Veteran's claim must be considered under all of the rating amendments during the period on appeal. The rating criteria in effect prior to February 2, 1988, for psychoneurotic disorders (for ratings of at least 30 percent) were as follows: A 30 percent rating was assigned where there was evidence of definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms resulted in such reduction in initiative, flexibility, efficiency and reliability levels as to produce considerable industrial impairment. A 50 percent rating was assigned where the Veteran's ability to establish or maintain effective or favorable relationships with people was substantially impaired. By reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels were so reduced as to result in severe industrial impairment. A 70 percent rating was assigned where the Veteran's ability to establish and maintain effective or favorable relationships with people was seriously impaired. The psychoneurotic symptoms were of such severity and persistence that there was pronounced impairment in the ability to obtain or retain employment. A 100 percent rating was assigned where the attitudes of all contacts except the most intimate were so adversely affects as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. See 38 C.F.R. § 4.132 (1961). Note 1 to the General Rating Formula for Psychoneurotic Disorders provided that "[s]ocial impairment per se will not be used as the sole basis for any specific percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings." See id. In addition, the version of 38 C.F.R. § 4.129 then in effect provided: Social integration is one of the best evidences of mental health and reflects the ability to establish (together with the desire to establish) healthy and effective interpersonal relationships. Poor contact with other human beings may be an index of emotional illness. However, in revaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from the mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. Effective February 3, 1988, the General Rating Formula for Psychoneurotic Disorders was revised, in applicable part, as follows: A 30 percent rating was assigned where the evidence showed definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms resulted in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite [revised from "considerable"] industrial impairment. A 50 percent rating was assigned where the Veteran's ability to establish or maintain effective or favorable relationships with people was considerably [revised from "substantially"] impaired. By reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels were so reduced as to result in considerable [revised from "severe"] industrial impairment. A 70 percent rating was assigned where the Veteran's ability to establish and maintain effective or favorable relationships with people was severely [revised from "seriously"] impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe [revised from "pronounced"] impairment in the ability to obtain or retain employment. A 100 percent rating was assigned where the attitudes of all contacts except the most intimate are so adversely affects as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. See 38 C.F.R. § 4.132 (1988). The United States Court of Appeals for Veterans Claims (Court) has held that the rating criteria in effect prior to November 1996 each contain separate, independent clauses, and that a given rating is warranted if the evidence satisfies any one of them. See, generally, Johnson v. Brown, 7 Vet. App. 95, 99 (1994); Diorio v. Nicholson, 20 Vet. App. 193, 198 (2006), vacated on other grounds, 216 F. App'x 974 (Fed. Cir. 2007). Thus, by way of example, the criteria for a 30 percent disability rating that were in effect at the start of the period on appeal would be met if the evidence shows either (1) definite impairment in the ability to establish or maintain effective and wholesome relationships with people, or (2) the Veteran's psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce considerable industrial impairment. In addition, Court has held that the term "definite" in 38 C.F.R. § 4.132 (as then in effect) was qualitative in nature, whereas the other terms, e.g., "considerable" and "severe," were quantitative. Hood v. Brown, 4 Vet. App. 301, 303 (1993). Thereafter, VA's Office of General Counsel issued a precedent opinion concluding that the term "definite," as used in 38 C.F.R. § 4.132 to describe a 30 percent disability rating for purposes of rating claims under the General Rating Formula for Psychoneurotic Disorders, should be construed to mean "distinct, unambiguous, and moderately large in degree," and that the term "considerable" was to be construed as "rather large in extent or degree." VAOPGCPREC 9-93. The VA schedule of ratings for mental disorders underwent substantial revisions effective November 7, 1996, and remain in effect. See 61 Fed. Reg. 52,700 (1996); 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders). The applicable rating criteria for the period beginning November 7, 1996, are as follows: A 30 percent rating is assigned where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of 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, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is assigned where there is 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. A 70 percent rating is assigned where 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 worklike setting); inability to establish and maintain effective relationships. A 100 percent rating is assigned where there is 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; memory loss for names of close relatives, own occupation, or own name. See 38 C.F.R. § 4.130. In addition, the language previously contained in 38 C.F.R. § 4.129 regarding social inadaptability was deleted in its entirety from that section, and replacement language was added as 38 C.F.R. § 4.126(b), which provides that "[w]hen evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment." The post-amended criteria may be applied only prospectively from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110(g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Therefore, the appeal prior to 1996 will be evaluated under the pre-amended criteria. The use of the term "such as" in the general rating formula for mental disorders in 38 C.F.R. § 4.130 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 symptoms, or their effects, that would justify a particular rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). It is not required to find the presence of all, most, or even some, of the enumerated symptoms recited for particular ratings. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. Id. In Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013), the Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." As noted above, in the February 2008 rating decision on appeal, the AOJ effectuated a December 2007 Board decision that assigned an earlier effective date of August 17, 1977, for the grant of service connection for PTSD. The AOJ assigned a 30 percent evaluation for the period from August 17, 1977, to October 5, 2000. A 100 percent evaluation was assigned from October 5, 2000. The Veteran appealed the initial 30 percent evaluation and has contended that she warrants a 100 percent evaluation from August 17, 1977. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an evaluation in excess of 30 percent for PTSD prior to October 5, 2000, for any portion of the period on appeal under the former or revised rating criteria, as applicable. The evidence prior to February 2, 1988 (the first applicable amendment to the rating schedule), does not show that the Veteran's ability to establish or maintain effective or favorable relationships with people was substantially impaired, or that by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in severe industrial impairment. During the February 2018 hearing, the Veteran testified that she began receiving psychiatric treatment for nightmares, anxiety, social impairment, and paranoia at the Milwaukee VAMC before she separated from service in 1977. However, as discussed above, attempts have been made to obtain such records, and there are no VA medical records corresponding to this reported treatment. During a January 1978 VA psychiatric examination, the VA examiner noted that the Veteran was under no psychiatric care or medications at that time. On mental status examination, the examiner noted that the Veteran's thought process was intact, relevant, and coherent, and she denied having suicidal and homicidal ideation. She also denied having any auditory and visual hallucinations and paranoid ideation. The Veteran's affect was appropriate, and she was oriented to person, place, and time. Her memory was also intact for remote and recent events, and her judgment and insight were good. The examiner diagnosed the Veteran with chronic anxiety-type neurosis manifested by nightmares, generalized fears, and repressed anger. A November 1979 private hospitalization record indicated that the Veteran was evaluated for generalized weakness and stuporous state. The physician noted that the Veteran was admitted to the hospital for evaluation of increasing weakness, easy fatigability, and an inability to stay awake for the previous four weeks. The physician reported that the Veteran was examined approximately one month earlier for generalized tiredness, but that all of her physical findings and labs were within normal limits. She was prescribed an antidepressant without any effect. The physician noted that, when the Veteran came to the clinic for examination, she was "sleepy up to the point that she falls asleep while completing a sentence." The physician indicated that the Veteran had a history of a head injury following a car accident in February 1979, and the doctor wanted to rule out any possibility of any intracranial hemorrhage. The Veteran reported a past history that included rape at age 17, which produced traumatic experiences, but she denied any history of psychiatric therapy since that time. In a November 1979 private hospital summary, the discharge physician noted that the Veteran was admitted for evaluation of generalized weakness and stupor-state for approximately one month with outpatient testing within normal limits. The physician noted a past history of rape and psychiatric therapy or care for approximately three to six months. The doctor indicated that the Veteran was admitted due to "a stupor state up to the point that she was catatonic." A physical examination, lab findings, skull x-rays, and brain scan were all within normal limits; therefore, the physician concluded that the Veteran had either physical exhaustion or depressive state. An August 1985 Army Reserve psychiatric consultation report revealed that the Veteran was evaluated in the emergency department eleven days prior secondary to closed head trauma. The psychiatrist noted that the Veteran's sensorium was clouded and that her social judgment may have been briefly impaired as a result of her head injury, but she required no medications and no particular interventions, as her condition cleared spontaneously and she was returned to duty two days later. The impression was an acute organic mental syndrome secondary to closed head trauma, resolved, and it was noted that she was doing well. In addition, the evidence from February 2, 1988, to November 7, 1996 (the second applicable amendment to the rating criteria during the appeal period), does not show that the Veteran's ability to establish or maintain effective or favorable relationships with people was considerably [revised from "substantially"] impaired, or that by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in considerable [revised from "severe"] industrial impairment. In a September 1992 Army Reserve treatment record, the Veteran stated that her civilian job consisted of supervising 93 Army people, which she considered very stressful, but she handled her stress by biking to relax. She also related that he had not considered hurting herself. The Board also finds that the evidence from November 7, 1996, to October 5, 2000, does not show that the Veteran had a 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. As to social impairment prior to October 5, 2000, the evidence shows that the Veteran had maintained relationships with family. During the February 2018 hearing, the Veteran testified that, while she was isolated and she did not let family come visit her at her home, she did visit her family members at their homes. She indicated that she went to her sister's house to visit and stayed overnight. She also stated that she was married to her husband for 47 years despite trying to divorce him four times. As to occupational impairment prior to October 5, 2000, the Veteran testified that she tried to work and that she applied for VA on-the-job training in June 1978, but that she was terminated from her employment at a nursing home due to an inability to touch the residents. During the February 2018 hearing, she also reported that she opened her own business in 1978 and that, while she opened and closed it numerous times, she owned the business until 2000. Upon questioning from her representative, she later indicated that she opened her business in 1998. She subsequently clarified that she did not work from 1978 to 1998 while her children were home. She related that the main reason that she opened her own business was so she could manage her time, and the Veteran noted that she only hired female employees and kept the building locked. The Veteran also indicated that she was a member of the Army Reserve from 1978 to 1998. She further testified that she completed at-home programs in massage therapy training in the early 1990s. The Board notes that the Veteran has contended that her PTSD was more severe than represented and that she had functional limitation not addressed in any VA examination. See November 2021 statement. The Board does acknowledge the Veteran's self-reported anxiety, social impairment, nightmares, paranoia, hypervigilance, and isolative behaviors. However, the Veteran's hearing testimony alone shows that she maintained relationships with her spouse and family, she was a member of the Army Reserve until 1998, she supervised employees, she raised her children, she completed at-home learning programs, and she owned her own business prior to October 5, 2000. In addition, during the February 2018 hearing, the Veteran denied suicidal ideation. After considering the evidence of record, the Board finds that overall, when taken together, the Veteran has not demonstrated symptoms or impairment consistent with the 50 percent criteria for any portion of the period on appeal under the former or revised rating criteria, as applicable. The criteria for the next higher rating of 50 percent for PTSD have not been met or approximated prior to October 5, 2000. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Based on the foregoing, the Board finds that the weight of the evidence is against an initial evaluation in excess of 30 percent prior to October 5, 2000. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49 (1990). Neither the Veteran nor her 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, 368 (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). J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Osegueda, 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.