Citation Nr: A25022016 Decision Date: 03/11/25 Archive Date: 03/11/25 DOCKET NO. 221007-286554 DATE: March 11, 2025 ORDER A rating in excess of 70 percent, but no higher, for PTSD, for the entire period on appeal is granted; a rating in excess of 70 percent is denied. Entitlement to an effective date of December 12, 2018, for the assignment of a total disability rating based on individual unemployability (TDIU), is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to an effective date of December 12, 2018, for basic eligibility to Dependents' Educational Assistance (DEA), is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to special monthly compensation (SMC) at the statutory housebound rate specified at 38 U.S.C. § 1114 (s), from August 24, 2021, granted, subject to the laws and regulations governing the award of monetary benefits. FINDINGS OF FACT 1. During the period on appeal, the Veteran's PTSD caused social and occupational impairment with deficiencies in most areas, but not total social and occupational impairment. 2. From December 12, 2018, the evidence persuasively supports finding that the Veteran's service-connected PTSD, alone, precludes him from obtaining or maintaining substantially gainful employment. 3. The Veteran's TDIU, based solely on the service-connected PTSD, is effective December 12, 2018, and the DEA benefits may be allowed on those same dates. 4. The Veteran's TDIU is based solely on the service-connected PTSD, he has additional disabilities rated at 60 percent or more, from August 24, 2021. CONCLUSIONS OF LAW 1. The criteria for a 70 percent rating, but no higher, for the entire period on appeal are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.126, 4.130, Diagnostic Code 9411. 2. The criteria for an effective date of December 12, 2018, for the grant of a TDIU, have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400. 3. The criteria for an effective date of December 12, 2018, for DEA benefits, have been met. U.S.C. §§ 3501, 5110, 5113; 38 C.F.R. §§ 3.155, 3.350, 3.400. 4. The criteria for SMC at the housebound rate, from August 24, 2021, have been met. 38 U.S.C. § 1114, 38 U.S.C. § 7104; 38 C.F.R. § 3.351 (d), 38 C.F.R. § 20.101. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 2008 to December 2009, with additional periods of service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2022 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In November 2021, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the increased rating claim for PTSD, most recently addressed in a November 2020 rating decision. In January 2022, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and adjudicated the claim based on the evidence of record at the time of that decision. Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window. In the October 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2022 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court of Appeals for Veterans Claims (Court) since has extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Increased Rating - PTSD The Veteran asserts that an effective date for the assignment of a 70 percent rating for PTSD, prior to November 15, 2021, and a higher rating for the entire period on appeal, is warranted. See VA Form 10182 received October 7, 2022. Review of the record shows that the Veteran's VA Form 21-526EZ for service connection for PTSD was received December 12, 2018. A rating decision denying service connection was issued March 20, 2019. Thereafter, a March 26, 2019, letter indicates VA had received the Veteran's Intent to File (ITF) a claim that date. This was followed by the Veteran's May 17, 2019, VA Form 20-0995 regarding the March 2019 denial of service connection for PTSD. The same day, the Veteran filed a VA Form 21-526EZ for, among other claims, "sleeping issues." An August 2019 rating decision construed the claim for sleeping issues as an increased rating claim for the service-connected acquired psychiatric disorder, recharacterized the service-connected acquired psychiatric disorder as PTSD, and decreased the rating from 70 percent to 50 percent disabling, effective August 12, 2019. The Veteran submitted a request for Higher-Level-Review (HLR) in July 2020, and a November 2020 rating decision denied a rating in excess of 50 percent. The Veteran submitted a Supplemental Claim in November 2021, within 1 year of the November 2020 rating decision, and a January 2022 rating decision assigned a 70 percent rating, effective November 15, 2021, the date the Supplemental Claim was received. The Veteran disagreed and this appeal ensued. First, the Board finds that there has been continuous pursuit of an increased rating through the filing of supplemental claims, such that the December 12, 2018, VA Form 21-526EZ is the date of claim regarding the increased rating claim for PTSD. Second, the Board acknowledges that the Veteran's attorney has framed the issue regarding PTSD as an earlier effective date claim. However, the Board will, in the course of adjudicating whether a higher rating is warranted since December 12, 2018, whether a 70 percent rating is warranted prior to November 15, 2021. Under the General Rating Formula for Mental Disorders, a 70 percent evaluation is assigned when a Veteran's psychiatric disability causes occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); or an inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned when a Veteran's psychiatric disability causes total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; danger of hurting self or others; intermittent inability to perform activities of living (including maintenance of minimal hygiene); disorientation to time or place; or, memory loss for names of close relatives, occupation, or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran's psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment, but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. Furthermore, the specified factors for each incremental rating are examples, rather than requirements, for a particular rating. The Board will not limit its analysis solely to whether the Veteran exhibited the symptoms listed in the rating criteria. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Indeed, the symptoms listed under § 4.130 are not intended to serve as an exhaustive list of the symptoms that VA may consider but as examples of the type of degree of symptoms, or the effects, that would warrant a particular rating. Id. at 442. The Veteran's actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The Veteran was afforded a VA examination in January 2019. The Veteran reported that he had a real good relationship with his son and that he kept in touch with his sister. He noted that he had a few friends, including some veterans, and an elderly woman he met at his church. He did note that he had broken up with his girlfriend of one year, because she was stuck in her old ways. He reported that he attended church and his son's basketball, baseball, and track practices and games. Regarding work, he reported that he most recently worked in October 2018, and that his last job was stressful because the people around him, made too much noise. The examiner noted the following symptoms: anxiety, suspiciousness, panic attacks that occur weekly or less, chronic sleep impairment, and mild memory loss. The Veteran was afforded a VA examination in August 2019. The Veteran reported that he was single and had never been married. He reported that he had a pretty good relationship with his son, but noted that he did not have any close friends to confide in. He stated that he was not currently employed and that he last worked in 2018. He also added that he struggled with most people and that he mostly stayed at home all day and played the radio. The examiner noted the following symptoms: depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, flattened affect, circumstantial, circumlocutory, or stereotyped speech, and impaired judgment. The Veteran submitted a private employability review dated October 25, 2021. The Veteran endorsed occasional suicidal thoughts, but denied homicidal ideation. He reported that his mood was unstable and that he was highly distractable. He also reported high anxiety and an irregular sleep pattern. He indicated that when he had bouts of depression, his hygiene suffered because he was physically inactive and not get out of bed. He stated that he isolates because he was unpredictable around a big group of people. He reported that when his sister has friends at her house, he books a hotel room. He also described getting into altercations in public, about 10-11 in the past five years. The examiner also indicated that he was last hospitalized in January 2021, for mental health symptoms. The Veteran was afforded a VA examination in December 2021. The Veteran reported that he has not been able to maintain employment. He also reported that he was close to his sister, her two children, and his son. He noted that he did not associate with his parents. He indicated that he enjoyed playing pool and watching television, but was socially isolated and had no friends. He reported that he completed HVAC training in 2019 and sporadically worked construction jobs in 2020. The examiner noted the following symptoms: depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, difficulty in understanding complex commands, difficulty in establishing and maintaining effective relationships, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, and impaired impulse control. A review of the Veteran's VA treatment records shows that in October 2018, he reported that he was uncomfortable in crowds, and would often avoid any crowded place, and if he went into place that make him anxious, he had extreme anxiety attacks. The Veteran was also shown to have attempted to be admitted to a residential rehabilitation treatment program (RRTP) in March 2019. However, he was discharged due to a positive breathalyzer and attempting to bring alcohol onto the unit. January 2021 VA treatment records show a 5-day hospitalization after he reported having suicidal ideation, with a plan to overdose, and nonspecific homicidal ideation. He reported that he had a suicide attempt, when he purposely shot up two times the amount, he usually does, because he was upset that he was unable to beat his drug addiction. See VA Treatment Record dated January 2021. After review of the record, the Board finds that a 70 percent rating, but no higher, for the entire period on appeal is warranted. Regarding the Veteran's social functioning, the record has shown that he has difficulty establishing and maintaining effective relationships. He reported at the August 2019 VA examination that he did not have any close friends to confide in; and that he struggled with most people and mostly stayed at home all day and played the radio. However, he also reported that he had a good relationship with his son and that he attended church and his son's basketball, baseball, and track activities. The Board also acknowledges that the Veteran reported that he had not worked since 2018, and that he had difficulty working with others at his last job. The impact of the Veteran's PTSD on his employability is discussed in more detail below. However, the impairment as discussed above with respect to employment does not suggest total occupational impairment. The Board also recognizes the occupational difficulties, but he reported working sporadically and completing HVAC training in 2019. Given the overall disability picture of his PTSD as discussed above, it cannot be concluded that the Veteran is totally socially or occupationally impaired. Further, the Veteran has not shown any of the symptoms associated with a 100 percent rating, such as gross impairment in thought processes or communication, persistent delusions of hallucinations, grossly inappropriate behavior, danger of hurting self or others, intermittent ability to perform activities of daily living, disorientation to time or place, or memory loss for names of close relatives, or own name. The Board is mindful of the January 2021 hospitalization, but suicidal ideation is contemplated by the 70 percent rating. Indeed, the Court of Appeals for Veterans Claims has held that suicidal ideation generally rises to the level contemplated in a 70 percent evaluation. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017) (stating the language of 38 C.F.R. § 4.130 "indicates that the presence of suicidal ideation alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment in most areas"). The difference is that the 100 percent rating requires persistent risk of hurting self or others, which is not demonstrated here. For the roughly 6 year period on appeal, the Veteran had one known hospitalization, for 5 days. The Board finds that this is not "persistent risk" as contemplated by the 100 percent rating. Accordingly, a 70 percent rating, but no higher, is warranted for the entire period on appeal. To that extent only, the appeal is granted. To the extent that the Veteran contends a 100 percent rating is warranted, the Board has discussed above why total occupational impairment is not shown. Accordingly, greater than a 70 percent rating at any point during the period on appeal is denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. As the evidence persuasively favors one side or the other, the doctrine is not for application. See Lynch v. McDonough, 21 F.4th. 776 (Fed. Cir. 2021) (en banc); 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Earlier Effective Dates In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400 (b)(2)(i). A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101 (a). A "claim" is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Any communication indicating an intent to apply for a benefit under the laws administered by VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155 (a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). Earlier Effective Date - TDIU The Veteran asserts that an effective date for the grant of a TDIU, prior to November 15, 2021, is warranted. Specifically, he asserts that he has been unemployed since December 2018, and that the medical evidence supports such an effective date. See VA Form 10182 received October 7, 2022. As noted above, the Board has found that the Veteran's increased rating claim for PTSD has been pending since December 12, 2018. During the pendency of the increased rating claim on appeal, in November 2021, the Veteran submitted a VA Form 21-8940, where he asserted that a TDIU was warranted. A March 2022 rating decision granted a TDIU, effective November 15, 2021, the date his VA Form 21-8940 was received. The Veteran disagreed with the assigned effective date, and this appeal ensued. As such, the appeal period for the issue of a TDIU begins on December 12, 2018, because it is part and parcel of the increased rating claim for PTSD. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, the disability shall be ratable at 60 percent or more, and that, if there are two or more service-connected disabilities, at least one must be rated at 40 percent or more and the combined rating must be 70 percent or more. 38 C.F.R. § 4.16 (a). Being unable to maintain substantially gainful employment is not the same as being 100 percent disabled. "While the term 'substantially gainful occupation' may not set a clear numerical standard for determining a TDIU, it does indicate an amount less than 100 percent." Roberson v. Principi, 251 F.3d 1378 (Fed Cir. 2001). Assignment of a TDIU evaluation requires that the record reflect some factor that "takes the claimant's case outside the norm" of any other veteran rated at the same level. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (citing 38 C.F.R. §§ 4.1, 4.15). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. A disability rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. Id. Here, the Veteran is in receipt of a 70 percent rating for PTSD, effective April 13, 2015; a 50 percent rating for migraines, effective March 26, 2019; and a 10 percent rating for tinnitus, effective August 24, 2021. As such, the schedular criteria for a TDIU are met for the entire period on appeal. 38 C.F.R. § 4.16 (a). The Veteran submitted a VA Form 21-8940 in November 2021. He reported that he became too disabled to work in December 2018. However, he noted that he worked for a short 3-month period in construction, from January 2020 to March 2020, with highest gross earnings per month of $1,500. The January 2019 VA examiner for mental health disorders did not provide an opinion regarding the Veteran's employability. The Veteran was afforded a VA examination for headaches in August 2019. The examiner noted that the Veteran would have difficulty working with frequent headache pain. The August 2019 VA examiner for mental health disorders did not provide an opinion regarding the Veteran's employability. The December 2021 VA examiner for mental health disorders did not provide an opinion regarding the Veteran's employability. The December 2021 VA examiner for tinnitus reported that the Veteran had difficulty sleeping, difficulty focusing and concentrating, due to ringing. He would also have difficulty hearing others while working. The Veteran submitted a private employability review dated October 25, 2021. The consultant reported that the Veteran's mental health symptoms included chronic irritability, impaired sleep, paranoia, poor impulse control, low insight, and impaired judgment. It would be expected that routine stress of work would tax his coping skills to such an extent that he would decompensate. Further, due to his paranoia and mood instability, he continued to have anger outbursts over minor issues. He also had difficulty managing stress and being flexible, which would interfere with his ability to work with supervisors or coworkers. The consultant also reported that his sleep issues would cause difficulty with focus, and also cause his behavior to be erratic and pace himself inappropriately. This would cause an increase in the likelihood of making mistakes and lead him to be off-task, and also difficulty following multi-step commands or completing tasks that required attention to minimal details. The consultant found that the Veteran's PTSD was severe enough to prevent gainful employment and that his mental health symptoms have been of the same severity since December 12, 2018. Here, the Board finds that an effective date of December 12, 2018, is warranted for the grant of a TDIU. In this regard, the VA Form 21-8940 showed that the Veteran reported that he became too disabled to work in December 2018. Further, the private consultant who provided the employability review reported that the Veteran's mental health symptoms were of the same severity from December 12, 2018, to the present; this opinion that the Veteran is unemployable due solely to his PTSD symptoms is supported by the contemporaneous evidence of record. Although the January 2019 and August 2019 VA examiners did not provide opinions regarding the Veteran's employability, they both documented significant symptoms such as anxiety, depressed mood, panic attacks, chronic sleep impairment, mild memory loss, impaired judgment, and circumstantial, circumlocutory, or stereotyped speech. These symptoms were also noted by the private examiner and would significantly impact the Veteran's ability to work. As discussed briefly, the Veteran reported on his VA Form 21-8940 in 2021 that he had worked for a period of three months in early 2020. However, the Board finds that TDIU is still warranted from December 12, 2018. The VA Form 21-8940 specifically indicates that for each of those three months, the Veteran's income was, at highest, $1,500 per month, with 3 weeks lost due to the contended disability. As he did not report working at any other time in 2019 or 2020, this would make the Veteran's gross earned income for any given 12 month period equal $4,500. The relevance of this is as follows. In Ray v. Wilkie, 31 Vet. App. 58, 71 (2019) the Court interpreted the phrase "unable to secure and follow a substantially gainful occupation" to have two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person, and the noneconomic component requires more than determining the presence or absence of employment producing income exceeding any particular threshold. In 2019, the poverty threshold for one person was $13,300. As the Veteran's gross earned income for that year was $4,500, his income does not exceed the threshold. Moreover, TDIU requires that a Veteran be able to secure and maintain substantially gainful employment. While this three-month period of employment may have been substantially gainful, it was not maintained. Thus, to the extent the Veteran was gainfully employed from January 2020 to March 2020, the Board finds that the economic component under Ray is not satisfied, and TDIU is still warranted despite this short-term full-time employment. Accordingly, the Board finds that the evidence of record supports finding that the Veteran has been precluded from securing or maintaining substantially gainful employment from December 12, 2018. As such, the Board finds an effective date of December 12, 2018, but no earlier, for the award of a TDIU, is warranted. Entitlement - DEA Benefits Survivors' and Dependents' Educational Assistance (DEA) is a program of education or special restorative training that may be authorized for an eligible person, such as a surviving spouse, if the applicable criteria are met. 38 U.S.C. §§ 3500, 3501; 38 C.F.R. §§ 21.3020, 21.3021. Basic eligibility for certification of DEA exists if the veteran was discharged from service under conditions other than dishonorable, or died in service, and among other reasons, has a permanent total service-connected disability. 38 C.F.R. § 3.807. Because the Board has assigned a TDIU effective December 12, 2018, the Veteran is also entitled to basic eligibility to DEA benefits as of that date, by virtue of having been awarded a permanent total service-connected disability, and to this extent, the Veteran's appeal is granted. See 38 C.F.R. §§ 3.807, 21.3021(p). Accordingly, an effective date December 12, 2018, for DEA benefits, but no earlier, is granted. Entitlement - SMC(s) SMC at the housebound rate is payable if a Veteran has a single service-connected disability rated at 100 percent and has an additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). A TDIU rating based on a single disability is permitted to satisfy the statutory requirement of a 100 percent rating. Bradley v. Peake, 22 Vet. App. 280, 293 (2008). A claim for increased disability compensation may include the "inferred issue" of entitlement to SMC, even where the appellant has not expressly raised the issue of SMC. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991). Here, this Board decision has found that TDIU is warranted based solely on the Veteran's service-connected PTSD. With regard to the disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, these criteria are met on August 24, 2021, the effective date for the award of the initial 10 percent rating for tinnitus, at which time a 50 percent rating had already been awarded for migraine headaches. As prior to August 24, 2021, the additional disabilities apart from TDIU do not combine to 60 percent rating, the earliest date the Veteran has been shown to have additional disabilities independently rated at 60 percent, is August 24, 2021. Accordingly, SMC(s) is warranted from August 24, 2021, but no earlier. J. Kirby Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fu, 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.