Citation Nr: 25005668 Decision Date: 04/25/25 Archive Date: 04/25/25 DOCKET NO. 10-12 830 DATE: April 25, 2025 ORDER An increased initial disability rating of 50 percent for chronic recurrent tenso-vascular headaches prior to August 30, 2016, is granted. An increased initial disability rating of 20 percent, but no higher, for left foot callosities prior to March 7, 2023, is granted. An initial disability rating higher than 30 percent for left foot callosities from March 7, 2023, onward is denied. An increased initial disability rating of 20 percent, but no higher, for right foot callosities prior to March 7, 2023, is granted. An initial disability rating higher than 30 percent for right foot callosities from March 7, 2023, onward is denied. REMANDED Entitlement to an initial disability rating higher than 10 percent for a cervical spine disability prior to November 13, 2018, is remanded. FINDINGS OF FACT 1. Granting the Veteran the benefit of the doubt, the competent and probative evidence shows his chronic recurrent tenso-vascular headaches manifested in very frequent completely prostrating and prolonged attacks capable of producing severe economic inadaptability prior to August 30, 2016. 2. Granting the Veteran the benefit of the doubt, the competent and probative evidence shows his left and right foot callosities manifested as a "moderately severe" foot disabilities prior to March 7, 2023. 3. The competent and probative evidence persuasively weighs against finding the Veteran's left and right foot callosities more nearly approximate "actual loss of use of the foot" from March 7, 2023, onward. CONCLUSIONS OF LAW 1. The criteria for an initial 50 percent disability for chronic recurrent tenso-vascular headaches prior to August 30, 2016, are met. 38 U.S.C. §§ 1155; 5107(b); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.124a, Diagnostic Code (DC) 8100. 2. The criteria for initial 20 percent disability rating, but no higher, for left foot callosities prior to March 7, 2023, are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.3, 4.7, 4.10, 4.40, 4.45, 4.56, DC 5284. 3. The criteria for initial 20 percent disability rating, but no higher, for right foot callosities prior to March 7, 2023, are met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.3, 4.7, 4.10, 4.40, 4.45, 4.56, DC 5284. 4. The criteria for a disability rating higher than 30 percent for left foot callosities from March 7, 2023, onward are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.3, 4.7, 4.10, 4.40, 4.45, 4.56, DC 5284. 5. The criteria for a disability rating higher than 30 percent for right foot callosities from March 7, 2023, onward are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.3, 4.7, 4.10, 4.40, 4.45, 4.56, DC 5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 2003 to September 2007. He served in Iraq and Kuwait and received the Army Commendation Medal among other awards and decorations for his meritorious service. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has a long procedural history and has been before the Board on multiple occasions. To assist with adjudication of the matters listed above, the Board will provide a brief, historical summary. In April 2018, the Board remanded the issues on appeal, among others, for additional evidentiary development. In a June 2020 decision, the Board denied entitlement to a disability rating in excess of 30 percent for headaches prior to August 30, 2016; a disability rating in excess of 10 percent for a cervical spine disability prior to November 13, 2018; and disability ratings in excess of 10 percent for bilateral foot callosities. The Veteran appealed the June 2020 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2021 Joint Motion for Partial Remand (JMPR), the parties agreed a remand was warranted because the Board did not provide adequate reasons or bases for the June 2020 decision. The Court granted the JMPR in a July 2021 Order, vacated the June 2020 Board decision, and remanded the appeal back to the Board for further consideration. In December 2021, the Board remanded the issues on appeal in accordance with the July 2021 JMPR. In September 2022, the Board once again remanded the issues on appeal for the agency of original jurisdiction (AOJ) to fully comply with the December 2021 Board remand directives. In a January 2024 decision, the Board denied entitlement to a disability rating in excess of 30 percent for headaches prior to August 30, 2016; a disability rating in excess of 10 percent for a cervical spine disability prior to November 13, 2018; and disability ratings in excess of 10 percent for bilateral foot callosities prior to March 6, 2023, and in excess of 30 percent, thereafter. The Veteran appealed the January 2024 Board decision to the Court. In a November 2024 JMPR, the parties agreed a remand was warranted because the Board did not provide adequate reasons or bases for the January 2024 decision. The Court granted the JMPR in a November 2024 Order, vacated the January 2024 Board decision, and remanded the appeal back to the Board for further consideration. Increased Rating Disability ratings are determined be evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The benefit-of-the-doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). 1. Entitlement to an initial disability rating in excess of 30 percent for chronic recurrent tenso-vascular headaches prior to August 30, 2016. The Veteran is seeking a disability rating in excess of 30 percent for his service-connected headaches prior to August 30, 2016. The Veteran's headaches are rated under 38 C.F.R. § 4.124a, Diagnostic Code 8100, which directs that a 10 percent disability rating is warranted for headaches with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent disability rating is warranted for migraine headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A maximum schedular disability rating of 50 percent is warranted for migraine headaches with very frequent and completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a, Diagnostic Code 8100. The Board notes that § 4.7 is not applicable to DCs that apply successive rating criteria, such as DC 8100. See Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018) (holding that criteria of DC 8100 are successive). Though Diagnostic Code 8100 does not provide a definition for "prostrating," prostration is defined as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical Dictionary 1554 (31st ed. 2007). Similarly, the term "productive of severe economic inadaptability" is also not defined in veterans' law. However, the Court has stated that this term is not synonymous with being completely unable to work and VA has established that the phrase "productive of" could be read to mean either "producing" or "capable of producing" economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 446-47 (2004) (stating that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50% rating"). Additionally, "Characteristic" is "a trait, quality, or property or a group of them distinguishing an individual, group, or type." Webster's Third New International Dictionary of the English Language Unabridged 376 (1966). "Prostrating" means "lacking in vitality or will: powerless to rise: laid low." Id. at 1822. "Completely" is defined as "to complete degree: entirely." Id. at 465. In other words, the headaches must render the veteran entirely powerless. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). The Veteran's service-connected headache disability is currently rated 30 percent disabling under DC 8100, effective September 5, 2007, and 50 percent disabling from August 30, 2017. The Veteran only appealed to the Court whether an initial increased rating prior to August 30, 2016, is warranted. As such, the Board will only adjudicate whether the Veteran is entitled to an initial rating in excess of 30 percent prior to August 30, 2016. Upon a thorough review of the evidence of record, the Board finds the Veteran's headache disability manifested as very frequent completely prostrating and prolonged attacks capable of producing severe economic inadaptability prior to August 30, 2016. Turning to the competent and probative medical evidence, the Veteran was afforded a VA examination in March 2008. The examiner diagnosed chronic recurrent tenso-vascular headaches. The examiner noted a history of recurrent headaches localized in the bifrontal and biparietal area, insidious in onset, that slowly progressed to causing symptoms of blurred vision and photophobia. The examiner indicated most of the migraine attacks were prostrating and occurred approximately twice per week lasting up to two days. The examiner also indicated the headaches impacted the Veteran's activities of daily living, including having a severe impact on performing chores, shopping, exercising, sports, recreation, and traveling. The examiner opined such limitations are based on his acute prostrating episodes. In a separate March 2008 VA examination, the Veteran reported his headache symptoms had worsened and could last up to three days. The Veteran was afforded another VA examination in August 2010. The Veteran reported having daily headaches localized at the bitemporal regions that radiated to the entire head, leading to such symptoms as nausea and photophobia. He said the symptoms could become so severe that he had to go to a dark room to lie down and take medication for relief. He also reported his headaches could last about two to three hours and that when they occurred during work he had to retire from the area until he experienced relief and could return. The examiner found the Veteran's headaches had a moderate impact on his daily activities and could produce mild to moderate impairment during acute episodes. Moreover, although the examiner stated the Veteran required special accommodations to continue working, such as being permitted a rest period during the headache episodes, she also stated the Veteran did not have time lost from work during the prior 12 months and opined that the Veteran's headaches did not render him unemployable. The Board finds that the March 2008 and August 2010 VA examination reports highly probative because they reflect that the examiners performed in-person examinations and considered the Veteran's reported history. VA treatment records show that the Veteran reported having headaches two to three times per week. See 5/6/2013 CAPRI, at page 142. After a review of the competent and probative evidence of record and affording the Veteran every benefit of the doubt, the Board finds that the criteria for an initial 50 percent disability rating for the Veteran's headache disability is warranted prior to August 30, 2016. The Veteran reported he experienced a number of symptoms, including headaches that radiated to the entire head, nausea, and photophobia, during the period under consideration. He reported the symptoms could become so severe that he had to go to a dark room to lie down and take medication for relief. He also indicated the headaches could last about two to three hours and when he had headaches during work, he had to retire from the area until he experienced relief and could return. Moreover, the March 2008 VA examiner found the Veteran experienced frequent prostrating attacks of headache pain that severely impacted his ability to perform activities of daily living, such as chores, shopping, exercising, sports, recreation, and traveling. The evidence also shows he required special accommodations, such as being permitted a rest period, to continue working during the headache episodes. After resolving every reasonable doubt in his favor Veteran, the Board finds the competent and probative evidence summarized above shows the Veteran's headaches manifested in very frequent completely prostrating and prolonged attacks capable of producing severe economic inadaptability prior to August 30, 2016. He clearly suffered from very frequent prostrating attacks of headache pain, and the Board finds these attacks were capable of producing severe economic inadaptability as shown by how they disrupted his work and impacted his ability to perform the activities of daily living. Accordingly, a 50 percent disability rating under 38 C.F.R. § 4.124a, DC 8100 is warranted, and the appeal is granted. 2. Entitlement to a disability rating in excess of 10 percent for left foot callosities prior to March 7, 2023, and in excess of 30 percent thereafter. 3. Entitlement to a disability rating in excess of 10 percent for right foot callosities prior to March 7, 2023, and in excess of 30 percent thereafter. The Veteran is seeking increased initial ratings for his service-connected bilateral foot callosities. The callosities of the left and right feet are individually rated 10 percent disabling from September 5, 2007, to March 7, 2023, and 30 percent thereafter under 38 C.F.R. § 4.71, DC 5284. Under Diagnostic Code 5284, a 10 percent rating is assigned for moderate foot injury; a 20 percent rating is assigned for moderately severe foot injury; and a 30 percent rating is assigned for severe foot injury. 38 C.F.R. § 4.71a, Code 5284. A 40 percent evaluation, under this code is only assignable with actual loss of use of the foot. Words such as "moderate" and "severe" are not defined in Code 5284, or elsewhere in the rating schedule in a way that might be applicable to Code 5284. In the absence of an express definition, words are given their ordinary meaning. Prokarym v. McDonald, 27 Vet. App. 307, 310 (2015) (citing Terry v. Principi, 340 F.3d 1378, 1382-83 (Fed. Cir. 2003)). The ordinary meaning of "severe" is "very great [or] intense," or "of a great degree." Id. (quoting, respectively, the NEW OXFORD AMERICAN DICTIONARY 1599 (3d ed. 2010) and MERRIAM-WEBSTER DICTIONARY online (internal citation omitted)). The ordinary meaning of "moderate" is "average in amount, intensity, quality, or degree." Gallagher v. Wilkie, No. 19-1855, 2020 U.S. App. Claims LEXIS 1889 (2020) (quoting NEW OXFORD AMERICAN DICTIONARY 1124 (3d ed. 2010). In a nonprecedential decision, the Court observed that because the dictionary definitions of words such as "moderate" or "marked" disability "only denote comparative degree or severity, their substantive meanings vary depending on the DC in which they are used." Cross v. Wilkie, No. 19-7832, 2020 U.S. App. Vet. Claims LEXIS 2197 (2020). While not binding precedent, the Board finds that observation provides helpful guidance. The Board finds that the phrase "moderately severe" denotes a level of disability that is between being "average in amount, intensity, quality, or degree" and being "very great [or] intense," such that it does not more nearly approximate the lower or the higher level of disability. After review of the competent and probative evidence of record, the Board finds that initial 20 percent disability ratings, but no higher, are warranted for the left and right foot callosities prior to March 7, 2023. The Board finds disability ratings higher than 30 percent for the left and right foot callosities from March 7, 2023, onward are not warranted. Turning to the relevant and competent medical evidence, the Veteran was provided a VA foot examination in February 2008. He reported left forefeet pain while walking, standing, and at rest, heat while walking, stiffness while standing, and weakness and fatigability while standing and walking. Additionally, the Veteran reported right forefeet pain, swelling, heat, redness, stiffness, fatigability, weakness, and lack of endurance while walking and standing. Further, the Veteran reported weekly flare-ups that last from one to two days and cause "difficulty and almost impossible walking." Moreover, the Veteran reported he had pain after standing for 15 to 30 minutes and when walking more than a quarter mile, but less than one mile. The physical examination showed tenderness on the second and fifth metatarsal head on callosities and corns. However, the examination also showed normal gait and no objective evidence of painful motion, swelling, instability, weakness, abnormal weight bearing, hammertoes, hallux vagus or rigidus, pes cavus, malunion or nonunion, flatfoot, atrophy, or foot deformity. The examiner opined the bilateral callosities moderately affected the Veteran's ability to perform chores, shopping, and recreation activities, severely affected his ability to exercise, and prevented his ability to perform sports. An additional VA examination was provided in November 2018. The Veteran reported that he had new areas of pain and that the callosities caused gait modifications to avoid pain during ambulation. He reported he had flare-ups that caused sharp pain with limited capacity for high impact activities, such as jogging and running. The examination showed bilateral foot pain and additional factors that contribute to disability, such as pain with weightbearing, interference with standing, and lack of endurance. The Veteran reported using custom orthotics without relief. The examiner characterized the severity of the Veteran's callosities as moderate. With regard to the functional impact of the callosities, the examiner opined the Veteran would be limited to a sedentary job with no prolonged standing or ambulation activities. Another examination was afforded in August 2019. This examination appears to be related to a separate claim for bilateral plantar fasciitis. However, the examiner noted that the Veteran had bilateral callosities of the feet and indicated that they were of moderate severity. The Veteran's most recent VA foot examination was in March 2023. The Veteran reported multiple symptoms, including a limited ability to walk; a sharp, severe pain with weightbearing due to the callosities; and mild to moderate constant pain on the plantar surface of his forefeet. He reported mild to moderate daily flare-ups that last from one to two hours. The physical examination showed the Veteran had tenderness and pain with weightbearing. The examiner noted additional factors that contribute to disability, including pain, deformity, disturbance of locomotion, and lack of endurance. The examiner found the severity of the right foot callosities was mild and the severity of the left foot was moderate. With regard to functional impact, the examiner stated the Veteran's bilateral foot disability would adversely affect his ability to perform prolonged or strenuous weight bearing activities, such as running, prolonged standing and walking, and prolonged carrying of extra weight. VA treatment records from the period under consideration reference the Veteran's history of bilateral callosities pain but do not provide specifics regarding the severity of the left and right foot disabilities. Based on the totality of the evidence above, and after resolving any reasonable doubt in favor of the Veteran, the Board finds that the competent and probative evidence supports a finding that the Veteran's left and right foot callosities were moderately severe, or a level of disability that is between being "average in amount, intensity, quality, or degree" and being "very great [or] intense" prior to March 7, 2023. Accordingly, separate 20 percent disability ratings, but no higher, are warranted for the left and right callosities prior to March 7, 2023, under 38 C.F.R. § 4.71, DC 5284. In this regard, the evidence shows Veteran reported experiencing symptoms, such as "difficulty and almost impossible walking" with flare-ups and pain after standing for 15 to 30 minutes and when walking more than a quarter mile, but less than a mile. He also reported experiencing sharp pain; gait modifications to avoid pain during ambulation; and no relief from orthotics. The February 2008 VA examiner found the Veteran's bilateral callosities moderately affected his ability to perform chores, shopping, and recreation activities; severely affected his ability to exercise; and prevented him from playing sports. These findings denote a severity greater than "average in amount, intensity, quality, or degree." However, while the February 2008 VA examiner found the Veteran's left and right foot disabilities severely affected his ability to perform strenuous activities and prevented him from being able to play sports, the examiner also found the disabilities only moderately affected Veteran's ability to perform activities of daily living, such as chores, shopping, and recreation activities. Further, the November 2018 and August 2019 VA examiners characterized the severity of the left and right foot disabilities as moderate. The March 2023 VA examiner characterized the severity of the Veteran's right foot callosities as mild and the severity of left foot callosities as moderate. Moreover, although the evidence shows that the Veteran had a decreased ability to perform activities, it also shows he generally ambulated with a normal gait. See 2/27/2008 VA Examination; see also 5/6/2013 CAPRI, at page 116; 10/25/2016 CAPRI, at page 26; 11/29/2023 CAPRI at 81. These factors persuasively weigh against the left and right foot disabilities were "very great" or "intense" prior to March 7, 2023. Therefore, the Board finds the left and right foot disabilities do not more nearly approximate severe other foot injuries prior to March 7, 2023, particularly when weighed against the severity of the foot disabilities from that date. Accordingly, the criteria for disability ratings higher than 20 percent for the left and right foot callosities under DC 5284 are not met for the period prior to March 7, 2023. Based on the totality of the evidence above, the Board finds ratings in excess of 30 percent for each foot are not warranted from March 7, 2023. While the Veteran reported his walking was limited and that he experienced sharp, severe pain with weightbearing during the March 2023 VA examination, the evidence, including a July 2023 VA treatment record, shows he generally ambulated with a normal gait. The March 2023 examiner stated the Veteran's bilateral foot disability would adversely affect his ability to perform prolonged or strenuous weight bearing activities, such as running, prolonged standing and walking, and prolonged carrying of extra weight, but did not suggest the severity of the left and right foot disabilities amounted to the actual loss of use of either foot. The Veteran did not have amputation, was able to ambulate, and the evidence does not show the left and right foot disabilities were functionally the equivalent of actual loss of use of the foot. The Board has also considered whether any other Diagnostic Codes pertaining to the foot are applicable to ensure the bilateral foot symptomatology is captured. In this regard, other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017); See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) ("[W]hen a condition is specifically listed in the Schedule, it may not be rated by analogy."). However, the Board has conducted a thorough review of the evidence and finds that separate ratings under a different DC are not warranted. The competent and probative evidence does not show plantar fasciitis; flatfoot; weak foot; claw foot with all toes hammer toes; metatarsalgia; hallux valgus; hallux rigidus; hammer toe; or malunion or nonunion of tarsal, or metatarsal bones. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased disability rating for the Veteran's service-connected bilateral foot callosities is not warranted based on functional loss due to pain or weakness, as the Veteran's symptoms are supported by pathology consistent with 20 percent rating for the period prior to March 7, 2023, and the 30 percent rating, thereafter, assigned under DC 5284. As the Veteran is already in receipt of the highest allowable schedular ratings for his left and right foot disabilities absent actual loss of use of either foot, and his symptoms are adequately considered under Diagnostic Code 5284 for these disabilities, ratings in excess of 30 percent for the period from March 7, 2023, must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). REASONS FOR REMAND Entitlement to an initial disability rating higher than 10 percent for a cervical spine disability prior to November 13, 2018. In the November 2024 JMPR, the parties agreed the Board failed to consider whether a retrospective medical opinion regarding the range of motion of the Veteran's cervical spine during the period under consideration was required. In this regard, the Veteran's representative argued a retrospective medical opinion was required because the VA cervical spine examinations from before November 2018 did not provide range-of-motion testing results for active and passive motion and in both weight-bearing and non-weight-bearing modes. The Veteran's representative stated that "[a] retrospective opinion would cure the deficiencies for this period on appeal." In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims held the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. On review of the JMPR and because the previous VA examination reports do not fully satisfy the requirements of Correia and 38 C.F.R. § 4.59, the Board finds a remand to obtain a VA medical opinion is necessary This matter is REMANDED for the following action: Obtain an addendum opinion from a qualified medical professional to address the nature and severity of the symptoms associated with the Veteran's service-connected cervical spine disability between September 5, 2007, and November 13, 2018. The examiner should review the entire record (to include this remand, prior remands, post-service treatment records, and VA examination reports) and respond to the following: (a) Discuss the functional impact of the Veteran's service-connected cervical spine disability between September 5, 2007, and November 13, 2018. (b) Based on the evidence of record and to the extent possible, the examiner should provide range of motion estimates for the cervical spine (in both active and passive motion, in weight-bearing and non-weight-bearing, and during flare-ups) between September 5, 2007, and November 13, 2018, based on the evidence of record. If the examiner cannot estimate the degrees of additional range of motion loss on active and passive motion, and in weightbearing and non-weightbearing conditions without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). **THE REVIEWING CLINICIAN MAY NOT RELY SOLELY UPON HIS OR HER INABILITY TO PERSONALLY OBSERVE THE VETERAN ON ACTIVE AND PASSIVE MOTION, AND IN WEIGHTBEARING AND NON-WEIGHTBEARING CONDITIONS.** The examiner should consider and discuss as necessary whether there are any distinct periods when the Veteran's cervical spine symptomatology improved and/or worsened. If so, the examiner should indicate when the change in severity occurred and provide range-of-motion or severity estimates for each distinct period. The opinion provider must explain the rationale for all opinions in detail, citing to supporting clinical data as appropriate. William Skowronski Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.F. 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.