TINNITUS

AMANDA G. ALDERMAN · 2026 · Case ID: A26004390

MIXED

Summary

The veteran, who served in the Army National Guard from May 2013 to November 2024, including service in Operation Enduring Freedom and Djibouti, appeals the denial of an increased rating for tinnitus and an initial compensable rating for unspecified insomnia disorder. The veteran was previously awarded service connection for tinnitus at 10 percent. The Board found that tinnitus was already assigned the maximum schedular rating of 10 percent, denying an increased rating. For unspecified insomnia disorder, the Board reviewed the veteran's service treatment records and a November 2024 VA examination. While the VA examiner diagnosed unspecified insomnia disorder and provided a positive nexus opinion linking it to service-connected tinnitus, the Board found the veteran's symptoms, primarily mild and transient, did not meet the criteria for a 10 percent rating, thus denying an initial compensable rating. The Board remanded the claim for headaches secondary to tinnitus, as the VA examiner failed to provide an opinion on aggravation, constituting a duty to assist error. The Board noted that any evidence submitted after the AOJ decision could not be considered, but would be reviewed by the AOJ upon remand.

Rationale

Tinnitus already assigned maximum schedular rating of 10%; No legal basis for higher schedular evaluation; No extraschedular symptomatology reported

Service Branch

ARMY NATIONAL GUARD

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6260

Docket No.

250322-526317

Full Decision Text

Citation Nr: A26004390
Decision Date: 01/16/26 Archive Date: 01/16/26

DOCKET NO. 250322-526317
DATE: January 16, 2026

ORDER

Entitlement to evaluation in excess of 10 percent for tinnitus is denied.

Entitlement to a compensable initial evaluation for unspecified insomnia disorder is denied.

REMANDED

Entitlement to service connection for headaches (claimed as migraines) is remanded.

FINDINGS OF FACT

1. Tinnitus is currently assigned a 10 percent rating, which is the maximum schedular rating authorized for tinnitus under Diagnostic Code 6260.

2. Unspecified insomnia disorder has been formally diagnosed but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.87, Diagnostic Code 6260 (2018).

2. The criteria for an initial compensable disability rating for unspecified insomnia disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served active duty from February 2022 to June 2022 in support of Operation Enduring Freedom with additional National Guard service from May 2013. He continued service with National Guard in November 2024. See DD214s; See VBMS entry document type "DPRIS Response," receipt date 11/14/2023, pgs. 71, 192, 214; VBMS entry document type "VIS," receipt date 11/14/2023; VBMS entry document type "VA 21-526 Veterans Application for Compensation or Pension," receipt date 11/09/2024; VBMS entry document type "C&P Exam" (mental health), receipt date 11/29/2024, pg. 3.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO).

For background, the Veteran was awarded service connection for tinnitus with a disability rating of 10 percent from November 7, 2023. See May 2024 Rating decision. In November 2024, he filed a new claim for, among other issues not pertinent here, service connection for insomnia secondary to service-connected tinnitus. A VA examination for mental health conditions was conducted on November 26, 2024. The examiner diagnosed unspecified insomnia disorder and provided a positive nexus opinion linking insomnia to the Veteran's service-connected tinnitus.

In the March 2025 rating decision on appeal, the AOJ referred to the Veteran's November 2024 claim as a "supplemental claim" and considered a claim for increased evaluation for service-connected tinnitus. In the text of the decision, the AOJ assigned a separate disability rating for insomnia, of zero percent disabling based on the November 26, 2024 VA examiner's formal diagnosis of a mental condition with symptoms that are not severe enough either to interfere with occupational and social functioning or to require continuous medications. The AOJ recharacterized the disability as tinnitus with insomnia and denied an evaluation in excess of 10 percent.

The Board finds that the AOJ implicitly awarded service connection for unspecified insomnia disorder rated at zero percent in the March 2025 rating decision on appeal. See 38 C.F.R. § 4.125, 4.126, 4.130. Thus, the issue on appeal in this regard is an initial compensable rating for unspecified insomnia disorder.

In the March 2025 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 March 2025 agency of original jurisdiction (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
issue on appeal in this regard is an initial compensable rating for unspecified insomnia disorder.

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

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.

However, because the Board is remanding the claim of entitlement to service connection for headaches, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

The Board acknowledges the decision by the United States Court of Appeals for Veterans Claims (CAVC) in Williams v. McDonough, 37 Vet. App. 305. In Williams, the Court held the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). The deadline to request an AMA docket switch is 1 year from the date of notice of the AOJ decision or 60 days from the date the VA Form 10182 was received by the Board, whichever is later. Williams v. McDonough, 37 Vet. App. 305 (2024). The notice of the rating decision on appeal was mailed to the Veteran on March 17, 2025, and the Board received the Notice of Disagreement on March 22, 2025. Although less than one year has passed, in approximately two months the deadline will approach. The Veteran's representative submitted a brief in August 2025 and waived AOJ review of new evidence. In the interest of time and with consideration of the Veteran's representative waiver of AOJ review of new evidence, the Board will thus proceed to adjudicate the appeal at this time.

The Board thoroughly reviewed all evidence in the Veteran's file. In every decision, the Board must provide a statement of the reasons and bases for its determination, adequate to enable an appellant to understand the precise basis for the Board's decision, as well as to facilitate review by the Court. 38?U.S.C. §?7104(d)(1). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15?Vet. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

Increased ratings

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. § 4.1.

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the
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. § 4.1.

Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire appeal period from the initial assignment of the disability rating to the present time. While the veteran's entire history is reviewed when making a disability determination, where service connection has already been established an increase in the disability rating is at issue, it is the present level of disability that is the primary concern.

The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.

1. Entitlement to evaluation in excess of 10 percent for tinnitus is denied.

The Veteran challenges the AOJ's denial of an evaluation in excess of 10 percent for tinnitus with insomnia.

Turning to the evidence, the Veteran's tinnitus with insomnia is currently rated as 10 percent disabling from November 7, 2023, the date of his original claim, under Diagnostic Code 6260. See 38 C.F.R. § 4.87; November 2023 Fully Developed Claim; May 2024 Rating decision. Under Diagnostic Code 6260, a single 10 percent rating is warranted for tinnitus, regardless of whether it is unilateral or bilateral, or whether it is constant versus recurrent. 38 C.F.R. § 4.87.

The Veteran seeks an evaluation in excess of 10 percent for tinnitus, contending insomnia and headaches related to tinnitus. However, the issues of insomnia and headaches are discussed separately in this decision.

Tinnitus has been assigned the maximum schedular rating available for tinnitus under 38 C.F.R. § 4.87, Diagnostic Code 6260. As there is no legal basis upon which to award a higher schedular evaluation for tinnitus, an increased rating on a schedular basis is denied.

The Veteran has not reported any extraschedular symptomatology, other than headaches and insomnia, addressed separately in this decision. Thus, the Board finds contemplation of an extraschedular rating for tinnitus is not warranted.

For all the reasons discussed above, the weight of the probative evidence is against the claim for an increased evaluation. Accordingly, the benefit of the doubt doctrine is not for application, and the Veteran's claim for an evaluation in excess of 10 percent for tinnitus is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

2. Entitlement to an initial compensable evaluation for unspecified insomnia disorder is denied.

The Veteran challenged the initial noncompensable evaluation for unspecified insomnia disorder.

Turning to the evidence, the Board found in this decision that the AOJ had implicitly awarded service connection for unspecified insomnia disorder and had assigned a separate zero percent disability rating under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 201
Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 10 percent or higher.

The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 10 percent or higher. The Veteran's symptoms more closely approximated the symptoms associated with a zero percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a zero percent rating.

A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause 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 normal conversation).

A 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for 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; or memory loss for names of close relatives, own occupation or own name.

Turning to the evidence of record, the Veteran's National Guard service treatment records prior to the period on appeal and the November 2024 VA examination shows that the Veteran's unspecified insomnia disorder was manifested primarily by mild, transient symptoms.

Evidence prior to the period on appeal provides context and is discussed for that purpose. The Veteran's National Guard service treatment records include periodic medical assessments from April 2014 through June 2021 with no report of insomnia. See VBMS entry document type "STR," receipt date 04/15/2024, pgs. 25, 26, 36, 38, 41, 128, 130, 159, 183, 185, 313. In June 2021, the Veteran reported more than five and less than seven hours of sleep a night during the preceding two weeks and denied related impairment. Id. at 138. During a pre-deployment periodic health assessment in March 2022, the Veteran denied current medications or any mental health treatment. Id. at 43.

During a health assessment in March 2022 prior to his deployment to Djibouti, the Veteran endorsed only "noises in head or ears" or "trouble hearing." The provider noted no significant impairment. Id. at 43, 46, 49. The Veteran served
38, 41, 128, 130, 159, 183, 185, 313. In June 2021, the Veteran reported more than five and less than seven hours of sleep a night during the preceding two weeks and denied related impairment. Id. at 138. During a pre-deployment periodic health assessment in March 2022, the Veteran denied current medications or any mental health treatment. Id. at 43.

During a post-deployment periodic health assessment in June 2022, the Veteran denied frequent trouble sleeping, rated his health as "excellent" over the past month, reported sleeping seven to nine hours a day in the preceding two weeks, and denied related impairment. Id. at 54, 108; VBMS entry document type "JLV/MTF," receipt date 11/14/2023, pg. 4.

In February 2023, the Veteran reported that he had slept seven to nine hours on most days during the previous 2 weeks. He also reported impairment from sleepiness or poor-quality sleep. The Veteran also endorsed that he was on physical profile or limited duty for recurring muscle, joint, or low back pain; recurring migraines/headaches; and tinnitus. However, he also denied a current or temporary profile or limited duty and indicated he had not been placed on a temporary profile or temporary limited duty during the previous two years. The Veteran indicated that "bad sleep" had developed since his last periodic health assessment, denied any over-the-counter medications, including medications for sleep or pain, and that a VA claim for disability compensation was pending. Id. at 68-71, 72, 77, 79.

In April 2023, the Veteran denied any physical or mental concerns during his annual National Guard periodic health assessment and was found fit for duty. See VBMS entry document type "STR," receipt date 04/15/2024, pgs. 84, 92.

In November 2023, the Veteran contended bilateral tinnitus caused headaches and the need to use white noise to sleep. See VBMS entry document type "VA 21-4142, Authorization for Release of Information," receipt date 11/23/2023.

A line of duty determination was completed by National Guard unit commander, T.C.H. of the Florida Army National Guard, in May 2024 regarding a lower back injury. Details of the incident included, "Soldier was also exposed to loud machinery thus agitating his existing tinnitus causing headaches. In turn, headaches interfering with his sleep resulting in insomnia." See VBMS entry document type "Correspondence," receipt date 05/20/2024. There is no indication that the unit commander is a medical professional. Thus, the Board affords this opinion zero probative weight.

The Veteran was afforded a VA examination in November 2024 regarding a mental health condition. He reported his occupational history of becoming a deputy sheriff in 2016 and that he continued as a sheriff and a National Guard member at the time of the November 2024 VA examination. See VBMS entry document type "C&P Exam" (mental health), receipt date 11/29/2024, pg. 3. The examiner diagnosed unspecified insomnia disorder with chronic sleep impairment as the only reported symptom.

Evidence in the claims file reflects the Veteran has not received any care from a VA facility. See VBMS entry document type "CAPRI," receipt date 11/22/204. The claims file contains no private medical records nor are any such records identified in the claims file.

Based on the evidence on appeal, the Board concludes that the Veteran's symptoms of unspecified insomnia disorder did not cause the level of impairment required for a disability rating of 10 percent or higher. The evidence of record shows the Veteran developed sleep issues after June 2022 and in November 2023 needed white noise to facilitate sleep with tinnitus. The Veteran continued his usual civilian occupation as a sheriff and service with the National Guard throughout the period on appeal without any reports or evidence that his unspecified insomnia disorder impacted his occupational or social functioning. The Veteran's symptoms more closely approximated the symptoms associated with a zero percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a zero percent rating.

For all the reasons discussed above, the weight of the probative evidence is against the claim for an increased evaluation. Accordingly, the benefit of
of impairment required for a disability rating of 10 percent or higher. The evidence of record shows the Veteran developed sleep issues after June 2022 and in November 2023 needed white noise to facilitate sleep with tinnitus. The Veteran continued his usual civilian occupation as a sheriff and service with the National Guard throughout the period on appeal without any reports or evidence that his unspecified insomnia disorder impacted his occupational or social functioning. The Veteran's symptoms more closely approximated the symptoms associated with a zero percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a zero percent rating.

For all the reasons discussed above, the weight of the probative evidence is against the claim for an increased evaluation. Accordingly, the benefit of the doubt doctrine is not for application, and the Veteran's claim for an initial compensable evaluation for unspecified insomnia disorder is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

Entitlement to service connection for headaches (claimed as migraines) is denied.

The Veteran contends "constant ringing" from tinnitus causes extreme headaches a few times a week during which he is unable to function. See VBMS entry document type "VA 21-526 Veterans Application for Compensation or Pension," receipt date 11/09/2024.

The Veteran was afforded a VA examination in November 2024 regarding his claim for headaches secondary to service-connected tinnitus. The examiner provided a negative medical opinion for secondary service connection of headaches related to tinnitus but failed to provide an opinion on aggravation. See Spicer v. McDonough, 61 F.4th 1360, 1364-65 (Fed. Cir. 2023); El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (a medical opinion is inadequate when it fails to adequately address the question of aggravation).

The Board finds the AOJ's failure to obtain a medical opinion on aggravation of the Veteran's headaches by his service-connected tinnitus was a pre-decisional duty to assist error and remand is necessary. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802(a).

The matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding the Veteran's headaches. A physical examination is not necessary as a diagnosis has been obtained. The examiner should review the claims file, including a copy of this remand.

The examiner should be informed that the Veteran believes his headaches are related to his service-connected tinnitus.

To assist in a review of the claims file, the examiner is informed of the following facts with citation to the record, when applicable:

National Guard service treatment records April 2014 through June 2021 include periodic medical assessments with no report of headaches. See VBMS entry document type "STR," receipt date 04/15/2024, pgs. 25, 26, 36, 38, 41, 128, 130, 159, 183, 185, 313.

Pre-deployment health assessment in March 2022 included the Veteran's endorsement of "noises in head or ears" or "trouble hearing." The provider noted no significant impairment. Id. at 43, 46, 49.

The Veteran served in Djibouti from May 21, 2022, to May 31, 2022.

During post-deployment health assessment on June 1, 2022, the Veteran denied any injury or healthcare visits during his deployment. Id. at 53-55, 108.

In a February 2023 National Guard periodic health assessment, the Veteran endorsed physical profile or limited duty for recurring muscle, joint, or low back pain; recurring migraines/headaches; and tinnitus. However, he also denied a current or temporary profile or limited duty and indicated he had not been placed on a temporary profile or temporary limited duty during the previous two years. Id. at 68-71.

In April 2023, the Veteran denied any physical or mental concerns during his annual National Guard periodic health assessment and was found fit for duty. Id. at 84, 92.

After reviewing the file, the examiner is asked to answer the following questions based upon the evidence of record and sound medical principles:

(a) Is the Veteran's headache disability caused by his service-connected tinnitus? Please state what facts, medical principles
. at 68-71.

In April 2023, the Veteran denied any physical or mental concerns during his annual National Guard periodic health assessment and was found fit for duty. Id. at 84, 92.

After reviewing the file, the examiner is asked to answer the following questions based upon the evidence of record and sound medical principles:

(a) Is the Veteran's headache disability caused by his service-connected tinnitus? Please state what facts, medical principles, and/or medical literature support the opinion.

(b) If the answer to (a) is negative, the examiner is asked if the Veteran's headaches are aggravated by service-connected tinnitus? Aggravation is different from causation in that it did not cause the disability but rather caused an increase in severity of the disability. Please state what facts, medical principles, and/or medical literature support the opinion.

(c) If the examiner finds that the service-connected tinnitus aggravates the Veteran's headaches, the examiner is asked to state whether there is medical evidence created prior to the aggravation or at any time between the time of aggravation and the current level of disability that shows a baseline for the headaches prior to aggravation. If the examiner is unable to establish a baseline for the headaches prior to the aggravation, he or she should state such and explain why a baseline cannot be determined.

A full rationale must be provided for all medical opinions given. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s).

AMANDA G. ALDERMAN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Spears, Elizabeth

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.

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