MULTIPLE MYELOMA

LESLEY A. REIN · 2026 · Case ID: 26004705

MIXED

Summary

The veteran, who served from September 1966 to March 1972, including service in Vietnam, appeals the denial of restoration of a 100 percent rating for monoclonal gammopathy of undetermined significance (MGUS), previously characterized as multiple myeloma, and seeks separate ratings for residuals of this condition. The veteran was initially assigned a 100 percent rating for multiple myeloma, which was later reduced to zero percent effective May 1, 2015, by the VA Regional Office. The veteran contends this reduction was improper and sought restoration of the 100 percent rating, arguing that his MGUS and its residuals, such as renal insufficiency and neuropathy, warranted separate evaluations. The Board reviewed extensive medical evidence, including opinions from oncologists and VA examiners, noting conflicting information regarding the progression and symptomatology of the veteran's condition. The Board found that the veteran's MGUS was not active or in a treatment phase at the time of the rating reduction, thus not meeting the criteria for the 100 percent rating. However, the Board acknowledged that residuals of the condition, specifically bilateral lower extremity neuropathy and renal insufficiency, were evident. The Board granted a 30 percent rating for right lower extremity neuropathy and a 30 percent rating for left lower extremity neuropathy, finding these conditions were evident since May 1, 2015. Furthermore, applying the benefit of the doubt doctrine, the Board granted service connection for renal insufficiency secondary to MGUS, finding it related to his service-connected hematologic disability.

Rationale

Veteran's MGUS was not active or in a treatment phase.; Criteria for 100 percent rating not met.; Benefit of the doubt doctrine not applicable for this claim.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

17-15 769

Full Decision Text

Citation Nr: 26004705
Decision Date: 04/17/26 Archive Date: 04/17/26

DOCKET NO. 17-15 769
DATE: April 17, 2026

ORDER

Entitlement to a restoration of a 100 percent rating for monoclonal gammopathy of undetermined significance (MGUS), previously characterized as multiple myeloma, is denied.

Entitlement to a 30 percent rating for right lower extremity (RLE) neuropathy from May 1, 2015 is granted.

Entitlement to a 30 percent rating for left lower extremity (LLE) neuropathy from May 1, 2015 is granted.

Entitlement to service connection for renal insufficiency secondary to MGUS is granted.

FINDINGS OF FACT

1. The Veteran has not had active multiple myeloma or been in a treatment phase for that disability since May 1, 2015, the effective date of the Agency of Original Jurisdiction's (AOJ's) reduction in the rating assigned that disability from 100 to zero percent, but he has been receiving treatment for complications of that disability.

2. LE neuropathy and renal insufficiency are complications of the Veteran's MGUS.

3. Significant RLE neuropathy has been evident since May 1, 2015, the effective date of the AOJ's reduction in the rating assigned the Veteran's multiple myeloma from 100 to zero percent.

4. Significant LLE neuropathy has been evident since May 1, 2015, the effective date of the AOJ's reduction in the rating assigned the Veteran's multiple myeloma from 100 to zero percent.

5. Resolving reasonable doubt in the Veteran's favor, renal insufficiency is related to the Veteran's MGUS.

CONCLUSIONS OF LAW

1. The criteria for entitlement to restoration of a 100 percent rating for MGUS, previously characterized as multiple myeloma, have not been met. 38 U.S.C.

§§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.13, 4.20, 4.117, Diagnostic Codes (DCs) 7799-7709 (prior to Dec. 9, 2018).

2. The criteria for entitlement to a 30 percent rating for RLE neuropathy from March 16, 2011 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.124a, DC 8521.

3. The criteria for entitlement to a 30 percent rating for LLE neuropathy from March 16, 2011 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.124a, DC 8521.

4. The criteria for entitlement to service connection for renal insufficiency secondary to MGUS have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R.

§§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1966 to March 1972, including in the Republic of Vietnam.

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a January 2015 Department of Veterans Affairs (VA) Regional Office rating decision recharacterizing the Veteran's multiple myeloma as MGUS and decreasing the 100 percent rating assigned that disability to zero percent effective May 1, 2015.

In January 2019, the Board denied the Veteran restoration of the 100 percent rating, and thereafter, the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In February 2020, based on a Joint Motion For Partial Remand (JMPR), the Court remanded this matter to the Board for action consistent with the terms of the JMPR.

The Board remanded this matter to the AOJ in July 2020, and in September 2022, it again denied restoration of the 100 percent rating. The Veteran then appealed the decision to the Court. In December 2023, based on a Joint Motion For Remand (JMR), the Court remanded the matter to the Board for action consistent with the terms of the JMR.

The Board in turn remanded this matter to the AOJ in April 2024 and January 2025.

Evaluation

Dis
In February 2020, based on a Joint Motion For Partial Remand (JMPR), the Court remanded this matter to the Board for action consistent with the terms of the JMPR.

The Board in turn remanded this matter to the AOJ in April 2024 and January 2025.

Evaluation

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (rating schedule). The percentage ratings represent average impairment of earning capacity. Individual disabilities are assigned separate DCs. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

A Veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). "Staged" ratings are appropriate when the factual findings show distinct time periods during which the service-connected disability manifests as symptoms warranting different ratings. See Hart v. Mansfield, 21 Vet. App. 505, 510 (2007). Where there is a question as to which of two ratings to assign, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Entitlement to restoration of a 100 percent rating for MGUS, previously characterized as multiple myeloma, from May 1, 2015

The Veteran is service connected for a hematologic system disability that has been variously diagnosed, including, in part, as multiple myeloma, smoldering multiple myeloma, and MGUS. For VA rating purposes, these diagnoses represent forms of multiple myeloma. See 38 C.F.R. § 4.117, DC 7712, Note (1) (current validated biomarkers of symptomatic multiple myeloma, asymptomatic, smoldering or MGUS are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma Working Group)) (effective Dec. 9, 2018). In January 2015, the AOJ decreased the rating assigned this disability from 100 to zero percent effective May 1, 2015.

The Veteran seeks restoration of the 100 percent rating effective "the date of the cancellation." He initially described his multiple myeloma as mild, indicating that it was under observation so that treatment could begin as soon as the condition became active. See May 2015 correspondence. In a June 2020 written statement, he claims that he was awarded a 100 percent rating on March 16, 2011 based on a multiple myeloma diagnosis rendered after a physical examination, lab tests, an

x-ray, and a PET scan had been conducted, and multiple physicians, including oncologists, and VA examiners were involved. When the AOJ reduced the rating to zero percent, it did not review his medical history, conduct a thorough physical examination, or determine his functional ability under 38 CFR 3.105(e). He appealed this improper reduction to the Court, which found that the Board needed a physician to review his medical history. The Veteran contends that any such review would demonstrate his rightful claim to the 100 percent rating retroactive to May 2, 2014. Referring to attached medical literature, he points out that VA has acknowledged that he has MGUS. There is an increased risk of MGUS in veterans like him who were exposed to Agent Orange. Agent Orange exposure worsens MGUS progression to multiple myeloma.

In December 2024 and February 2026 written statements, the Veteran asserts that regulations require the consideration of residuals of his multiple myeloma and MGUS and questions why these residuals, including in pertinent part, renal insufficiency and anemia, have not been separately evaluated. They are all documented by VA physicians.

The evidence persuasively weighs against restoring the 100 percent rating. The benefit of the doubt doctrine is therefore not for application in that case. 38 U.S.C. §
, he points out that VA has acknowledged that he has MGUS. There is an increased risk of MGUS in veterans like him who were exposed to Agent Orange. Agent Orange exposure worsens MGUS progression to multiple myeloma.

The evidence persuasively weighs against restoring the 100 percent rating. The benefit of the doubt doctrine is therefore not for application in that case. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). As asserted, however, the evidence supports separately service connecting/evaluating residuals of the Veteran's multiple myeloma/MGUS.

In January 2015, the AOJ decreased the 100 percent rating assigned the Veteran's multiple myeloma to zero percent pursuant to 38 C.F.R. § 4.117, DCs 7799-7709, by analogy to Hodgkin's lymphoma. At that time, multiple myeloma was not a listed condition in the rating schedule. See 38 C.F.R. § 4.20 (it is permissible to rate an unlisted condition under a closely related disease that is analogous in functions affected, anatomical localization, and symptomatology); 38 C.F.R. § 4.27 (when an unlisted disease is encountered, requiring rating by analogy, the DC number will be built up with the first two digits selected from that part of the rating schedule that most closely identifies the part or system of the body involved and the last two digits noted as "99", representing an unlisted condition).

Under DC 7709, a 100 percent rating is warranted for active disease or during a treatment phase. The 100 percent rating is to continue beyond the cessation of any surgical therapy, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any reduction in rating based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e). If there has been no local recurrence or metastasis, the disability is to be rated on residuals under the appropriate DC. 38 C.F.R. § 4.117, DC 7709.

The 100 percent rating is to continue for five years after the diagnosis of symptomatic multiple myeloma, at which time the appropriate disability evaluation shall be determined by mandatory VA examination. Any reduction in an evaluation based upon that or any subsequent examination shall be subject to the provisions of 38 C.F.R. § 3.105(e) and § 3.344(a) and (b). 38 C.F.R. § 4.117, DC 7712. Note (2) .

Effective December 9, 2018, VA amended the criteria for rating, in part, hematologic and lymphatic system disabilities, including under DC 7709, and these amendments added DC 7712, governing ratings of multiple myeloma. See Schedule for Rating Disabilities: The Hematologic and Lymphatic Systems, 83 Fed. Reg. 54,250, 54,255-56 (Oct. 29, 2018).

DC 7709 provides that a 100 percent rating is warranted for symptomatic multiple myeloma. A zero percent rating is warranted for asymptomatic multiple myeloma, smoldering multiple myeloma, or MGUS. See 38 C.F.R. § 4.117, DC 7712. As previously noted, smoldering multiple myeloma and MGUS represent forms of multiple myeloma. See 38 C.F.R. § 4.117, DC 7712, Note (1).

If a law or regulation changes during the claims process or an appeal period, the more favorable version will apply to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the amended 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 the amendments. If the former version is more favorable, VA may apply that version of the regulation for the periods prior to, and from, the effective date of the
1).

In this case, prior to December 9, 2018, DC 7709 controlled (multiple myeloma was not listed in the rating schedule), and it provided step by step instructions on how to rate the Veteran's multiple myeloma and its residuals. Any discontinuance of the 100 percent rating did not constitute a traditional rating reduction subject to 38 C.F.R. § 3.344. Instead, it was considered a change in the initial rating assigned the disability. Any discontinuance of the 100 percent rating, however, was subject to 38 C.F.R. § 3.105(e).

Under 38 C.F.R. § 3.105(e), where a reduction in the rating of a service-connected disability is considered warranted and the lower rating will result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action, furnished detailed reasons therefor, and given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. If additional evidence is not received, final rating action will be taken to reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice of the final action expires. 38 C.F.R. § 3.105(e).

In reducing the 100 percent rating in this case, the AOJ complied with these procedures, first notifying the Veteran in a February 2014 letter of the proposed reduction based on medical records noting some improvement in his multiple myeloma. The AOJ also informed the Veteran of his due process rights, indicated that no action would be taken on the proposed reduction for 60 days following the date of the notification letter, and advised the Veteran to provide evidence showing that the proposed reduction was not warranted. The Veteran responded by requesting an examination (weather interfered with the one that was initially scheduled), which the AOJ provided in December 2014. In January 2015, based on the examination findings and other evidence of record, the AOJ effectuated the proposed reduction from 100 to zero percent effective May 1, 2015.

The question that remains is whether, when the reduction occurred, the Veteran was entitled to a compensable rating for the multiple myeloma and/or separate ratings for residuals thereof.

The Veteran was initially service connected for multiple myeloma and assigned a 100 percent rating for that disability in June 2011 based on his inability to stand on his toes, tingling in his fingers and toes, and calf muscle atrophy and his oncologist's notation of two M-spikes and asymptomatic punched-out calvarium lesions and renal stones on testing. During an April 2011 VA hemic disorders examination, an examiner noted that, aside from peripheral neuropathy, the multiple myeloma was essentially in an asymptomatic stage. The examiner diagnosed smoldering multiple myeloma and explained that such a condition progresses very slowly and has little effect on the body. The Veteran then had no bone pain or symptoms associated with the punched-out calvarium lesions and renal stones, both of which "can come from multiple myeloma."

Medical evidence that was of record at that time shows that the Veteran reported neuropathy-related symptoms, including difficulty standing on his toes, progressive leg weakness and balance issues, during 2009 private treatment visits and a May 2010 VA knee examination. During the examination, an examiner recommended that he see a neurologist. In July 2010, he underwent testing for worsening renal function, and he reported "an old problem of weakness in his calf muscles". Testing revealed, in part, an elevated M spike and slowly progressing kidney disease.

DW, M.D., an oncologist, first examined the Veteran in September 2010 due to the peripheral neuropathy and M
, both of which "can come from multiple myeloma."

DW, M.D., an oncologist, first examined the Veteran in September 2010 due to the peripheral neuropathy and M-proteins on testing. A bone marrow biopsy was conducted the next month and showed a plasma cell clone with trisomy 13 and tetrasomy 11, which could indicate a hyperdiploid clone, later described as a significant kappa-predominant population, resulting in diagnoses of, in part, myeloma/MGUS and macrocytic anemia with no significant dysplasia. According to an April 2011 letter from Dr. DW, on follow up, no new symptomatology was shown. The Veteran had two M-proteins, one faint, a gamma fraction of 1.61, a few lucencies in the calvarium, and it was then unknown whether there was a relationship between the peripheral neuropathy and the "multiple myeloma with two M-spikes: IgG kappa."

During an April 2012 Hemic and Lymphatic Conditions examination, while the multiple myeloma was still rated 100 percent disabling, an examiner characterized the condition as active but not in a treatable spectrum. He referred to a serum protein test conducted the prior month, which showed an increased gamma fraction of 1.68 and kidney dysfunction. He indicated that the Veteran was under close observation for progression of his multiple myeloma and being monitored for any developmental changes "with initiation of chemotherapy upon threshold bridge." By that point, symptoms of the disease had manifested more profoundly in the lower extremities as significant neuropathy, tingling, muscle weakness and fatigue (worsening and developing globally), the loss of sensation of most of the foot, an inability to use the toes, balance issues and impacted muscle tone. He did not have anemia.

During a March 2013 oncology visit, the Veteran reported no pain. He had mild chronic renal insufficiency and his neuropathy was "a little worse since [his] diagnosis". Test results the Veteran brought to the visit showed a slightly increased M-spike and kappa light chains in his serum. A VA problem list indicated that there was no mention of his multiple myeloma having achieved remission. In October 2013, a nephrologist indicated that the Veteran was not receiving any treatment for his multiple myeloma but had mild chronic kidney disease with a 20-year history of elevated creatinine probably due to renal stone disease and some interstitial fibrosis in the renal parenchyma, not multiple myeloma. Shortly thereafter, a provider prescribed prednisone for the Veteran's leg pain and other providers noted that the Veteran had improved neuropathy. During a September 2014 Hematologic and Lymphatic Conditions examination, an examiner confirmed that the Veteran had weakness and easy fatigability but noted that the Veteran was not receiving treatment for his hematologic disability, was watchful and waiting, and had no anemia.

Since then, no provider/examiner has characterized the Veteran's hematologic system disability, whether diagnosed as multiple myeloma, including smoldering, or MGUS, as active or in a treatment phase, and the Veteran has not claimed that he has active, or is on treatment for, multiple myeloma. He claims that in 2010, his oncologist recommended Velcade, a proteasomes inhibitor, but he declined because of the neuropathy risk. See September 2014 Hematologic and Lymphatic Conditions examination report. He also claims that he receives treatment for other conditions related to his multiple myeloma, including peripheral neuropathy, kidney dysfunction, and anemia.

The Veteran did not have active multiple myeloma and was not in a treatment phase for this disability when, in January 2015, the AOJ reduced the rating assigned the disability from 100 to zero percent. The criteria that were then in effect for restoration of the 100 percent rating are therefore not met. 38 U.S.C.

§ 1155; 38 C.F.R. § 4.117, Diagnostic Codes (DCs) 7799-7709 (prior to Dec. 9, 2018).

Separate Ratings

As the Veteran asserts, when the January 2015 reduction
related to his multiple myeloma, including peripheral neuropathy, kidney dysfunction, and anemia.

§ 1155; 38 C.F.R. § 4.117, Diagnostic Codes (DCs) 7799-7709 (prior to Dec. 9, 2018).

Separate Ratings

As the Veteran asserts, when the January 2015 reduction occurred, there had not been any local recurrence or metastasis of the multiple myeloma, and as such, the AOJ should have rated residuals of that disability under the appropriate DCs. 38 C.F.R. § 4.117, DC 7709 (prior to Dec. 9, 2018). At the time, the Veteran did not have anemia, but he had LE neuropathy and kidney dysfunction, and the record conflicted regarding whether the neuropathy was related to his hematologic system disability. The AOJ has since service connected the Veteran for RLE and LLE neuropathy secondary to MGUS from June 18, 2025. As the bilateral LE neuropathy was evident in January 2015, the AOJ should have then developed the record further to determine whether the neuropathy and hematologic system disability were related.

The Veteran's neuropathy is currently rated under DC 8521, which governs ratings of the external popliteal nerve (common peroneal). This DC provides that a 10 percent rating is warranted for mild incomplete paralysis of that nerve. A 20 percent rating is warranted when there is moderate incomplete paralysis. A 30 percent rating is warranted for severe incomplete paralysis. A 40 percent rating requires complete paralysis of the external popliteal nerve (foot drop and slight droop of first phalanges of all toes, cannot dorsiflex the foot, extension of proximal phalanges of toes lost, abduction of foot lost, adduction weakened, anesthesia covers entire dorsum of foot and toes). 38 C.F.R. § 4.124a, DC 8521.

The words "mild," "moderate," and "severe" as used in the above DC is not defined in the rating schedule. The Board will thus consider the following dictionary definitions for guidance. "Mild" is "gentle in nature or behavior." "Moderate" is "tending toward the mean or average amount or dimension." "Severe" is "of a great degree." See www.merriam-webster.com/dictionary.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves."

As previously noted, in this case, the AOJ did not further develop this claim in January 2015; therefore, there is no medical opinion of record describing the severity of the Veteran's neuropathy in terms of the rating schedule. In April 2012, however, a provider described the Veteran's LE neuropathy as "significant", causing more than sensory symptoms, including muscle weakness and fatigue (worsening and developing globally), the loss of sensation of most of the foot, an inability to use the toes, balance issues and impacted muscle tone. In this context. the word "significant" more closely matches the meaning of "severe" ("of a great degree) than the meaning of "moderate" ("average amount").

Thereafter, the Veteran's neuropathy continued to worsen slightly despite the temporary and effective use of prednisone, but treatment providers and examiners never described it in a manner indicating that it was causing complete nerve paralysis. As significant/severe LLE and RLE neuropathy has been evident since May 1, 2015, the effective date of the AOJ's reduction in the rating assigned the Veteran's multiple myeloma from 100 to zero percent, the criteria for a 30 percent rating, but no higher, for neuropathy in each LE are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124, DC 8521.

Secondary Service Connection

The Veteran attributes his renal insufficiency to his service-connected hematologic system disability and claims that it should be separately rated as a
treatment providers and examiners never described it in a manner indicating that it was causing complete nerve paralysis. As significant/severe LLE and RLE neuropathy has been evident since May 1, 2015, the effective date of the AOJ's reduction in the rating assigned the Veteran's multiple myeloma from 100 to zero percent, the criteria for a 30 percent rating, but no higher, for neuropathy in each LE are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124, DC 8521.

Secondary Service Connection

The Veteran attributes his renal insufficiency to his service-connected hematologic system disability and claims that it should be separately rated as a residual of the disability.

There is positive and negative evidence of record on the matter of whether the renal insufficiency is related to the hematologic system disability. The benefit of the doubt doctrine is therefore applicable in this case. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th at 776.

Establishing service connection generally requires evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and

(3) a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may be granted on a secondary basis for a disability that is proximately due to, the result of, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

In this case, in October 2013, a nephrologist found that the Veteran's mild chronic kidney disease with a 20-year history of elevated creatinine was probably due to renal stone disease and some interstitial fibrosis in the renal parenchyma, not multiple myeloma. The AOJ did not initially develop this matter further despite the nephrologist's use of speculative language. Later, however, in January 2026, a VA examiner reviewed the file and determined that the Veteran's renal insufficiency is a complication of his MGUS. He based this finding on (i) a July 2010 note from KS, M.D., indicating that the Veteran had experienced a worsening of renal function most likely due to paraproteins and consistent with MGUS, and (ii) the Veteran's statements, which were consistent with symptoms with renal insufficiency brought about by MGUS.

When, like here, there is a balance of positive and negative evidence on a material matter that might prove or disprove a claim, reasonable doubt should be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board thus finds this evidence sufficient to establish that the Veteran's renal insufficiency is related to his MGUS. The criteria for entitlement to service connection for renal insufficiency on a secondary basis are thus met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310.

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. N.

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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