HEARING LOSS

SONJA S. AN · 2022 · Case ID: A22018445

DENIED

Summary

The veteran, who served from June 1966 to June 1969, including service in Korea, appeals the denial of service connection for bilateral hearing loss, tinnitus, a right arm condition, a right shoulder condition, diabetes mellitus type II, and hypertension. The veteran alleged hearing loss and tinnitus were due to in-service noise exposure, and that diabetes and hypertension were due to Agent Orange exposure. The Board found a current disability for hearing loss and tinnitus, and noted in-service complaints of right arm pain, but ultimately denied service connection for all conditions. For hearing loss and tinnitus, the Board found the service treatment records silent for complaints and that the separation examination showed no significant shift in hearing, despite the veteran's claims of noise exposure. The Board afforded low probative value to an early VA exam due to inconsistencies but gave significant weight to a later VA exam that found less likelihood of service connection, citing the lack of a 4000 Hz shift and the Veteran's post-service employment. For the shoulder/arm condition, the Board found the in-service complaints and later lay statements credible and corroborated by STRs, but ultimately denied service connection due to the negative separation examination findings and the later VA examiner's opinion that it was less likely than not related to service. For diabetes and hypertension, the Board found current diagnoses but no in-service complaints or treatment, and noted the Veteran's service in Korea predated the presumptive period for Agent Orange exposure. The Board also found the Veteran's claims of exposure and the alternative theory of canned meat causation to be uncorroborated. The Board denied all claims.

Rationale

Current disability found; STRs silent for complaints; Separation exam showed no significant shift; Later VA exam found less likelihood of service connection

Special Benefit

NO SPECIAL BENEFIT

Docket No.

191115-61409

Full Decision Text

Citation Nr: A22018445
Decision Date: 09/12/22 Archive Date: 09/12/22

DOCKET NO. 191115-61409
DATE: September 12, 2022

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for a right arm condition is denied.

Entitlement to service connection for a right shoulder condition is denied.

Entitlement to service connection for diabetes mellitus type II, to include as due to Agent Orange exposure, is denied.

Entitlement to service connection for hypertension, to include as due to Agent Orange exposure, is denied.

FINDINGS OF FACT

1. The competent and credible evidence of record persuasively establishes a finding that the bilateral hearing loss and tinnitus are not related to active-duty service.

2. The competent and credible evidence of record persuasively establishes a finding that the shoulder strain is not related to active-duty service.

3. The competent and credible evidence of record persuasively establishes a finding that the Veteran serviced on active duty in Korea, but is not presumed to have been exposed to Agent Orange.

4. The competent and credible evidence of record persuasively establishes a finding that the diabetes and hypertension are not related to active-duty service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

3. The criteria for entitlement to service connection for a shoulder or arm condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for entitlement to diabetes mellitus type II was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309.

5. The criteria for entitlement to hypertension was not incurred in or aggravated by service and may not be presumed related to service. 38 U.S.C. §§ 1110, 1111, 1131, 1132, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1966 to June 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO).

In the November 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. A February 2022 notification advised them that a hearing was scheduled for May 11, 2022. The Veteran did not appear for the scheduled Board hearing. Therefore, the Board may only consider the evidence of record at the time of the September 2019 Statement of the Case, as well as any evidence submitted by the Veteran or their representative within 90 days following the date of the scheduled hearing. 38 C.F.R. § 20.302(c).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be
C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

1. Entitlement to service connection for bilateral hearing loss

2. Entitlement to service connection for tinnitus

The Veteran alleges that the hearing loss and tinnitus are due to in service noise exposure.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). A March 2018 VA examination found diagnoses of sensorineural hearing loss and tinnitus. Accordingly, the first element of service connection is met.

Second, the Board finds that there was an in-service event. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's service treatment records (STRs) are silent for any complaints of or treatment for hearing loss or tinnitus, and the Veteran specifically denied any such issues at the separation examination in April 1969.

The threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 159 (1993). However, for the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

At the March 1966 entrance examination, audiometric testing results showed the Veteran's auditory thresholds at the frequencies of 500, 1000, 2000, 3000, and 4000 hertz were 5, 0, 10, unspecified, and 35 decibels respectively in the right ear, and 0, 0, 15, unspecified, and 45 decibels respectively in the left ear. At the April 1969 separation examination, audiometric testing results showed the Veteran's auditory thresholds at 500, 1000, 2000, 3000, 4000, and 6000 hertz were 5, 0, 15, 40, 40, and 55 respectively in the right ear, and -5, -5, 25, 55, 50, 55 respectively in the left ear. A second test showed the thresholds were 0, -10, 20, 30, 50, and 35 in respectively the right ear, and -5, -10, 20, 30, 50, and 35 respectively in the left ear.

The Veteran has asserted that the hearing loss and tinnitus are due to in-service noise exposure. In a March 2015 statement, they reported that they were a heavy transport truck operator while in Korea, that they were attached to an infantry, armor/tanks, and artillery out in the field in combat ready operations where they conducted alerts, exercises, and maneuvers firing missions on and by the Korean Demilitarized Zone (DMZ). They explained that the heavy transport trucks were very loud. At the March 2015 VA examination, the Veteran reported exposure to tanks, diesel engines, Howitzers, guns, and rocket fire without hearing protection. The Veteran's DD-214 indicates that their MOS was a heavy vehicle driver. The Board finds these statements competent as they are capable of lay observation. 38 U.S.C. § 1154(a); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). The Board finds these statements to be credible as they are corroborated by the military personnel records. Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does not support a finding that the hearing loss and tinnitus are related to active service.

The examiner in March 2015 was unable to provide an etiology of the hearing loss or tinnitus due to inconsistencies of the Veteran's responses without resorting to speculation. They explained that the Veteran was able to have a conversation at a normal level with and without facing them the majority of the time, but when speech recognition was tested, the Veteran was unable to repeat the words, stating that they could not hear the examiner speaking. The examiner terminated testing due to the inconsistencies seen between speech recognition and puretone audiometry. The examiner did note that hearing loss was seen bilaterally prior to service; however, the Board notes that the entrance examination did not indicate any results for 6000 hertz, but the separation examination did. Accordingly, the Board affords this opinion low probative value.

The Veteran underwent another VA examination in March 2018 where the examiner provided negative nexus opinions.

Regarding the hearing loss, the examiner noted the mild hearing loss at 4000 hertz at enlistment, but that at discharge there was no significant shift in hearing at comparable measured frequencies. They acknowledged that at discharge there was moderate hearing loss at 6000 hertz, but opined that it is less likely than not that the hearing was affected by military noise exposure because of the lack of a shift at 4000 hertz during service. They explained that noise-induced hearing loss is usually greatest at 4000 hertz, where it is the most affected. The examiner stated that it is more likely that the Veteran enlisted with loss at 4000 hertz, and also had lost at 6000 hertz. They explained that a shift at 4000 hertz would have been noted before affecting 6000 hertz. The examiner also noted that the Veteran worked at a chemical plant with Exxon for 25 years following service, and that they have suffered significant hearing loss bilaterally since service. Therefore, the examiner opined that it is less likely than not that the hearing was
military noise exposure because of the lack of a shift at 4000 hertz during service. They explained that noise-induced hearing loss is usually greatest at 4000 hertz, where it is the most affected. The examiner stated that it is more likely that the Veteran enlisted with loss at 4000 hertz, and also had lost at 6000 hertz. They explained that a shift at 4000 hertz would have been noted before affecting 6000 hertz. The examiner also noted that the Veteran worked at a chemical plant with Exxon for 25 years following service, and that they have suffered significant hearing loss bilaterally since service. Therefore, the examiner opined that it is less likely than not that the hearing was affected by military service noise exposure.

Regarding the tinnitus, the examiner noted that there were no complaints of tinnitus in service. They explained that there was no significant shift in hearing at comparable frequencies during service, and the Veteran actually reported that the onset of tinnitus was several years ago without a specific causal event. Therefore, the examiner opined that it is less likely than not that the tinnitus was related to military noise exposure.

The Board affords theses opinions significant probative value as they were made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran, and are supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board accepts that the Veteran is competent to report symptoms and treatment. However, they are not competent to on the etiology of these conditions. The etiology of symptoms is a complex medical question beyond the knowledge of a layperson. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board has also considered whether presumptive service connection can be established where there is evidence of continuity of symptomology of a chronic condition since service. See 38 C.F.R. § 3.309. However, the record of evidence does not show that service aggravated any existing hearing loss during service, or a diagnosis of tinnitus until many years following separation from active service. Therefore, consideration based on presumptive service connection for continuity of symptomatology is not warranted.

In the case of a Veteran who engaged in combat with the enemy during active service during a period of war, VA will accept lay evidence of in-service incurrence of a disease or injury, if the lay evidence of onset is consistent with the circumstances, conditions, or hardships of the Veteran's service, notwithstanding the lack of documentation of this in-service incurrence. See 38 U.S.C. § 1154(b). However, here, while the Veteran engaged in drills in Korea, they do not assert, nor does the record suggest, that they serviced in combat, so service connection based on the combat presumption is also not warranted. See 38 C.F.R. § 1154(b).

Accordingly, service connection is denied.

In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the evidence is persuasively against the claim and the positive and negative evidence is not in approximate balance, the doctrine is not for application. Lynch v. McDonough, No. 2020-2067, 2021 U.S. App. LEXIS 37307, at *10 (Fed. Cir. Dec. 17, 2021).

3. Entitlement to service connection for a right arm condition

4. Entitlement to service connection for a right shoulder condition

The Veteran alleges that the right shoulder/arm condition began during service, has existed since that time, and is related to an in-service baseball injury.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). During a March 2015 VA examination of the shoulder and arm, the examiner found a diagnosis of right shoulder strain. Accordingly, the first element of service connection is met.

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). May 1967 STRs show the Veteran's complaints of right arm pain after heavy exercise. The examiner found no loss of range of motion in the arm, gave the Veteran some pain medication, and recommended that they refrain from playing softball for some time. The Veteran returned a week later reporting that they could not sleep at night due to tenderness over the biceps muscle. The examiner noted that the Veteran was fit for duty. At separation from service, the Veteran specifically denied any history of broken arms, arthritis or rheumatism, bone, joint or other deformity, lameness, loss of arm, leg, finger, or toe, and painful or trick shoulder or elbow. The corresponding report of medical examination found the Veteran's condition to be normal.

In a March 2015 statement, the Veteran reported that they participated in team sports while in Korea, that they threw their right arm and shoulder out of the joint, and that they were treated at the medical clinic. At the March 2015 VA examination, they explained that while playing baseball in Korea, they threw their arm out while training and throwing fast balls. They asserted that the doctor placed their arm in a sling for 2 to 3 months, and that they eventually began having trouble sleeping due to the pain. At a February 2018 Decision Review Officer (DRO) hearing, the Veteran reported that while playing baseball in Korea, they threw the ball so hard that his arm broke loose, and that he could not sleep due to the pain after.

The Board finds these statements competent as they are capable of lay observation. 38 U.S.C. § 1154(a); Washington, 19 Vet. App. at 368 (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). The Board finds these statements regarding the throwing injury to be credible as they are corroborated by the STRs. Caluza, 7 Vet. App. at 511 (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Third, the Board finds that the evidence of record does not support a finding that the shoulder strain is related to active service.

The March 2015 examiner provided a negative nexus opinion, explaining that there is insufficient evidence to support the contention that the in-service complaints of right arm shoulder pain persisted to the present. They stressed that the separation examination had negative findings or complaints of any right arm or shoulder condition. Therefore, the examiner found it less likely than not that the shoulder strain is related to service.

The Board affords this opinion significant probative value as it was made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran, and is supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board accepts that the Veteran is competent to report symptoms and treatment. However, they are not competent to on the etiology of the condition. The etiology of symptoms is a complex medical question beyond the knowledge of a layperson. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board has also considered whether presumptive service connection can be established where there is evidence of continuity of symptomology of a chronic condition since service. See 38 C.F.R. § 3.309. However, the record of evidence does not show a diagnosis until many years following separation from active service. Therefore, consideration based on presumptive service connection for continuity of symptomatology is not warranted.

Accordingly, service connection is denied.

In reaching this decision the Board considered the doctrine of reasonable doubt, however, as
medical question beyond the knowledge of a layperson. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board has also considered whether presumptive service connection can be established where there is evidence of continuity of symptomology of a chronic condition since service. See 38 C.F.R. § 3.309. However, the record of evidence does not show a diagnosis until many years following separation from active service. Therefore, consideration based on presumptive service connection for continuity of symptomatology is not warranted.

Accordingly, service connection is denied.

5. Entitlement to service connection for diabetes mellitus type II, to include as due to Agent Orange exposure

6. Entitlement to service connection for hypertension, to include as due to Agent Orange exposure

The Veteran alleges that the diabetes and hypertension are due to in-service Agent Orange exposure.

Veterans who, during active military, naval, or air service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 CFR § 3.307(a)(6)(iv).

For Veterans presumed to have been exposed to herbicides, certain enumerated diseases, including diabetes mellitus type II, shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e).

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). October 2014 private treatment records indicate diagnoses of hypertension and diabetes. Accordingly, the first element of service connection is met.

Second, the Board finds that there was not an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's STRs are silent for any complaints of or treatment for diabetes or hypertension. At the April 1969 separation examination, the Veteran specifically denied any high or low blood pressure, and the corresponding report of medical examination listed the Veteran's condition to be normal with a blood pressure at 124/72. In a March 2015 statement, the Veteran asserted that the diabetes and hypertension are due to Agent Orange exposure while in Korea.

While the Veteran's military personnel records confirm that the Veteran was in Korea from October 1966 to November 1967, this is before the period where Veteran's stationed near the DMZ are presumed to have been exposed to Agent Orange. A November 2014 VA Memorandum regarding a formal finding on a lack of information required to verify service connection to Agent Orange noted that a letter was sent to the Veteran in October 2014 requesting further information from the Veteran regarding the reported exposure. As the Veteran did not reply to this letter, a finding was made that exposure to herbicides could not be conceded.

The Board finds these statements competent as they are capable of lay observation. 38 U.S.C. § 1154(a); Washington, 19 Vet. App. at 368 (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). However, they are not corroborated by the evidence of record. Caluza, 7 Vet. App. at 511 (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996).

At the February 2018 DRO hearing,
be conceded.

The Board finds these statements competent as they are capable of lay observation. 38 U.S.C. § 1154(a); Washington, 19 Vet. App. at 368 (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). However, they are not corroborated by the evidence of record. Caluza, 7 Vet. App. at 511 (noting that the credibility of a witness may be impeached by a showing of interest, bias, inconsistent statements, consistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996).

At the February 2018 DRO hearing, the Veteran raised an alternate theory of entitlement that the hypertension and diabetes were related to eating canned meat in service. However, they provided no other information in support of this contention.

Here, the RO did not provide the Veteran with any examination to evaluate the hypertension or diabetes. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology).

However, the Board finds that remanding for a VA examination is not warranted at present. The STRs are silent for a diagnosis of or treatment for hypertension or diabetes, including during the Veteran's separation examination. As the Veteran reported numerous other ailments during service, and diabetes and hypertension are the type of condition that a reasonable person would report while in the military with access to healthcare, if the Veteran was experiencing problems with these issues during service, the Board would expect that they would have reported these problems to medical professionals, as they did with their other complaints. And the Veteran's vague assertion that eating canned meat during service caused these conditions, without citing to any supporting documentation, provides no basis for which service connection on a direct basis could possibly be granted.

The Board accepts that the Veteran is competent to report symptoms and treatment. However, they are not competent to on the etiology of the conditions. The etiology of symptoms is a complex medical question beyond the knowledge of a layperson. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

The Board has also considered whether presumptive service connection can be established where there is evidence of continuity of symptomology of a chronic condition since service. See 38 C.F.R. § 3.309. However, the record of evidence does not show diagnoses until many years following separation from active service. Therefore, consideration based on presumptive service connection for continuity of symptomatology is not warranted.

Accordingly, the claims of entitlement to service connection for hypertension and diabetes are denied.

SONJA S. AN

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Rogos

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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