HIP IMPAIRMENT OF

J. NICHOLS · 2025 · Case ID: A25084263

MIXED

Summary

The Veteran, an Army Veteran who served from October 2001 to September 2002, appeals the denial of service connection for tension headaches and an increased rating for left knee strain. The Veteran also sought service connection for a left hip strain. The Board granted service connection for the left hip strain, finding that while service treatment records only noted a single instance of hip pain during service, the Veteran's current hip strain was diagnosed by VA examiners and the Board afforded the Veteran the benefit of the doubt, finding the hip condition related to the in-service injury. Service connection for tension headaches was denied, both directly and secondarily. The Board found the evidence weighed against direct service connection, noting the Veteran's inconsistent reporting of headaches and lack of in-service complaints. For secondary connection, the Board found the evidence against a link between the headaches and the service-connected lumbosacral strain, as VA opinions indicated the headaches were more likely related to non-service-connected sleep apnea. The claim for an increased rating for left knee strain was also denied. While the Veteran had a 10 percent rating for left knee strain, the Board found the evidence did not support a higher rating based on the range of motion limitations or functional loss due to pain, as the most limited flexion was 90 degrees, which did not meet the criteria for a higher rating under Diagnostic Code 5260.

Rationale

Service treatment records show in-service hip pain after August 2001 road march.; VA examinations diagnosed left hip strain.; Benefit of the doubt applied due to in-service onset and current diagnosis.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5260

Docket No.

220627-254130

Full Decision Text

Citation Nr: A25084263
Decision Date: 09/30/25 Archive Date: 09/30/25

DOCKET NO. 220627-254130
DATE: September 30, 2025

ORDER

Entitlement to service connection for left hip strain is granted.

Entitlement to service connection for tension headaches, including as secondary to sleep apnea and lumbosacral strain, is denied.

Entitlement to a higher initial rating for left knee strain (limitation of flexion), which is currently rated 10 percent disabling, is denied.

FINDINGS OF FACT

1. The evidence is at least in approximate balance that the left hip strain was caused by the August 2001 in-service injury to the left hip.

2. The evidence is against a finding that the Veteran's tension headaches were caused by or onset during service, or that they are caused or aggravated by a service-connected disability.

3. At its most limited, the Veteran's left knee flexion is limited to 90 degrees with fatigability but no instability, weakness, or other factors of disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for left hip strain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304.

2. The criteria for service connection for tension headaches, as secondary to sleep apnea and lumbosacral strain have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310.

3. The criteria for an initial rating higher than 10 percent for left knee strain (limitation of flexion) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Army from October 2001 to September 2002, with additional service in the U.S. Army Reserve.

These matters are before the Board of Veterans' Appeals (Board) on appeal from December 2021 and May 2022 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In June 2022, the Veteran filed a VA Form 10182 and selected the Evidence Submission docket. Accordingly, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the VA Form 10182, Notice of Disagreement. 38 C.F.R. § 20.303.

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 claim, considering the new evidence in addition to the evidence previously considered.

1. Entitlement to service connection for left hip strain

The Veteran contends that he has a left hip strain which warrants service connection on a direct or secondary basis. See VA 21-526EZ, Fully Developed Claim, March 1, 2021.

Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first 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).

Secondary service connection may be granted 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(a). Establishing service connection on a secondary basis requires evidence of (1)
disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first 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).

Secondary service connection may be granted 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(a). Establishing service connection on a secondary basis requires evidence of (1) a current disability for which service connection is sought; (2) an already service-connected disability; and (3) that the disability for which service connection is sought was either (a) caused or (b) aggravated by the already service-connected disability. 38 C.F.R. § 3.310(a), (b).

Turning to the evidence, service treatment records show that the Veteran reported left hip pain and low back pain after a road march during active duty service in August 2001. He was given 800mg Motrin and light duty. There is no other evidence of complaints, diagnoses, or treatment for the left hip in the service treatment records.

In April 2021, VA completed a Disability Benefits Questionnaire (DBQ) for Hip and Thigh Conditions. Based on an in-person examination and review of the VA e-folder, the examiner diagnosed a left hip strain. The Veteran was uncertain when hip symptoms began but said that his low back injury was in 2001. At the time of this examination, his symptoms included sharp left hip pain and pain when walking.

The April 2021 examiner also prepared a medical opinion for VA. He concluded that the left hip strain was less likely than not due to or the result of a service-connected condition. The rationale for this conclusion was "evidence shows that both the low back and hip were documented as being injured during road march on 08/18/2001."

VA treatment records show that the Veteran was undergoing physical therapy at the time. During an April 2021 physical therapy treatment, the Veteran wore a knee sleeve brace and said that he had swelling of the knee and pain on bending it (4 to 7 on a scale of 10). On testing, he had active flexion to 90 degrees with pain in the hip, and passive flexion to 120 degrees. His gait was antalgic. The examiner diagnosed rectus femoris restriction. By the end of the session, the Veteran was able to flex the left knee to 130 degrees with no pain.

VA obtained a new examination in May 2022. After an in-person examination and review of the VA e-folder, the examiner again diagnosed a left hip strain. The Veteran said that his hip symptoms began during his active duty service in 2001, after falling from a truck and injuring his lower back. He reported attending physical therapy for the hip and using diclofenac, Tylenol, ice packs, gel, stretching, and massages for pain relief.

The May 2022 examiner prepared a medical opinion for secondary service connection. He opined that the left hip condition was less likely than not caused by the Veteran's service connected lumbosacral strain. The rationale noted the in-service report of hip pain in August 2001, but found "[t]he two conditions are not medically related. The claimed disorder is a separate entity from the service-connected condition and unrelated to it. Veteran's left hip condition may have occurred around the same time as the lower back condition per c-file exam however, there is no medical literature to support a medical relationship."

Turning to the criteria for direct service connection, the Veteran has been diagnosed with a left hip strain in the April 2021 and May 2022 VA examinations. Service treatment records show that he injured his left hip during active duty service in August 2001. Therefore, the first two requirements for direct service connection have been met. See 38 C.F.R. § 3.303(a); Saunders, supra.

Turning to the third requirement for direct service connection, the Board notes that while the two VA medical opinions addressed secondary service connection, there is no opinion as to whether the August 2001 injury caused the present left hip strain. However, service treatment records reflect that the left hip symptoms onset during service after the same injury which caused his service-connected back disability. Affording the Veteran the benefit of the doubt, direct service connection is warranted for the left hip strain. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir
2001. Therefore, the first two requirements for direct service connection have been met. See 38 C.F.R. § 3.303(a); Saunders, supra.

Turning to the third requirement for direct service connection, the Board notes that while the two VA medical opinions addressed secondary service connection, there is no opinion as to whether the August 2001 injury caused the present left hip strain. However, service treatment records reflect that the left hip symptoms onset during service after the same injury which caused his service-connected back disability. Affording the Veteran the benefit of the doubt, direct service connection is warranted for the left hip strain. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021), affirmed en banc (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

2. Entitlement to service connection for tension headaches, including as secondary to sleep apnea and lumbosacral strain

The Veteran also appeals the December 2021 rating decision denying service connection for tension headaches, including as secondary to sleep apnea and lumbosacral strain. In the VA 21-526EZ, Fully Developed Claim (Compensation) filed on March 1, 2021, the Veteran requested service connection for "headaches secondary to sleep apnea and neck/back." An April 2021 statement to a VA examiner also raised the issue of direct service connection, and the Board will address both.

Turning to the evidence, some of the service treatment records could not be located. See VA Memo, April 6, 2016 ("Unfortunately, no records were located for this Veteran at the RMC"). The service treatment records in evidence reveal no complaint, diagnosis, or treatment for headaches during service.

In a November 2003 Report of Medical History, from a period of reserve duty after the Veteran's active duty service, the Veteran stated that he did not have frequent or severe headaches. See STR - Reserve STR, January 12, 2017, p5-6.

VA treatment records show that the Veteran denied having headaches in April 2017, February 2018, November 2018, April 2019, July 2019, August 2019, December 2019, and February 2020. See CAPRI, July 10, 2020, p191, 176, 148, 72, 38, 29, 12, 6.

In March 2021, the Veteran submitted an unsigned, undated statement from an unidentified person which opined that the Veteran's headaches were caused by an in-service fall in 2000. The document states "sometimes these symptoms can lay dormant for some time and then manifest later." See Medical Treatment Record - Non-Government Facility, March 1, 2021.

In April 2021, VA completed a Disability Benefits Questionnaire for Headaches. Based on an in-person examination and review of the VA e-folder, the examiner diagnosed tension headaches. The Veteran said that the headaches began in 2001, while he was in active duty service, and he said that they were caused by sleep apnea. He reported constant headache pain, pulsating or throbbing, on both sides of his head. Additional symptoms included nausea. The headache attacks lasted less than one day.

The April 2021 VA examiner also prepared a medical opinion. The opinion concluded that the headaches were less likely than not proximately due to or the result of back pain. The rationale was that four progress notes showed reports of headaches and improvement from January to December 2017, and that the Veteran's headaches were caused by his diagnosed obstructive sleep apnea. The examiner also stated, "There is no medical research that can also link a history of lumbosacral strain to symptom such as headache."

Before turning to the criteria for service connection, the Board notes that in the June 2022 VA Form 10182, the Veteran argued that VA had relied on an inadequate examination in denying service connection. The brief did not state why the examination was inadequate. As explained below, the April 2021 examination and medical opinion were adequate for VA purposes.

As the Veteran originally requested secondary service connection, the Board will address that theory first. The Veteran has a diagnosis of tension headaches from the April 2021 VA examination. His lumbosacral strain disability is service-connected - however his obstructive sleep apnea is not. Therefore, the first two requirements of service connection have been met. See 38 C.F.R. § 3.310.

The evidence is against a finding that the diagnosed tension headaches are caused or aggravated by the service connected lumbosacral strain. The
denying service connection. The brief did not state why the examination was inadequate. As explained below, the April 2021 examination and medical opinion were adequate for VA purposes.

The evidence is against a finding that the diagnosed tension headaches are caused or aggravated by the service connected lumbosacral strain. The April 2021 medical opinion concluded that the tension headaches were caused by obstructive sleep apnea (which is not service-connected), and were less likely than not caused by his back pain. It then stated that there was no medical research that could link tension headaches with a history of lumbosacral strain. The opinion is based on an examination of the Veteran and his medical history, it is supported by a rationale, and it cites medical research. There is no lay or medical evidence indicating otherwise. Therefore, the preponderance of the evidence is against a finding that the tension headaches are caused or aggravated by his service-connected lumbosacral strain, and secondary service connection has not been established. 38 C.F.R. § 3.310.

Turning to direct service connection (which was raised in the Veteran's statement to the examiner in April 2021), the Veteran has a current disability as diagnosed in the April 2021 DBQ. The first requirement is met. See Saunders, supra.

However, the evidence is against a finding that the headaches onset during service. The Veteran told the April 2021 examiner that his headaches began in 2001, during active duty service. However, in the November 2003 Report of Medical History, the Veteran denied having frequent or severe headaches. He also denied having headaches in VA treatment records in April 2017, February 2018, November 2018, April 2019, July 2019, August 2019, December 2019, and February 2020. See CAPRI, July 10, 2020, p191, 176, 148, 72, 38, 29, 12, 6. The Board finds that the Veteran's statements in his November 2003 Report of Medical History and his statements to VA personnel that he did not have headaches during his visits in 2017, 2018, 2019, and 2020 hold more probative value than his April 2021 statement to the examiner because they were closer in time to the period in question. As a result, the evidence is against a finding that the current headaches onset during the Veteran's active duty service.

The Board acknowledges the letter received in March 2021 and the opinion stated therein. However, this letter lacks any probative value as there is no indication who wrote it and whether they have any medical knowledge sufficient to provide a medical opinion - or indeed any personal observations. Therefore, the evidence is against a finding that the Veteran's current tension headaches were caused by or onset during his active duty service, and direct service connection has not been established. See Saunders, supra.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted. Rather, the evidence persuasively weighs against it. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021), affirmed en banc (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

3. Entitlement to a higher initial rating for left knee strain (limitation of flexion), which is currently rated 10 percent disabling

The Veteran contends that his service-connected left knee strain warrants an initial rating higher than 10 percent.

An April 2021 rating decision granted service connection for left knee strain with an initial rating of 10 percent. The Veteran filed a request for a higher level review and, in December 2021, a Higher Level Review Rating Decision denied a higher rating. The Veteran then appealed the rating to the Board by filing a VA Form 10182 in June 2022. He has continually appealed the initial rating decision since it was issued; therefore, the initial rating is on appeal before the Board. See 38 C.F.R. § 3.2500(h).

Disability
which is currently rated 10 percent disabling

The Veteran contends that his service-connected left knee strain warrants an initial rating higher than 10 percent.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14.

However, a veteran may be entitled to a higher disability evaluation than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes "additional functional loss i.e., 'the inability...to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and endurance' including as due to pain and/or other factors" or "reduction of a joint's normal excursion of movement in different planes, including changes in the joint's range of movement, strength, fatigability, or coordination." Lyles v. Shulkin, 29 Vet. App. 107, 117-18 (2017) (quoting 38 C.F.R. § 4.40 and citing 38 C.F.R. § 4.45); Mitchell v. Shinseki, 25 Vet. App. 32, 36-37 (2011); DeLuca v. Brown, 8 Vet. App. 202, 205-07 (1995).

The intent of the rating schedule is to recognize painful motion with joint and periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59.

The Veteran's left knee strain has been rated according to Diagnostic Code 5260. Under Diagnostic Code 5260, a noncompensable rating will be assigned for limitation of flexion of the knee to 60 degrees, a 10 percent rating will be assigned for limitation of flexion of the knee to 45 degrees, a 20 percent rating will be assigned for limitation of flexion of the knee to 30 degrees, and a 30 percent rating will be assigned for limitation of flexion of the knee to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

The VA General Counsel held that a knee disability may receive separate ratings under diagnostic codes evaluating instability (Code 5257) and those evaluating range of motion (Codes 5003, 5010, 5256, 5260, and 5261). See VAOPGCPREC 23-97. Additionally, the General Counsel held that separate ratings under Code 5260 (limitation of flexion of a knee) and Code 5261 (limitation of extension of a knee) may be assigned for disability of the same joint. See VAOPGCPREC 9-2004.

Turning to the evidence, VA completed a DBQ for knee and lower leg disabilities in April 2021. Based on an in-person examination and review of the VA e-folder, the examiner diagnosed a
Code 5257) and those evaluating range of motion (Codes 5003, 5010, 5256, 5260, and 5261). See VAOPGCPREC 23-97. Additionally, the General Counsel held that separate ratings under Code 5260 (limitation of flexion of a knee) and Code 5261 (limitation of extension of a knee) may be assigned for disability of the same joint. See VAOPGCPREC 9-2004.

Turning to the evidence, VA completed a DBQ for knee and lower leg disabilities in April 2021. Based on an in-person examination and review of the VA e-folder, the examiner diagnosed a left knee strain. Symptoms at the time of this examination included sharp left knee pain and pain with walking. The Veteran said that for relief, he used ice, Tylenol, diclofenac, and rest. In terms of functional impairment, the Veteran was unable to run for longer than 10 minutes, and he could not walk or stand for more than 30 minutes. Initial range of motion testing showed flexion limited to 100 degrees (compared to a normal 140 degrees); extension was a normal 0 degrees, with pain on both movements. Passive range of motion testing was the same as active. There was evidence of pain on weight-bearing, active motion, and passive motion, and it caused the functional loss described above (the Veteran could not run for longer than 10 minutes, or walk or stand for more than 30 minutes.) There was no evidence of crepitus but there was slight (2/10) tenderness on the anterior knee. After three repetitions, the flexion was further reduced to 95 degrees; extension was unchanged at 0 degrees. Additional factors of impairment included pain and fatigability. There was no further change with repeated use over time. During flare ups, the Veteran reported that he had pain and fatigability, and left knee extension was further limited to only 90 degrees. There were no additional factors of disability; there was no muscle atrophy, ankylosis, or joint instability. The Veteran did not have a meniscal condition, tibial or fibular impairment, and no history of knee surgery. The Veteran used a left knee brace at all times.

The Veteran was also undergoing physical therapy treatment at a VA facility at this time. At a physical therapy session on April 13, 2021, the Veteran wore a knee sleeve brace and said that he had swelling of the knee and pain on bending it (4 to 7 on a scale of 10). On testing, he had active flexion to 90 degrees with pain in the hip, and passive flexion to 120 degrees. His gait was antalgic. The examiner diagnosed rectus femoris restriction. By the end of the session, the Veteran was able to flex the left knee to 130 degrees with no pain.

Applying the rating criteria for Diagnostic Code 5260, the evidence is against a finding that the Veteran has limitation of flexion of the knee to 30 or 15 degrees which would warrant a 20 or 30 percent rating. At its most limited, the Veteran's flexion was limited to 90 degrees. Therefore, the rating criteria do not call for a higher rating. 38 C.F.R. § 4.71a.

The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, increased evaluations for the Veteran's left knee flexion are not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran's symptoms are supported by pathology consistent with the assigned evaluations, and no higher. In this regard, the Board observes that the Veteran complained of pain and difficulty with prolonged standing and walking throughout the appeal period. However, the effect of the pain and disturbance of locomotion on the Veteran's left knee is already contemplated in the assigned rating. The Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation beyond the evaluation already assigned.

The Board has also considered whether the Veteran is entitled to a separate rating for recurrent subluxation, lateral instability, or patellar instability under the version of Diagnostic Code 5257 in effect since February 7, 2021. However, in both examinations, joint stability testing was normal. Thus, a separate rating is not warranted under Diagnostic Code 5257.

A separate rating is also not warranted under Diagnostic Code 525
otion on the Veteran's left knee is already contemplated in the assigned rating. The Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an increased evaluation beyond the evaluation already assigned.

A separate rating is also not warranted under Diagnostic Code 5258 or 5259 or 5261 as the April 2021 VA examination report found there was no evidence of a meniscus condition or limitation of extension of the knee.

The Board has also considered whether a higher or separate evaluation is warranted under any other diagnostic code. However, as the evidence of record does not demonstrate that the Veteran has ankylosis, impairment of the tibia and fibula, MTSS or shin splints, or genu recurvatum, he is not entitled to higher evaluations under Diagnostic Codes 5256 (ankylosis), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum). There is simply no evidence of such manifestations. Indeed, based on the aforementioned range of motion findings, the record shows that the Veteran's left knee is not fixated or immobile. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, surgical procedure." Lewis v. Derwinski, 3 Vet. App. 259 (1992) (internal medical dictionary citation omitted). Moreover, the April 2021 VA examiner specifically reported that the Veteran had no ankylosis of the left knee. In addition, the examiner indicated that the Veteran did not have recurrent patellar dislocation, shin splints, or any other tibial and/or fibular impairments. Therefore, separate or higher evaluations are not warranted under Diagnostic Codes 5256, 5262, and 5263.

The brief filed with the VA Form 10182 in June 2022 contended that the rating decision was silent about additional functional loss during the Veteran's flare ups and did not address the functional impairment in the Veteran's daily life. The Board notes that the April 2021 examination indicates that during flare ups, flexion was limited to 90 degrees. The evidence also indicates that the functional impairment caused by the left knee prevented the Veteran from running longer than 10 minutes, or walking or standing for more than 30 minutes. This level of functional impairment is not more nearly approximated by leg flexion limited to 30 degrees which would make running altogether impossible.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether an initial rating higher than 10 percent is warranted. Rather, the evidence persuasively weighs against it. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021), affirmed en banc (only when

the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Dean, Robert

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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