CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

L. B. CRYAN · 2025 · Case ID: A25108287

DENIED

Summary

The veteran, who served in the U.S. Navy from November 1964 to August 1975, including service in Vietnam, appeals the denial of service connection for Chronic Obstructive Pulmonary Disease (COPD) and stage 3 chronic kidney disease. The veteran contended that COPD was due to in-service exposure to toxins, and chronic kidney disease was secondary to his service-connected hypertension. The Board acknowledged favorable findings from the Regional Office regarding a current COPD diagnosis, a conceded toxic exposure risk activity (TERA) due to presumed herbicide exposure and high probability of asbestos exposure, and a current diagnosis of stage 3 chronic kidney disease secondary to service-connected hypertension. However, the Board found the evidence weighed against service connection for COPD, noting the lack of in-service complaints or treatment, post-service treatment only starting in 2015, and conflicting statements regarding smoking cessation. While a VA examiner initially opined COPD was at least as likely as not due to TERA/asbestos, a subsequent VA opinion concluded it was due to smoking, which the Board found more persuasive. For chronic kidney disease, the Board noted the lack of in-service complaints or treatment, with the first diagnosis occurring in 2005. A VA examiner opined the kidney disease was less likely than not due to hypertension or TERAs, a conclusion the Board found persuasive. Service connection for both COPD and chronic kidney disease was denied.

Rationale

Lack of in-service complaints or treatment for COPD; Post-service treatment began in 2015; Conflicting statements regarding smoking history; Subsequent VA opinion attributing COPD to smoking was more persuasive than initial TERA/asbestos opinion

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250722-560838

Full Decision Text

Citation Nr: A25108287
Decision Date: 12/16/25 Archive Date: 12/16/25

DOCKET NO. 250722-560838
DATE: December 16, 2025

ORDER

Service connection for chronic obstructive pulmonary disease (COPD) is denied.

Service connection for chronic kidney disease stage 3, to include as secondary to hypertension, is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran's COPD was incurred in service or that it is otherwise related to an in-service event, injury, or disease, to include participation in a toxic exposure risk activity (TERA).

2. The evidence of record persuasively weighs against finding that the Veteran's stage 3 chronic kidney disease began during his active service or within the first post-service year, that it was caused or aggravated by his service-connected hypertension, or that it is otherwise related to an in-service event, injury, or disease, to include participation in a TERA.

CONCLUSIONS OF LAW

1. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1110, 1112 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for chronic kidney disease stage 3, including as secondary to hypertension, have not been met. 38 U.S.C. §§ 1110, 1112 1131, 5107; 38 C.F.R. §§ 3.102, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United Staes Navy from November 1964 to August 1975.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which is an agency of original jurisdiction (AOJ). The February 2025 rating decision denied service connection for COPD and stage 3 chronic kidney disease.

In a July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran disagreed with the denial of service connection for COPD and chronic kidney disease; he also elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2025 decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the Notice of Disagreement (NOD). 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the NOD, or (2) more than 90 days following the date the Board received the NOD, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Notably, in the present case, evidence was submitted with the Veteran's July 2025 NOD. However, evidence was added to the claims file in June 2025, during a period of time when new evidence was not allowed (the period after the AOJ issued the decision on appeal and prior to the date the Board received the NOD); and as such, the ineligible evidence was not considered in this decision. See 38 C.F.R. §§ 20.300, 20.301, 20.801.

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.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in
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.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Service connection for certain chronic diseases, including calculi of the kidney, bladder, or gallbladder, may be established based upon a legal "presumption" by showing that the disease manifested to the required degree within the applicable time period as specified in 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a). The option of establishing service connection through a demonstration of continuity of symptomatology rather than through a finding of nexus is specifically limited to the chronic disabilities listed in 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established on a presumptive basis for certain diseases, if a veteran was exposed to an herbicide agent during active military, naval, or air service. A veteran will be presumed to have been exposed to an herbicide agent during such service, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service, if the veteran served (a) in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; (b) from April 1, 1968, through August 31, 1971, in or near the Korean Demilitarized Zone (DMZ); (c) in Thailand at any United States or Royal Thai base from January 9, 1962 through June 30, 1976, without regard to where on the base the veteran was located or what military job specialty the veteran performed; in (d) Laos during the period beginning on December 1, 1965, and ending on September 30, 1969; (e) in Cambodia at Mimot or Krek, Kampong Cham Province from April 16, 1969 through April 30, 1969; or (f) in Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980, or served on Johnston Atoll or on a ship that called at Johnston Atoll during the period beginning on January 1, 1972, and ending on September 30, 1977. 38 U.S.C. § 1116(c)-(d); 38 C.F.R. § 3.307(a)(6)(iii).

For veterans who are entitled to the presumption of in-service herbicide exposure due to such covered active military, naval, or air service, there is a presumption of service connection for certain diseases enumerated under 38 C.F.R. § 3.309(e), provided that the disease manifested to a degree of 10 percent at any time after service. 38 C.F.R. § 3.307(a)(6)(ii); 38 C.F.R. § 3.309(e).

However, even when a veteran is not entitled to the presumption of service connection, he or she may nonetheless establish service connection with proof of actual direct causation. See generally Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

In determining whether service connection may be granted, a review of the entire evidence of record is warranted. 38 C.F.R. § 3.303(a).

Where there is an "approximate balance" of positive and negative evidence to support a claim, the claimant will receive the "benefit of the doubt". Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

1. Entitlement to service connection for COPD

The Veteran seeks service connection for COPD, which he generally contends is the result of "in-service exposure to toxins."
. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

In determining whether service connection may be granted, a review of the entire evidence of record is warranted. 38 C.F.R. § 3.303(a).

1. Entitlement to service connection for COPD

The Veteran seeks service connection for COPD, which he generally contends is the result of "in-service exposure to toxins." See June 2024 VA Form 21-526EZ, Fully Developed Claim (Compensation); see also July 2025 NOD.

VA's Adjudication Procedures Manual (M21-1) provides general guidelines for determining the probability of a Navy veteran's exposure to asbestos based on the veteran's military occupational specialty (MOS). See M21-1, Part VIII, Subpart iii, Ch.7, C.1.b., Use of Navy MOS to Determine Probability of In-Service Asbestos Exposure.

As an initial matter, the AOJ made a favorable finding in the February 2025 AOJ decision on appeal that the Veteran was diagnosed with a current COPD disability based on an August 2024 VA medical examination report. The AOJ also conceded in-service participation in a toxic exposure risk activity (TERA) due to the Veteran's presumed in-service exposure to herbicides and his high probability for in-service exposure to asbestos based on his military occupational specialty (MOS) of Fire Control Radar Technician. See M21-1, Part VIII, Subpart iii, Ch.7, C.1.b. Notably, the Veteran's service personnel records confirm he served in Da Nang Harbor in the Republic of Vietnam in September of 1967. See also August 2024 VA memorandum to the file (indicating herbicide exposure is recognized due to the Veteran's nautical service in or on: "the Republic of Vietnam's inland waterways," "one or more of the approved Republic of Vietnam bays or harbors," and "the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23." As such, the Board is bound by the AOJ's favorable finding absent evidence of a clear and unmistakable error in the finding. 38 C.F.R. § 3.104. Accordingly, the remaining questions are whether the Veteran's COPD began during his active service or whether it is otherwise related to an in-service event, injury, or disease, such as his in-service TERAs.

Turning to the evidence of record, the Veteran's service treatment records do not contain any in-service diagnoses of or treatment for COPD. Similarly, a review of the Veteran's August 1975 discharge examination report did not reveal any abnormalities with his chest or lungs.

The Veteran's post-service records do not contain any complaints or treatment for COPD until January 2015. Specifically, the Veteran's January 2015 private pulmonary function testing revealed results that were consistent with a diagnosis of COPD. It was also noted that the Veteran had a 30-year smoking history but that he quit smoking in 1998. See also May 2021 private pre-operative telephone appointment visit (TAV) note (showing the Veteran's quit smoking April 15, 1998). In August 2018, following a private adult and family medicine office visit, during which the Veteran sought treatment for upper respiratory infection symptoms, the Veteran was diagnosed with acute exacerbation of his COPD. COPD was also formally added to the Veteran's problem list based on his January 2015 pulmonary function testing.

Curiously an August 2018 private emergency department note suggests the Veteran quit smoking on May 3, 1996, and a September 2022 private telephone appointment visit note indicates the Veteran only smoked one pack per day for 20 years. However, an April 2021 private surgery office visit note indicates that the Veteran is a former smoker who smoked one pack per day for 35 years and quit smoking on April 15, 1998.

The Veteran underwent a VA medical examination in connection with his claim in August 2024, during which the Veteran reported that his COPD began approximately 10 years prior (although he was unsure of the exact date of onset). As noted above, the August 2024 VA examiner diagnosed the Veteran with COPD. The VA examiner also diagnosed the Veteran with benign respiratory neoplasms, noting that an April 2018 private computed tomography (CT)
Veteran only smoked one pack per day for 20 years. However, an April 2021 private surgery office visit note indicates that the Veteran is a former smoker who smoked one pack per day for 35 years and quit smoking on April 15, 1998.

The Veteran underwent a VA medical examination in connection with his claim in August 2024, during which the Veteran reported that his COPD began approximately 10 years prior (although he was unsure of the exact date of onset). As noted above, the August 2024 VA examiner diagnosed the Veteran with COPD. The VA examiner also diagnosed the Veteran with benign respiratory neoplasms, noting that an April 2018 private computed tomography (CT) scan of the Veteran's chest showed "several pulmonary nodules." The VA examiner further noted that the Veteran had a high probability of in-service asbestos exposure.

The August 2024 VA examiner opined that the Veteran's COPD was at least as likely as not due to his in-service TERA(s) after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic, combined effect of all of the Veteran's TERAs. As a rationale, the VA examiner explained that inhaling "foreign fumes or substances can cause COPD" and that "these irritants are often inhaled in the workplace." The VA examiner also explained that "workers who inhale chemical, dust, and fumes are at risk for developing COPD," as several studies have shown "a statistically significant incidence of COPD among those exposed to toxic materials such as asbestos and silica." The VA examiner further explained,

[a] 2020 study published in Environmental Research and Public Health reported a marginal association between COPD and asbestos exposure among insulators. Researchers stated asbestos may cause airflow limitation in the presence of other substances, vapors, gases, and dust. The study also found that chest infections were significantly associated with asbestos exposure.

Based on the above rationale, the August 2024 VA examiner concluded that the Veteran's COPD was at least as likely as not caused by in-service exposure to asbestos after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic, combined effect of all of the Veteran's TERAs.

Curiously, the August 2024 VA medical opinion did not address the Veteran's risk factors for developing COPD, such as smoking one pack per day for at least 20 years, nor did the VA examiner address the fact that the Veteran did not have a current diagnosis of asbestosis or mesothelioma despite having a high likelihood of having been exposed to asbestos in service.

The AOJ obtained an additional VA opinion in November 2024, which addressed the Veteran's risk factors of developing COPD based on his relevant medical history. Following a review of the Veteran's medical records, the November 2024 VA examiner opined that the Veterans COPD was due to smoking. As a rationale, the November 2024 VA examiner explained that studies show smoking is a "major and common" risk factor for developing COPD. The VA examiner also noted that the Veteran reported his COPD began in approximately 2024, but he was unaware of the exact onset date.

In July 2025 the Veteran submitted a December 2013 Board decision along with his July 2025 NOD. The December 2013 Board decision is not probative with respect to the dispositive issues in the present case as it does not discuss the specific facts of this Veteran's case, nor any of the disabilities that are presently on appeal. In July 2025, the Veteran also submitted a December 2018 article titled "Occupational Exposure to Vapor, Gas, Dust, and Fumes, and Emphysema and Small Airways Disease: A New Role for Imaging with Computed Tomography," which suggests, "occupational exposure to vapor, gas, dust, and fumes [is] linked to a higher degree of emphysema and a greater proportion of small airways disease." However, the December 2018 article is of no probative value with respect to whether the Veteran has service-related COPD because the article does not address whether the Veteran in the present case has COPD that was caused by or related to his active service.

Based on the foregoing, the evidence of record persuasively weighs against finding that the Veteran's COPD was incurred in service or that it is otherwise related to an in-service event, injury, or disease, to include participation in a TERA. At the outset, the Veteran has not asserted, and the evidence does not otherwise show that the Veteran's COPD began during his active service. Notably, the Veteran's service treatment records lack any complaints of, or treatment for COPD and his post-service records do not show that he was treated for COPD prior to January 2015. Furthermore, the Veteran reported during the August 2024 VA medical examination that his COPD began approximately 10 years prior to the examination. As such, the evidence of record does not show that the Veteran's COPD began during his active service. Similarly, the evidence of record persuasively weighs against finding that the Veteran's COPD is related to his active service. While both the August 2024 and November 2024 VA medical opinions adequately address the likely etiology of the Veteran's COPD, the November 2024 VA medical opinion is more persuasive as it addresses the Veteran's risk factors for developing COPD. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Stefl, 21 Vet. App. at 123 ("An opinion is adequate where it is based upon consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one") (internal citations omitted); Nieves-Rodriguez v. Peake, 22 Vet. App. at 301 ("A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two") (internal citations omitted). Furthermore, despite the November 2024 VA medical opinion's brevity, it specifically considers the Veteran's primary risk factor for developing COPD, his 30 pack-year smoking history, and indicates that all of the evidence of record had been reviewed. See Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement). As discussed above, even though the Veteran has a high probability of in-service asbestos exposure, the August 2024 VA medical opinion heavily relies on correlative evidence rather than weighing the Veteran's medical history against his probable asbestos exposure. In contrast, the November 2024 VA medical opinion contains a well-reasoned rationale that is based on review of all of the competent evidence of record. In this regard, the November 2024 VA medical opinion is highly probative and persuasive.

Lastly, while the Veteran generally asserts his COPD was caused by in-service exposure to toxins, he is not competent to opine on the likely etiology of his COPD, as such a determination is medically complex, requiring knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing, such that it is outside the competence of the Veteran, who has not been shown to possess the medical training or credentials to make such determinations. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011).

Thus, for the reasons set forth above, the evidence of record persuasively weighs against finding that the Veteran's COPD was incurred in service or that it is otherwise related to an in-service event, injury, or disease, to include participation in a TERA. Accordingly, service connection for COPD is not warranted and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107; Lynch, 21 F.4th at 781.

2. Service connection for chronic kidney disease stage 3, including as secondary to hypertension,

The Veteran seeks service connection for stage 3 chronic kidney disease, which he asserts he was diagnosed with due to his service-connected hypertension. See November 2024 VA Form 21-526EZ; see also July 2025 NOD.

Even when a veteran is not entitled to the presumption of service connection, he or she may nonetheless establish service connection based with proof of actual direct causation. See generally Combee v. Brown, 34 F.3
and the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107; Lynch, 21 F.4th at 781.

2. Service connection for chronic kidney disease stage 3, including as secondary to hypertension,

As an initial matter, the AOJ made additional favorable findings in the February 2025 decision on appeal that the Veteran was currently diagnosed with stage 3 chronic kidney disease based on a December 2024 VA medical examination report and that the Veteran's claimed primary disability of hypertension is service-connected. The Board is bound by the AOJ's favorable finding. 38 C.F.R. § 3.104. Accordingly, the remaining questions are whether the Veteran's chronic kidney disease (i) began during the Veteran's active service or within the first post-service year; (ii) is etiologically related to his active service; or (iii) was caused or aggravated by his service-connected hypertension.

A review of the Veteran's service treatment records did not reveal any complaints or treatment for a kidney disease or injury in service.

Post-service medical records show the Veteran was first diagnosed with nephrolithiasis in April 2005 when he was treated for a ureteral stone. See private emergency room note. A November 2011 private internal medicine note shows the Veteran was treated for recurrent kidney stones and diagnosed with calculus of the kidney at that time. A February 2015 private adult medicine record shows the Veteran was diagnosed with stage 2 chronic kidney disease based on his urinalysis results. The Veteran was ultimately diagnosed with stage 3 chronic kidney disease in February 2024.

The Veteran was provided with a VA medical opinion in connection with his claim in December 2024, following which his diagnosis of chronic kidney disease, stage 3, was confirmed. The VA examiner opined that the Veteran's chronic kidney disease was not etiologically related to his service-connected hypertension. In support of the opinion, the VA examiner explained that "there is no pathological or etiological correlation or evidence in the medical records provided establishing a nexus between the Veteran's claimed condition of [chronic kidney disease] and hypertension."

The VA examiner also opined that the Veteran's chronic kidney disease was less likely than not due to his in-service TERA(s) after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic, combined effect of all of the Veteran's TERAs. As a rationale, "the VA examiner explained that "there is no medical or scientific evidence available that provides any indication of a relationship between the development of Chronic Kidney Disease and the [indicated] TERA." The VA examiner further explained that nothing in the Veteran's medical records supported a nexus between his chronic kidney disease and his in-service toxic exposures.

In July 2025, the Veteran submitted a March 2016 study report, titled "Association between Blood Dioxin Level and Chronic Kidney Disease in an Endemic Area of Exposure." Notably, the March 2016 report suggests that independent of risk factors such as hypertension, "a high dioxin level was associated with an increased prevalence of [chronic kidney disease]." The March 2016 report also indicates that "the mechanisms by which dioxin causes renal toxicity are still unclear and need further research." While the March 2016 report suggests there is a correlation between dioxin and chronic kidney disease, it does not demonstrate that dioxin causes kidney disease. Furthermore, the March 2016 report is of no probative value regarding whether the Veteran has service-related kidney disease because the report does not address the likely etiology of the Veteran's stage 3 chronic kidney disease in the present case.

Based on the foregoing, the evidence of record persuasively weighs against finding that the Veteran's stage 3 chronic kidney disease began during his active service or within the first post-service year. As discussed above, the Veteran has not asserted, and the evidence does not otherwise show that the Veteran's chronic kidney disease began during his active service or within a year of his separation. Notably, the Veteran's service treatment records lack any complaints of, or treatment for a kidney disease or injury, and his post-service records do not show that he was treated for kidney stones
value regarding whether the Veteran has service-related kidney disease because the report does not address the likely etiology of the Veteran's stage 3 chronic kidney disease in the present case.

Based on the foregoing, the evidence of record persuasively weighs against finding that the Veteran's stage 3 chronic kidney disease began during his active service or within the first post-service year. As discussed above, the Veteran has not asserted, and the evidence does not otherwise show that the Veteran's chronic kidney disease began during his active service or within a year of his separation. Notably, the Veteran's service treatment records lack any complaints of, or treatment for a kidney disease or injury, and his post-service records do not show that he was treated for kidney stones or a kidney disease prior to April 2005. Therefore, the competent evidence of record does not show that the Veteran's chronic kidney disease, stage 3, began during his active service or within the first post-service year, such that service connection for a chronic disease based on presumed in-service incurrence may be granted under 38 C.F.R. § 3.307 and §3.309.

The evidence of record also persuasively weighs against finding that the Veteran's stage 3 chronic kidney disease was caused or aggravated by his service-connected hypertension, or that it is otherwise related to an in-service event, injury, or disease, to include participation in a TERA. Given the December 2024 VA examiner provided two adequate opinions that sufficiently informed the Board of the clinician's judgment on the relevant medical questions and the "essential rationale" for the opinions, the December 2024 VA medical opinions are highly probative. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate). Significantly, the VA examiner concluded that the Veteran's stage 3 chronic kidney disease was less likely than not due to his service-connected hypertension or his in-service TERAs. In the absence of any other competent evidence of record that would otherwise diminish the probative value of the December 2024 VA medical opinions, the opinions are extremely persuasive. Thus, the evidence of record persuasively weighs against finding that the Veteran's stage 3 chronic kidney disease began during his active service or within the first post-service year, that it was caused or aggravated by his service-connected hypertension, or that it is otherwise related to an in-service event, injury, or disease, to include participation in a TERA.

(Continued on the next page)

Accordingly, service connection for chronic kidney disease, stage 3, is not warranted and the benefit of the doubt doctrine is inapplicable. See 38 U.S.C. § 5107; Lynch, 21 F.4th at 781.

L. B. CRYAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Jenkins Moody, Morgan B.

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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