HEARING LOSS

Summary

The veteran, who served in the Air Force from May 1990 to April 2000, with subsequent periods of service in the Air Force Reserve, appeals the denial of service connection for bilateral hearing loss, a cervical spine disorder, and a nerve disorder of the right lower extremity. The veteran also claims a left ankle disorder and a right ankle disorder as secondary to service-connected knee disabilities. The Board found that new and relevant evidence, including VA treatment records reflecting neck pain and hearing loss, warranted readjudication of the bilateral hearing loss and cervical spine disorder claims. The Board denied service connection for a right lower extremity nerve disorder, finding no current diagnosis or evidence linking it to service or the service-connected knee disability, and noting the VA examiner's opinion that the reported symptoms were non-physiological. The Board remanded the hearing loss and cervical spine claims for new VA examinations to determine the nature, etiology, and service connection, noting inadequacy in prior examinations and evidence. The ankle claims were also remanded due to an inadequate VA opinion that failed to address aggravation and the in-service ankle injury. The Board's decision means the hearing loss and cervical spine claims will be re-evaluated, while the right lower extremity nerve disorder claim was denied.

Rationale

New and relevant evidence received since prior denial; STRs negative for diagnosis, but post-deployment assessment and later VA problem lists show hearing loss; In-service noise exposure coincident with MOS

Full Decision Text

Citation Nr: A26030895
Decision Date: 04/03/26	Archive Date: 04/03/26

DOCKET NO. 200406-81260
DATE: April 3, 2026

ORDER

New and relevant evidence having been received, readjudication of the claim for entitlement to service connection for bilateral hearing loss is warranted. 

New and relevant evidence having been received, readjudication of the claim for entitlement to service connection for a cervical spine disorder is warranted. 

Service connection for nerve disorder of the right lower extremity is denied.

REMANDED

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to service connection for a cervical spine disorder is remanded.

Entitlement to service connection for a left ankle disorder, to include as secondary to service-connected disability, is remanded.

Entitlement to service connection for a right ankle disorder as secondary to service-connected disability is remanded.

FINDINGS OF FACT

1. Evidence added to the record since the prior final denial in August 2017 was not previously part of the actual record before the Agency Original Jurisdiction (AOJ) and tends to prove or disprove a matter at issue in regard to the claim for service connection for bilateral hearing loss. 

2. Evidence added to the record since the prior final denial in April 2002 was not previously part of the actual record before the AOJ and tends to prove or disprove a matter at issue in regard to the claim for service connection for a cervical spine disorder.

3. At no time during the pendency of his claim does the Veteran have a current disability of a nerve disorder of the right lower extremity, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim of entitlement to service connection for bilateral hearing loss have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.2501(a)(1).

2. The criteria for readjudicating the claim of entitlement to service connection for a cervical spine disorder have been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156, 3.2501(a)(1).

3. The criteria for service connection for nerve disorder of the right lower extremity have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1990 to April 2000, from September 2005 to November 2005, from May 2007 to September 2007, from January 2009 to June 2009, and from September 2010 to February 2011, with additional periods of service in the Air Force Reserve. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2019 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA).  In April 2020, the Veteran timely appealed such rating decision by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and elected the Hearing docket. On May 13, 2024, the Veteran withdrew the hearing request.  Therefore, the Board may only consider the evidence of record at the time of the May 2019 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

However, because the Board is remanding the claims of entitlement to service connection for bilateral hearing loss, a cervical spine disorder, a bilateral ankle disorder, and a nerve disorder affecting the right lower extremity, any evidence the Board could not consider will be considered by the AOJ in the re-adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that a December 2022 rating decision awarded service connection for lumbar spine degenerative joint disease and degenerative disc disease.  As such is a full grant of
 did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

However, because the Board is remanding the claims of entitlement to service connection for bilateral hearing loss, a cervical spine disorder, a bilateral ankle disorder, and a nerve disorder affecting the right lower extremity, any evidence the Board could not consider will be considered by the AOJ in the re-adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that a December 2022 rating decision awarded service connection for lumbar spine degenerative joint disease and degenerative disc disease.  As such is a full grant of the benefit sought with respect to such issue, it is no longer before the Board.  Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). 

1. Whether new and relevant evidence has been received to readjudicate the claim for entitlement to service connection for bilateral hearing loss.  

2. Whether new and relevant evidence has been received to readjudicate the claim for entitlement to service connection for a cervical spine disorder.

By way of background, VA received the Veteran's original claims for service connection for bilateral hearing loss in May 2017 and for a cervical spine disorder in January 2001.  In a rating decision issued in August 2017, the AOJ considered his service treatment records (STRs) and an August 2017 VA examination report and denied service connection for bilateral hearing loss. In this regard, the AOJ found that the Veteran's STRs were negative for any complaints, treatment, or diagnosis referable to bilateral hearing loss and that he did not have a current disability related to bilateral hearing loss. In a rating decision issued in March 2002, the AOJ considered the Veteran's STRs and a June 2000 VA examination reported and denied service connection for a cervical spine disorder. In this regard, the AOJ found that the Veteran's STRs were negative for any complaints, treatment, or diagnosis referable to a cervical spine disorder and that he did not have a current disability related to a cervical spine disorder. Further, in an April 2002 rating decision, the AOJ confirmed the previous denial of entitlement to service connection for a cervical spine disorder, finding that the Veteran's VA treatment records did not reflect complaints or treatment for a cervical spine disorder.

In February 2019, the Veteran filed a claim seeking service connection for bilateral hearing loss and a cervical spine disorder. Thus, in order for VA to readjudicate such previously denied claims, there must be "new and relevant" evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d). Specifically, if new and relevant evidence is presented or secured, the Secretary shall readjudicate the claim taking into consideration all of the evidence of record. 38 U.S.C. § 5108(a); 38 C.F.R. 

§ 3.156.  The AMA defines "new evidence" as "evidence not previously part of the actual record before agency adjudicators" and "relevant evidence" as "information that tends to prove or disprove a matter at issue in a claim." 38 C.F.R. 

§ 3.2501(a)(1).

The relevant evidence received since the issuance of the March 2002 and August 2017 rating decisions includes statements from the Veteran and VA treatment records. In this regard, a May 2018 VA treatment record reflects the Veteran's report of his neck being a trigger point, and an April 2017 record reflects his complaint of neck pain. Additionally, May 2018 and April 2019 VA treatment records reflect hearing loss listed on the Veteran's problem list.   

As the new evidence tends to prove a matter at issue, namely, the presence of a current disability, the Board finds new and relevant evidence has been received since the prior final denials, and readjudication of such claims is warranted.

3. Entitlement to service connection for a nerve disorder of the right lower extremity as secondary to service-connected disability.

As an initial matter, the Board notes that the Veteran does not allege, and the record does not reflect, that a right lower extremity nerve disorder is directly or presumptively related to any aspect of his military service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). Rather, he claims that he has a current right lower extremity nerve disorder as a result of his service-connected right knee disability. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38
 service connection for a nerve disorder of the right lower extremity as secondary to service-connected disability.

As an initial matter, the Board notes that the Veteran does not allege, and the record does not reflect, that a right lower extremity nerve disorder is directly or presumptively related to any aspect of his military service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). Rather, he claims that he has a current right lower extremity nerve disorder as a result of his service-connected right knee disability. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).  Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury.  Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).  

An award of service connection requires a finding of a current disability that is related to an injury or disease in service.  Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992).  Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions.  38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen, 7 Vet. App. 439; Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").  

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim.  However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

The AOJ favorably found that the Veteran was in receipt of service connection for right knee status post ACL reconstruction, posterior cruciate ligament and meniscal tear, chondromalacia, osteoarthritis, tendinosis and patellar spurs. 

A March 2019 VA back examination reflects the finding that the Veteran had non-physiological and non-dermatomal decreased sensation on examination, which was not supportive of spinal nerve root compression or radiculopathy.

During a March 2019 VA examination, the Veteran reported that he underwent a right knee surgery during service that resulted in muscle atrophy, numbness, tingling, and pain of the right lower extremity. However, the VA examiner found the Veteran did not have a peripheral nerve disorder or peripheral neuropathy or any symptoms attributable to any peripheral nerve condition. Although the report findings reflect decreased sensation in the right lower extremity at the thigh/knee, lower leg/ankle, and foot/toes, the examiner indicated that the circumferential distribution of decreased right leg sensation was non-dermatomal and non-physiological.  

The VA examiner opined that the Veteran's claimed right lower extremity nerve disorder was less likely than not proximately due to or the result of his service-connected right knee disability. In support thereof, the examiner opined that the subjective numbness and non-dermatomal
 and pain of the right lower extremity. However, the VA examiner found the Veteran did not have a peripheral nerve disorder or peripheral neuropathy or any symptoms attributable to any peripheral nerve condition. Although the report findings reflect decreased sensation in the right lower extremity at the thigh/knee, lower leg/ankle, and foot/toes, the examiner indicated that the circumferential distribution of decreased right leg sensation was non-dermatomal and non-physiological.  

The VA examiner opined that the Veteran's claimed right lower extremity nerve disorder was less likely than not proximately due to or the result of his service-connected right knee disability. In support thereof, the examiner opined that the subjective numbness and non-dermatomal decreased sensation on examination was non-physiological.  The examiner found significant that the Veteran had intact neurovascular status after surgery, with no numbness noted in post-deployment screens. In addition, there was no documentary, historical, or clinical evidence of a primary peripheral neuropathy condition. 

Here, the Board affords great probative value to the aforementioned VA examination reports and associated opinions as such were completed by a trained medical professional who reviewed the record and performed appropriate examinations of the Veteran.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

The Board has considered the Veteran's assertions as to the presence of a right lower extremity nerve disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such complex medical matters.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis).  In this regard, the diagnosis of such involves a medical subject concerning internal physical processes extending beyond immediately observable cause-and-effect relationships.  Therefore, such matter may not be competently addressed by lay statements.  See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions).  Therefore, the Board affords the Veteran's lay statements regarding a diagnosis of a nerve disorder in the right lower extremity little probative weight.  

Moreover, the findings reported in the VA examination reports and associated opinions are consistent with the contemporaneous medical evidence of record.  Here, the medical evidence, to include diagnostic testing, does not reflect a diagnosis referable to a nerve disorder in the right lower extremity.  Additionally, such treatment records do not document consistent reports of lower right leg pain or reflect a diagnosis proximate to the pendency of the claim.

Consequently, the Board finds that at no time during the pendency of the claim does the Veteran have a nerve disorder affecting the right lower extremity, and the record does not contain a diagnosis of such prior to the Veteran's filing of a claim.  Furthermore, the record does not reflect that the Veteran's reported symptoms result in functional impairment of earning capacity (other than such attributed to other diagnosed disorders).  Therefore, service connection for such disorder must be denied.  Watson, supra; Brammer, supra; Rabideau, supra.  In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine.  However, the competent evidence persuasively weighs against the Veteran's claim for service connection.  As such, that doctrine is not applicable in the instant appeal, and his claim must be denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral hearing loss. 

The Veteran contends that his current bilateral hearing loss is related to his military service.  In this regard, his STRs are negative for a diagnosis referable to such disorder; however, the Veteran reported difficulty hearing on his October 2005 Post-Deployment Health Assessment, and an October 2009 record reflects that the Veteran had an abnormal audiogram and reported difficulty hearing.  Furthermore, the Board notes that he was exposed to noise in service coincident with his military occupational specialty as a tactical aircraft maintenance journeyman.

The Veteran underwent a VA examination in August 201
 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral hearing loss. 

The Veteran contends that his current bilateral hearing loss is related to his military service.  In this regard, his STRs are negative for a diagnosis referable to such disorder; however, the Veteran reported difficulty hearing on his October 2005 Post-Deployment Health Assessment, and an October 2009 record reflects that the Veteran had an abnormal audiogram and reported difficulty hearing.  Furthermore, the Board notes that he was exposed to noise in service coincident with his military occupational specialty as a tactical aircraft maintenance journeyman.

The Veteran underwent a VA examination in August 2017, at which time the examiner noted that the Veteran's puretone thresholds were within normal limits and that he did not meet the criteria for a disability under VA regulations. 

However, the Board notes that his post-service treatment records reflect that the May 2018, August 2018, and April 2019 VA active problem lists include hearing loss. In light of such, the Board finds the failure to obtain an updated VA examination constitutes a pre-decisional duty to assist error that must be cured on remand by affording the Veteran a new VA examination so as to determine the nature and etiology of his claimed bilateral hearing loss.

2. Entitlement to service connection for a cervical spine disorder.

The Veteran contends that he currently has a neck disorder which had its onset in and is related to his military service. In this regard, his STRs reflect that in December 2013, he complained of neck tenderness while serving as a Reservist on active orders. 

In February 2017, the Veteran was noted to have limited range of motion of the cervical spine, he reported neck pain in April 2017, and during the November 2017 VA fibromyalgia examination, the Veteran reported tender points of the low cervical region at C5-7.  

Despite the foregoing, the Veteran has not been afforded a VA examination so as to determine the nature and etiology of his claimed neck disorder. Thus, a remand is necessary to cure such pre-decisional duty to assist error.

3. Entitlement to service connection for a left ankle disorder, to include as secondary to service-connected disability. 

4. Entitlement to service connection for a right ankle disorder as secondary to service-connected disability.

As an initial matter, the Board notes that the Veteran does not allege, and the record does not reflect, that his claimed right ankle disorder is directly or presumptively related to any aspect of his military service. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). Rather, he claims that he has a current right ankle disorder as a result of his service-connected bilateral knee disabilities. 

The Veteran claims that he has a current left ankle disorder as a result of his service-connected bilateral knee disability or, alternatively, that such is the result of an injury sustained while on active duty in January 2011. In this regard, the Veteran's STRs reflect that he sustained an injury to the left ankle as a result of fall. 

The AOJ favorably found that the Veteran has a current bilateral ankle disorder diagnosed as bilateral ankle tendonitis and noted that he is in receipt of service connection for left knee arthritis with posterior cruciate ligament tear and right knee status post ACL reconstruction. 

In March 2019, a VA examiner opined that the Veteran's bilateral ankle tendonitis was less likely than not proximately due to or the result of or aggravated by left knee arthritis with posterior cruciate ligament tear, meniscal pathology. In support thereof, the examiner noted that the Veteran's medical records were silent for a bilateral ankle disorder. Further, the examiner noted that medical literature does not support the contention that a pathology in the left knee has direct causative effect in the development of a pathology in the bilateral ankles unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity resulting in a limb length discrepancy of more than four or five centimeters causing Trendelenburg gait. 

Notably, the opinion addresses only secondary service connection based on causation and fails to address aggravation.  Furthermore, the examiner failed to address the Veteran's in-service left ankle injury. As such, the Board finds the opinion inadequate for the purpose of determining entitlement to service connection.  Accordingly, the Board finds that a remand is necessary in order to cure such pre-decisional duty to assist error by obtaining addendum opinions addressing the etiology of the Veteran's bilateral ankle disorders. 

The matters are REMANDED for the following actions:

1. Afford the Veteran an appropriate examination to determine the nature and etiology of his
 in a limb length discrepancy of more than four or five centimeters causing Trendelenburg gait. 

Notably, the opinion addresses only secondary service connection based on causation and fails to address aggravation.  Furthermore, the examiner failed to address the Veteran's in-service left ankle injury. As such, the Board finds the opinion inadequate for the purpose of determining entitlement to service connection.  Accordingly, the Board finds that a remand is necessary in order to cure such pre-decisional duty to assist error by obtaining addendum opinions addressing the etiology of the Veteran's bilateral ankle disorders. 

The matters are REMANDED for the following actions:

1. Afford the Veteran an appropriate examination to determine the nature and etiology of his claimed bilateral hearing loss. The record, including a copy of this Remand, must be made available for review in connection with the examination, and all indicated tests and studies should be undertaken.  Thereafter, the examiner should address the below inquiries:

(a.) The examiner should indicate whether the Veteran has a diagnosis of bilateral hearing loss as defined by VA regulations.  Specifically, the examiner should identify auditory thresholds, in decibels, at frequencies of 500, 1000, 2000, 3000, and 4000 Hertz.  A Maryland CNC Test should also be administered to determine speech recognition scores.

(b.) If the Veteran has a disability of bilateral hearing loss as defined by VA regulations, the examiner should offer an opinion as to whether it is at least as likely as not that such had its onset in, or is otherwise related to, the Veteran's military service, to include his acknowledged in-service noise exposure coincident with his military occupational specialty as tactical aircraft maintenance journeyman.

(c.) If the Veteran has a disability of bilateral hearing loss as defined by VA regulations, the examiner should offer an opinion as to whether such manifested within one year of his service discharge (and if so, please describe the manifestations).

The examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran's service treatment records are silent as to bilateral hearing loss or complaints thereof, or the lack of post-service treatment records demonstrating a continuity of care.

A rationale for any opinion offered should be provided.

2. Afford the Veteran an appropriate examination to determine the nature and etiology of his claimed cervical spine disorder.  Following a review of the record and any necessary testing, the examiner should address the following inquiries:

(a.) Identify all current cervical spine disorders that have been present at any point pertinent to the Veteran's February 2019 claim, even if such is asymptomatic or has since resolved.  

If no cervical spine disorder is diagnosed, the examiner should offer an opinion as to whether the Veteran's neck symptomatology results in functional impairment of earning capacity.  If so, the examiner is advised that they should accept that the Veteran has a disability for the purpose of rendering the opinions requested below.

(b.) For each cervical spine disability found to be present, the examiner should offer an opinion as to whether it is at least as likely as not that such had its onset in, or is otherwise related to, the Veteran's military service.  

The examiner should specifically address the December 2013 record showing the Veteran's report of neck tenderness, and his lay statements regarding an in-service injury and symptoms and post-service symptomatology.

(c.) If arthritis is diagnosed, the examiner should offer an opinion as to whether such manifested within one year of the Veteran's separation from active duty in February 2011 (i.e., by February 2012).  If so, please describe the manifestations.

A rationale for any opinion offered should be provided.

3. Forward the record, to include a copy of this Remand, to an appropriate VA examiner for an opinion addressing the etiology of the Veteran's bilateral ankle disorder.  Following a review of the record, the examiner should address the following inquiries:

(a.) Provide an opinion as to whether it is at least as likely as not that the Veteran's left ankle tendonitis had its onset in, or is otherwise related to, any period of his military service, to include the documented January 2011 injury to the left ankle.

(b.) Provide an opinion as to whether it is at least as likely as not that any current ankle disorder was caused or aggravated by service-connected disability, to include as a result of altered biomechanics and overcompensation.

For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology.

The sole basis of a negative opinion cannot be the fact that the Veteran's STRs are silent as to a bilateral ankle disorder or the lack of post-service treatment records demonstrating a continuity of care. 

A rationale for any opinion offered should be provided.

 

 

M. M. Celli

Act
 the left ankle.

(b.) Provide an opinion as to whether it is at least as likely as not that any current ankle disorder was caused or aggravated by service-connected disability, to include as a result of altered biomechanics and overcompensation.

For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology.

The sole basis of a negative opinion cannot be the fact that the Veteran's STRs are silent as to a bilateral ankle disorder or the lack of post-service treatment records demonstrating a continuity of care. 

A rationale for any opinion offered should be provided.

 

 

M. M. Celli

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Sharrocks-Marchione

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.