UNDIAGNOSED ILLNESSES

J.W. ZISSIMOS · 2026 · Case ID: A26040184

MIXED

Summary

The Veteran served from March 1988 to September 1996. This case involves appeals from September 2024 rating decisions concerning chronic fatigue, left ankle scars, and right and left arm and left knee disorders. The Veteran sought service connection for chronic fatigue, arguing it was a qualifying chronic disability under 38 C.F.R. § 3.317, but the Board denied this claim, finding no diagnosis of chronic fatigue syndrome and that any reported fatigue was attributable to already service-connected conditions like PTSD and muscle pain. The Board also denied increased evaluations for the left ankle scar, noting it was painful but not unstable, and did not meet the size or frequency criteria for higher ratings. The case was remanded for further development on the arm and knee claims. A March 2015 VA examiner opined that the Veteran's right elbow epicondylitis and osteoarthritis were not service-related, attributing them to lifestyle and aging, but no opinion was provided on secondary service connection. The Board found a remand necessary for a VA examination to determine the nature and etiology of right and left arm disorders, including secondary connection to PTSD and weight gain, and for a left knee disorder, given the in-service injury and subsequent pain. The Board noted the Veteran's lay statements regarding fatigue were considered but found less probative than the VA examiners' opinions.

Rationale

No diagnosis of chronic fatigue syndrome documented.; Fatigue attributed to other service-connected disabilities (PTSD, muscle pain, sleep apnea).; VA examiners found Veteran did not meet criteria for chronic fatigue syndrome.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250809-570181

Full Decision Text

Citation Nr: A26040184
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250809-570181
DATE: April 29, 2026

ORDER

Entitlement to service connection for chronic fatigue is denied.

Entitlement to an initial evaluation in excess of 10 percent for a painful scar on the left ankle is denied.

Entitlement to an initial compensable evaluation for a residual scar on the left ankle is denied.

REMANDED

Entitlement to service connection for a left arm disorder is remanded.

Entitlement to service connection for a right arm disorder is remanded.

Entitlement to service connection for a left knee disorder is remanded.

FINDINGS OF FACT

1. The Veteran does not have a chronic disability manifested by fatigue, to include as due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness such as chronic fatigue syndrome. His fatigue and sleep impairment and resulting symptoms of fatigue have been attributed to his other service-connected disabilities, and there are no additional symptoms that manifested in service or are otherwise related thereto.

2. The Veteran's left ankle scar measures less than 929 square centimeters, is not unstable, and does not have any disabling effects.

CONCLUSIONS OF LAW

1. Chronic fatigue was not incurred in active service. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 3.317.

2. The criteria for an initial evaluation in excess of 10 percent for a painful scar of the left ankle have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Code 7804.

3. The criteria for a compensable evaluation for a residual scar of the left ankle have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Code 7802.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1988 to September 1996.

This case comes before the Board of Veterans' Appeals (Board) on appeal from September 2024 rating decisions, which were higher-level review of a July 2021 rating decision (left ankle scars) and July 2023 rating decisions (chronic fatigue syndrome, right and left arm disorders, and a left knee disorder).

The Veteran submitted a VA Form 10182 in August 2025 and elected the evidence submission docket. Therefore, the Board may only consider the evidence of record at the time of the July 2021 agency of original jurisdiction (AOJ) decision, as to the left ankle scars, the June 2023 decision as to chronic fatigue syndrome, and the July 2023 decision with regard to the left and right arm and left knee disorders, which were subject to higher-level review, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 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 VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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 addressing the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. However, because the Board is remanding some of the issues case, any evidence that the Board could not consider will be considered by the agency of original jurisdiction (AOJ) in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

The Veteran and his representative have not raised any pre-decisional issues with the duty to notify or duty to assist with regard to the
C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision addressing the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. However, because the Board is remanding some of the issues case, any evidence that the Board could not consider will be considered by the agency of original jurisdiction (AOJ) in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Law and Analysis

The Veteran and his representative have not raised any pre-decisional issues with the duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board...to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).

Service Connection

Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). 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).

Because the Veteran served in the Southwest Asia Theater of operations during the Persian Gulf War, service connection may also be established under 38 C.F.R. § 3.317. Under that section, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia Theater of operations during the Persian Gulf War.

There are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi-symptom illness; and (3) a diagnosed illness that VA determines in regulations warrants a presumption of service connection. 38 C.F.R. § 3.317(a)(2). An undiagnosed illness is a condition that, by history, physical examination, and laboratory tests, cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1). To fulfill the requirement of chronicity, the illness must have persisted for six months. 38 U.S.C. § 1117, 38 C.F.R. § 3.317.

Signs or symptoms which may be manifestations of undiagnosed illness include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. 38 C.F.R. § 3.317(b).

A medically unexplained chronic multi-symptom illness is defined by a cluster of signs or symptoms and specifically includes chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), as well as any other illness that VA determines meets the criteria in paragraph 3.317(a)(2)(ii) of this section for a medically unexplained chronic multi-symptom illness. A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to
A medically unexplained chronic multi-symptom illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to service connection for chronic fatigue.

Initially, the Board notes that the Veteran has been granted service connection for posttraumatic stress disorder (PTSD) with alcohol use disorder, generalized anxiety disorder, and persistent depressive disorder, He is also service-connected for muscle pain due to undiagnosed illness (claimed as fibromyalgia) associated with his PTSD and obstructive sleep apnea. Those disabilities are assigned separate evaluations, which contemplate chronic sleep impairment, widespread musculoskeletal pain with or without associated fatigue, and hypersomnolence. See 38 C.F.R. §§ 4.71a (Diagnostic Code 5025), 4.97 (Diagnostic Code 6847), 4.130 (Diagnostic Code 9411).

Moreover, the evidence does not show that that the Veteran has been diagnosed with chronic fatigue syndrome at any time during the appeal period. For VA purposes, the diagnosis requires: (1) the new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least 6 months, and (2) the exclusion, by history, physical examinations, and laboratory tests, of all other clinical conditions that may produce similar symptoms, and (3) 6 or more of the following: (i) acute onset of the condition, (ii) low grade fever, (iii) nonexudative pharyngitis, (iv) palpable or tender cervical or axillary lymph nodes, (v) generalized muscle aches or weakness, (vi) fatigue lasting 24 hours or longer after exercise, (vii) headaches (of a type, severity or pattern that is different from headaches in the pre-morbid state), (viii) migratory joint pains, (ix) neuropsychologic symptoms, and (x) sleep disturbance. 38 C.F.R. § 4.88a.

Indeed, there are no treatment records documenting a diagnosis or treatment of chronic fatigue syndrome. A February 2020 VA examiner also specifically found that the Veteran did not meet the criteria for chronic fatigue syndrome, and an April 2023 VA examiner determined that a diagnosis of chronic fatigue disorder was not warranted because the Veteran did not have 6 or more symptoms as required by VA for a diagnosis of chronic fatigue syndrome.

The Board has also considered the Veteran's claim more broadly as fatigue, but finds that fatigue did not manifest in service and is not otherwise related thereto. Indeed, the Veteran's service treatment records are negative for any complaints, diagnosis, or treatment of fatigue. Moreover, the post-service treatment records show that his reports of fatigue have largely been attributed to other service-connected disabilities, including muscle pain and PTSD. The April 2023 VA examiner also indicated that he had been diagnosed with several disorders that produce similar symptoms, to include osteoarthritis, fibromyalgia, and PTSD.

As previously noted, the rating criteria for the Veteran's service-connected PTSD, muscle pain, and sleep apnea already contemplate sleep impairment, fatigue, and hypersomnolence. See 38 C.F.R. §§ 4.71a (Diagnostic Code 5025), 4.97 (Diagnostic Code 6847), 4.130 (Diagnostic Code 9411). The rating schedule generally prohibits pyramiding (evaluating the same disability under different diagnostic codes), and the United States Court of Appeals for Veterans Claims (Court) has held that pyramiding is disfavored "unless the regulation expressly provides otherwise." Cullen v. Shinseki, 24 Vet. App. 74, 84 (2010) and
the rating criteria for the Veteran's service-connected PTSD, muscle pain, and sleep apnea already contemplate sleep impairment, fatigue, and hypersomnolence. See 38 C.F.R. §§ 4.71a (Diagnostic Code 5025), 4.97 (Diagnostic Code 6847), 4.130 (Diagnostic Code 9411). The rating schedule generally prohibits pyramiding (evaluating the same disability under different diagnostic codes), and the United States Court of Appeals for Veterans Claims (Court) has held that pyramiding is disfavored "unless the regulation expressly provides otherwise." Cullen v. Shinseki, 24 Vet. App. 74, 84 (2010) and 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 262 (1994) (separate evaluations 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 condition).

There is no medical opinion otherwise showing that the Veteran has chronic fatigue that is not attributable to his service-connected disability and that is related to his military service.

The Board has also considered the Veteran's lay statements regarding his fatigue. Although lay persons are competent to provide opinions on some medical issues, as to the specific issues in this case, the diagnosis and etiology of chronic fatigue, falls outside the realm of common knowledge of a lay person, particularly in light of his other disorders to which his fatigue has been attributed. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Indeed, 38 C.F.R. § 4.88a sets forth specific diagnostic criteria that must be met for the diagnosis of chronic fatigue syndrome, including the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms.

Moreover, even assuming the Veteran's lay assertions regarding a diagnosis or etiology are competent, the Board nevertheless finds the VA examiners' opinions to be more probative, as they are based on a review of the record, an examination, and the examiners own medical expertise, training, and knowledge.

For the foregoing reasons, the Board finds that the claim for service connection for service connection for chronic fatigue, to include as due to a qualifying chronic disability pursuant to 38 U.S.C. § 1117, must be denied. The evidence of record shows that the Veteran does not have chronic fatigue syndrome or any other fatigue that is related to his miliary service other than the symptoms that are already contemplated in the rating for his service-connected disabilities.

Increased Evaluation

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 rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7.

In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings.

Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board notes that the Veteran in this case is appealing the initial assignment of a disability rating, and as such, the severity of that disability is to be considered
4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings.

Where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board notes that the Veteran in this case is appealing the initial assignment of a disability rating, and as such, the severity of that disability is to be considered during the entire period from the initial assignment of the evaluation to the present time. Fenderson v. West, 12 Vet. App. 119 (1999). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27.

The Veteran is currently assigned a 10 percent evaluation for a painful scar on his left ankle, pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7804. He is also assigned a separate noncompensable evaluation for the scar under Diagnostic Code 7802.

Under Diagnostic Code 7802, a maximum 10 percent evaluation is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with soft tissue damage, affecting an area or areas of 144 square inches (929 sq. cm.) or greater.

Under Diagnostic Code 7804, a 10 percent evaluation is warranted for one or two scars that are unstable or painful; a 20 percent evaluation is warranted for three or four scars that are unstable or painful; and, a 30 percent rating is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, Diagnostic Code 7804.

There are three notes to 38 C.F.R. § 4.118, Diagnostic Code 7804. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) indicates that scars evaluated under diagnostic codes 7800, 7801, 7802, and 7805 may also receive an evaluation under this diagnostic code, when applicable.

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31.

In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is not entitled to higher evaluations for his service-connected left ankle scar.

The evidence shows that the Veteran has one scar located on his left ankle following a surgical repair of the left Achilles tendon, but as previously noted, that scar has been assigned two separate evaluations.

A June 2021 VA examiner noted that the Veteran had a left ankle scar that was painful, but not unstable with frequent loss of skin over the scar. A physical examination found that he had one scar that measured 16 centimeters in length and 1 centimeter in width, which was not located on the head, face, or neck or due to burns. There was also no underlying tissue damage or functional impairment found.

The evidence of record does not show that the total area of the Veteran's scar is 144 square inches or greater. Therefore, a compensable evaluation is not warranted under Diagnostic Code 7802.

As previously noted, the same scar has also been assigned a separate 10 percent evaluation, pursuant

The evidence of record does not show that the total area of the Veteran's scar is 144 square inches or greater. Therefore, a compensable evaluation is not warranted under Diagnostic Code 7802.

As previously noted, the same scar has also been assigned a separate 10 percent evaluation, pursuant to 38 C.F.R. § 4.118, Diagnostic Code 7804. However, an evaluation in excess of 10 percent is not warranted under that diagnostic code, as the scar is not unstable, and the Veteran does not have three or four scars that are unstable or painful.

The Board has also considered other potentially applicable diagnostic codes, but finds that a higher or separate evaluation is not warranted. In this regard, the Veteran's scar is not located on his head, face, or neck; therefore, Diagnostic Code 7800 is not for application. The scar also measures less than 39 square centimeters and is not associated with underlying soft tissue damage. Thus, Diagnostic Code 7801 does not apply. There are also no other disabling effects to warrant a higher evaluation under Diagnostic Code 7805. Thus, the Board finds that increased evaluations are not warranted for the left ankle scar, and the appeal is denied.

The Veteran and his representative have raised not any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

REASONS FOR REMAND

Upon review, the Board finds that a remand is needed to correct pre-decisional duty to assist errors for the remaining issues on appeal.

A March 2015 VA examiner diagnosed the Veteran with right elbow epicondylitis and osteoarthritis, but he noted that there was no history of an elbow injury during active duty and found that epicondylitis and osteoarthritis were not related to Gulf War exposures. Instead, the examiner opined that the disorders were more likely related to the Veteran's active lifestyle and aging process. However, there is no medical opinion addressing secondary service connection. In this regard, a February 2016 VA treatment record noted that the Veteran attributed the pain in his arms to a 30-pound weight gain, which he believed was due to a depressed mood. It was also noted at that time that there were findings that were consistent with early onset osteoarthritis from repetitive use as a Marine and current police officer and with increasing obesity. Therefore, the Board finds that an additional medical opinion was needed.

The Board also notes that the Veteran was not afforded a VA examination in connection with his claim for service connection for a left knee disorder. His service treatment records show that he was treated for left knee pain after he was injured sliding during a softball game in April 1993. He was assessed as having a contusion and soft tissue injury at that time. Moreover, the Veteran reported having knee pain during the appeal period. Therefore, the Board finds that a VA examination and medical opinion were needed.

The matters are REMANDED for the following action:

1. The Veteran should be afforded a VA examination to determine the nature and etiology of any right and left arm disorders that may be present.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation.

The examiner should identify any right and left arm disorders other than the already service-connected right and left shoulder disorders and muscle pain.

For any diagnosis identified, the examiner should opine as to whether it is at least as likely as not that the disorder is causally or etiologically related to his military service, to include any duties, training, or repetitive use therein. See e.g. February 2016 VA treatment record.

The examiner should also opine as to whether any current arm disorder was caused by or resulted from his service-connected PTSD. He or she should address whether any arm disorder would have
If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation.

The examiner should identify any right and left arm disorders other than the already service-connected right and left shoulder disorders and muscle pain.

The examiner should also opine as to whether any current arm disorder was caused by or resulted from his service-connected PTSD. He or she should address whether any arm disorder would have been less severe but-for the service-connected PTSD, to include any worsening of functionality.

In providing the secondary service connection opinion, the examiner should address whether any weight gain or obesity was an intermediate step between the Veteran's service-connected PTSD and any current arm disorder. He or she should opine as to whether it is at least as likely as not that the Veteran's service-connected PTSD caused him to become obese or gain weight. If so, he or she should provide an opinion as to whether the obesity was a substantial factor in causing any current arm disorder. He or she should also provide an opinion as to whether any current arm disorder would not have occurred or worsened but for the weight gain caused by his service-connected PTSD.

A clear rationale for all opinions must be provided.

2. The Veteran should be afforded a VA examination to determine the nature and etiology of any left knee disorder that may be present.

The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions.

The examiner should opine as whether it is at least as likely as not that the Veteran has a left knee disorder other than his already service-connected muscle pain that is causally or etiologically related to his military service, to include any injury or symptomatology therein.

A clear rationale for all opinions must be provided.

J.W. ZISSIMOS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Rideout-Davidson, 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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