CHRONIC MYELOGENOUS LEUKEMIA (CML)

Summary

The veteran, who served from July 1979 to February 1987, appeals the rating decision for chronic myelogenous leukemia (CML). The veteran sought Board review of the March 2021 rating decision which granted service connection for CML and assigned staged ratings of 10 percent from June 4, 2014, and 30 percent from December 9, 2018. The appeal concerns the initial rating assigned for CML, starting from the claim's receipt on June 4, 2014. The Board reviewed the evidence under both former and current schedular criteria, noting that amended criteria effective December 9, 2018, updated the evaluation for hematologic and lymphatic systems, specifically adding Diagnostic Code 7719 for CML. The Board found a 100 percent rating warranted from June 4, 2014, to September 27, 2018, as the CML was active and undergoing treatment without molecular remission. From September 27, 2018, the CML achieved complete molecular remission, but the veteran continued treatment with a tyrosine kinase inhibitor and experienced fatigue and weakness. This status was rated by analogy to Diagnostic Code 7700 at 30 percent, and also aligned with the criteria under Diagnostic Code 7719 for CML in apparent remission on continuous molecularly targeted therapy. The Board rejected the veteran's testimony and his attorney's contention for higher ratings, finding the medical evidence consistently showed molecular remission by September 27, 2018, and that imatinib (Gleevec) is a targeted therapy, not chemotherapy, thus not warranting higher ratings under the cited diagnostic codes.

Rationale

CML in complete molecular remission as of September 27, 2018; Continued treatment with tyrosine kinase inhibitor (imatinib/Gleevec); Experienced weakness and fatigue from treatment; Rated 30 percent by analogy to DC 7700 and under DC 7719 criteria

Full Decision Text

Citation Nr: A26040864
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 210615-166117
DATE: April 30, 2026

ORDER

From June 4, 2014, to September 27, 2018, a 100 percent rating for chronic myelogenous leukemia (CML) is granted.

From September 27, 2018, a 30 percent rating, but not more, for CML is granted.

FINDINGS OF FACT

1. From June 4, 2014, to September 27, 2018, the Veteran's CML was not in remission, and the Veteran was undergoing active treatment for CML.

2 From September 27, 2018, the Veteran's CML was in hematological, cytogenic, and molecular remission, and the Veteran experienced weakness and easy fatiguability while continuing to take a tyrosine kinase inhibitor.

CONCLUSIONS OF LAW

1. From June 4, 2014, to September 27, 2018, the criteria for a 100 percent rating for CML are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3 4.117, Diagnostic Codes (DCs) 7700, 7703, 7704, 7716, 7718, 7719.

2. From September 27, 2018, a 30 percent rating, but not more, for CML are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3 4.117, DCs 7700, 7703, 7704, 7716, 7718, 7719.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had continuous active service from July 1979 to February 1987.

The instant matter comes to the Board of Veterans' Appeals (Board) from a March 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office.  The Veteran sought Board review of that rating decision by submitting a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in June 2021.  The Veteran elected the Board's Hearing docket.  

The Veteran testified before a Veterans Law Judge on November 7, 2024.  A transcript of the hearing is included in the claims file.  As a result of the Veteran's docket election, the Board may only consider the evidence of record at the time of rating decision on appeal as well as any evidence submitted by the Veteran or his attorney at the hearing or within 90 days following the hearing (Wednesday, February 5, 2025).  38 C.F.R. § 20.302(a).  Evidence of record specifically identified by the Veteran or his representative in his November 7, 2024, hearing is likewise considered "submitted" during the evidence submission window.  See Cash v. Collins, No. 2024-1811, __ F.4th __, 2026 U.S. App. LEXIS 3596 (Fed. Cir., Feb. 5, 2026).

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.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

The Board notes that the undersigned VLJ did not conduct the November 2024 hearing.? Under the AMA, the VLJ who conducts a Board hearing is not required to decide an AMA appeal.? Frantzis v. McDonough, 35?Vet. App.?354 (2022).

1. Increased Initial Ratings for Chronic Myelogenous Leukemia

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability.  See 38 U.S.C. § 1155; 38 C.F.R. Part 4.  In evaluating the severity of a particular disability, it is essential to consider its history.  See 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (
 a Board hearing is not required to decide an AMA appeal.? Frantzis v. McDonough, 35?Vet. App.?354 (2022).

1. Increased Initial Ratings for Chronic Myelogenous Leukemia

Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability.  See 38 U.S.C. § 1155; 38 C.F.R. Part 4.  In evaluating the severity of a particular disability, it is essential to consider its history.  See 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

Under 38 C.F.R. § 4.2, a rating specialist is directed to review the recorded history of a disability to make a more accurate evaluation.  Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation.  Otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.  Any reasonable doubt as to the degree of disability will be resolved in favor of the Veteran.  See 38 C.F.R. § 4.3. 

Evidence of record from the time an application for disability benefits is presented should be considered in an initial evaluation of a service-connected disability.  See Fenderson v. West, 12 Vet. App. 119, 126 (1999); AB v. Brown, 6 Vet. App. 35 (1993) (holding that a claim for an original or increased rating remains in controversy when less than the maximum available benefit is awarded); see also Moore v. Nicholson, 21 Vet. App. 211, 216-17 (2007) (for initial disability ratings, VA must consider the severity of a disability during the period for which a veteran is eligible for service connection starting on the date application was filed).  

In a March 2021 decision, the Board granted service connection for CML. The Veteran has sought Board review of the March 2021 rating decision that implemented the Board's award of service connection and assigned staged ratings for the Veteran's CML, i.e., a 10 percent rating from June 4, 2014, and a 30 percent rating from December 9, 2018.  Thus, the appeal implicates the initial rating assigned for the Veteran's service-connected CML and starts with receipt of the Veteran's service connection claim on June 4, 2014.

?

During the pendency of the Veteran's appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the hematologic and lymphatic systems.  The effective date of the rule is December 9, 2018.  The final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems.  In cases where rating criteria are amended during the course of the appeal, the Board must consider both the former and current schedular criteria.  Should an increased rating be warranted under new, revised criteria, the award may not be made effective before the effective date of change.  See Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003).

From June 4, 2014, the Veteran's CML was rated as 10 percent disabling under 38 C.F.R. § 4.117, Diagnostic Code 7703-7716.  The criteria effective prior to December 9, 2018, 38 C.F.R. § 4.117, Diagnostic Code 7703 (leukemia) provided that a 100 percent rating is warranted with active disease or during the treatment phrase.  Otherwise, the adjudicator is to rate the disability as anemia (Diagnostic Code 7700) or aplastic anemia (Diagnostic Code 7716), whichever would result in the greater benefit.

Under Diagnostic Code 7700, a 10 percent rating is warranted for a hemoglobin level of 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches.  A 30 percent rating is warranted for a hemoglobin level of 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath.  A 70 percent rating is warranted for a hemoglobin level of 7gm/100 ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (
Diagnostic Code 7716), whichever would result in the greater benefit.

Under Diagnostic Code 7700, a 10 percent rating is warranted for a hemoglobin level of 10gm/100ml or less with findings such as weakness, easy fatigability, or headaches.  A 30 percent rating is warranted for a hemoglobin level of 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath.  A 70 percent rating is warranted for a hemoglobin level of 7gm/100 ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months).  A 100 percent rating is warranted for a hemoglobin level of 5gm/100 ml or less, with findings such as high output congestive heart failure or dyspnea at rest.  38 C.F.R. § 4.117, Diagnostic Code 7700.

Under Diagnostic Code 7716, aplastic anemia requiring continuous medication for control is rated 10 percent disabling.  Anemia requiring transfusion of platelets or red cells, on average, at least once per 12-month period; or infections recurring, on average, at least once per 12-month period warrants a 30 percent rating.  Anemia requiring transfusion of platelets or red cells, on average, at least once every three months per 12-month period; or infections recurring, on average, at least once every three months per 12-month period; or using continuous therapy with immunosuppressive agent or newer platelet stimulating factors warrants a 60 percent rating, and anemia requiring peripheral blood or bone marrow stem cell transplant; or requiring transfusion of platelets or red cells, on average, at least once every six weeks per 12-month period; or infections recurring, on average, at least once every six weeks per 12-month period warrants a 100 percent rating.  38 C.F.R. § 4.117, Diagnostic Code 7716.

Following the amendments that became effective on December 9, 2018, the Veteran's CML is to be evaluated under 38 C.F.R. § 4.117, Diagnostic Code 7719, which applies to chronic myelogenous leukemia (CML) (chronic myeloid leukemia or chronic granulocytic leukemia).  Under Diagnostic Code 7719, a 30 percent evaluation is for apparent remission on continuous molecularly targeted therapy with tyrosine kinase inhibitors, a 60 percent evaluation is for warranted for intermittent myelosuppressive therapy, molecularly targeted therapy with tyrosine kinase inhibitors, or interferon treatment when not in apparent remission.  A 100 percent evaluation is warranted for required peripheral blood or bone marrow stem cell transplant or continuous myelosuppressive or immunosuppressive therapy treatment.  See 38 C.F.R. § 4.117, Diagnostic Code 7719.

The Board concludes a 100 percent rating is warranted from June 4, 2014, to September 27, 2018, because the Veteran's CML was undergoing active treatment and was not in remission.  The Veteran's CML entered complete remission, to include hematological, cytogenetic, and molecular remission, as of September 27, 2018.  From September 27, 2018, the Veteran's CML was no longer active insofar as it was in remission; however, the Veteran continued to take a tyrosine kinase inhibitor and experienced weakness and easy fatiguability.

?

A.	From June 4, 2014, to September 27, 2018

From June 4, 2014, to September 27, 2018, the Veteran's CML was active, warranting a 100 percent rating under Diagnostic Code 7703. 

The record shows that the Veteran was diagnosed with CML in April 2014 based on laboratory results detecting bcr ABL 1 B2A2, a marker for CML, also known as the Philadelphia chromosome.  The Veteran was placed on Gleevec, a tyrosine kinase inhibitor.  The Veteran's hearing testimony included his describing the three stages of remissions for CML: hematologic remission, cytogenetic remission, and molecular remission.  

In April 2017 treatment records, the Veteran reported that his symptoms that onset with the start of Gleevec included weakness, decrease in strength, and weight gain.  April 2017 private treatment records note that his providers could not determine whether his symptoms were indeed associated with Gleevec or were instead the result
 April 2014 based on laboratory results detecting bcr ABL 1 B2A2, a marker for CML, also known as the Philadelphia chromosome.  The Veteran was placed on Gleevec, a tyrosine kinase inhibitor.  The Veteran's hearing testimony included his describing the three stages of remissions for CML: hematologic remission, cytogenetic remission, and molecular remission.  

In April 2017 treatment records, the Veteran reported that his symptoms that onset with the start of Gleevec included weakness, decrease in strength, and weight gain.  April 2017 private treatment records note that his providers could not determine whether his symptoms were indeed associated with Gleevec or were instead the result of other medical conditions.  The Veteran was continued on Gleevec.

VA treatment records include the Veteran's reports that his CML entered molecular remission in December 2016.  See, e.g., VA treatment records dated April 18, 2022 ("He tells me that he has been in molecular remission since 12/2016.") & October 6, 2022 ("He tells me that he has been in molecular remission since December 2016.").  However, private treatment records in 2016 and 2017 consistently show that CML was active and that the Veteran was in hematologic remission on Gleevec with symptoms that included fatigue and joint pain.  They do not note molecular remission.  For instance, December 2016 private treatment records show that the Veteran's CML remained active.  Its status is described as active, and it was noted to be in hematologic remission on Gleevec with symptoms that included joint pain and fatigue.  A history of CML provided in December 2016 private treatment records report that the Veteran achieved hematologic remission and cytogenetic remission within 6 months of starting Gleevec.  The Veteran remained symptomatic as of December 2016 based on private treatment records in which he reported that the start of Gleevec coincided with weight gain, weakness, and loss of strength.  November 2017 private treatment records similarly show that the Veteran's CML remained in active status, was treated with Gleevec, and the Veteran experienced joint pain and fatigue.  Thus, as of November 2017, the Veteran's CML was not in molecular remission and he was undergoing treatment on a tyrosine kinase inhibitor.  

However, October 30, 2018, private treatment records show that the Veteran's CML was in complete molecular remission as of September 27, 2018.  Peripheral smear testing was negative for bcr/ABL 1, and that treatment had achieved a "complete molecular response" as of September 27, 2018.  The Board takes judicial notice that the National CML Society describes complete molecular response as meaning "that no BCR-ABL protein is detectable in the marrow utilizing the Polymerase Chain Reaction test."  National CML Society, Response/Remission, https://www.nationalcmlsociety.org/response-remission.   The National CML Society notes that, "[w] hen discussing the disease with fellow survivors or medical teams, the word 'remission' may often be replaced with the word 'response,' particularly when one is taking daily treatment."  Id.  Thus, the Veteran's CML was in a state of complete molecular response or remission in which the Philadelphia chromosome, the marker for CML, was not detectible on PCR testing as of September 27, 2018.  Accordingly, a 100 percent rating is warranted from June 4, 2014, to start of the period on appeal when VA received the Veteran's claim for service connection for CML, to September 27, 2018, the date from which blood testing no longer detected the marker for CML.

B.	From September 27, 2018

A 30 percent rating is warranted from September 27, 2018.  Even though the Veteran's CML was no longer detectible based on PCR testing, the Veteran has since September 27, 2018, remained on a daily treatment regimen taking a tyrosine kinase inhibitor.  The Veteran reported fatigue and weakness as a result of treatment with Gleevec, or imatinib, a type of tyrosine kinase inhibitor.  For instance, October 2018 private treatment records discuss ongoing musculoskeletal symptoms associated with imatinib treatment.  December 2016 treatment records describe those symptoms as fatigue and joint pain.  Rated, by analogy, the Board concludes that these ongoing symptoms are most analogous to those contemplated by a 30 percent rating under Diagnostic Code 7700.  Diagnostic Code 7700 provides a 30 percent rating for a hemoglobin level of
 PCR testing, the Veteran has since September 27, 2018, remained on a daily treatment regimen taking a tyrosine kinase inhibitor.  The Veteran reported fatigue and weakness as a result of treatment with Gleevec, or imatinib, a type of tyrosine kinase inhibitor.  For instance, October 2018 private treatment records discuss ongoing musculoskeletal symptoms associated with imatinib treatment.  December 2016 treatment records describe those symptoms as fatigue and joint pain.  Rated, by analogy, the Board concludes that these ongoing symptoms are most analogous to those contemplated by a 30 percent rating under Diagnostic Code 7700.  Diagnostic Code 7700 provides a 30 percent rating for a hemoglobin level of 8gm/100ml or less, with findings such as weakness, easy fatigability, headaches, lightheadedness, or shortness of breath.  Notwithstanding the Veteran's hemoglobin levels, his weakness at fatigue align with the 30 percent criteria in Diagnostic Code 7700.

From December 9, 2018, Diagnostic Code 7719, which is specific to CML, provides a 30 percent rating for CML in apparent remission on continuous molecularly targeted therapy with tyrosine kinase inhibitors.  That is precisely the status for the Veteran's CML since the effective date of Diagnostic Code 7719.  As discussed above, the Veteran's CML was noted to be in molecular remission-or that the Veteran had achieved a complete molecular response-as of September 27, 2018, and he was continued on a daily regimen with a tyrosine kinase inhibitor.  The Veteran has been on Gleevec, or imatinib, since CLM was first diagnosed in June 2014.  April 2022 VA treatment records show that he has tolerated imatinib well, and PCR tests for the Philadelphia chromosome remained negative.  This is most consistent with a 30 percent rating.  

Similarly, November 2023 VA treatment records continue to show PCR tests as negative for the Philadelphia chromosome, and the Veteran continued treatment on imatinib.  He hearing testimony reported continued treatment on imatinib.  This is most consistent with a 30 percent rating under Diagnostic Code 7719.

A rating in excess of 30 percent is not warranted.  Prior to the effective date for Diagnostic Code 7719, the Veteran's CML did not manifest as symptoms most closely approximating a rating in excess of 30 percent under Diagnostic Code 7700 or Diagnostic Code 7716.  The record does not show that the Veteran required transfusion of platelets or red blood cells, and the record does not show that CML manifested as recurring infections during the period, let alone with the frequency required for either a 60 percent rating or a 100 percent rating under Diagnostic Code 7716.  Neither did he undergo bone marrow or peripheral blood stem cell transplant or transfusion of platelets or red blood cells.  A rating in excess of 30 percent is, thus, not warranted.  These procedures are not documented in the Veteran's VA or private treatment records, and his CML symptoms do not manifest with symptoms of a similar severity.

?

A rating in excess of 30 percent is not warranted under Diagnostic Code 7700.  The next available rating of 70 percent rating is warranted for a hemoglobin level of 7gm/100 ml or less, with findings such as dyspnea on mild exertion, cardiomegaly, tachycardia (100 to 120 beats per minute) or syncope (three episodes in the last six months).  These symptoms are not shown.  A 100 percent rating is warranted for a hemoglobin level of 5gm/100 ml or less, with findings such as high output congestive heart failure or dyspnea at rest.  38 C.F.R. § 4.117, Diagnostic Code 7700.  These symptoms or symptoms of a similar severity are not shown in the evidence of record.  Instead, the Veteran complained of fatigue associated with Gleevec.  Again, this is most consistent with the criteria for a 30 percent rating under Diagnostic Code 7700.

With respect to a rating in excess of 30 percent under Diagnostic Code 7719, the Veteran's hearing testimony included reports that CML was not in complete molecular remission.  The Veteran contends that a 100 percent rating is warranted because CML is not remission and imatinib is a chemotherapy type drug.  His attorney similarly contends that a 60 percent rating is warranted under Diagnostic Code 7719 because CML is not in remission.  His representative argued that the medical evidence of record prior to a VA examination does not state that the Veteran is in remission.  As the discussion of the evidence above has shown,
 this is most consistent with the criteria for a 30 percent rating under Diagnostic Code 7700.

With respect to a rating in excess of 30 percent under Diagnostic Code 7719, the Veteran's hearing testimony included reports that CML was not in complete molecular remission.  The Veteran contends that a 100 percent rating is warranted because CML is not remission and imatinib is a chemotherapy type drug.  His attorney similarly contends that a 60 percent rating is warranted under Diagnostic Code 7719 because CML is not in remission.  His representative argued that the medical evidence of record prior to a VA examination does not state that the Veteran is in remission.  As the discussion of the evidence above has shown, this is simply not the case.  Private treatment records show molecular remission, or a complete molecular response, as of September 27, 2018. VA treatment records likewise document the Veteran's reports to his VA providers that molecular remission was achieved as of December 2016.  The discussion documented in the VA treatment records includes PCR test results demonstrating that the Philadelphia chromosome was not detectable as of December 2016, and private treatment records show that the Philadelphia was not detectable as of September 27, 2018.  The record includes ample evidence of CML being in molecular remission as early as December 2016 and certainly by September 27, 2018.  

Despite this, the Veteran testified in November 2024 that he had not reached molecular remission.  His representative summarized the history as reaching hematologic remission and cytogenic remission, but not molecular remission.  The Veteran's hearing testimony baldly contradicts the medical evidence of record and his own statements to VA providers when initiating treatment with VA in April 2022.  In his November 2024 hearing, the Veteran reported that his private providers discontinued their practice and he switched his care for CML to VA.  Upon starting care for CML with VA, the Veteran reported that he had been in molecular remission since December 2016.  This is well-documented in his VA treatment records as discussed above.  Thus, the Veteran's November 2024 hearing testimony is afforded no probative value because of its glaring inconsistency with the other evidence of record.

The Veteran's attorney also argues that imatinib, a tyrosine kinase inhibitor, is type of chemotherapy warranting a rating in excess of 30 percent.  This is incorrect.  The Board takes judicial notice that chemotherapy is a non-targeted, systemic treatment for cancers.  In contrast, tyrosine kinase inhibitors are specific, targeted therapy that aids in managing how cells grow and divide.  Growth factors are chemicals that control cell growth and tyrosine kinase is an enzyme in cells that controls cell division.  Growth factor turns on tyrosine kinase to signal cells to divide.  The cells continue to divide until tyrosine kinase is "turned off."  CML involves mutations in blood-forming myeloid cells in the bone marrow in which tyrosine kinase, after it is turned on, does not turn off.  As a result, myeloid cells in the bone marrow divide and multiple uncontrollably, making it difficult for the bone marrow to make other blood cells and platelets that the body needs.  Tyrosine kinase inhibitors, like imatinib, treat CML by flipping the "on" switch back to "off"; they block the abnormal enzyme signals that are responsible for cancerous cell growth.  Cleveland Clinic, Tyrosine Kinase Inhibitors (TKIs): Uses & Side Effects, https://my.clevelandclinic.org/health/treatments/24984-tyrosine-kinase-inhibitors.  

This non-systemic, targeted approach is in stark contrast to the systemic treatment that occurs with chemotherapy drugs.  Such drugs travel throughout the entire body and may target healthy as well as cancerous cells.  Cleveland Clinic, Chemotherapy: Types & How They Work, https://my.clevelandclinic.org/health/

treatments/16859-chemotherapy.  Thus, the contention that imatinib is a type of chemotherapy that supports a rating in excess of 30 percent is incorrect and unavailing here.  

?

In summary, the record shows that a 30 percent rating is warranted from September 27, 2018.  The Veteran's CML was in molecular remission, he continued treatment on a tyrosine kinase inhibitor, imatinib or Gleevec, and experienced fatigue and weakness as side effects of the treatment.  Rating by analogy from September 27, 2018, this is most consistent with leukemia receiving treatment and resulting in fatigue and weakness.  A rating in excess of 30 percent is not shown, however.  The Veteran's CML was in molecular remission and
 that imatinib is a type of chemotherapy that supports a rating in excess of 30 percent is incorrect and unavailing here.  

?

In summary, the record shows that a 30 percent rating is warranted from September 27, 2018.  The Veteran's CML was in molecular remission, he continued treatment on a tyrosine kinase inhibitor, imatinib or Gleevec, and experienced fatigue and weakness as side effects of the treatment.  Rating by analogy from September 27, 2018, this is most consistent with leukemia receiving treatment and resulting in fatigue and weakness.  A rating in excess of 30 percent is not shown, however.  The Veteran's CML was in molecular remission and treated with a tyrosine kinase inhibitor.  The Veteran's hearing testimony arguing to the contrary is not probative insofar as it contradicts contemporaneous medical evidence and his statements to his VA providers upon initiating treatment with them in April 2022. 

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Douglas M. Humphrey, Counsel

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.