1. Entitlement to an initial 70 percent disability rating for posttraumatic stress disorder (PTSD) is granted. 2. Special monthly compensation (SMC) at the housebound rate under 38 U.S.C. § 1114(s) is granted, effective…

Citation Nr: A26069911 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 221021-289909 DATE: July 30, 2026 ORDER 1. Entitlement to an initial 70 percent disability rating for posttraumatic stress disorder (PTSD) is granted. 2. Special monthly compensation (SMC) at the housebound rate under 38 U.S.C. § 1114(s) is granted, effective October 8, 2019. 3. Entitlement to SMC based on aid and attendance is denied. FINDINGS OF FACT 1. Affording the benefit of the doubt to the Veteran, his service-connected PTSD results in occupational and social impairment with deficiencies in most areas. 2. On and after October 8, 2019, in addition to the Veteran's entitlement to a total disability rating for individual unemployability (TDIU) due to service-connected disabilities, the Veteran has a separate additional service-connected disability (PTSD) ratable as 60 percent or more. 3. The Veteran did not experience the anatomical loss or loss of use of both feet, or of one hand and one foot; he was not blind in both eyes, with visual acuity of 5/200 or less; he was not permanently bedridden; and he was not so helpless as to be in need of regular aid and attendance due to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria for an initial 70 percent disability rating for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 2. On and after October 8, 2019, the criteria for SMC at the statutory housebound rate have been met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i)(1). 3. The criteria for special monthly compensation based on aid and attendance have not been met. 38 U.S.C. §§ 1114(l), 5107; 38 C.F.R. §§ 3.102, 3.350, 3.351, 3.352, 4.3. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1982 to January 1989, and from September 2004 to January 2005. This appeal was originally processed in the Legacy appeal system, eventually resulting in the issuance of a Statement of the Case (SOC) in August 2022. The Veteran opted into the modernized decision review system when he submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in October 2022. In the Notice of Disagreement, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the August 2022 SOC. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the SOC, the Board did not consider it in its decision. 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. By way of background, the Board denied, in part, the Veteran's claim of entitlement to an increased initial disability rating in excess of 50 percent for his PTSD in a December 2024 decision. The Veteran appealed this decision. In a September 2025 Order, the Court of Appeals for Veterans Claims (Court) issued an order that granted a Joint Motion for Partial Remand (JMPR). The JMPR moved the Court to vacate the portion of the December 2024 Board decision that decided the increased rating claim for PTSD and remand the matter back to the Board for action consistent with the terms of the JMPR. The appeal has been returned to the Board. 1. Increased rating for PTSD. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The 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. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. 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 any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran's medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence "used to decide whether an original rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). The Veteran is in receipt of a 50 percent disability rating for PTSD for the entire claim period, which extends back to May 21, 2013. His psychiatric disorder is rated under Diagnostic Code 9411, which rates PTSD under the General Formula for Mental Disorders (General Formula). Under the General Formula the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name. The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 70 percent or higher. Factual History Turning to the evidence, the Veteran presented for VA examinations conducted in December 2018 and August 2021. Of record, also, is a comprehensive psychiatric assessment conducted by VA in June 2014. The Veteran also submitted a private psychological evaluation that was conducted in September 2016, and a vocational assessment conducted in June 2022. The Veteran also received psychiatric treatment at times during the appeal period. The Board notes that though the evidence shows psychiatric diagnoses other than PTSD at various points during the appeal period, the Board will consider all psychiatric symptoms to rate the Veteran's PTSD. No evidence of record properly delineates any non-PTSD psychiatric symptoms from the Veteran's PTSD. In such circumstances, it is proper to consider all symptoms as part of the service-connected disorder. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). In the June 2014 VA psychological assessment, the Veteran is documented presenting for treatment with complaints of PTSD symptoms. The Veteran reported that he isolated and rarely talked to others. He had been married four times and had varying degrees of success with his relationships with children and previous spouses. He reported a good relationship with his wife of two years and his stepson. Though he was not working at the time, he reported being a hard worker and was able to focus well. The completing social worker noted that the Veteran was casually dressed and adequately groomed. His speech was normal, his thoughts were goal-directed and relevant, and he maintained fair eye contact. He was cooperative, his mood euthymic, and his affect was constricted. He was oriented to time, place, person, and date, and he denied any auditory or visual hallucinations. He denied suicidal or homicidal ideations. The completing social worker found that the Veteran had fair judgment and insight. His psychosocial stressors were lack of work and having no friends. The September 2016 private assessment does not provide insight into the severity of the Veteran's PTSD. The document bears solely on the question of diagnosis. In December 2018, VA provided its initial examination for PTSD. The examiner found that the Veteran's PTSD resulted in anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. These symptoms combined to result in occupational and social impairment with reduced reliability and productivity, opined the examiner. During the clinical interview, the Veteran described a family history that was consistent with the history discussed in the June 2014 VA assessment. The Veteran was still unemployed, and he explained that he had switched roles in his most recent employment so that he did not have to deal with people. Additional mental health treatment after the June 2014 VA assessment was not noted. The August 2021 VA examination showed only symptoms of anxiety and chronic sleep impairment. The examiner found that the Veteran's PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication. The examiner commented that the Veteran was well-groomed and cooperative, alert, and fully oriented. His mental status was normal. The examiner commented that at the present time, the Veteran's occupational impairment was controlled by medication. In June 2022, a vocational specialist conducted a vocational assessment and interviewed the Veteran regarding his PTSD symptoms. The Veteran reported that since December 2013, he had preferred to limit his social interactions by isolating and avoiding crowded areas. He would park his cars away from others in a parking lot, would isolate himself from his wife on a daily basis, and become easily irritated over minor incidents. The Veteran would isolate until he could manage his irritability and anger. The Veteran also reported a history of severe depressive symptoms, an overall lack of motivation, and a lack of energy. He indicated that he had difficulty completing simple daily tasks as a result of his psychiatric symptoms. He also had intrusive thoughts that impaired his ability to maintain consistent concentration and focus. The vocational specialist concluded that the Veteran limited his need to socialize and experienced difficulty performing activities of daily living due to his service-connected PTSD. In addition to the symptoms regularly noted in the VA examinations and psychological assessments conducted during the appeal period, VA treatment records also document memory issues. For instance, October 2013 VA treatment records document the Veteran's report of having memory loss or lapses. In addition to other symptoms listed throughout the appeal period, memory loss is raised at later dates in VA treatment records. See, e.g., August 2014 MHC social work note and September 2014 VA treatment record. At a January 2014 primary care behavioral health initial evaluation, the Veteran reported that he had had a history of memory difficulties since 2006. ? Analysis As noted above, the Veteran is in receipt of an initial 50 percent disability rating for his PTSD for the duration of the appeal period that extends back to May 21, 2013. The Board finds that an initial 70 percent disability rating is warranted. In making this finding, the Board observes that none of the symptoms enumerated in the General Formula for a 70 percent disability rating are shown at any point during the appeal period. In the September 2025 JMPR, the parties cited to the VA treatment records that document memory loss when finding the Board erred in the December 2024 decision. However, the Board did discuss memory loss in the December 2024 decision, and that symptom is specifically contemplated by the diagnostic criteria for a 50 percent disability rating under the General Formula. Having that said, the Board will afford the Veteran the benefit of the doubt and find that the June 2022 vocational assessment shows occupational and social impairment with deficiencies in most areas and that this assessment is indicative of the Veteran's psychiatric health for the entire appeal period. As noted above, the June 2022 vocational assessment showed that the Veteran had difficulties with his activities of daily living as a result of his PTSD. The vocational assessment further found that the Veteran's PTSD completely precluded his ability to secure or follow substantially gainful employment. In December 2024, the Board found that this opinion was not borne out by the evidence of record. However, a reading of the evidence from 2014 until 2022 could be construed as the Veteran expressing more optimism in his ability to work in 2014 compared to his assessment of his employability in the eight years separating the two dates. Therefore, the Board finds that the evidence shows that the Veteran's PTSD results in occupational and social impairment with deficiencies in most areas for the duration of the appeal. The evidence does not show total occupational and social impairment, however. While the Veteran's ability to perform some activities of daily living is impacted by his PTSD, as discussed in the June 2022 vocational assessment, this symptom (which is listed in the General Formula under the criteria for a 100 percent disability rating), is not of a severity, frequency, and duration to result in total occupational and social impairment. The severity of disability contemplated by a 100 percent disability rating under the General Formula is total occupational and social impairment. This is not shown in the June 2022 vocational assessment. No other symptom for a total disability rating is shown in the record. Therefore, the Board finds that an initial 70 percent disability rating is warranted, but no higher. To the extent the Board does not grant the highest schedular disability rating, the Board considered the benefit of the doubt rule; however, as the evidence of record is persuasively against a 100 percent disability rating, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc) (providing that only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). 2. Entitlement to a TDIU and SMC based on housebound status. The Board grants entitlement to a TDIU based on the Veteran's PTSD, alone, effective October 8, 2019. The Board will grant a TDIU based on the Veteran's PTSD, effective October 8, 2019, because on and after that date, the Veteran is in receipt of a combined 60 percent disability rating for his remaining service-connected disabilities. Beginning with the TDIU claim, the Veteran is already in receipt of a TDIU based on the combined effects of his service-connected disabilities on and after January 1, 2014. As found in a June 2025 Board decision, the Veteran stopped full time employment in a substantially gainful job on December 31, 2013. Now that the Veteran is in receipt of a 70 percent disability rating for his service-connected PTSD, the Veteran now meets the schedular criteria for a TDIU based on his PTSD, alone. 38 C.F.R. § 4.16(a). In light of the June 2022 vocational assessment, the Board finds that the Veteran's PTSD did cause him to be unable to secure or follow substantially gainful employment on and after October 8, 2019. The Board makes this finding in order to also grant SMC at the housebound rate on and after October 8, 2019. Special monthly compensation is payable where the Veteran has a single service-connected disability rated as 100 percent and (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. This requirement is met when the Veteran is substantially confined as a direct result of service-connected disabilities to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical areas and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 U.S.C. §?1114(s); 38 C.F.R. § 3.350(i). Although no additional disability compensation may be paid when a total schedular disability rating is already in effect, a separate award of TDIU predicated on a single disability may form the basis for an award of SMC. Bradley v. Peake, 22 Vet. App. 280 (2008) (holding that there could be a situation where a veteran has a schedular total rating for a particular service-connected disability, and could establish a TDIU rating for another service-connected disability in order to qualify for SMC under 38 U.S.C. § 1114(s) by having an additional disability of 60 percent or more). Additionally, where TDIU is based on one service-connected disability and there are service-connected disabilities that constitute the required additional disability under Section 1114(s), SMC may be awarded. Buie v. Shinseki, 24 Vet. App. 242, 250 (2010). In this case, the Veteran is now assigned a TDIU based solely on his service-connected PTSD on and after October 8, 2019. Although PTSD is not rated as 100 percent, for SMC purposes the TDIU satisfies the requirement of a "service-connected disability rated as total." See Buie, 24 Vet. App. at 251; Bradley, 22 Vet. App. at 293. On and after October 8, 2019, the Veteran is also service connected for other disorders, and application of these ratings to the combined ratings table yields a combined disability rating of at least 60 percent. 38 C.F.R. § 4.25. As such, on and after October 8, 2019, there are additional service-connected disabilities that are independently ratable as 60 percent, separate and distinct from the TDIU which is based on the service-connected PTSD. ? In summary, on and after October 8, 2019, the Veteran has a single service-connected disability rated as 100 percent by way of his TDIU predicated on his service-connected PTSD and has additional service-connected disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems. Therefore, the criteria for special monthly compensation at the housebound rate are met on and after October 8, 2019. Prior to that date, the Veteran does not meet the additional service-connected disabilities independently ratable at 60 percent, and SMC at the housebound rate is not warranted. 3. Entitlement to SMC based on aid and attendance. In the September 2025 JMPR, the parties agreed that the Board erred in the December 2024 decision by failing to address the reasonably raised claim of entitlement to SMC based on aid and attendance of another. This matter was adjudicated in a June 2025 Board decision. However, given the different appellate periods, the Board will again address this issue. Much of the same analysis is incorporated herein. In an August 2022 correspondence, the Veteran's representative raised the issue of entitlement to special monthly compensation (SMC) based on aid and attendance. She asserts that the evidence of record demonstrates that due to his service-connected disabilities, the Veteran "relies on his spouse for help with medication management, attending doctor's appointments, performing household chores, driving, grocery shopping, and preparing meals." She argues that entitlement to SMC based on a need for regular aid and attendance is warranted effective no later than December 31, 2013. SMC at the aid and attendance rate is available when a veteran, as the result of service-connected disability, has experienced the anatomical loss or loss of use of both feet, or of one hand and one foot; is blind in both eyes, with visual acuity of 5/200 or less; is permanently bedridden; or is so helpless as to be in need of regular aid and attendance. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). The criteria for determining that a veteran is so helpless as to be in need of regular aid and attendance include: (1) inability to dress or undress or to keep ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without assistance; (3) inability to feed oneself through loss of coordination of upper extremities or through extreme weakness; (4) inability to attend to the wants of nature; or (5) incapacity, either physical or mental, that requires care or assistance on a regular basis to protect from hazards or dangers incident to their daily environment. 38 C.F.R. § 3.352(a). It is not required however that all of the disabling conditions enumerated be present before a favorable rating may be made. The particular personal functions which the claimant is unable to perform should be considered in connection with his or her condition as a whole, and the need for aid and attendance must be regular, not that there be a constant need. 38 C.F.R. § 3.352(a). An individual who is bedridden by reasons of service-connected disability shall also be considered to require regular aid and attendance. "Bedridden" constitutes a condition that through its essential character actually requires that an individual remain in bed. The fact that a claimant has voluntarily taken to bed or that a physician has prescribed bedrest for a lesser or greater portion of the day to promote convalescence or cure will not suffice. Id. The Veteran is service connected for PTSD, lumbosacral strain status post-surgery, bilateral hearing loss, left ankle arthritis, tinnitus, medial compartment narrowing of the left knee, right ankle strain, and a back scar. Here, the Veteran does not contend and the evidence does not show that he had anatomical loss or loss of use of both of his feet or of one hand and one foot as the result of a service-connected disability. He is not blind in both eyes, and he was not permanently bedridden. The question for the Board is whether the Veteran's service-connected disabilities were so significant to render the Veteran to be in need of regular aid and attendance. After reviewing the evidence of record, the Board finds that the Veteran was not in need of regular aid and attendance due to his service-connected disabilities. In this case, the evidence is against finding that during the period on appeal, the Veteran's service-connected disabilities rendered him unable to dress or undress himself or to keep ordinarily clean and presentable, adjust a prosthetic or appliance used for a service-connected disability, feed himself through loss of coordination of upper extremities or through extreme weakness, attend to the wants of nature, or protect himself against the dangers or hazards inherent in his daily environment. The evidence indicates that the Veteran experienced some impairment due to his service-connected back disability, bilateral ankle disability, and knee disability. However, the record does not establish an inability to dress or undress or to keep ordinarily clean and presentable, an inability to attend to the wants of nature, or physical incapacity that requires care or assistance on a regular basis to protect from hazards or dangers incident to his daily environment. The February 2021 VA back, ankle, and knee examinations documented that he had difficulty with prolonged walking more than half a mile, climbing stairs, and heavy lifting. He ambulated without any assistive devices. The examinations did not indicate any need for regular aid and attendance. A November 2018 VA ankle examination reported that he used a cane and brace as assistive devices; however, he only required the use of these occasionally when he knew he would be walking for extended periods (as in hours). The Board therefore does not find that the severity or frequency of the Veteran's back, ankle, or knee disabilities established a regular need for aid and attendance. The Board also finds that the Veteran's PTSD did not render him so helpless to be in need of regular aid and attendance. As noted above, his symptoms included anxiety; suspiciousness; chronic sleep impairment; mild memory loss, such as forgetting names, directions, or recent events; flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. The examination does not support a finding that he experienced symptoms of such severity or frequency that may have indicated a need for regular aid and attendance, such as grossly inappropriate behavior, persistent danger of hurting himself or others, neglect of personal appearance and hygiene, or disorientation to time or place. He was also found to be competent to manage his financial affairs. Thus, given the above, the evidence is against finding that his PTSD prevented the Veteran from keeping ordinarily clean and presentable or protecting himself against the dangers or hazards inherent in his daily environment. The record also does not support that his back scar, hearing loss, or tinnitus rendered him in need of regular aid and attendance. The Board acknowledges that he may experience reduced hearing clarity and acuity due to his hearing loss; however, the record does not support that his hearing loss resulted in a need for regular aid and attendance. Moreover, the record does not show an inability to feed himself through loss of coordination of upper extremities or through extreme weakness, and he had no special prosthetic or orthopedic appliances requiring adjustment to warrant him in need of regular aid and attendance. Additionally, a May 2015 VA treatment record shows that the Veteran was independent in activities of daily living. The Board has considered the June 2022 private vocational assessment but finds that the evidence is overall against finding that the Veteran required regular need for aid and attendance. The assessment reported that the Veteran was able to shower independently, dress himself while sitting, and drive himself short distances, which goes against finding that the Veteran's service-connected disabilities resulted in a need for regular aid and attendance. The Board acknowledges that the report stated that the Veteran's wife performed household chores, grocery shopping, meal preparation, and driving long distances due to his service-connected disabilities. However, the Board finds that this alone is not indicative of the sort of helplessness described in the regulations as qualifying for special monthly compensation based on the need for regular aid and attendance. For the foregoing reasons, the Board finds that special monthly compensation based on a need for regular aid and attendance is not warranted. The Board has considered the benefit of the doubt rule; however, as the evidence of record persuasively weighs against the claim, that doctrine is not applicable. Lynch, 21 F.4th at 781. Accordingly, the claim must be denied. S. CHARLES NEILL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board SG, 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.