Citation Nr: 19144807 Decision Date: 06/11/19 Archive Date: 06/10/19 DOCKET NO. 16-14 421 DATE: June 11, 2019 ORDER The appeal to reopen the claim for service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy, is granted. Entitlement to a rating of 10 percent, but no higher, for yeast vaginitis is granted. Entitlement to a compensable rating for Bartholin cyst is denied. Entitlement to a compensable rating for extraction of tooth number 19 is denied. REMANDED Entitlement to service connection for an upper respiratory disorder, to include sinus infection, is remanded. Entitlement to service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy, is remanded. FINDINGS OF FACT 1. Evidence received since the July 1993 and March 2002 unappealed rating decisions is not cumulative, was not previously considered by decision makers, and raises a reasonable possibility of substantiating the claim for service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy. 2. The Veteran’s service-connected yeast vaginitis is productive of symptoms that require continuous treatment. 3. The Veteran’s service-connected Bartholin cyst is currently not productive of any symptoms. 4. The Veteran’s service-connected extraction of tooth number 19 has not been productive of loss of substance of body of maxilla or mandible or other impairment of the maxilla, mandible, temporomandibular joint, or hard palate. CONCLUSIONS OF LAW 1. New and material evidence has been received to warrant reopening of the claim for service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy. 38 U.S.C. §§ 5107, 5108 (2012); 38 C.F.R. § 3.156 (2018). 2. The criteria for a rating of 10 percent, but no higher, for the Veteran’s service-connected yeast vaginitis have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.116, Diagnostic Code 7611 (2018). 3. The criteria for a compensable rating for the Veteran’s service-connected Bartholin cyst is denied. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.116, Diagnostic Code 7699-7627 (2018). 4. The criteria for a compensable evaluation for extraction of tooth number 19 have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.150, Diagnostic Codes 9999-9913 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service in the Army from November 1990 to March 1991 and from November 1991 to March 1993. This appeal comes to the Board of Veterans’ Appeals (Board) from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In February 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. During the hearing, the undersigned Veterans Law Judge granted the Veteran’s motion to hold the record open for 30 days for the submission of additional evidence. Subsequently, the Veteran’s representative submitted additional medical evidence along with a waiver of initial agency of original jurisdiction (AOJ) consideration. New and Material Evidence to Reopen A previously denied claim may be reopened by submission of new and material evidence. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). Evidence is new if it has not been previously submitted to agency decision makers. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2018). Evidence is material if it, either by itself or considered in conjunction with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence cannot be cumulative or redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. When determining whether the claim should be reopened, the credibility of the newly submitted evidence is generally to be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003); Justus v. Principi, 3 Vet. App. 510 (1992). Moreover, in Shade v. Shinseki, 24 Vet. App. 110, 117 (2010), the United States Court of Appeals for Veterans Claims (Court) clarified that the phrase “raises a reasonable possibility of substantiating the claim” is meant to create a low threshold that enables, rather than precludes, reopening. Specifically, the Court stated that reopening is required when the newly submitted evidence, combined with VA assistance and considered with the other evidence of record, raises a reasonable possibility of substantiating the claim. Id. Service connection for status post right salpingectomy and drainage of pelvic abscess with pelvic pain and abnormal bleeding and secondary infertility was originally denied in a July 1993 rating decision based on a finding that there was no evidence that the condition treated prior to service was aggravated during service. In a March 2002 rating decision, the RO denied service connection for uterine fibroids, status post-surgical excision (also claimed as hysterectomy) and service connection for dysmenorrhea. The RO denied service connection for uterine fibroids because the disorder was neither incurred in or caused by service. The RO concluded that new and material evidence had not been received to reopen the claim for dysmenorrhea. It was noted that the term dysmenorrhea was another medical term to describe the symptomatic manifestations that were denied in the July 1993 rating decision. The Veteran did not appeal the March 2002 decision or submit new and material evidence within one year of notice of that decision; therefore, it is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 3.156(a), (b) (2018). In October 2013, the Veteran filed claims for service connection for uterine fibroids; service connection for pelvic pain, abnormal bleeding and secondary infertility (now claimed as total hysterectomy); and entitlement to a temporary total evaluation because of surgery for a total hysterectomy. In the July 2014 rating decision, the RO, continued the denial of service connection for uterine fibroids and continued the denial of service connection for pelvic pain, abnormal bleeding, and secondary infertility (now claimed as total hysterectomy). The RO also denied entitlement to a temporary total evaluation because of surgery for a total hysterectomy. In August 2014, the Veteran filed a notice of disagreement (NOD) with the July 2014 rating decision regarding the issues currently on appeal. The Board has interpreted this as a request to reopen the previously denied claims in the July 1993 and March 2002 rating decisions. Additionally, the Board has decided to combine the issues of service connection into one issue: entitlement to service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy. See February 2019 Hearing Transcript. The evidence received since the March 2002 rating decision includes new contentions from the Veteran claiming that her residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy, is related to her service-connected yeast vaginitis and Bartholin cyst. See February 2019 Hearing Transcript. Further, the Veteran has also claimed that her disorders are due to her exposure to environmental hazards or chemicals while she was stationed at Fort McClellan in Anniston, Alabama. See April 2014 Correspondence. The Veteran has provided new information that is material to the claim for service connection. Accordingly, the Veteran’s new theory of entitlement constitutes new and material evidence sufficient to reopen the claim. Thus, the Board finds that the claim for entitlement to service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy, is reopened. To this extent only, the appeal is granted. Increased Rating Disability evaluations are determined by the application of the Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practicably be determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual disorders in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321(a), 4.1 (2018). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7 (2018). Otherwise, the lower rating will be assigned. Id. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2018). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Additionally, staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a compensable rating for yeast vaginitis. 2. Entitlement to a compensable rating for Bartholin cyst. The Veteran is seeking compensable ratings for yeast vaginitis and Bartholin cyst. The Board concludes that a 10 percent rating is warranted for the Veteran’s service-connected yeast vaginitis. However, a compensable rating for the Veteran’s Bartholin cyst is not warranted. Currently, the Veteran is rated at 0 percent for her service-connected yeast vaginitis under 38 C.F.R. § 4.116, Diagnostic Code 7611. The Veteran is rated at 0 percent for her service-connected Bartholin cyst under 38 C.F.R. § 4.116, Diagnostic Codes 7699-7627. Diagnostic Codes 7610-7615 are rated under Diagnostic Code 7615, which is the general rating formula for disease, injury, or adhesions of female reproductive organs. Under Diagnostic Code 7615, a 0 percent rating is assigned where symptom do not require continuous treatment. A 10 percent rating is assigned where symptoms require continuous treatment. A 30 percent rating is assigned for symptoms not controlled by continuous treatment. See 38 C.F.R. § 4.116, Diagnostic Code 7615. In June 2014, the Veteran was afforded a VA examination for her gynecological conditions. The VA examiner noted that the Veteran was diagnosed with Bartholin cyst in 2010, abnormal PAP smear in 1998, and abnormal uterine bleeding in 2004. The Veteran had also been diagnosed with candida vaginitis. The Veteran reported that she underwent a hysterectomy in August 2013 and has not had any vaginal bleeding, bloating, or gynecological issues since then. The Veteran also had ovarian cysts, but those symptoms were resolved. She denied any vaginal pain, itching, rash, discharge, cyst, mass in vaginal area, and regarding Bartholin cyst, she denied any issues. Her last episode of yeast vaginitis was in September 2013, which did not require any medications. The VA examiner noted that the Veteran did not currently have symptoms related to a gynecological condition, including any disease, injuries, or adhesions of the female reproductive organs. The VA examiner noted that the Veteran did not currently require treatment or medications for symptoms related to reproductive tract conditions. The VA examiner noted that the Veteran did not have uterine fibroids, enlargement of the uterus, and/or displacement of the uterus. It was noted that the Veteran had surgical menopause. The Veteran had complete removal of her ovaries in August 2013. The Veteran did not have incontinence or fistulae. Also, the Veteran had not been diagnosed with endometriosis. The VA examiner reported that after a review of the Veteran’s medical records, as well as outside gynecological records in the past few years, the VA examiner found that it was negative for any mention of a Bartholin cyst or complaints associated with it. The last exam by a gynecologist in July and August of 2013 and current examination was negative for any Bartholin cyst. The VA examiner concluded that the Veteran’s diagnosis of Bartholin cyst was inactive. The VA examiner noted that the Veteran had a history of vaginal itching and irritation and had been treated for bacterial vaginosis and candida vaginitis empirically in the past. However, the symptoms were resolved; there was no history or evidence of recurrence since August 2013. The Veteran was not on any medications for her vaginal condition. The VA examiner concluded that it was also inactive. In February 2016, the Veteran had an evaluation for her gynecological issues. She reported that she had issues with cramps, abdominal pain, discharge, and itching while in the military. She still had issues with discharge and itching. The Veteran reported having a laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy in August 2015 due to all the issues that she had with her cycles. She reported that she still had frequent yeast and bacterial vaginosis infections and used over the counter drugs to treat the infections. However, her problems kept coming back. In March 2016, the Veteran was afforded a VA examination for gynecological conditions. The VA examiner noted that the Veteran had been diagnosed with yeast vaginitis and Bartholin cyst. The Veteran reported that she had mild intermittent pain caused by her condition. She also had itching in the vaginal area with white discharge since November. The Veteran reported that she has been treating herself with over the counter medications. However, the VA examiner noted that the Veteran did not currently require treatment or medications for symptoms related to reproductive tract conditions. The Veteran did not have any problems with her cervix. She did not have uterine prolapse or fibroids. She previously had a hysterectomy. The Veteran did not have urinary incontinence, fistula, or endometriosis. Based on the foregoing, the Board finds that a rating of 10 percent, but no higher, is warranted for the Veteran’s service-connected yeast vaginitis. Although the VA examiner concluded that the Veteran did not currently require treatment or medications for symptoms related to reproductive tract conditions, in February and March 2016, the Veteran reported that she had been using over the counter medication to treat her yeast infections. The Veteran had frequent yeast and bacterial vaginosis infections and used over the counter drugs to treat the infections; however, her infections kept coming back. The Veteran’s symptoms also included itching in the vaginal area with white discharge and mild intermittent pain. The Board finds that this is evidence that the Veteran’s yeast vaginitis requires continuous treatment. The Veteran’s lay statements regarding her use of over the counter medication to continue to treat her symptoms are credible. The Veteran is competent to testify to such lay observable symptomology and these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board acknowledges the fact that the March 2016 VA examination states that the Veteran did not currently require treatment or medications for symptoms related to reproductive tract conditions. Therefore, the evidence is at least in relative equipoise as to whether the Veteran’s yeast vaginitis symptoms require continuous treatment. However, it has not been shown that the Veteran’s symptoms have not been controlled by continuous treatment. As such, a rating of 10 percent, but no higher, is warranted for the Veteran’s service-connected yeast vaginitis. As for the Veteran’s service-connected Bartholin cyst, a compensable rating is not warranted. The VA examinations confirm that the Veteran’s Bartholin cyst symptoms have resolved. The June 2014 VA examiner reported that after a review of the Veteran’s medical records, as well as outside gynecological records in the past few years, the VA examiner found that it was negative for any mention of a Bartholin cyst or complaints associated with it. The VA examiner concluded that the Veteran’s diagnosis of Bartholin cyst was inactive. Further, the Veteran has not shown any other symptoms of gynecological conditions, such as urinary incontinence, fistula, endometriosis, fibroids, or malignant neoplasms. Therefore, a compensable rating is not warranted for the Veteran’s service-connected Bartholin cyst. 3. Entitlement to a compensable rating for extraction of tooth number 19. The Veteran is currently assigned a noncompensable evaluation from her service-connected extraction of tooth number 19 pursuant to 38 C.F.R. § 4.150, Diagnostic Codes 9999-9913. Hyphenated diagnostic codes including a diagnostic code ending in the digits “99” are used when there is no specifically applicable diagnostic code and the disability is rated by analogy. 38 C.F.R. § 4.27 (2018). Under Diagnostic Code 9913, a noncompensable evaluation is warranted for loss of teeth due to loss of substance of body of maxilla or mandible without loss of continuity, where the loss of masticatory surface can be restored by suitable prosthesis. Higher evaluations are warranted where the lost masticatory surface cannot be restored by suitable prosthesis based on the teeth lost. 38 C.F.R. § 4.150, Diagnostic Code 9913 (2018). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that a compensable evaluation is not warranted for the Veteran’s service-connected extraction of tooth number 19. In June 2014, the Veteran was afforded a VA examination for dental and oral conditions, including mouth, lips, and tongue. The VA examiner noted that the Veteran had not been diagnosed with an oral or dental condition. The VA examiner reported that the Veteran reported that her lower jaw sometimes dislocated at dental appointments and had to be manipulated to return it to position. This had not happened though in over three years because she had not been to the dentist. The range of motion was within normal limits and was not limited on repetition. The dislocation did not occur during the VA examination. Tooth number 19 was lost due to fracture while eating a malted milk ball. Based on the foregoing, the Board finds that a compensable rating for the Veteran’s service-connected extraction of tooth number 19 is not warranted. The record does not show any evidence as to a loss of substance of body of maxilla or mandible. Further, the Veteran’s VA treatment records do not indicate such a dental disability. The Board has also considered other potentially applicable diagnostic codes but finds that a higher or separate evaluation is not available in the absence of evidence of other impairment of the maxilla, mandible, temporomandibular joint, or hard palate as part of the service-connected dental disability. See 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916 (2018). As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49 (1990). During the February 2019 Board hearing, the Veteran requested a VA examination for her tooth disability due to the fact that she has not had an examination since June 2014. However, the Veteran made no assertion that her tooth disability had worsened since her last VA examination. There is no evidence of record showing her symptoms to be worse. Thus, the Board finds that the evidence of record is adequate to rate the Veteran’s disability, and that remand for any new examination of it is not warranted. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994). REASONS FOR REMAND 1. Entitlement to service connection for an upper respiratory disorder, to include sinus infection, is remanded. The Veteran is seeking service connection for an upper respiratory disorder, to include sinus infection. The Veteran claims that her respiratory disorder/sinus infection began in 1991 when she was in basic training and/or in Fort McClellan, Alabama. She was treated for it and on continuous medications, but it kept coming back. See February 2019 Hearing Transcript. The Veteran asserts that her sinus infection/upper respiratory disorder is the result of being exposed to chemicals or environmental hazards while stationed at Fort McClelland in Anniston, Alabama. See April 2014 Correspondence. Service treatment records show that the Veteran had upper respiratory problems. For example, in an April 1992 health record, the Veteran complained of having cold symptoms and was diagnosed with an upper respiratory infection. On the Veteran’s February 1993 Report of Medical History for separation, the Veteran noted that she had hay fever. Moreover, post service treatment records show that the Veteran continued to have problems with her sinuses. For example, in a March 2001 VA treatment record, the Veteran complained of a sinus infection. In February 2014, the Veteran was assessed for a viral upper respiratory infection. As the Veteran has not been afforded a VA examination for her upper respiratory disorder/sinus infection, the Board finds that the evidence of record is sufficient to trigger VA’s duty to assist in providing the Veteran with a VA examination to determine whether her claimed condition is etiologically related to military service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy, is remanded. The Veteran is seeking service connection for residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, to include a temporary total evaluation due to surgery for total hysterectomy. The Veteran asserts that she has had these problems since service. The Veteran contends that this condition is related to her service-connected yeast vaginitis and Bartholin cyst. See February 2019 Hearing Transcript. Further, the Veteran has also claimed that her issues are due to her exposure to environmental hazards or chemicals while she was stationed at Fort McClellan in Anniston, Alabama. See April 2014 Correspondence. Prior to service, a May 1981 private treatment record shows that the Veteran had a salpingectomy of the right fallopian tube. Also, service treatment records show that the Veteran had numerous gynecological problems. A private treatment record reveals that in August 2013, the Veteran had a hysterectomy. Although the Veteran has had VA examinations for her gynecological issues, a medical opinion has not been provided specifically addressing this claim. Therefore, on remand, the RO should schedule the Veteran for a VA examination to determine the nature and etiology of her condition. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment or private treatment records and associate with the claims file. 2. Attempt to verify with the U.S. Joint Services Records Research Center (JSRRC) or other appropriate U.S. Government records repository that the Veteran was exposed to chemicals or environmental hazards while stationed in Fort McClellan, Alabama, during any part of her service. If the JSRRC determines that insufficient information is available to verify the Veteran’s claimed exposure to environmental hazards or chemicals while stationed at Fort McClellan, the JSRRC coordinator should make a formal finding that sufficient information is not available, and such a determination should be associated with the claims file. The Board notes that the Veteran has provided articles regarding the toxic chemicals found at Fort McClellan, Alabama. See August 2014 Web/HTML Documents. 3. After the above development has been completed, schedule the Veteran for an appropriate VA examination to determine the nature and likely etiology of her upper respiratory disorder/sinus infection. The record and a copy of this remand must be made available to and reviewed by the examiner in conjunction with the examination. All necessary tests should be completed. The VA examiner should address the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s upper respiratory disorder/sinus infection is related to her active military service, to include exposure to chemicals and environmental hazards while stationed in Fort McClellan, if verified. The VA examiner should also consider instances of upper respiratory and/or sinus infections that occurred while the Veteran was in military service. (b.) A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in the medical community at large and not those of the particular examiner. 4. Schedule the Veteran for appropriate an VA examination to determine the nature and likely etiology of her residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility. The record and a copy of this remand must be made available to and reviewed by the examiner in conjunction with the examination. All necessary tests should be completed. The VA examiner should address the following: (a.) Whether there is clear and unmistakable (obvious or manifest) evidence that the Veteran’s other non-service connected gynecological issues, to include symptoms leading to a hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, existed prior to the Veteran’s active duty service. (b.) If so, whether there is clear and unmistakable (obvious or manifest) evidence that the Veteran’s other non-service connected gynecological issues, to include symptoms leading to a hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, were NOT aggravated (did NOT undergo an increase in severity beyond the natural scope of the disability) during the Veteran’s active duty service. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, are related to her military service, to include gynecological issues in service and exposure to chemical and/or environment hazards, if verified. (d.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, are caused by her service-connected yeast vaginitis and/or Bartholin cyst. (e.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s residuals of a total hysterectomy, to include pelvic pain, abnormal bleeding, and secondary infertility, were aggravated by her service-connected yeast vaginitis and/or Bartholin cyst. For the purposes of secondary service connection, the examiner is advised that aggravation is defined as “any increase in disability.” See Allen v. Brown, 7 Vet. App. 439, 448 (1995). If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of her observable symptoms over time. (f.) A rationale for all requested opinions should be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she should provide a complete explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge (CONTINUED ON NEXT PAGE) in the medical community at large and not those of the particular examiner. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Crawford, Associate 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.