Citation Nr: 21004112 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 15-16 932 DATE: January 26, 2021 ORDER 1. For the period from February 1, 2014 forward, a rating in excess of 20 percent for left leg weakness is denied. 2. A higher rating for left hand weakness, in excess of 10 percent for the period from February 1, 2014 to January 3, 2020, and in excess of 20 percent for or the period from January 3, 2020 forward, is denied. 3. For the period from February 1, 2014 forward, a rating in excess of 10 percent for a thrombosis, cerebral infarction, is denied. 4. For the period from November 10, 2014 forward, a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is granted. FINDINGS OF FACT 1. For the period from February 1, 2014 forward, the left leg disability was manifested by moderate muscle weakness. 2. The Veteran is right-hand dominant. 3. For the period from February 1, 2014 to January 3, 2020, the left-hand disability was manifested by moderate muscle weakness. 4. For the period from January 3, 2020 forward, the Veteran is already in receipt of the maximum schedular rating for damage to Muscle Group VIII of the non-dominant left upper extremity (left hand). 5. A 100 percent rating was assigned for six months following a cerebral event on August 6, 2013, and there has not been another cerebral event since then. 6. The service-connected headaches and vertigo stem from a common etiology of exposure to environmental hazards during Gulf War service. 7. For the period from November 10, 2014 forward, the Veteran has been unable to maintain substantially gainful employment as a result of service-connected disabilities. CONCLUSIONS OF LAW 1. For the period from February 1, 2014 forward, the criteria for a rating in excess of 20 percent for left leg weakness (Muscle Group XI) have not been met. 38 U.S.C. §§ 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4,55, 4.56, 4.71, 4.73, Diagnostic Code 5311. 2. For the period from February 1, 2014 to January 3, 2020, the criteria for a rating in excess of 10 percent for left hand weakness (Muscle Group VIII), have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2. 4.10, 4.56, 4.73, Diagnostic Code 5308. 3. For the period from January 3, 2020 forward, the criteria for a rating in excess of 20 percent for left hand weakness (Muscle Group VIII), have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2. 4.10, 4.56, 4.73, Diagnostic Code 5308. 4. For the period from February 1, 2014 forward, the criteria for a rating in excess of 10 percent for a thrombosis, cerebral infarction, have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, Diagnostic Code 8008. 5. Resolving reasonable doubt in favor of the Veteran, the criteria for a TDIU from November 10, 2014 forward have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.3, 4.15, 4.16, 4.18, 4.19, 4.25. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1960 to September 1960, from January 1985 to May 1985, and from November 1990 to May 1991. The Veteran declined a Board of Veterans’ Appeals (Board) hearing by submitting a VA Form 20-0995 Decision Review Request: Supplemental Claim in June 2020. In November 2017, the issues currently on appeal were remanded by the Board for further development. Development has been completed, and the case is again before the Board. The Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA), creates a new framework of review for veterans disagreeing with VA’s decision on their claim. This decision has been written consistent with the new AMA framework. Disability Rating Legal Authority Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. 38 C.F.R. § 4.2; Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). If an increase in disability occurred within one-year prior to the claim for increase, the increase is effective as of the date the increase was factually ascertainable. See 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010) (holding “that an increase in a veteran’s service-connected disability must have occurred during the one year prior to the date of the veteran’s claim in order to receive the benefit of an earlier effective date”). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran’s service-connected disabilities. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits compensating a veteran twice for the same symptoms or functional impairment). When an unlisted condition is encountered, it will be permissible to rate it under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. Conjectural analogies will be avoided, as will the use of analogous ratings for conditions of doubtful diagnosis, or for those not fully supported by clinical and laboratory findings. Nor will ratings assigned to organic diseases and injuries be assigned by analogy to conditions of functional origin. 38 C.F.R. § 4.20. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011). Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. 1. Rating Left Leg Weakness The functions of Muscle Group XI include flexion of the knee and muscles of the calf. Under DC 5311, a 20 percent rating is provided for moderately severe impairment of Muscle Group XI. A 30 percent rating is provided for severe impairment of Muscle Group XI. 38 C.F.R. § 4.73, Diagnostic Code 5311. Muscle group damage is categorized as mild, moderate, moderately severe, and/or severe, and rated accordingly. 38 C.F.R. § 4.56. Disability of a muscle group is based on impaired joint motion and its ability to perform its full work. Principal symptoms are weakness, fatigability, coordination, swelling, deformity, and atrophy. The principal factors are impairment of delicate coordination, strength of scar bound muscles, and lowering of fatigue threshold. For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56(c). Moderately severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Entrance and (if present) exit scars indicating track of missile through one or more muscle groups. Indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side demonstrate positive evidence of impairment. Severe disability of muscles--(i) Type of injury. Through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. (ii) History and complaint. Service department record or other evidence showing hospitalization for a prolonged period for treatment of wound. Record of consistent complaint of cardinal signs and symptoms of muscle disability as defined in paragraph (c) of this section, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. (iii) Objective findings. Ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track. Palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area. Muscles swell and harden abnormally in contraction. Tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, the following are also signs of severe muscle disability: (A) X-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile. (B) Adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle. (C) Diminished muscle excitability to pulsed electrical current in electrodiagnostic tests. (D) Visible or measurable atrophy. (E) Adaptive contraction of an opposing group of muscles. (F) Atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle. (G) Induration or atrophy of an entire muscle following simple piercing by a projectile. The Veteran is currently assigned a 20 percent rating for weakness of the left lower extremity. The Veteran contends generally that a higher rating in excess of 20 percent is warranted for this disability. See June 2020 Supplemental Claim. After review of all the lay and medical evidence of record, the Board finds that the criteria for an increased rating higher than 20 percent for the service-connected left lower extremity disability are not met or approximated for the period on appeal. Throughout the rating period on appeal, the left lower extremity disability has been manifested by no worse than moderate muscle weakness in the left lower extremity. See January 2020 VA examination. An April 2014 VA examination shows only mild muscle weakness in the left lower extremity. A July 2014 VA examination shows moderate muscle weakness in the left lower extremity. Because the evidence of record shows moderate muscle weakness and does not show severe impairment of the left lower extremity, a higher rating in excess of 20 percent under DC 5311 is not warranted. 38 C.F.R. §§ 4.3, 4.7. 2. Rating Left Hand Weakness February 1, 2014 to January 3, 2020 The provisions of 38 C.F.R. § 4.73, Diagnostic Code 5308, apply to impairment of Muscle Group VIII. This muscle group involves the functions of extension of the wrist, fingers, and thumb; and abduction of the thumb. It includes the muscles arising mainly from the external condyle of the humerus (extensors of the carpus, fingers, and thumb; and the supinator). Diagnostic Code 5308 makes a distinction between the dominant and non-dominant upper extremity. In this case, a January 2020 VA examination reflects that the Veteran is right-handed; thus, the right arm is the dominant upper extremity and the left arm is the non-dominant upper extremity. Under Diagnostic Code 5308, slight impairment of Muscle Group VIII on the non-dominant side is rated noncompensable (zero percent); moderate impairment is rated 10 percent disabling; moderately severe impairment is rated 20 percent disabling; and severe impairment is also rated 20 percent disabling. 38 C.F.R. § 4.73. After review of all the lay and medical evidence of record, the Board finds that the criteria for an increased rating higher than 10 percent for the service-connected left-hand disability are not met or approximated for the period from February 1, 2014 to January 3, 2020. Throughout the rating period on appeal, the left-hand disability has been manifested by no worse than moderate muscle weakness in the left hand. For example, an April 2014 VA examination and a July 2014 VA examination both show moderate muscle weakness in the left upper extremity. Because the evidence of record shows moderate muscle weakness and does not show moderately severe impairment of the left hand, a higher rating in excess of 10 percent under DC 5308 is not warranted for the period from February 1, 2014 to January 3, 2020. 38 C.F.R. §§ 4.3, 4.7. From January 3, 2020 For the period from January 3, 2020 forward, the Veteran is already in receipt of the maximum schedular rating of 20 percent that is available for damage to Muscle Group VIII of the non-dominant upper extremity. As such, a rating higher than 20 percent is not warranted under Diagnostic Code 5308 as a matter of law. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board has considered whether other diagnostic codes could provide a higher rating for the Veteran’s service-connected muscle injury to the left hand; however, Diagnostic Code 5308 explicitly pertains to rating Muscle Group VIII. There is another muscle injury indicated by the record to Muscle Group XI, which, as noted, has already been assigned a separate rating. For this reason, the Board finds no other diagnostic codes that can properly be applied for purposes of evaluating the damage to Muscle Group VIII; therefore, the claim for increase must be denied. 38 C.F.R. §§ 4.3, 4.7. 3. Rating Thrombosis, Cerebral Infarction The Veteran is currently assigned a 10 percent rating for thrombosis, cerebral infarction. Under DC 8008 thrombosis of a blood vessel of the brain is rated 100 percent disabling for six months, and thereafter is rated on the basis of residuals with a rating of 10 percent. A 100 percent rating was assigned throughout the six months following the date of thrombosis on August 6, 2013. A 10 percent rating is assigned from February 1, 2014. A higher rating of 100 percent is not warranted in the absence of recently active disease. To the extent that the Veteran now has any residual injuries due to thrombosis, these are assigned separate disability ratings. A higher 100 percent rating for the thrombosis is not warranted in the absence of recently active disease. The evidence of record, including a January 2020 VA examination, shows no recent cerebral event. As there has been no other cerebral event, another 100 percent rating under DC 8008 is not warranted; therefore, the claim for increase must be denied. 38 C.F.R. §§ 4.3, 4.7. 4. TDIU Disability ratings are determined applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155. Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. 38 C.F.R. § 3.340(a)(1). Total ratings are authorized for any disability or combination of disabilities for which the rating schedule prescribes a 100 percent rating. 38 C.F.R. § 3.340(a)(2). A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. The service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue will be addressed in both instances. 38 C.F.R. § 4.16(a), (b). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. 38 C.F.R. § 4.16(a). If a veteran’s disabilities do not meet the objective combined rating percentage criteria of 38 C.F.R. § 4.16(a), it then becomes necessary to consider whether the criteria for referral for extraschedular consideration are met under § 4.16(b) criteria. It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. Submission to the Director, Compensation and Pension Service, for extraschedular consideration is warranted in all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in § 4.16(a). 38 C.F.R. § 4.16(b). See Wages v. McDonald, 27 Vet. App. 233 (2015) (holding that a decision of TDIU under 38 C.F.R. § 4.16(b) by the Director of C&P is not evidence, and is not a policy decision, but is simply a decision or adjudication that is adopted by the RO and reviewed de novo by the Board). Cf. Kuppamala v. McDonald, 27 Vet. App. 447 (2015) (applying principles announced in Wages to 38 C.F.R. § 3.321 (b) extraschedular adjudication, namely, Director of C&P decision is not evidence, and is not a policy decision, but is simply a decision or adjudication that is adopted by the RO and reviewed de novo by the Board). Individual unemployability must be determined without regard to any non-service-connected disabilities or a veteran’s advancing age. 38 C.F.R. §§ 3.341(a), 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether a veteran is capable of performing the physical and mental acts required by employment, not whether a veteran can find employment. Id. at 361. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in a veteran’s favor. 38 C.F.R. § 4.3. In Faust v. West, 13 Vet. App. 342 (2000), the Court defined “substantially gainful employment” as an occupation that provides an annual income that exceeds the poverty threshold for one person, irrespective of the number of hours or days that a veteran actually works and without regard to a veteran’s earned annual income. In Hatlestad v. Derwinski, 5 Vet. App. 524, 529 (1993), the Court held that the central inquiry in determining whether a veteran is entitled to a TDIU is whether a veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. The determination as to whether a total disability is appropriate should not be based solely upon demonstrated difficulty in obtaining employment in one particular field, which could also potentially be due to external bases such as economic factors, but rather to all reasonably available sources of employment under the circumstances. See Ferraro v. Derwinski, 1 Vet. App. 326, 331-332 (1991). In evaluating a veteran’s employability, consideration may be given to the level of education, special training, and previous work experience in arriving at a conclusion, but not to age or impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. Marginal employment is not considered substantially gainful employment and generally is deemed to exist when a veteran’s earned income does not exceed the amount established by the U.S. Department of Commerce, Bureau of the Census, as the poverty threshold for one person. Marginal employment may also be held to exist in certain cases when earned annual income exceeds the poverty threshold on a facts-found basis. Consideration shall be given in all claims to the nature of the employment and the reason for termination. 38 C.F.R. § 4.16(a). Marginal employment, odd-job employment, and employment at half the usual remuneration is not incompatible with a determination of unemployability if the restriction to securing or retaining better employment is due to disability. 38 C.F.R. § 4.17(a). The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Moore v. Nicholson, 21 Vet. App. 211, 218 (2007) (ultimate question of whether a veteran is capable of substantial gainful employment is not a medical one; that determination is for the adjudicator), rev’d on other grounds sub nom, Moore v. Shinseki, 555 F.3d 1369 (Fed. Cir. 2009). Although VA must give full consideration, per 38 C.F.R. § 4.15, to “the effect of combinations of disability,” VA regulations place responsibility for the ultimate TDIU determination on VA, not a medical examiner’s opinion. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013); 38 C.F.R. § 4.16(a). In this case, the Veteran has asserted that he is unable to maintain substantially gainful employment due to service-connected disabilities. From November 10, 2014 through January 3, 2020, the Veteran was service connected for depressive disorder, rated as 30 percent disabling, headaches, rated as 30 percent disabling, lumbar myositis, rated as 20 percent disabling, left leg weakness, rated as 20 percent disabling, left hand weakness, rated as 10 percent disabling, vertigo, rated as 10 percent disabling, left lower extremity radiculopathy, rated as 10 percent disabling, right lower extremity radiculopathy, rated as 10 percent disabling, thrombosis, rated as 10 percent disabling, and hypertension, rated as noncompensable, for a combined 80 percent rating. On January 3, 2020, the rating for left hand weakness was increased to 20 percent, increasing the combined rating to 90 percent. The Board finds that from November 10, 2014 forward, the combined disability rating eligibility criteria for a TDIU under 38 C.F.R. § 4.16(a) have been met. The service-connected headaches (rated as 30 percent disabling) and the service-connected vertigo (rated as 10 percent disabling) stem from a common etiology of exposure to environmental hazards during the Gulf War, so may be combined to produce a 40 percent rating to satisfy the combined rating percentage requirements for TDIU eligibility under 38 C.F.R. § 4.16(a). After reviewing all of the evidence of record, both lay and medical, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran’s service-connected disabilities have prevented him from maintaining substantially gainful employment for the period from November 10, 2014 forward. The most recent March 2020 Application for Increased Compensation Based on Unemployability (TDIU claim) reflects the Veteran has not worked full time since December 2011 due to service-connected disabilities including left leg radiculopathy. A January 2020 VA examiner wrote that “The Veteran is incapable of acquiring and holding any full-time, regularly scheduled occupation due to the marked limitations imposed by the left hemiparesis that makes the left upper extremity basically useless. Has difficulties ambulating also.” A March 2006 Veterans Application for Increased Compensation Based on Unemployability shows that the Veteran was previously employed as a security guard by the Department of Education and has a high school education. Considering the education, type of employment for which the Veteran is trained and has experience, including that employment history was in an occupation that requires a moderate amount of physical activity and agility, and resolving reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s service-connected disabilities prevented the Veteran from maintaining substantially gainful employment for the period from November 10, 2014 forward. The ultimate issue of whether a TDIU should be awarded is not a medical issue, but rather is a determination for the adjudicator. See Geib, 733 F.3d at 1354; Moore, 21 Vet. App. at 218, rev’d on other grounds sub nom, Moore, 555 F.3d 1369; see also 38 C.F.R. § 4.16. Thus, for these reasons, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that the service-connected disabilities have prevented the Veteran from maintaining a substantially gainful occupation from November 10, 2014 forward. 38 C.F.R. §§ 3.340, 3.341, 4.15, and 4.16. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Department of Veterans Affairs A. Caruso, Attorney for the Board 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.