Citation Nr: 21061583 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 18-20 352 DATE: October 4, 2021 ORDER Entitlement to an initial rating of 20 percent, but no higher, prior to August 19, 2020 for left lower extremity reflex sympathetic dystrophy (previously left genitofemoral neuralgia) is granted. Entitlement to an initial rating in excess of 20 percent from August 19, 2020 forward for left lower extremity reflex sympathetic dystrophy is denied. Entitlement to an initial compensable rating for an inguinal hernia repair is denied. Entitlement to an initial compensable rating for left ilioinguinal neuralgia is denied. FINDINGS OF FACT 1. Prior to August 19, 2020, the Veteran's left lower extremity reflex sympathetic dystrophy resulted in moderate incomplete paralysis of the femoral nerve. 2. From August 19, 2020 forward, the Veteran's left lower extremity reflex sympathetic dystrophy resulted in moderate incomplete paralysis of the femoral nerve. 3. Throughout the period on appeal, the Veteran's inguinal hernia repair was manifested by nonrecurrence and the lack of a true hernia protrusion. 4. Throughout the period on appeal, the Veteran's left ilioinguinal neuralgia resulted in moderate incomplete paralysis of the ilioinguinal nerve. CONCLUSIONS OF LAW 1. The criteria for an increased rating of 20 percent, but no higher, prior to August 19, 2020 for left genitofemoral neuralgia have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.123, 4.124, 4.124a, Diagnostic Code 8799-8726. 2. The criteria for an increased rating in excess of 20 percent from August 19, 2020 forward for left genitofemoral neuralgia have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.123, 4.124, 4.124a, Diagnostic Code 8799-8726. 3. The criteria for a compensable rating for an inguinal hernia repair have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7338. 4. The criteria for a compensable rating for left ilioinguinal neuralgia have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.123, 4.124, 4.124a, Diagnostic Code 8730. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 2009 to October 2015. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal for additional development in July 2020. VA treatment record were obtained in July 2020, October 2020, and November 2020, and the requested examinations were performed in September 2020. As such, the directives have been substantially complied with and the matter is again properly before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). While on remand, the RO granted an additional increased rating of 20 percent for the Veteran's left lower extremity reflex sympathetic dystrophy in a September 2020 rating decision, effective August 19, 2020. As this does not constitute a full grant of the benefits sought, the issue remains on appeal before the Board. Ab v. Brown, 6 Vet. App. 35 (1993). The issue has been recharacterized to reflect the date of the stated increased rating. The Veteran and his spouse testified at a hearing before the undersigned Veterans Law Judge (VLJ) in July 2020. A transcript of the hearing is of record. Increased Ratings Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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. 38 C.F.R. § 4.7. 1. Entitlement to an increased rating for left lower extremity reflex sympathetic dystrophy. The Veteran's left lower extremity reflex sympathetic dystrophy (RSD) is rated under Diagnostic Code 8799. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the Diagnostic Code number will be the first two digits from the part of the schedule most closely identifying the part, or system of the body involved, and the last two digits will be "99" for all unlisted conditions. 38 C.F.R. § 4.27. When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. In accordance with the above, the disability has been rated by analogy to 8726, governing neuralgia or the anterior crural (femoral) nerve. 38 C.F.R. §§ 4.124, 4.124a, Diagnostic Code 8726. Neuralgia is to be rated on the same scale as the nerve affected, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. Here, the nerve affected is the femoral nerve. Thus, the Board will use the criteria contained in Diagnostic Code 8526, with the caveat that the maximum allowable rating is for moderate incomplete paralysis. 38 C.F.R. §§ 4.124, 4.124a, Diagnostic Code 8526. Under Diagnostic Code 8726, a 10 percent rating is warranted for mild incomplete paralysis and a 20 percent rating is warranted for moderate incomplete paralysis. 38 C.F.R. § 4.124a, Diagnostic Code 8726. Throughout the period on appeal, the Veteran has reported that he has experienced on-going pain since his hernia surgery. During his July 2020 hearing, the Veteran and his spouse testified that he experiences persistent dull pain in the groin, periodic sharp pain, and heat. The Veteran denied experiencing any numbness. The Veteran and his spouse are competent to report such lay-observable symptoms, and there is no evidence they are not credible. Jandreau, 492 F.3d 1372. As such, these statements are entitled to probative weight. The Veteran was provided with VA examinations in November 2014, June 2017, and August 2020. In November 2014, the examiner noted severe constant pain and moderate intermittent pain, but no paresthesias or dysesthesias or numbness. On examination the Veteran has full muscle strength in the left lower extremity with no evidence of atrophy. The Veteran's reflexes and sensation were normal, and there was no evidence of trophic changes. There was no loss of use of the lower extremity. The examiner stated that the Veteran had moderate incomplete paralysis of the ilioinguinal nerve, but that the femoral nerve was normal. In June 2017, the examiner diagnosed the Veteran with ilioinguinal neuropathy and genitofemoral neuropathy. The examiner noted that the Veteran reported experiencing pain in the hernia surgery area with some radiating pain into the lower extremity. The examiner noted mild constant pain, moderate intermittent pain, mild paresthesias and / or dysesthesias, and moderate numbness. Muscle strength was normal in the left lower extremity with no evidence of atrophy. Reflexes and sensation were normal, and there was no evidence of trophic changes or loss of use of the lower extremity. The examiner stated that the Veteran had mild incomplete paralysis of the femoral nerve. Finally, in August 2020 the examiner noted that the Veteran reported severe pain, and trouble with the left knee. The examiner noted moderate constant and intermittent pain, mild paresthesias and / or dysesthesias, and moderate numbness. Muscle strength was normal in the left lower extremity with no evidence of muscle atrophy. Reflexes were noted to be 2+ throughout the extremity. The Veteran also had normal sensation to light touch except for the left upper anterior thigh, where sensation was found to be decreased but not absent. There was no loss of use of the lower extremity. Although the examining physician did not specifically fill out the section of the examination report concerning the overall severity of the femoral nerve impairment, the examiner stated in the remarks section that there was moderate impairment of the genitofemoral nerve. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012); Acevedo v. Shinseki, 25 Vet. App. 286, 29394 (2012). There is no evidence that the above examiners were either not competent or credible. Further, each assessment was based on the Veteran's own reports of his symptoms as well as each examiner's own objective examination of the disability As such, the Board finds that each respective examination report is entitled to significant probative weight as to the severity of the Veteran's disability during the period on appeal. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran's physical evaluation board documents reflect complaints of left groin pain, with diagnoses of genitofemoral neuralgia and ilioinguinal neuralgia. Post-service treatment records reflect on-going treatment for pain associated with the Veteran's inguinal hernia repair. Based on the foregoing, the Board finds that an increased rating of 20 percent, but no higher, is warranted prior to August 19, 2020. During the period on appeal the Veteran has consistently stated that he experiences persistent dull pain as well as instances of intermittent severe pain, including during his July 2020 hearing testimony. Further, the November 2014 examiner noted that the Veteran experienced severe constant pain and moderate intermittent pain. Treatment records during the period prior to August 19, 2020, as well as the in-service physical evaluation board documents, reflect reports of significant pain. The Board notes that the June 2017 examiner noted only mild constant pain, moderate intermittent pain, mild paresthesias and / or dysesthesias, and moderate numbness. However, the Board finds that overall the evidence of record reflects that the Veteran's RSD during the period on appeal was generally manifested by at least periods of severe pain. As such, an in the interest of affording the Veteran the full benefit of the doubt, an increased rating of 20 percent prior to August 19, 2020 is warranted. 38 C.F.R. §§ 4.3, 4.7, 4.124, 4.124a, Diagnostic Code 8726. As the Veteran has been assigned the highest allowable rating for neuralgia of the femoral nerve throughout the period on appeal, an increased rating in excess of 20 percent under Diagnostic Code 8726 is not warranted. 38 C.F.R. § 4.124, 4.124a, Diagnostic Code 8526. No additional higher or alternative ratings under different Diagnostic Codes can be applied in this case. As discussed above, the Veteran has consistently been found to have normal reflexes and muscle strength, and there is no evidence of muscle atrophy or trophic changes. As the Veteran's impairment is sensory only, the maximum allowable rating under Diagnostic Code 8526 is that for moderate incomplete paralysis. 38 C.F.R. § 4.124a, Note. Therefore, an increased rating is not possible even if the Veteran were to be rated directly under Diagnostic Code 8526, as opposed to being rated based on neuralgia of the affected nerve. The Veteran is already service-connected for the documented ilio-inguinal impairment, discussed below. 38 C.F.R. § 4.124a, Diagnostic Code 8530. None of the examiners indicated that there was impairment of any other nerves in either the left lower extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8520 to 8525, 8526 to 8529. The Board notes that the Veteran has also reported that his disability interferes with his sleep and has caused him to develop knee disabilities. Thun v. Peake, 22 Vet. App. 111, 115116 (2008), aff'd, 572 F.3d 1366 (Fed. Cir. 2009). As to the reported knee issues, the Veteran is already service connected for a left knee disability, and therefore the reported left knee symptoms are fully contemplated by the rating assigned for that disability, and therefore the rating schedule generally, and cannot serve as grounds for referral for extraschedular consideration. Long v. Wilkie, 33 Vet. App. 167, 17374 (2020). As to the reported sleep issues, the Veteran is not competent to diagnose himself with a sleep disability of any kind, as to do so requires medical knowledge and training beyond that which may be expected of a lay person. Jandreau, 492 F.3d 1372; Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). Further, there is no evidence that the Veteran has otherwise been diagnosed with a sleep disability that has been attributed to his service-connected disability. Morgan v. Wilkie, 31 Vet. App. 162 (2019). Finally, while the Veteran has reported sleep interference, there is no evidence that this has resulted in marked interference with employment or frequent periods of hospitalization. Thun, 22 Vet. App. at 115116. The Veteran has been able to continue going to school and is currently in search of employment in his chosen field, and the medical records contain no evidence of frequent hospitalizations. As such, referral for extraschedular consideration is not warranted. Id.; see Chudy v. O'Rourke, 30 Vet. App. 34, 3839 (2018). All potentially applicable Diagnostic Codes have been considered. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Based on the foregoing, an increased rating of 20 percent, but no higher, is warranted prior to August 19, 2020. However, the preponderance of the evidence is against an increased rating in 20 percent at any point during the period on appeal for the Veteran's service-connected left lower extremity RSD. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. 2. Entitlement to a compensable rating for an inguinal hernia repair. The Veteran's inguinal hernia repair is rated under Diagnostic Code 7338. Under Diagnostic Code 7338, a noncompensable rating is warranted for an inguinal hernia that is not operated but remediable or that is small, reducible or without true hernia protrusion. 38 C.F.R. § 4.114, Diagnostic Code 7338. A 10 percent rating is warranted for an inguinal hernia that is postoperative recurrent, readily reducible, and well supported by truss or belt. Id. A 30 percent rating is warranted for an inguinal hernia that is small, postoperative recurrent, or unoperated irremediable, not well supported by truss, or not readily reducible. Id. A 60 percent rating is warranted for an inguinal hernia that is large, postoperative, recurrent, not well supported under ordinary conditions and not readily reducible, when considered inoperable. Id. Throughout the period on appeal, the Veteran has reported that he has experienced groin pain since his hernia surgery. During his July 2020 hearing, the Veteran and his spouse testified that he experiences continuous dull pain with periodic episodes of sharp pain. The Veteran denied any recurrence of the hernia. The Veteran and his spouse are competent to report such lay-observable symptoms, and there is no evidence they are not credible. Jandreau, 492 F.3d 1372. As such, these statements are entitled to probative weight. The Veteran was provided with VA examinations in November 2014, June 2017, and August 2020. In November 2014, the examiner noted that the Veteran had a left inguinal hernia, but that the Veteran did not require medication and that there were no associated symptoms. In an addendum opinion completed that same month, the examiner noted that the Veteran underwent surgery for an inguinal hernia in 2013, and stated that there was there was no indication of a supporting belt. The examiner in conclusion stated that there was no evidence of surgical complications on the left side. In June 2017 the examiner diagnosed the Veteran with residuals of a left inguinal hernia repair with mesh. At the examination the Veteran denied any recurrence of the hernia, but did report pain at the site of the surgery. The examiner noted a 2013 surgery to repair a left inguinal hernia, and stated that there was no evidence of a hernia on examination. During the August 2020 examination the Veteran reported pain and a burning sensation. The examiner noted that the Veteran had undergone left inguinal hernia surgery, and that no hernia was detected on examination. The examiner further noted that there was no indication for support. There is no evidence that the above examiners were either not competent or credible, and each examination report was based on the Veteran's own account of his symptoms and each examiner's objective examination of the disability. As such, the Board finds that each respective examination report is entitled to significant probative weight as to the severity of the Veteran's inguinal hernia during the period on appeal. Nieves-Rodriguez, 22 Vet. App. 295. Treatment records reflect a history of a hernia and corrective surgery, as well as on-going complaints of pain at the surgery site. However, there is no evidence of recurrence in the Veteran's treatment records. Based on the foregoing, the preponderance of the evidence is against a finding that a compensable rating is warranted for the Veteran's inguinal hernia. Each of the VA examiners noted the history of surgical intervention but stated that there was no evidence of a hernia on examination and that there was no indication of support. Treatment records likewise do not reflect any recurrence of the Veteran's hernia or the need for any kind of support. Indeed, the Veteran himself testified that there had not been any recurrence of the inguinal hernia since the prior surgery. As all of the evidence of record reflects that the Veteran's post-operative inguinal hernia is not recurrent, and compensable rating is not warranted in this case. 38 C.F.R. § 4.3, 4.7, 4.114, Diagnostic Code 7338. The Veteran has only been diagnosed with an inguinal hernia, which is specifically covered by Diagnostic Code 7338. As such, it would be inappropriate to rate this disability by analogy to any other Diagnostic Codes. Copeland v. McDonald, 27 Vet. App. 333, 33637 (2015) ("the Court reiterates that when a condition is specifically listed in the Schedule, it may not be rated by analogy"). Thus, consideration of any alternative Diagnostic Codes is not warranted in this case. The Veteran has also reported that his disability interferes with his ability to sleep and has resulted in knee issues and pain. Thun, 22 Vet. App. at 115116. However, as discussed above the Veteran's knee disability is already service connected. Long, 33 Vet. App. at 17374. Likewise, the reports of pain are contemplated by the ratings assigned for the femoral and ilioinguinal nerve impairments. Id. Further, there is no competent evidence showing the Veteran has been diagnosed with a sleep disability that is related to his inguinal hernia, and further there is no evidence that the sleep impairment results in marked interference with employment or frequent hospitalizations. Morgan, 31 Vet. App. 162; Thun, 22 Vet. App. at 115116. Indeed, as noted during the period on appeal the Veteran the Veteran has been able to go to school and testified that he was looking for work in his chosen career field. Thun, 22 Vet. App. at 115116. As such, referral for extraschedular consideration is not warranted. See Chudy, 30 Vet. App. 34, 3839. All potentially applicable Diagnostic Codes have been considered. See Schafrath, 1 Vet. App. at 593. The preponderance of the evidence is against an initial compensable rating for the Veteran's inguinal hernia repair. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. 3. Entitlement to a compensable rating for left ilioinguinal neuralgia. The Veteran's left ilioinguinal neuralgia is rated under Diagnostic Code 8730, governing neuralgia of the ilio-inguinal nerve. As discussed above, neuralgia is to be rated on the same scale as the nerve affected, with a maximum equal to moderate incomplete paralysis. 38 C.F.R. § 4.124. Here, the nerve affected is the ilio-inguinal nerve, and therefore the Board will use the criteria contained in Diagnostic Code 8530 with the caveat that the maximum allowable rating is for moderate incomplete paralysis. 38 C.F.R. §§ 4.124, 4.124a, Diagnostic Code 8530. Under Diagnostic Code 8730, a noncompensable rating is warranted for mild or moderate incomplete paralysis. 38 C.F.R. § 4.124, 4.124a, Diagnostic Code 8730. Throughout the period on appeal, the Veteran has reported that he has experienced on-going pain since his hernia surgery. During his July 2020 hearing, the Veteran and his spouse testified that he experiences persistent dull pain in the groin, periodic sharp pain, and heat. The Veteran denied experiencing any numbness. The Veteran and his spouse are competent to report such lay-observable symptoms, and there is no evidence they are not credible. Jandreau, 492 F.3d 1372. As such, these statements are entitled to probative weight. The Veteran was provided with VA examinations in November 2014, June 2017, and August 2020. In November 2014, the examiner noted severe constant pain and moderate intermittent pain, but no paresthesias or dysesthesias or numbness. On examination the Veteran has full muscle strength in the left lower extremity with no evidence of atrophy. The Veteran's reflexes and sensation were normal, and there was no evidence of trophic changes. There was no loss of use of the lower extremity. The examiner stated that the Veteran overall had moderate incomplete paralysis of the ilioinguinal nerve, but that the femoral nerve was normal. In June 2017, the examiner diagnosed the Veteran with ilioinguinal neuropathy and genitofemoral neuropathy. The examiner noted that the Veteran reported experiencing pain in the hernia surgery area with some radiating into the lower extremity. The examiner noted mild constant pain, moderate intermittent pain, mild paresthesias and / or dysesthesias, and moderate numbness. Muscle strength was normal in the left lower extremity with no evidence of atrophy. Reflexes and sensation were normal, and there was no evidence of trophic changes. There was no loss of use of the lower extremity. The examiner stated that the Veteran had moderate incomplete paralysis of the ilioinguinal nerve. Finally, in August 2020 the examiner noted that the Veteran reported severe pain, and trouble with the left knee. The examiner noted moderate constant and intermittent pain, mild paresthesias and / or dysesthesias, and moderate numbness. Muscle strength was normal in the left lower extremity with no evidence of muscle atrophy. Reflexes were noted to be 2+ throughout the extremity. The Veteran also had normal sensation to light touch expected for the left upper anterior thigh, where sensation was found to be decreased. There was no loss of use of the lower extremity. The examiner concluded that the Veteran had moderate incomplete paralysis of the ilioinguinal nerve. There is no evidence that the above examiners were either not competent or credible. Further, each assessment was based on the Veteran's own reports of his symptoms as well as each examiner's own objective examination of the disability As such, the Board finds that each respective examination report is entitled to significant probative weight as to the severity of the Veteran's disability during the period on appeal. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran's physical evaluation board documents reflect complaints of left groin pain, with diagnoses of genitofemoral neuralgia and ilioinguinal neuralgia. Post-service treatment records reflect on-going treatment for pain associated with the Veteran's inguinal hernia repair. Based on the foregoing, a compensable rating is not warranted for the Veteran's ilioinguinal neuralgia. As discussed earlier, the maximum rating for neuralgia is equivalent to the rating for moderate incomplete paralysis of the affected nerve. Here, the affected nerve is the ilioinguinal nerve, and Diagnostic Code 8530 assigns a noncompensable rating for mild or moderate incomplete paralysis. As such, a higher rating is not possible in this case. 38 C.F.R. §§ 4.3, 4.7, 4.124, 4.124a, Diagnostic Code 8730. No additional higher or alternative ratings under different Diagnostic Codes can be applied in this case. The Veteran has consistently been found to have normal reflexes and muscle strength, and there is no evidence of muscle atrophy or trophic changes. As the Veteran's impairment is sensory only, the maximum allowable rating under Diagnostic Code 8530 is that for moderate incomplete paralysis. 38 C.F.R. § 4.124a, Note. Therefore, an increased rating is not possible even if the Veteran were to be rated directly under Diagnostic Code 8530, as opposed to being rated based on neuralgia. The Veteran is already service-connected for the documented femoral nerve impairment, as discussed above. 38 C.F.R. § 4.124a, Diagnostic Code 8530. None of the examiners indicated that there was impairment of any other nerves in either the left or right lower extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8520 to 8529. The Board notes that the Veteran has also reported that his disability interferes with his ability to sleep and has resulted in knee symptoms. Thun, 22 Vet. App. at 115116. However, the Veteran's left knee disability is already service connected. Long, 33 Vet. App. at 17374. Further, there is no competent evidence showing the Veteran has been diagnosed with a sleep disability that is related to his ilioinguinal nerve impairment or that the sleep impairment results in marked interference with employment or frequent hospitalizations. Morgan, 31 Vet. App. 162; Thun, 22 Vet. App. at 115116. Indeed, the Veteran has been able to go to school and testified that he was looking for work in his chosen career field. Thun, 22 Vet. App. at 115116. As such, referral for extraschedular consideration is not warranted. See Chudy, 30 Vet. App. 34, 3839. All potentially applicable Diagnostic Codes have been considered. See Schafrath, 1 Vet. App. at 593. The preponderance of the evidence is against an initial compensable rating for the Veteran's left ilioinguinal neuralgia. As such, the benefit-of-the-doubt doctrine is inapplicable. 38 C.F.R. § 4.3. For these reasons, the claim is denied. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Wendell, 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.