Citation Nr: 21066947 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-18 108 DATE: November 3, 2021 ORDER Entitlement to service connection for an acquired psychiatric disability, to include post-traumatic stress disorder (PTSD), is denied. Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for hypertension is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for a stroke with residuals is denied. Entitlement to service connection for sleep apnea is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. FINDINGS OF FACT 1. The preponderance of the competent evidence shows that the Veteran does not have a current diagnosis of PTSD or any other acquired psychiatric disability. 2. The preponderance of the evidence is against finding that diabetes mellitus began during active service or within a year of separation from service or is otherwise related to an in-service injury or disease. 3. The preponderance of the evidence is against finding that hypertension began during active service or within a year of separation from service or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence is against finding that a heart disability began during active service or within a year of separation from service or is otherwise related to an in-service injury or disease. 5. The preponderance of the evidence is against finding that a stroke with residuals began during active service or is otherwise related to an in-service injury or disease. 6. The preponderance of the evidence is against finding that sleep apnea began during active service or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). 2. The criteria for entitlement to service connection for diabetes mellitus have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). 3. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). 4. The criteria for entitlement to service connection for a heart disability have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). 5. The criteria for entitlement to service connection for a stroke with residuals have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). 6. The criteria for entitlement to service connection for sleep apnea have not been met. 38 U.S.C. §§ 1131, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1977 to February 1979. This matter came before the Board of Veterans Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A January 2019 BVA decision remanded all the issues on appeal for further development, asking that a request that any of the Veteran's VA treatment records prior to 2005 be obtained and that a request be made to the Veteran regarding any outstanding private treatment records. The Board's review indicates that a request for the Veteran's pre-2005 VA treatment records was made and that a response was provided indicating that no such records were able to be located. This response indicates that all available records were provided, and the Board therefore finds that there has been substantial compliance with the remand directive. The Board's review also indicates that a September 2019 letter asked the Veteran to identify any private providers and complete an enclosed authorization form. However, the record is silent for any indication that the Veteran provided the requested authorization or otherwise responded to the request. There is also no indication in the file that the Veteran did not receive the request for authorization. The Board notes that the duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190. 192 (1991). While VA does have a duty to assist the Veteran in the development of the claim, that duty is not limitless, and the Veteran must be prepared to cooperate with VA's efforts to obtain all relevant evidence. Olson v. Principi, 3 Vet. App. 480, 483 (1992). The Board therefore finds that there has been substantial compliance with the remand directives and will proceed to adjudicate the issues on appeal based on the evidence of record. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection for certain chronic diseases will be presumed if they are manifest to a compensable degree within the year after active service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For benefits to be denied, "the preponderance of the evidence must be against the claim." Id. at 54. 1. Entitlement to service connection for PTSD (also claimed as anxiety & depression) The Veteran contends that he is entitled to service connection for PTSD. The Board concludes that the Veteran does not have a current diagnosis of PTSD or any other acquired psychiatric disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Service connection is therefore not warranted. 38 C.F.R. § 3.303 (a), (d); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); credible supporting evidence that the claimed in-service stressor occurred; and a link, established by medical evidence, between current symptoms and the in-service stressor. 38 C.F.R. § 3.304 (f). The Board's review indicates that service and VA treatment records are silent for complaints, diagnosis, or treatment of PTSD or any other acquired psychiatric disability, during or after service. A January 2020 record shows a negative screen for depression, and the Veteran again denied depressive symptoms in a February 2020 record. An August 2020 VA examination found that the Veteran did not have a diagnosis of PTSD and his symptoms did not meet the diagnostic criteria for PTSD or any other mental disorder that conformed to the DSM-5 criteria. The Veteran denied any mental health symptoms or concerns. The examiner did not note any symptoms related to a PTSD diagnosis and found that the Veteran did not have any findings, signs, or symptoms for any acquired psychiatric disorder, to include anxiety and depression. The examiner also noted that the Veteran had been married 40 years and had close familial relationships. At the outset, the Board finds that the VA examination is adequate for appellate review. There is no evidence that the examiner was not competent or credible, and as the report is based on the Veteran's statements, a virtual examination and the examiners' observations, the Board finds it is entitled to significant probative weight. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 30205 (2008). The Veteran has submitted a statement in December 2014, in which he reported that, while stationed at Camp Pendleton in December 1976, racial tensions and violence in the surrounding area made him fear for his safety. The Veteran's DD-214 indicates that he was stationed at Camp Pendleton during this time. He also submitted a New York Times article in June 2020 which documented rising racial tensions around Camp Pendleton in December 1976. The Board finds that the competent evidence does not show that the Veteran has ever been diagnosed with PTSD or any other acquired psychiatric disability. As noted above, service connection for PTSD specifically requires medical evidence diagnosing a disability. While the Board acknowledges the Veteran's reports of events at Camp Pendleton and notes that he is competent to report his lay-observable symptoms, he does not possess the medical expertise required to provide a diagnosis. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Significantly, in addition to the lack of a diagnosis, both VA treatment records and the August 2020 VA examination show that the Veteran denied having mental health symptoms. The December 2014 statement also did not report current mental health symptoms. There is simply no basis upon which the Board can conclude that the Veteran had a diagnosis of PTSD or any other acquired psychiatric disability at any point during the period on appeal. The Board therefore finds that the Veteran does not have a disability of PTSD or other acquired psychiatric disorder and has not had one at any point during the period on appeal. As with all claims for service-connection, in the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for PTSD or other acquired psychiatric disorder is therefore not warranted. 38 C.F.R. § 3.303. 2. Entitlement to service connection for diabetes mellitus The Veteran seeks service connection for diabetes mellitus. After a review of the evidence of record, the Board concludes that, while the Veteran has a diagnosis of diabetes mellitus, the preponderance of the evidence is against finding that it began during active service, or within a year of separation from service, or is otherwise related to an in-service injury or disease. 38 C.F.R. § 3.303, 3.307, 3.309. Service treatment records (STR) are silent for complaints, treatment or diagnosis of diabetes. The Veteran's active service ended in February 1979. To manifest to a compensable degree within one year, the evidence would need to show diabetes manageable by diet alone. 38 C.F.R. § 4.119, DC 7913. A review of the evidence shows the record is silent for evidence of either elevated blood sugar readings or a diabetes mellitus diagnosis during the presumptive period. The VA treatment records do not include the original diagnosis date for the Veteran's diabetes but do show that the Veteran has been receiving consistent treatment and medication for diabetes since February 2006. However, in February 2006, the Veteran stated that he had been diagnosed with diabetes during a job physical in 2003. No mention is made of any earlier symptoms, treatment, or diagnosis, in service or otherwise. The Veteran submitted a VA 21-526EZ claiming compensation benefits for diabetes but did not make any specific assertions regarding the onset of his diabetes or the relationship between his disability and his active service. The Veteran submitted seven lay statements from those who either know or served with him, all stating that they believe the Veteran has had diabetes since 1979. Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, a lay person cannot competently provide a diagnosis unless they are shown to have relevant medical expertise. Id. None of the lay statements of record indicate that the authors possess the relevant medical expertise. In addition, none report lay-observable symptoms that would be associated with diabetes. Instead, they simply claim that the Veteran had diabetes during service, with no description of their basis for that knowledge. This is not competent evidence sufficient to prove an in-service diagnosis of diabetes and the Board assigns the statements no probative weight. The Board finds that the competent evidence of record does not support the conclusion that the Veteran's diabetes began in service or was otherwise due to service. Service treatment records are silent for diabetes or any reports of abnormal blood sugar. The Veteran was discharged from service in February 1979, and February 2006 treatment records show that the Veteran himself stated that he was not diagnosed with diabetes mellitus until 2003, over 24 years later. There is simply no competent evidence of record that establishes either an earlier onset of diabetes mellitus or a relationship between the Veteran's diabetes and his active service. The record is negative for any evidence, other than the Veteran's own generalized assertion that he is entitled to service connection, of a relationship between his service and the later diagnosis of diabetes. The Veteran did not present any competent lay or medical evidence of symptoms or diagnosis of diabetes prior to 2003 or any evidence of a relationship between diabetes and his service. While the Veteran contends that his diabetes is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. Id. The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for diabetes, there is no indication that diabetes was manifested in, or is otherwise directly related to, the Veteran's service. Moreover, STRs are silent for diabetes, the record first shows treatment in 2006, and the Veteran reported an initial diagnosis in 2003. The Board therefore finds that the competent evidence of record is against a finding that diabetes mellitus had its onset during the Veteran's period of qualifying service or that it manifested to a compensable degree within a year after the end of his qualifying period of service. Service connection is therefore not warranted. 38 C.F.R. § 3.303, 3.307, 3.309. 3. Entitlement to service connection for hypertension The Veteran seeks service connection for hypertension. After a review of the evidence of record, the Board concludes that, while the Veteran has a diagnosis of hypertension, the preponderance of the evidence is against finding that it began during active service, within a year of separation from service, or is otherwise related to an in-service injury or disease. 38 C.F.R. § 3.303, 3.307, 3.309. The Veteran's service treatment records from his qualifying period of service are silent for diagnosis or treatment for hypertension. His service treatment records also do not contain a pattern of elevated blood pressure. The Veteran's entrance examination from February 1975 documents a blood pressure reading of 134/82. There are no additional readings or notation of high blood pressure in the STRs. The Veteran's active service ended in February 1979. To manifest to a compensable degree within one year, the evidence would need to show diastolic pressure predominantly 100 or more, systolic pressure predominantly 160 or more, or continuous medication. 38 C.F.R. § 4.104, DC 7101. A review of the evidence shows the record is silent for evidence of either elevated blood pressure readings or a prescription for blood pressure medication during the presumptive period. The first medical evidence of record of hypertension is a February 2012 treatment record noting hypertension with a blood pressure reading of 148/102, nearly 33 years after service and well outside the presumptive period. The Board particularly notes that the provider characterized hypertension as "new" at that appointment. There was no notation of an earlier onset, treatment, or symptoms manifesting to a compensable degree within the year after active service. To the contrary, the Veteran actively denied any previous concerns for blood pressure or diagnosis of hypertension when asked to provide a history. The Veteran submitted a VA 521-526EZ claiming compensation benefits for hypertension (initially claimed as blood pressure) but did not make any specific assertions regarding the onset of his hypertension or the relationship between his disability and his active service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran's hypertension began in service or was otherwise due to service. Service treatment records are silent for hypertension or any reports of high blood pressure. The Veteran was discharged from service in February 1979, and the evidence does not show complaints of hypertension symptoms or that he sought treatment for hypertension until February 2012, 36 years later when the provider indicated that the hypertension was "new". There is no competent evidence of record that establishes an earlier onset of hypertension or a relationship between the Veteran's hypertension and his active service. The record is negative for any evidence, other than the Veteran's own generalized assertion that he is entitled to service connection, of a relationship between his service and the later diagnosis of hypertension. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of hypertension prior to February 2012 or any evidence of a relationship between hypertension and his service. While the Veteran contends that his hypertension is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. Id. The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for hypertension, there is no indication (or specific assertion) that hypertension was manifested in, or is otherwise directly related to, the Veteran's service. Moreover, STRs are silent for hypertension and VA treatment records are silent for a diagnosis of hypertension until February 2012. The Board therefore finds that the competent evidence of record is against a finding that hypertension had its onset during the Veteran's period of qualifying service or that it manifested to a compensable degree within a year after the end of his qualifying period of service. Service connection is therefore not warranted. 38 C.F.R. § 3.303(a), (d), 3.307, 3.309. 4. Entitlement to service connection for a heart disability The Veteran contends that he is entitled to service connection for a heart disability. After a review of the competent evidence of record, the Board concludes that the Veteran's heart disability is not related to service and service connection is therefore not warranted. Arteriosclerotic heart disease (coronary artery disease) is manifest to a compensable degree when metabolic testing shows a workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. 38 C.F.R. § 4.104, DC 7005. Service treatment records are silent for complaints, treatment or diagnosis of a heart disability, to include chest pain. The Veteran's active service ended in February 1979. To manifest to a compensable degree within one year, the evidence would need to show specific METS testing results or the continuous use of medication during the presumptive period. The Board's review shows that the record is silent for the required showings in service or within a year of service, and that the VA treatment records first document a complaint of chest pain in July 2014. At that time, the Veteran was diagnosed with coronary artery disease and underwent a quadruple coronary bypass graft. The July 2014 record is silent for any notation of a history of prior cardiac diagnosis, treatment, or symptoms. The Veteran submitted a VA 521-526EZ claiming compensation benefits for a heart disability but did not make any specific assertions regarding the onset of his heart disability or the relationship between his disability and his active service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran's heart disability began in service or was otherwise due to service. Service treatment records are silent for a heart disability or any reports of cardiac symptoms. The Veteran was discharged from service in February 1979, and the evidence does not show complaints of cardiac symptoms or otherwise sought treatment for a heart disability until July 2014, over 35 years later. There is simply no competent evidence of record that establishes either an earlier onset of a heart disability or a relationship between the Veteran's heart disability and his active service. The record is negative for any evidence, other than the Veteran's own generalized assertion that he is entitled to service connection, of a relationship between his service and the later diagnosis of a heart disability. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of a heart disability or any other cardiac disability prior to July 2014 or any evidence of a relationship between heart disability and his service. While the Veteran contends that his heart disability is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. Id. The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for a heart disability, there is no indication (or specific assertion) that a heart disability was manifested in, or is otherwise directly related to, the Veteran's service. Moreover, STRs are silent for a heart disability and VA treatment records are silent for a diagnosis of a heart disability until July 2014. The Board therefore finds that the competent evidence of record is against a finding that the Veteran's heart disability had its onset during the Veteran's period of qualifying service or that it manifested to a compensable degree within a year after the end of his qualifying period of service. Service connection is therefore not warranted. 38 C.F.R. § 3.303, 3.307, 3.309. 5. Entitlement to service connection for stroke residuals The Veteran contends that he is entitled to service connection for his stroke residuals. After a review of the competent evidence of record, the Board concludes that the Veteran's stroke is not related to service and service connection for its residuals is therefore not warranted. STRs are silent for complaints, treatment or diagnosis of a neurologic disability. His February 1975 entrance examination did not note any neurologic symptoms or a diagnosis of a neurologic condition. In September 1975, the Veteran complained of dizziness when standing or bending over following a fall without loss of consciousness 4 months prior. He also reported a blackout event 2 years prior, but this would have been prior to his entry in the service. There were no records of any follow-up treatment. The Veteran again reported lightheadedness, slight dizziness, eye pain, floating spots, red or bloodshot eyes, and headaches in December 1976 at an optometry examination. The provider noted no irregular objective findings or provide a diagnosis, and no follow-up treatment notes were included in the file. The Board's review indicates that VA treatment records are silent for neurologic symptoms under February 2006, when the Veteran presented for acute onset headaches and unsteadiness. He was diagnosed with a right cerebellar hemisphere ischemic stroke, though his imaging was normal. The treatment record did not include any notation of any earlier diagnosis, treatment, or neurologic symptoms. The Veteran submitted a VA 521-526EZ claiming compensation benefits for a stroke but did not make any specific assertions regarding the onset of his neurologic disability or the relationship between his disability and his active service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran's stroke began in service or was otherwise due to service. Service treatment records are silent for a stroke or any reports of neurologic symptoms. The Veteran was discharged from service in February 1979, and the evidence does not show complaints of neurologic symptoms or otherwise sought treatment for a stroke until February 2006, 27 years later. There is simply no competent evidence of record that establishes either an earlier onset of a stroke or a relationship between the Veteran's stroke and his active service. The record is negative for any evidence, other than the Veteran's own generalized assertion that he is entitled to service connection, of a relationship between his service and the later diagnosis of a stroke. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of a stroke or any other neurologic disability prior to February 2006 or any evidence of a relationship between his stroke and his service. While the Veteran contends that his stoke is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. Id. The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for a stroke, there is no indication (or specific assertion) that his stroke was manifested in, or is otherwise directly related to, the Veteran's service. Moreover, STRs are silent for neurologic symptoms and VA treatment records are silent for a diagnosis of a stroke until February 2006. The Board therefore finds that the preponderance of the evidence indicates that the Veteran's stroke was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. 6. Entitlement to service connection for sleep apnea The Veteran contends that he is entitled to service connection for sleep apnea. After a review of the competent evidence of record, the Board concludes that the Veteran's sleep apnea is not related to service and service connection is therefore not warranted. Service treatment records are silent for complaints, treatment or diagnosis of sleep issues, to include sleep apnea. VA treatment records note symptoms and treatment for sleep apnea beginning in April 2011. The Veteran's symptoms were documented as fatigue, daytime somnolence, snoring, and apneic episodes, without any commentary regarding an earlier onset or duration of symptoms. The Veteran was diagnosed with obstructive sleep apnea following a sleep study in November 2012. The Veteran submitted a VA 521-526EZ claiming compensation benefits for sleep apnea but did not make any specific assertions regarding the onset of his sleep apnea or the relationship between his disability and his active service. The Board finds that the competent evidence of record does not support the conclusion that the Veteran's sleep apnea began in service or was otherwise due to service. Service treatment records are silent for sleep apnea or any reports of sleep issues. The Veteran was discharged from service in February 1979, and the evidence does not show complaints of sleep apnea symptoms or otherwise sought treatment for sleep apnea until April 2011, over 32 years later. There is simply no competent evidence of record that establishes either an earlier onset of sleep apnea or a relationship between the Veteran's sleep apnea and his active service. The record is negative for any evidence, other than the Veteran's own generalized assertion that he is entitled to service connection, of a relationship between his service and the later diagnosis of sleep apnea. The Veteran did not present any lay or medical evidence of symptoms or diagnosis of sleep apnea or any other sleep disability prior to April 2011 or any evidence of a relationship between sleep apnea and his service. While the Veteran contends that his sleep apnea is related to service, as a layperson, he does not possess the medical expertise required to provide a nexus opinion. Id. The Board acknowledges that a VA examination was not obtained for this issue but finds that an examination is not required to make a final adjudication. Although the Veteran contends service connection is warranted for sleep apnea, there is no indication (or specific assertion) that sleep apnea was manifested in, or is otherwise directly related to, the Veteran's service. Moreover, STRs are silent for sleep apnea and VA treatment records are silent for a diagnosis of sleep apnea until April 2011. The Board therefore finds that the preponderance of the evidence indicates that the Veteran's sleep apnea was not caused by or incurred in service. Service connection is therefore not warranted. 38 C.F.R. § 3.303. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. In July 2015, a VA examination and etiology opinion was provided for the Veteran's left knee disability. The examiner diagnosed a left knee meniscal tear, effusion, and Baker's cyst. Regarding the etiology of the Veteran's left knee disability, the examiner opined that it was less likely than not incurred in or caused by his service. She based this opinion on the lack of service treatment records. The Board finds that the etiology opinion offered by the examiner in July 2015 is inadequate. The examiner notes in the accompanying VA examination that the Veteran claims the left knee disability began in service. However, the opinion disregards the Veteran's lay statements regarding the in-service onset of his left knee disability merely because they are unaccompanied by contemporaneous medical evidence. The opinion is therefore inadequate, and a new opinion is required upon remand. Buchanan v. Nicholson, 451 F.3d 1331, 133637 (Fed. Cir. 2006). The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's left knee disability from a different provider than the one who rendered the July 2015 opinion. An in-person examination is not required unless deemed necessary by the provider. The provider should review the file and provide a complete rationale for all opinions expressed. The provider should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left knee disability is related to his active service. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. If the examiner finds that the lay evidence of record does not support a finding of nexus, the examiner should indicate why that is the case. The examiner is advised that competent lay statements should not be disregarded merely because they are unaccompanied by contemporaneous medical evidence. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Bock 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.