Citation Nr: 21076834 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-26 745 DATE: December 28, 2021 ORDER A rating in excess of 30 percent for interstitial lung disease prior to July 27, 2009 is denied. A compensable rating for interstitial lung disease between July 27, 2009 and March 27, 2018 is denied. A rating in excess of 30 percent interstitial lung disease between March 28, 2018 and September 24, 2019 is denied. A rating in excess of 60 percent for interstitial lung disease from September 25, 2019 onward is denied. An initial rating of 50 percent, but no higher, for chronic adjustment disorder is granted. An initial compensable rating for chronic rhinitis is denied. FINDINGS OF FACT 1. Prior to July 27, 2009, the Veteran's interstitial lung disease did not have forced vital capacity (FVC) of 50 to 64 percent predicted, single-breath diffusing capacity of the lung for carbon monoxide (DLCO (SB)) of 40 to 55 percent predicted, or maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. 2. From July 27, 2009 to March 27, 2018, the Veteran's interstitial lung disease did not have FVC of 75 to 80 percent predicted, or DLCO (SB) of 66 to 80 percent predicted. 3. From March 28, 2018 to September 24, 2019, the Veteran's interstitial lung disease did not have FVC of 50 to 64 percent predicted, DLCO (SB) of 40 to 55 percent predicted, maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. 4. From September 25, 2019 onward, the Veteran's interstitial lung disease did not have FVC of less than 50percent predicted, DLCO (SB) less than 40percent predicted, maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or pulmonale or pulmonary hypertension, or a requirement of outpatient oxygen therapy. 5. For the period on appeal, the Veteran's chronic adjustment disorder is productive of occupational and social impairment with reduced reliability and productivity due to nightmares, irritability, loss of enjoyment, anger, social isolation, and difficulty in establishing and maintaining effective social relationships. 6. The weight of the competent and probative evidence is against finding the Veteran has nasal polyps, greater than 50 percent obstruction in both nasal passages, or complete obstruction on one side. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 30 percent prior to July 27, 2009, for an interstitial lung disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6899-6828. 2. The criteria for a compensable rating from July 27, 2009, to March 27, 2018, for an interstitial lung disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6899-6828. 3. The criteria for a disability rating in excess of 30 percent from March 28, 2018, to September 24, 2019, for an interstitial lung disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6899-6828. 4. The criteria for a disability rating in excess of 60 percent since September 25, 2019, for an interstitial lung disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, Diagnostic Code 6899-6828. 5. The criteria for an initial rating of 50 percent for chronic adjustment disorder are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, DC 9411. 6. The criteria for an initial compensable rating for service-connected rhinitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.97, DC 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Army from October 1973 to October 1975. This matter is before the Board of Veterans' Appeals (Board) on appeal from January 2013 and September 2014 (chronic adjustment disorder) rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the above claims were vacated and remanded by the U.S. Court of Veteran's Claims (Court). They were remanded to address the Veteran request, through his attorney, for the Board to wait 90 days before issuing a decision so the attorney could submit argument. Since that time, the Veteran's attorney submitted a brief in support of the Veteran's claims in November 2021. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 50910 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). 1. Entitlement to a rating in excess of 30 percent for interstitial lung disease prior to July 27, 2009. 2. Entitlement to a compensable rating for interstitial lung disease between July 27, 2009 and March 27, 2018. 3. Entitlement to a rating in excess of 30 percent interstitial lung disease between March 28, 2018 and September 24, 2019. 4. Entitlement to a rating in excess of 60 percent for interstitial lung disease from September 25, 2019 onward. The Veteran is rated under DC 6899-6828 for his interstitial lung disease. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. The disability is rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. See 38 C.F.R. §§ 4.20, 4.27. When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be "built-up" as follows: the first two digits will be selected from that part of the schedule most closely identifying the part, or system of the body involved, in this case, the musculoskeletal system, and the last two digits will be "99" for all unlisted conditions. Then, the disability is rated by analogy under a diagnostic code for a closely related disability that affects the same anatomical functions and has closely analogous symptomatology. 38 C.F.R. §§ 4.20, 4.27. Under the General Rating Formula for Interstitial Lung Disease, a 10 percent rating is granted for FVC of 75 to 80 percent predicted; or, DLCO (SB) of 66 to 80 percent predicted. A 30 percent rating is warranted on FVC of 65 to 74 percent predicted; or, DLCO (SB) of 56 to 65 percent predicted. For a 60 percent rating, the evidence must show FVC of 50 to 64 percent predicted; or, DLCO (SB) of 40 to 55 percent predicted; or, maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. Finally, a 100 percent rating is assigned for FVC of less than 50-percent predicted; or, DLCO (SB) less than 40-percent predicted; or, maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation; or, cor pulmonale or pulmonary hypertension; or, where outpatient oxygen therapy is required. 38 C.F.R. § 4.97. The Veteran's attorney representative submitted a brief in November 2021. Concerning his interstitial lung disorder, the attorney asserted the Veteran's noncompensable staged rating warrants a compensable rating. In support, the attorney explains the 2014 examination shows the Veteran was in the emergency room and such a potential flare-up warrants a compensable rating. Prior to July 27, 2009 The Veteran receives a 30 percent rating during this period on appeal for his interstitial lung disease. During this period, VA treatment records show pulmonary function testing (PFT) results. The Veteran's FVC was 74 percent predicted on July 28, 2008, and DLCO (SB) was 57 percent predicted. These readings are consistent with the 30 percent rating assigned. A higher, 60 percent rating is not warranted during this period, as the evidence does not reflect FVC of 50 to 64 percent predicted, DLCO (SB) of 40 to 55 percent predicted, or a maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. 38C.F.R. §4.97, Diagnostic Code 6828. From July 27, 2009 until March 27, 2018 The Veteran receives a noncompensable rating during this period on appeal for his interstitial lung disease based on VA treatment records noting normal lung volume testing on July 27, 2009. The Veteran, through his attorney, asserted that his symptoms warranted a compensable rating as a January 2014 letter showed pulmonary function testing with fixed restrictive defect of the lungs. Additionally, as referenced above, the attorney asserted the Veteran's noncompensable staged rating warrants a compensable rating as the 2014 examination shows the Veteran was in the emergency room and such a potential flare-up warrants a compensable rating. After a review of the competent evidence, there is no probative evidence during this period in conflict with these findings. Initially, treatment records show that the Veteran's FVC on July 27, 2009 was 84 percent pre-bronchodilator. The record also shows that the Veteran under several examination during this stage and those results will be discussed next. He underwent an examination in December 2012. His disability required intermittent courses or bursts of system (oral or parenteral corticosteroids), but zero courses or bursts in the past 12 months. His November 2012 chest x-ray was normal. The Veteran had PFT with pre-bronchodilator of FVC 86 percent predicted and DLCO 98 percent predicted. Post-bronchodilator was FVC 83 percent predicted. He participated in another examination in August 2014. The Veteran reported he was in the emergency room the prior month because of severe shortness of breath, sinus drainage, and fever. It was unclear whether he had bronchitis, pneumonia, or a Wegener's flare-up. He briefly used albuterol during the acute and transitory respiratory illness. His chest imaging had largely remained the same since November 2012. His respiratory illness was believed to be unrelated to Wegener's, but it was unclear, and he had been advised to discuss with his primary care. His FVC was 57 percent pre-bronchodilator and 46 percent post. DLCO was 57 percent. The examiner stated that his testing results were likely affected by his acute respiratory illness and did not accurately reflect the Veteran's disability. Additionally, the examiner stated the August 2014 PFT was deemed "suboptimal for interpretation" due to poor effort during testing. Therefore, the August 2014 PFT is afforded no probative value, as a medical profession determined that there was suboptimal for interpretation. After review of the competent and probative evidence, the Board finds that a compensable rating from July 28, 2009 until March 28, 2018 is not warranted. In this regard, the Veteran has had FVC of 83 precent at the December 2012 examination. The Board acknowledges the 2014 examination reporting FVC of 46 percent and DLCO of 57 percent. However, the examiner also stated that his testing results were not accurate. The Board also acknowledges the argument that the Veteran's lungs had a restrictive defect. However, the rating criteria establish objective testing results for a higher rating. Additionally, the competent evidence does not tend to show during this period on appeal that his DLCO was less than 55 percent predicted or that his maximum exercise capacity was 15 to 20 ml/kg/min with cardiorespiratory limitation. As such, a compensable rating during this period on appeal is not warranted as he has had greater than 80 percent FVC predicted and DLCO of 98 percent predicted. The Board acknowledges the Veteran's attorney's argument, but find that the 2014 emergency room visit, about a month prior to the August 2014 examination, should warrant a compensable rating. However, when this evidence showing symptomatology, such as shortness of breath and sinus drainage, are view against other relevant, competent as evidence as described above, the Board finds an additional staged rating is not warranted. In support, the Board finds July 2009 FVC and the 2012 examination report, with diagnostic testing, to be more probative of the Veteran's disability picture during this period. Further, the 2014 examination report also indicates that the Veteran stated he felt back to baseline now (one month later at the time of the August 2014 examination). Such evidence tends to show that the emergency room visit is not reflective of the overall status of the respiratory disability during this period. As such, an additional stage is not warranted. See 38 C.F.R. § 3.344(a) ("Rating agencies will handle cases affected by change of medical findings or diagnosis, so as to produce the greatest degree of stability of disability evaluations consistent with the laws and Department of Veterans Affairs regulations governing disability compensation and pension."). From March 28, 2018 until September 24, 2019 The Veteran receives a 30 percent rating during this period on appeal for his interstitial lung disease. On March 28, 2018, his FVC was 70 percent predicted and his DLCO (SB) was 65 percent predicted. The test was deemed adequate for interpretation. As such, a rating in excess of 30 percent is not warranted as the competent evidence did not show that he had FVC of 50 to 64 percent predicted; or, DLCO (SB) of 40 to 55 percent predicted; or, maximum exercise capacity of 15 to 20 ml/kg/min oxygen consumption with cardiorespiratory limitation. From September 25, 2019 onward The Veteran receives a 60 percent rating during this period on appeal for his interstitial lung disease. His most recent examination is from August 2019, but PFT results were conducted on September 25, 2019. This PFT shows that his FVC was 61 percent pre-bronchodilator and 60 percent post bronchodilator. The examiner reported that FEV-1/FVC was the best indicator of the severity and that DLCO (SB) testing was not indicated. The examiner noted that DLCO (SB) testing was not indicated in this Veteran's case. Additionally, the examiner indicated that, other than monitoring with the Veteran's pulmonologist as needed, his respiratory conditions did not require treatment, including medication, oral bronchodilators, or oxygen therapy. Based on the foregoing, the preponderance of the evidence is against a finding that the severity of the Veteran's interstitial lung disease warrants a higher rating of 100 percent as there is no indication of FVC of less than 50-percent predicted, DLCO (SB) less than 40-percent predicted, maximum exercise capacity less than 15 ml/kg/min oxygen consumption with cardiorespiratory limitation, or pulmonale or pulmonary hypertension, or where outpatient oxygen therapy is required. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran is not, however, competent to identify a specific level of disability according to the appropriate diagnostic codes, such as those needing PFT. Such competent evidence concerning the nature and extent of the Veteran's disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which the disabilities on appeal are evaluated thus are probative and given weight. The relevant medical and lay evidence has been assessed by the Board in determining the overall disability ratings over the course of this appeal. 5. Entitlement to a rating in excess of 10 percent for chronic adjustment disorder prior to July 8, 2019 and 30 percent thereafter. The Veteran is rated under DC 9440 for his adjustment disorder. He receives an initial rating of 10 percent prior to July 8, 2019, and 30 percent thereafter. Psychiatric disabilities are rated based on the General Rating Formula codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. "A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and (5th ed. 2013) (DSM-5). See Mauerhan v. Principi, 16 Vet. App. 436, 44243 (2002). VA is to engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran's service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Under the General Rating Formula for Mental Disorders per 38 C.F.R. § 4.130, in pertinent part, a 10 rating is warranted for Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted if the disability is productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material; forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. The criteria for a 100 percent rating are: total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in October 2018. As such, the DSM-5 applies, and the GAF scores will not be considered. He participated in an examination in August 2014. The examiner reported that he had a mental disorder, but that he did not have symptoms severe enough to interfere with occupational and social functioning or to require continuous medication. He had good grooming and was oriented. His affect was appropriate, and mood was euthymic. His speech was normal. Thought processes were logical and goal directed. He did not have evidence of psychosis or delusional beliefs. He denied suicidal and homicidal ideations. He reported depression due to his financial circumstances. He underwent an additional examination in July 2019. The examiner reported that he had occupational and social impairment due to mild or transient symptoms. His marriage was "rocky." The examiner largely reported no changes since the August 2014 examination. His symptoms included: depressed mood, anxiety, and chronic sleep impairment. His hygiene was good, and he was oriented. He did not have hallucinations, delusions, or suicidal/homicidal ideations. His medical records show depression, anxiety, and social isolation in April 2015. While he would occasionally go fishing with friends, he preferred to be socially isolated. Additionally, in October 2015, he had nightmares, poor sleep, low energy, social isolation, and sexual apathy. In November, he reported feeling more anxious, agitated, angry, and increased nightmares. The Veteran's attorney submitted a brief in November 2021. For the Veteran's acquired psychiatric disorder, the attorney asserted the Veteran's symptoms were more nearly approximated by a 50 percent rating as medical records showed a difficulty in establishing and maintaining effective social relationships. After review of the competent and probative evidence, the Board finds that an initial rating of 50 percent is warranted. 38 C.F.R. § 4.7. When viewing his symptoms as a whole, the Board concludes that his symptoms more nearly approximate a rating of 50 percent. In this regard, the Veteran's medical records show social isolation, nightmares, low energy, increased anxiety, agitation, and anger. His relationship with his spouse has been strained at times. He also has increased social isolation as he spends less times fishing and enjoying activities with friends and family. The Board acknowledges the examinations that show his symptoms were not as severe. However, the Veteran's statements and medical records showing worse symptoms are credible. Additionally, a rating in excess of 50 percent is not warranted as the Board finds that the frequency and severity of such symptoms do not more nearly approximate deficiencies in most areas, such as judgment, thinking, or mood. In this regard, this examination and the medical records show clear, logical, linear, coherent and goal directed thought processes. Additionally, as a factor, the competent evidence does not reflect that he has illogical speech, nor is he near continuously panicking or depressed, or has the presence of suicidal or homicidal ideations. He has denied suicidal or homicidal ideations and has not had hallucinations or delusions. Therefore, after looking at the totality of the Veteran's disability picture, the Board finds that the preponderance of the evidence shown displayed symptoms that warrant an initial rating of 50 percent, but no higher, because of his nightmares, irritability, loss of enjoyment of activities, anger, and social isolation. 6. Entitlement to an initial compensable rating for chronic rhinitis. The Veteran receives a noncompensable rating for his chronic rhinitis under DC 6522. Under Diagnostic Code 6522, a 10 percent rating is assigned for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side; and, a 30 percent rating is assigned for allergic or vasomotor rhinitis with polyps. 38 C.F.R. § 4.97, DC 6522. He underwent an examination in December 2012. For his rhinitis, he did not have greater than 50 percent obstruction of the nasal passage of both sides; complete obstruction on one side; permanent hypertrophy of the nasal turbinates; or nasal polyps. The Veteran, through his attorney, asserted in 2017 that the 2012 examination did not reflect the current severity of his disability. He participated in another examination in August 2014. He did not have greater than 50 percent obstruction of the nasal passage of both sides; complete obstruction on one side; permanent hypertrophy of the nasal turbinates; or nasal polyps. On examination, he did not have saddle nose deformity, nasal/sinus region tenderness, nasal bleeding/purulent drainage/or crusting, but had some leftward septal deviation with partial obstruction to airflow. In August 2017, another examination was scheduled. He did not have greater than 50 percent obstruction of the nasal passage of both sides; complete obstruction on one side; permanent hypertrophy of the nasal turbinates; or nasal polyps. His medical records show polyps, but from May 2003, which is multiple years before the claim that began this appeal was filed. As such, the Board does not find this evidence to be probative of the current status of his rhinitis disability picture. After review of the competent and probative evidence, the Board finds that an initial compensable rating is not warranted. The Board acknowledges the Veteran's previous medical records showed nasal polyps. However, those records are from a period outside the current appeal period. His examinations during the period on appeal do not show nasal polyps. Additionally, the examinations do not show greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. The Board acknowledges the Veteran's assertions that his disability is worse than a noncompensable rating and that it is worsened by seasonal allergies and he has had used nasal sprays. However, the evidence of record does not show a 10 percent rating is warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable, and the claim for a higher rating is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 4.3, 4.7. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Morales, 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.