Citation Nr: 21005455 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 19-00 734 DATE: February 1, 2021 ORDER As new and material evidence has not been received, the previously denied claim of service connection for a disability manifested by chronic allergies is not reopened. Entitlement to service connection for a cervical spine disability, including as due to an undiagnosed illness, is denied. Entitlement to service connection for fibromyalgia, including as due to an undiagnosed illness, is denied. Entitlement to service connection for a disability of the fourth finger of the right hand is denied. Entitlement to service connection for a right hand disability is denied. REMANDED Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a bilateral shoulder disability, including as due to an undiagnosed illness, is remanded. Entitlement to service connection for a right knee disability, including as due to an undiagnosed illness, is remanded. FINDINGS OF FACT 1. In a rating decision dated on September 11, 2014, and issued to the Veteran on September 15, 2014, the AOJ denied, in pertinent part, a claim of service connection for a disability manifested by chronic allergies; this decision was not appealed and became final. 2. The evidence received since September 2014 is either cumulative or redundant of evidence previously submitted in support of the Veteran’s claim of service connection for a disability manifested by chronic allergies. 3. The record evidence shows that the Veteran had active service in the southwest Asia theater of operations during the Persian Gulf War. 4. The Veteran’s neck pain complaints and fibromyalgia symptoms are not undiagnosed illnesses; the neck pain complaints are diagnosed as degenerative joint disease of the cervical spine and the fibromyalgia symptoms are diagnosed as fibromyalgia. 5. The record evidence shows that the Veteran’s cervical spine disability and fibromyalgia are not related to active service, including as due to an undiagnosed illness. 6. The record evidence shows that the Veteran does not experience any current disability due to claimed disabilities of the fourth finger of the right hand or the right hand which could be attributed to active service. CONCLUSIONS OF LAW 1. The September 2014 rating decision, which denied the Veteran’s claim of service connection for a disability manifested by chronic allergies, is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.302 (2019). 2. Evidence received since the September 2014 rating decision in support of the claim of service connection for a disability manifested by chronic allergies is not new and material; thus, this claim is not reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2019). 3. The criteria for entitlement to service connection for a cervical spine disability, including as due to an undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 1118, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.317 (2019). 4. The criteria for entitlement to service connection for fibromyalgia, including as due to an undiagnosed illness, have not been met. 38 U.S.C. §§ 1110, 1118, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.317 (2019). 5. The criteria for entitlement to service connection for a disability of the fourth finger of the right hand have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 6. The criteria for entitlement to service connection for a right hand disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1972 to April 1994, including in the southwest Asia theater of operations during the Persian Gulf War from September 1990 to April 1991. The Veteran appointed his attorney to represent him before VA by filing a completed VA Form 21-22a at the Agency of Original Jurisdiction (AOJ) in April 2018. The Board observes that, in a September 2014 rating decision, the AOJ denied the Veteran’s claim of service connection for a disability manifested by chronic allergies. The Veteran did not appeal this decision and it became final. See 38 U.S.C. § 7104 (2012). He also did not submit any relevant evidence or argument within 1 year of the September 2014 rating decision which would render it non-final for VA adjudication purposes. See Buie v Shinseki, 24 Vet. App. 242, 251-52 (2011) (explaining that, when statements are received within one year of a rating decision, the Board's inquiry is not limited to whether those statements constitute notices of disagreement but whether those statements include the submission of new and material evidence under 38 C.F.R. § 3.156 (b)). The Board does not have jurisdiction to consider a claim that has been adjudicated previously unless new and material evidence is presented. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). Therefore, the issue of whether new and material evidence has been received to reopen a claim of service connection for a disability manifested by chronic allergies is as stated on the title page. Regardless of the AOJ’s actions, the Board must make its own determination as to whether new and material evidence has been received to reopen this claim. That is, the Board has a jurisdictional responsibility to consider whether a claim should be reopened. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). In August 2019, the Board denied the Veteran’s claims of service connection for a bilateral shoulder disability and for a right knee disability, each including as due to an undiagnosed illness. The Veteran, through his attorney, and VA’s Office of General Counsel appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court) by filing a Joint Motion for Remand (Joint Motion). In July 2020, the Court granted the Joint Motion, vacating and remanding the Board’s August 2019 decision. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. Service Connection 1. Whether new and material evidence has been received to reopen the claim of service connection for a disability manifested by chronic allergies The Board finds that the preponderance of the evidence is against granting the Veteran’s request to reopen his previously denied claim of service connection for a disability manifested by chronic allergies. The Board notes initially that claims of service connection may be reopened if new and material evidence is received. Manio v. Derwinski, 1 Vet. App. 140 (1991). The Veteran essentially requested that this claim be reopened in statements on a VA Form 21-526EZ dated on August 16, 2017, and date-stamped as received by the AOJ that same day. New and material evidence is defined by regulation. See 38 C.F.R. § 3.156 (a). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). With respect to the Veteran’s application to reopen the previously denied service connection claim for a disability manifested by chronic allergies, the evidence before VA at the time of the prior final AOJ decision in September 2014 consisted of his service treatment records and post-service VA outpatient treatment records. The AOJ concluded that this evidence did not show the existence of a disability manifested by chronic allergies which could be attributed to active service. Thus, the claim was denied. The newly received evidence still does not show that the Veteran experiences a disability manifested by chronic allergies which could be attributed to active service. The evidence received since September 2014 consists of additional VA outpatient treatment records and examination reports and additional lay statements. All of this evidence, including lay statements asserting an etiological link between any of these claimed disabilities and active service, is duplicative of evidence which had been before the AOJ prior to the previous decision. Critically, there is no new evidence that a disability manifested by chronic allergies is related to active service. The Board notes that the Court held in Shade v. Shinseki, 24 Vet. App. 110 (2010), that the phrase “raises a reasonable possibility of substantiating the claim” found in the post-VCAA version of 38 C.F.R. § 3.156(a) must be viewed as “enabling” reopening of a previously denied claim rather than “precluding” it. All of the newly received evidence is presumed credible solely for the limited purpose of reopening the previously denied claim. See Justus, 3 Vet. App. at 513. With respect to the Veteran’s request to reopen his previously denied service connection claim for a disability manifested by chronic allergies, the Board finds that there is no reasonable possibility that the newly received evidence would enable rather than preclude reopening this claim. Unlike in Shade, there is no new evidence in this case either previously considered in the September 2014 AOJ decision or received since this decision became final which demonstrates that this claimed disability is related to active service or any incident of service. Thus, the analysis of new and material evidence claims that the Court discussed in Shade is not applicable to the Veteran’s request to reopen the previously denied service connection claim. In summary, as new and material evidence has not been received, the previously denied claim of service connection for a disability manifested by chronic allergies is not reopened. 2. Entitlement to service connection for a cervical spine disability and for fibromyalgia, each including as due to an undiagnosed illness The Board next finds that the preponderance of the evidence is against granting the Veteran’s claims of service connection for a cervical spine disability and for fibromyalgia, each including as due to an undiagnosed illness. The Veteran essentially contends that he incurred a cervical spine disability (which he characterized as spinal stenosis) and fibromyalgia during active service or, alternatively, an undiagnosed illness initially experienced while deployed to the southwest Asia theater of operations during the Persian Gulf War caused or contributed to his current cervical spine disability and fibromyalgia. The record evidence does not support these assertions. It shows instead that the Veteran’s complaints of neck pain and fibromyalgia have been attributed to known clinical diagnoses of degenerative joint disease of the cervical spine and fibromyalgia, respectively, which are not related to active service. The Board notes initially that, because the Veteran’s available service personnel records show that he served in the southwest Asia theater of operations during the Persian Gulf War, he is considered a “Persian Gulf Veteran.” See generally 38 U.S.C. §§ 1117, 1118 (2012); 38 C.F.R. § 3.317 (2019). The Board next notes initially that VA shall pay compensation in accordance with Chapter 11 of Title 38, United States Code, to a Persian Gulf Veteran who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in 38 C.F.R. § 3.317(b), provided that such disability: (i) became manifest either during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2021; and (ii) by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. §§ 3.317(a)(1)(i) and (ii). For purposes of 38 C.F.R. § 3.317, a qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; a medically unexplained chronic multi symptom illness that is defined by a cluster of signs or symptoms such as chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders (excluding structural gastrointestinal diseases. 38 C.F.R. § 3.317(a)(2). “Objective indications of chronic disability” include both “signs,” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). For purposes of 38 C.F.R. § 3.317, disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. The 6-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4). Compensation shall not be paid under 38 C.F.R. § 3.317 : (1) if there is affirmative evidence that an undiagnosed illness was not incurred during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War; or (2) if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran’s most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or (3) if there is affirmative evidence that the illness is the result of the Veteran’s own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(a)(7). Regarding the Veteran’s claim for a cervical spine disability as due to an undiagnosed illness, the Board again notes that his complaints of neck pain have a clinical diagnosis of degenerative joint disease of the cervical spine (see November 2017 VA neck (cervical spine) conditions Disability Benefits Questionnaire (DBQ)). Similarly, regarding his claim for fibromyalgia as due to an undiagnosed illness, his complaints have a clinical diagnosis of fibromyalgia (see November 2017 VA fibromyalgia DBQ). The November 2017 VA examiners specifically opined in separate medical nexus opinions that it was less likely than not that the Veteran’s degenerative joint disease of the cervical spine and fibromyalgia were due to an undiagnosed illness. These opinions were fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to service connection for a cervical spine disability or for fibromyalgia, each as due to an undiagnosed illness. Thus, the Board finds that service connection for a cervical spine disability and for fibromyalgia, each as due to an undiagnosed illness, is not warranted. The record evidence also does not support granting service connection for a cervical spine disability and for fibromyalgia on a direct service connection basis. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). It shows instead that, although the Veteran has complained of and sought treatment for each of these disabilities since his service separation, neither of them is related to active service. For example, the Board notes initially that the Veteran’s available service treatment records show no complaints of or treatment for a cervical spine disability or fibromyalgia during his approximately 22 years of active service. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). The post-service evidence also does not support granting the Veteran’s service connection claims for a cervical spine disability and for fibromyalgia. It shows instead that, although the Veteran has complained of and been treated for each of these disabilities since his service separation, neither of them is related to active service. For example, on VA fibromyalgia DBQ in November 2017, the Veteran’s complaints included chronic neck pain radiating in to his back, hips, and legs, chronic shoulder pain, left wrist pain, daily low back pain, chronic bilateral hip pain, chronic bilateral knee pain, and some intermittent paresthesias in the distal calves “with some numbness.” The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran reported that he was diagnosed as having fibromyalgia by his neurosurgeon following an evaluation for degenerative joint disease of the cervical spine. Continuous medication was required for control of his fibromyalgia symptoms. He used an analgesic gel daily. His fibromyalgia symptoms were refractory to treatment. His symptoms attributable to fibromyalgia were stiffness, sleep disturbance, paresthesias, and headache. His fibromyalgia symptoms were constant or nearly constant and often precipitated by activities. He had tender (or trigger) points in his bilateral low cervical regions and trapezius muscles. Physical examination in November 2017 showed 4/10 tender points, a normal bilateral hand examination, non-tender lateral hips, and mild tenderness in the lower left lumbar spine. The VA examiner opined that it was less likely than not that the Veteran’s fibromyalgia is related to active service. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran’s musculoskeletal pain from degenerative joint disease in “various areas of [his] body” were secondary myalgia. The rationale further was that the Veteran’s medical history was “not suggestive” of primary fibromyalgia. The diagnosis was fibromyalgia per the Veteran’s report. On VA neck (cervical spine) conditions DBQ in November 2017, the Veteran’s complaints included neck stiffness, loss of motion, intermittent cervical radiculopathy of the bilateral upper extremities, and persistent paresthesias of the right upper extremity. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran reported frequent flare-ups of cervical spine pain which stopped his activities for about an hour. He avoided lifting and limited overhead activities. Physical examination showed pain with weight bearing, mild tenderness to the low neck, 5/5 muscle strength, no muscle atrophy, hypoactive deep tendon reflexes, normal sensation in the shoulders, decreased sensation in the right inner/outer forearm, normal sensation in the left inner/outer forearm, decreased sensation in the right hand/fingers, and normal sensation in the left hand/fingers. The Veteran also had moderate intermittent pain, moderate paresthesias and/or dysesthesias, and mild numbness of the bilateral upper extremities. The VA examiner opined that it was less likely than not that the Veteran’s cervical spine disability is related to active service. The rationale for this opinion was based on a review of the claims file. The diagnosis was degenerative joint disease of the cervical spine. Contrary to the Veteran’s lay assertions, the record evidence shows that his cervical spine disability and fibromyalgia are not related to active service. The Board recognizes that the Veteran has reported consistently that he complained of and sought treatment for each of these disabilities since his service separation. The November 2017 VA fibromyalgia DBQ examiner specifically opined that the Veteran’s medical history was “not suggestive” of primary fibromyalgia although he noted that the Veteran reported being diagnosed as having fibromyalgia in approximately 2016. More importantly, this examiner opined that it was less likely than not that the Veteran’s fibromyalgia is related to active service. Similarly, the November 2017 VA neck (cervical spine) conditions DBQ examiner opined that it was less likely than not that the Veteran’s cervical spine disability (which he characterized as spinal stenosis and which this VA examiner related to a diagnosis of degenerative joint disease of the cervical spine) is related to active service. All of these opinions were fully supported. See Stefl, 21 Vet. App. at 124. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to service connection for a cervical spine disability and for fibromyalgia on a direct basis. Thus, the Board finds that service connection for a cervical spine disability and for fibromyalgia is not warranted. 3. Entitlement to service connection for a disability of the fourth finger of the right hand and for a right hand disability The Board finally finds that the preponderance of the evidence is against granting the Veteran’s claims of service connection for a disability of the fourth finger of the right hand and for a right hand disability. Contrary to the Veteran’s lay assertions, the record evidence shows that he does not experience any current disability due to either of these claimed disabilities which is attributable to active service. The Veteran’s available service treatment records show that, on outpatient treatment in June 1977, he complained of numbness at the tip of the fourth finger of the right hand. Objective examination showed “no obvious sign of pathology.” The diagnosis was numbness of the fourth finger. The post-service evidence also does not support granting the claims of service connection for a disability of the fourth finger of the right hand and for a right hand disability. They show instead that the Veteran does not experience any current disability due to either of these claimed disabilities which is related to active service. For example, on VA neck (cervical spine) conditions DBQ in November 2017, the Veteran reported a history of right hand numbness in 1977 while on active service. Physical examination showed decreased sensation in the right hand/fingers (as noted above). The VA examiner opined that it was less likely than not that the Veteran’s claimed right hand disability is related to active service. The rationale for this opinion was based on a review of the claims file. The rationale also was that repeated examinations of the Veteran’s hands have been normal without “abnormalities or complaints.” A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced a disability of the fourth finger of the right hand or a right hand disability at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). The Board acknowledges that the Veteran was diagnosed as having numbness of the fourth finger of the right hand in June 1977 while on active service. It appears that this complaint was acute, transitory, and resolved with treatment because it was not seen on subsequent outpatient treatment visits during service or at his separation physical examination in December 1993 prior to his separation from service in April 1994. Critically, there is no evidence – other than the Veteran’s unsupported lay assertions – that he experiences current disability due to his claimed disability of the fourth finger of the right hand or his claimed right hand disability which could be attributed to active service. The November 2017 VA examiner specifically found that it was less likely than not that the Veteran’s claimed right hand disability is related to active service. This opinion was fully supported. See Stefl, 21 Vet. App. at 124. Thus, the Board finds that service connection for a disability of the fourth finger of the right hand and for a right hand disability is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for a left wrist disability is remanded. The Veteran contends that he incurred a left wrist disability during active service and experienced continuous post-service disability. The Board acknowledges that the Veteran’s left wrist was examined in November 2017. Unfortunately, a review of the medical nexus opinion provided following VA wrist conditions DBQ in November 2017 shows that it is unlikely to survive judicial review. The November 2017 VA wrist conditions DBQ examiner opined that it was less likely than not that a left wrist disability is related to active service. The rationale for this opinion was, “No chronic wrist condition noted in [service].” This suggests that the VA examiner found the lack of contemporaneous service treatment records to be persuasive support for his medical nexus opinion. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan, 451 F.3d at 1337, and Barr, 21 Vet. App. at 303. Because the November 2017 VA wrist conditions DBQ examiner’s opinion violates Buchanan and Barr, the Board finds that it is not probative on the issue of whether a left wrist disability is related to active service. There otherwise is no medical nexus opinion addressing this contended etiological relationship. Thus, the Board finds that, on remand, another medical nexus opinion should be obtained from an appropriate clinician concerning this matter. 2. Entitlement to service connection for a bilateral shoulder disability and for a right knee disability, each including as due to an undiagnosed illness, is remanded. The Veteran finally contends that he incurred a bilateral shoulder disability and a right knee disability during active service or, alternatively, an undiagnosed illness initially experienced while deployed to the southwest Asia theater of operations during the Persian Gulf War caused or aggravated (permanently worsened) these disabilities. Both parties to the Joint Motion argued successfully to the Court that the Board erred in the August 2019 decision by relying on September 2014 VA examinations which addressed the contended causal relationships between these disabilities and active service. The Board acknowledges that a medical nexus opinion concerning the contended etiological relationship between a right knee disability and active service was obtained in October 2018. The Board notes that the October 2018 VA clinician found the lack of contemporaneous records documenting post-service right knee complaints or treatment to be persuasive support for a negative nexus opinion concerning the contended etiological relationship between a right knee disability and active service. Because the October 2018 VA clinician’s opinion violates Buchanan and Barr, the Board finds that it is not probative on the issue of whether a right knee disability is related to active service. There otherwise is no medical nexus opinion evidence addressing these contended etiological relationships. Thus, the Board finds that, on remand, the AOJ should obtain medical nexus opinions addressing the contended causal relationships between a bilateral shoulder disability, a right knee disability, and active service, including as due to an undiagnosed illness. The matters are REMANDED for the following action: 1. Forward the claims file to a clinician for an opinion concerning the contended etiological relationship between a left wrist disability and active service. If possible, this opinion should be provided by a clinician other than the VA clinician who conducted the Veteran’s November 17, 2017, VA wrist conditions DBQ. The Veteran does not need to report for examination. Based on a review of the claims file, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a left wrist disability, if present, is related to active service. A rationale must be provided for any opinion(s) expressed. 2. Forward the claims file to a clinician for an opinion concerning the contended etiological relationship between a bilateral shoulder disability and active service. If possible, this opinion should not be obtained from the VA clinician who conducted the September 30, 2014, VA shoulder and arm conditions DBQ. The Veteran does not need to report for examination. Based on a review of the claims file, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a bilateral shoulder disability, if present, is related to active service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that an undiagnosed illness initially experienced while the Veteran was deployed to the southwest Asia theater of operations during the Persian Gulf War caused or aggravated (permanently worsened) a bilateral shoulder disability, if present. A rationale must be provided for any opinion(s) expressed. 3. Forward the claims file to a clinician for an opinion concerning the contended etiological relationship between a right knee disability and active service. If possible, this opinion should not be obtained from the VA clinician who conducted the September 30, 2014, VA knee and lower leg conditions DBQ or the VA clinician who provided the October 3, 2018, medical nexus opinion. The Veteran does not need to report for examination. Based on a review of the claims file, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that a right knee disability, if present, is related to active service. The clinician next is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that an undiagnosed illness initially experienced while the Veteran was deployed to the southwest Asia theater of operations during the Persian Gulf War caused or aggravated (permanently worsened) a right knee disability, if present. A rationale must be provided for any opinion(s) expressed. 4. Readjudicate the appeal. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael T. Osborne, 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.