Citation Nr: 21006414 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 14-14 882 DATE: February 4, 2021 ORDER Entitlement to service connection for a lumbar spine disorder, to include as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Entitlement to service connection for bilateral foot calluses, to include as a qualifying chronic disability under 38 C.F.R. § 3.317, is denied. Entitlement to a rating in excess of 40 percent for fibromyalgia is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities on an extraschedular basis, prior to November 13, 2018, is remanded. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia theater of operations during the Persian Gulf War; he does not have any condition that has not been attributed to an undiagnosed condition. 2. The Veteran's lumbar spine disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The Veteran's bilateral foot calluses were not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 4. The Veteran is in receipt of the maximum schedular rating for fibromyalgia, and there is no indication of symptoms or effects not contemplated by the rating schedule. CONCLUSIONS OF LAW 1. The criteria for service connection for a lumbar spine disorder, to include as due to a qualifying chronic disability under 38 C.F.R. § 3.317, have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.317. 2. The criteria for service connection for bilateral foot calluses, to include as a qualifying chronic disability under 38 C.F.R § 3.317, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. 3. The criteria for a schedular rating in excess of 40 percent for fibromyalgia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.71a, Diagnostic Code 5025. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from February 1979 to February 1983 and from November 1990 to June 1991, including service in the Southwest Asia theater of operations from January 1991to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO)in Roanoke, Virginia. In February 2018, the Board remanded the case to the RO for further evidentiary development. Specifically, the Board directed that the Veteran’s Social Security Administration (SSA) records be obtained, that updated VA treatment records be obtained, that the Veteran be provided the opportunity to identify any private treatment providers and that a VA examination be conducted. The Veteran’s updated VA treatment records and SSA records have been associated with the record, the Veteran was asked to complete an authorization form to allow VA to obtain records from private providers in a November 2018 letter and VA examinations were conducted in April 2019. Following the requested development, a supplemental statement of the case (SSOC) was issued in August 2020. The Board concludes that there has been substantial compliance with the previous remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection will be presumed for certain chronic diseases, including arthritis, if they were 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(a). For a showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. If the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Furthermore, compensation may be granted for disability due to undiagnosed illness of a Veteran who served in the Southwest Asia Theater of operations during the Persian Gulf War. 38 U.S.C. § 1117. During the pendency of this appeal, Congress revised 38 U.S.C. § 1117, effective March 1, 2002. In the revised statute, the term "chronic disability" was changed to "qualifying chronic disability," and the definition of "qualifying chronic disability" was expanded to include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness, to include chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. Effective June 10, 2003, VA promulgated revised regulations to, in part, implement these statutory changes. See 38 C.F.R. § 3.317(a)(2). Under 38 U.S.C. § 1117(a)(1), as amended, compensation is warranted for a Persian Gulf veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. The period within which such disabilities must become manifest to a compensable degree in order for entitlement to compensation to be established is currently December 31, 2016. See 38 C.F.R. § 3.317(a)(1)(i). In order to qualify, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b). The term "objective indications of a qualifying chronic disability" includes both "signs," in a 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). Signs or symptoms that may be manifestations of undiagnosed illness or a chronic multi-symptom illness include the following: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, or menstrual disorders. 38 U.S.C. § 1117(g). The term "medically unexplained chronic multi symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). Disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-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). The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id. see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for a lumbar spine disorder, to include as a qualifying chronic disability under 38 C.F.R. 3.317 The Veteran maintains that his claimed lumbar spine disorder is due partly to his service in Southwest Asia. The Veteran indicated that his back condition existed since 1982; he stated that he damaged his back when his army vehicle went off a cliff in 1982. In this regard, following a VA examination in August 2011, the examiner reported a diagnosis of intervertebral disc syndrome with trace degenerative arthritic changes, L5and remote unilateral par interarticularis defect. A more recent Disability Benefits Questionnaire (DBQ) examination in April 2019 reported a diagnosis of degenerative disease of the thoracolumbar spine, status post laminectomy. As this is a known clinical diagnosis, service connection is not warranted based on having an undiagnosed illness. This does not preclude consideration of the Veteran's claim on a direct causation basis. The Board concludes that, while the Veteran has a current diagnosis of degenerative disease of the lumbar spine, status post laminectomy, and evidence shows that he was treated on several occasions for and diagnosed with low back pain and muscle strain in service, the preponderance of the evidence weighs against finding that the Veteran's diagnosed degenerative disease of the spine began during service or are otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Board has first considered whether service connection for arthritis is warranted on a presumptive basis. Post service treatment records show the Veteran was not diagnosed with chronic low back pain and degenerative changes in the lumbar spine until 2007, more than 16 years decade after his separation from service. A September 2007 private treatment note indicates that Veteran sustained an injury at work in February 2007 while lifting concrete and that he had sustained a previous work injury in 2006 and that he had minor symptoms since 2003. As such, presumptive service connection is not warranted for arthritis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Further, the August 2011 VA examiner opined that it is less likely as not that the low back condition is related to the incidents in the service treatment records. The examiner explained that there is no documentation of any medical or orthopedic treatment for any low back condition from service separation until 2009. However, this opinion appears to be based on an inaccurate factual premise, as the Veteran suffered a back injury related to a motor vehicle crash in 2006 and the record reflects a magnetic resonance imaging (MRI) scan dated in December 2003. See Reonal v. Brown, 5 Vet. App. 460, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). This opinion is therefore afforded little, if any, probative weight. In response to a remand for an additional etiology opinion, the Veteran was afforded a DBQ examination in April 2019. Following examination of the Veteran and review of the claims file, the examiner opined that the Veteran's degenerative arthritis of the thoracolumbar spine, status post laminectomy was less likely as not incurred in or caused by military service. The examiner stated that the record supports the onset of a back disability due to a motor vehicle crash in 2006 and acute injury in 2007. The examiner noted that arthritis was present at diagnosis and most likely had onset years prior to diagnosis, most likely five to 10 years prior. The examiner explained that medical literature supports natural aging beyond 40 years and axial load bearing as risk factors with highest predictive value. The examiner further noted that the record is silent to any chronic unresolved low back disorder on active duty or within one year of separation. The examiner noted that, in this case, the disabling back pain is clear and unmistakably due to an acute injury in 2007; in fact, the Veteran testified that his chronic back pain was due to a work-related injury in 2007. The examiner concluded that, there is insufficient evidence to support a low back disability that had its onset during or was aggravated by military service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). This opinion is therefore afforded probative weight. The Board has also considered the Veteran's statements asserting a nexus between the degenerative disease of the thoracolumbar spine, status post laminectomy and his military service. While the Veteran is competent to report having experienced symptoms of back pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of chronic low back pain. The issue is medically complex, as it requires knowledge of the orthopedic and musculoskeletal system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). Further, the etiology of the Veteran's low back disorder is a medical etiological question involving internal and unseen system processes unobservable by the Veteran. As the record does not reflect that the Veteran has such understanding or ability to relate a low back disorder to his in-service complaints of low back pain, any contention regarding the claimed relationship does not have probative value. The Board places great weight upon the April 2019 opinion of the DBQ examiner, in part, because a competent medical opinion on how a low back disability is related to in-service finding of low back pain requires expert understanding of anatomy and the largely unseen, unobservable mechanics within the musculoskeletal system. For all of the above reasons, the preponderance of the evidence is against a finding that there is a nexus between the Veteran's current lumbar spine disorder and his active service. The Board has considered the benefit of the doubt doctrine when making these findings, but the preponderance of the evidence is against the Veteran's claim for entitlement to service connection. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to service connection for bilateral foot calluses, to include as a qualifying chronic disability under 38 C.F.R. 3.317. The Veteran essentially contends that he suffers from bilateral foot calluses which developed from wearing the military issued boots during his period of active duty. As an initial matter, the Board notes that the post-service medical records show that the Veteran receives medical treatment for pain in his feet and callouses. An August 2011 VA examination reported a diagnosis of bilateral soft callus of the feet with mild osteoarthritis of the proximal interphalangeal (PIP) joint, fourth and fifth toes. A more recent DBQ examination in April 2019 reflects a diagnosis of callouses on the feet. To the extent that the Veteran claims he is entitled to service connection for his bilateral foot disorder as a qualifying chronic disability resulting from an undiagnosed illness or combination of undiagnosed illnesses, the Veteran's bilateral foot calluses is a known clinical diagnosis. Therefore, presumptive service connection for Persian Gulf veterans as due to an undiagnosed illness is not warranted. This does not preclude consideration of the Veteran’s claim on a direct causation basis. The Board concludes that, while the Veteran has a current diagnosis of bilateral soft callus of the feet with mild osteoarthritis of the PIP joint, fourth and fifth toes and evidence shows that he was treated for left foot pain in August 1981, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of bilateral soft callus of the feet began during service or is otherwise related to an in-service injury, event, or disease. The Board has first considered whether service connection for arthritis is warranted on a presumptive basis. The Veteran was not diagnosed with bilateral soft callus of the feet until April 2000, years after his separation from active service. An August 2011 X-ray revealed mild narrowing of the PIP joint of the fourth and fifth digits bilaterally. As such, presumptive service connection is not warranted for arthritis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Further, following the August 2011 VA examination, the examiner concluded that it is less likely as not that the bilateral soft calluses of the feet are related to the incidents in the service treatment records. The examiner stated that there was no mention of any treatment for calluses in service, during service separation or any treatment for this condition since service. The examiner further stated that there was a paucity of findings for the claimed symptoms; he noted that the Veteran’s obesity is a contributing factor to his present condition. Following another examination of the Veteran and review of the claims file in April 2019, in compliance with a Board remand, the DBQ examiner concluded that bilateral foot calluses is less likely as not incurred in or caused by military service. The examiner noted that the Veteran has a disease with a clear and specific etiology and diagnosis; as such, it is not related to Gulf War exposure and not a “presumptive” condition. The examiner added that the bilateral foot calluses is less likely as not caused by service in Southwest Asia. The rationale is that the records are silent as to any chronic unresolved painful callouses that had its onset during or incurred in or was worsened by active duty service from 1979 to 1991. The examiner noted that the earlies documentation of chronic foot pain is 1995. Current painful callouses is most likely due to laborious occupation over a lifetime, exacerbated by congenitally crowded toe anatomy, axial load bearing, natural aging and exogenous obesity over time. The examiner concluded that, based on the timeline and years of active duty service, the condition is less likely as not proximately due to or aggravated by military service. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, supra. This opinion is therefore afforded probative weight. The Veteran believes that his bilateral soft callus of the feet with mild osteoarthritis of the PIP joint, fourth and fifth toes is related to an in-service injury, event, or disease. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, supra; see also Kahana v. Shinseki, supra. Further, the etiology of the Veteran's bilateral soft callus of the feet is a medical etiological question involving internal and unseen system processes unobservable by the Veteran. As the record does not reflect that the Veteran has such understanding or ability to relate bilateral soft callus of the feet to his in-service complaints of foot pain, any contention regarding the claimed relationship does not have probative value. The Board places great weight upon the April 2019 opinion of the DBQ examiner, in part, because a competent medical opinion on the etiology of the bilateral soft callus of the feet requires expert understanding of anatomy and the largely unseen, unobservable mechanics within the musculoskeletal system. For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran's claim of entitlement to service connection for bilateral soft callus of the feet with mild osteoarthritis of the PIP joint, fourth and fifth toes and his appeal must be denied. There is no reasonable doubt to be resolved as to this issue. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. 3. Entitlement to a rating in excess of 40 percent for fibromyalgia The Veteran contends that his fibromyalgia is worse than currently rated. Throughout the claim, he has been in receipt of a 40 percent disabling rating. Fibromyalgia is rated under Diagnostic Code 5025, which provides a maximum 40 percent disability rating when fibromyalgia manifests with widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms, that is constant, or nearly so, and refractory to therapy. "Widespread pain" means pain in both the left and right sides of the body that is both above and below the waist, and that affects both axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities. 38 C.F.R. § 4.71a, Diagnostic Code 5025. As the Veteran is in receipt of the maximum schedular rating for the entire period on appeal, there is no legal basis for awarding a higher schedular rating for fibromyalgia. See Sabonis v. Brown, 6 Vet. App. 426 (1994). The Veteran has not alleged that an extraschedular rating is warranted for his fibromyalgia and such was not reasonably raised by the record. Bagwell v. Brown, 9 Vet. App. 337, 339 (1996); Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the evidence does not indicate that Veteran's disability picture could not be adequately contemplated by the applicable schedular rating criteria discussed above. Specifically, the Board has reviewed all of the Veteran’s relevant symptoms related to the issue on appeal and concludes that there are no symptoms that were not able to be addressed by the applicable diagnostic codes. See Mittleider v. West, 11 Vet. App. 181 (1998). When asked about the functional impact of her fibromyalgia during the Veteran's VA examinations, he reported widespread musculoskeletal pain, stiffness, fatigue, sleep disturbance, and depression. The Board notes that these symptoms are specifically contemplated by the diagnostic criteria assigned for fibromyalgia and his service-connected posttraumatic stress disorder. Therefore, given that the applicable schedular rating criteria are more than adequate in this case, the Board need not consider whether the Veteran's disability picture includes exceptional factors, and referral for consideration of the assignment of a disability evaluation on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, supra; Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). In light of the foregoing, service connection must be denied. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim for a rating in excess of 40 percent for fibromyalgia. As such, that doctrine is not applicable in the instant claims, and her claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND 1. Entitlement to an extraschedular TDIU prior to November 13, 2018 is remanded. The Board notes that the criteria for a TDIU under 38 C.F.R. § 4.16(a) prior to November 13, 2018 are not met. However, even when the criteria under 38 C.F.R. § 4.16(a) are not met, entitlement to a TDIU on an extraschedular basis may be considered when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. 38 C.F.R. § 4.16(b). After a review of the record, the Board finds that referral for extraschedular TDIU is warranted. Specifically, during a VA examination for fibromyalgia in August 2011, the Veteran reported that he had not been able to work since 2007 partly as a result of his widespread musculoskeletal pain. However, the Board does not have the authority to assign an extraschedular TDIU in the first instance. Bowling v. Principi, 15 Vet. App. 1 (2001). Therefore, referral to the Director, Compensation Service, for consideration of entitlement to a TDIU prior to November 13, 2018, is warranted on remand. 38 C.F.R. § 4.16(b). The failure to refer this matter ot the Director of the Compensation Service for consider of an award of a TDIU on an extraschedular basis is a pre-decisional duty to assist error. The matter is REMANDED for the following action: 1. Refer the Veteran’s claim for a TDIU, prior to November 13, 2018 to the Director of Compensation Service for extraschedular consideration. 2. After completing the requested actions, and any additional actions deemed warranted, the AOJ should readjudicate the claim on appeal. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished a supplemental statement of the case (SSOC) and given the opportunity to respond thereto. The case should then be returned to the Board for further appellate consideration, if in order. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Suzie S. Gaston, 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.