Citation Nr: 21022156 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 19-05 068 DATE: April 14, 2021 ORDER A separate rating for radiculopathy of the right lower extremity as a neurological manifestation of the Veteran’s service-connected chronic lumbosacral spine strain is granted. A separate rating for radiculopathy of the left lower extremity as a neurological manifestation of the Veteran’s service-connected chronic lumbosacral spine strain is granted. As new and material evidence has been received, the claim of entitlement to service connection for left knee disorder is reopened. As new and material evidence has been received, the claim of entitlement to service connection for frostbite of the bilateral lower extremities, including a right toe, is reopened. As new and material evidence has been received, the claim of entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD), is reopened. Service connection for tinnitus is granted. REMANDED Entitlement to service connection for an acquired psychiatric disability, to include PTSD, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to medications for an acquired psychiatric disability, to include PTSD, is remanded. Entitlement to service connection for left knee disorder is remanded. Entitlement to service connection for frostbite of the bilateral lower extremities, including a right toe, is remanded. Entitlement to a rating in excess of 10 percent for chronic lumbosacral spine strain is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s radiculopathy of the right lower extremity is associated with the service-connected chronic lumbosacral spine strain. 2. The Veteran’s radiculopathy of the left lower extremity is associated with the service-connected chronic lumbosacral spine strain. 3. In a May 2002 VA rating decision, the claim for entitlement to service connection for left knee pain was denied; the Veteran was notified of this action and of his appellate rights but did not file a timely notice of disagreement (NOD) or submit new and material evidence within a year thereafter. 4. In a September 2010 VA rating decision, the claim for entitlement to service connection for left knee patellofemoral syndrome was reopened and denied on the merits; the Veteran was notified of this action and of his appellate rights but did not file a timely NOD or submit new and material evidence within a year thereafter. 5. The evidence received since the September 2010 VA rating decision, regarding service connection for left knee disorder, is not cumulative or redundant and raises the possibility of substantiating the claim. 6. In a September 2010 VA rating decision, the claim for entitlement to service connection for frostbite of the bilateral lower extremities was denied; the Veteran was notified of this action and of his appellate rights but did not file a timely NOD or submit new and material evidence within a year thereafter. 7. The evidence received since the September 2010 VA rating decision, regarding service connection for frostbite of the bilateral lower extremities, including a right toe, is not cumulative or redundant and raises the possibility of substantiating the claim. 8. In a November 2010 VA rating decision, the claim for entitlement to service connection for PTSD was denied; the Veteran was notified of this action and of his appellate rights but did not file a timely NOD or submit new and material evidence within a year thereafter. 9. The evidence received since the November 2010 VA rating decision, regarding service connection for an acquired psychiatric disability, to include PTSD, is not cumulative or redundant and raises the possibility of substantiating the claim. 10. The Veteran’s tinnitus is related to service. CONCLUSIONS OF LAW 1. A separate rating for radiculopathy of the right lower extremity associated with the service-connected chronic lumbosacral spine strain have been satisfied. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5235-5243, Note (1). 2. A separate rating for radiculopathy of the left lower extremity associated with the service-connected chronic lumbosacral spine strain have been satisfied. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5235-5243, Note (1). 3. The May 2002 VA rating decision, denying service connection for left knee pain, is final. 38 U.S.C. § 7105(b), (d) (2012); 38 C.F.R. §§ 19.52, 19.55, 20.1103 (2019). 4. The September 2010 VA rating decision, reopening service connection for left knee patellofemoral syndrome and denying on the merits, is final. 38 U.S.C. § 7105(b), (d) (2012); 38 C.F.R. §§ 19.52, 19.55, 20.1103 (2019). 5. New and material evidence has been received since the September 2010 VA rating decision to reopen service connection for left knee disorder. 38 U.S.C. §§ 1110, 5108 (2012); 38 C.F.R. §§ 3.156, 3.303 (2019). 6. The September 2010 VA rating decision, denying service connection for frostbite of the bilateral lower extremities, is final. 38 U.S.C. § 7105(b), (d) (2012); 38 C.F.R. §§ 19.52, 19.55, 20.1103 (2019). 7. New and material evidence has been received since the September 2010 VA rating decision to reopen service connection for frostbite of the bilateral lower extremities, including a right toe. 38 U.S.C. §§ 1110, 5108 (2012); 38 C.F.R. §§ 3.156, 3.303 (2019). 8. The November 2010 VA rating decision, denying service connection for PTSD, is final. 38 U.S.C. § 7105(b), (d) (2012); 38 C.F.R. §§ 19.52, 19.55, 20.1103 (2019). 9. New and material evidence has been received since the November 2010 VA rating decision to reopen service connection for an acquired psychiatric disability, to include PTSD. 38 U.S.C. §§ 1110, 5108 (2012); 38 C.F.R. §§ 3.156, 3.303 (2019). 10. The criteria for service connection for tinnitus are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1998 to June 2002 and March 2003 to January 2005. The Board has recharacterized the Veteran’s claims for residuals of cold weather injury, frostbite, and frostbite right toe (toe and nail dead) more broadly to frostbite of the bilateral lower extremities, including a right toe, in order to clarify the nature of the benefit sought and ensure complete consideration of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009). The Board also recharacterized the Veteran’s claim for PTSD more broadly to an acquired psychiatric disability, to include PTSD, in order to clarify the nature of the benefit sought and ensure complete consideration of the claim. Id. Before reaching the merits of the claims for left knee disorder, frostbite of the bilateral lower extremities, including a right toe, and an acquired psychiatric disability, to include PTSD, the Board must first determine whether new and material evidence has been received to reopen these previously denied claims. Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Therefore, the Board has recharacterized these issues accordingly. The Veteran requested a video conference hearing before the Board and was scheduled for September 2020. The Veteran’s requests to withdraw his hearing request were received in July 2020 and February 2021. 1. Entitlement to a separate rating for radiculopathy of the right lower extremity 2. Entitlement to a separate rating for radiculopathy of the left lower extremity The Board considers whether a separate evaluation may be warranted for any associated objective neurological abnormalities of the service-connected chronic lumbosacral spine strain, including, but not limited to, bowel or bladder impairment, under an appropriate Diagnostic Code. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243, Note (1). Review of the December 2018 VA examination report for back (thoracolumbar spine) conditions documents that, while the Veteran’s bilateral straight leg test results were negative, he demonstrated bilateral radicular pain. Such pain was characterized as moderate intermittent pain, moderate paresthesias and/or dysesthesias, moderate numbness in the right and left lower extremities, and decreased sensation in the left lower extremity. The VA examiner further indicated involvement of the bilateral sciatic nerve roots and concluded mild radiculopathy of the right lower extremity and moderate radiculopathy of the left lower extremity. With resolution of reasonable doubt in the Veteran’s favor, the Board finds that the Veteran’s radiculopathy of the right and left lower extremities are associated with the service-connected chronic lumbosacral spine strain. As such, separate ratings for radiculopathy of the right and left lower extremities are warranted. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243, Note (1). The RO will assign an appropriate disability rating. 3. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for left knee disorder In the May 2002 VA rating decision, service connection for left knee pain was denied because the available evidence of record did not show a confirmed diagnosed condition. The Veteran was notified of this action and of his appellate rights but did not appeal by filing a NOD or submitting new and material evidence within a year thereafter. Therefore, the May 2002 VA rating decision is final. See 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 19.55, 19.52, 20.1103. In October 2009, VA received the Veteran’s request to reopen the previously denied claim of service connection for left knee pain. In the September 2010 VA rating decision, the claim for entitlement to service connection for left knee patellofemoral syndrome was reopened based on evidence of a chronic left knee patellofemoral syndrome condition, and denied on the merits because the evidence of record failed to show this diagnosis is related to his active duty military service. The Veteran was notified of this action and of his appellate rights but did not appeal by filing a NOD or submitting new and material evidence within a year thereafter. Therefore, the September 2010 VA rating decision is final. Id. In December 2013, the Veteran requested to reopen his claim for left knee disorder. Evidence received since the September 2010 VA rating decision includes a December 2018 VA examination for knee and lower leg conditions that shows a diagnosis of bilateral knee strain. The Board finds that this evidence is new and material to the element of establishing a current disability, including an additional current diagnosis which was not established at the time of the September 2010 VA rating decision. As a result, this claim is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 4. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for frostbite of the bilateral lower extremities, including a right toe In the September 2010 VA rating decision, service connection for frostbite of the bilateral lower extremities was denied because the available evidence of record was positive for complaints of frostbite but did not show the condition existed from military service to the present time or relates to his military service in any way. The Veteran was notified of this action and of his appellate rights but did not appeal by filing a NOD or submitting new and material evidence within a year thereafter. Therefore, the September 2010 VA rating decision is final. See 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 19.55, 19.52, 20.1103. In December 2013, the Veteran requested to reopen his claim for frostbite of right toe. Evidence received since the September 2010 VA rating decision includes a December 2018 VA examination for cold injury residuals that shows a diagnosis of right fifth toenail onychomycosis. The Board finds that this evidence is new and material to the element of establishing a current disability, including an additional current diagnosis which was not established at the time of the September 2010 VA rating decision. As a result, this claim is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 5. Whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for an acquired psychiatric disability, to include PTSD In the November 2010 VA rating decision, service connection for PTSD was denied because the available evidence of record did not show a confirmed diagnosis of PTSD. The Veteran was notified of this action and of his appellate rights but did not appeal by filing a NOD or submitting new and material evidence within a year thereafter. Therefore, the November 2010 VA rating decision is final. See 38 U.S.C. § 7105(b), (d); 38 C.F.R. §§ 19.55, 19.52, 20.1103. In December 2013, the Veteran requested to reopen his claim for PTSD. Evidence received since the November 2010 VA rating decision includes A December 2014 VA examination for PTSD that shows diagnoses of PTSD and depressive disorder not otherwise specified (NOS). The Board finds that this evidence is new and material to the element of establishing a current disability, which was not established at the time of the November 2010 VA rating decision. As a result, this claim is reopened. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.156(a), 3.303. 6. Service connection for tinnitus is granted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish service connection for the claimed disability, there must be (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran has been diagnosed with tinnitus. The December 2018 VA examiner found that the Veteran’s military occupational specialty (MOS) of construction equipment operator indicated highly probably exposure to hazardous noise. The first and second elements of a service connection claim are met. Shedden, 381 F.3d at 1166-67. The nexus requirement of a service connection claim may be satisfied by evidence that a chronic disease subject to presumptive service connection manifested itself to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Tinnitus is considered an “organic disease of the nervous system” under 3.309(a) and therefore presumptive service connection may be considered. Fountain v. McDonald, 27 Vet. App. 258 (2015). If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303(a),(b), 3.309(a); see also Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran was afforded VA examinations for hearing loss and tinnitus in April 2014 and December 2018. Following the clinical evaluations, to include a diagnosis of tinnitus, the VA examiners opined that the condition is less likely than not caused by or a result of military noise exposure. In April 2014, the VA examiner explained, in part, that “[t]here was no significant threshold shifts of hearing comparing reference audiogram [in June 1998] to audiogram[s] [in March 2000] or [May 2001] [and] no complaints of tinnitus in the service records.” In December 2018, the VA examiner explained, in part, that “[a]lthough [the Veteran’s] military occupational specialty (MOS) of construction equipment operator indicates highly probably exposure to hazardous noise, a comparison of his current audiogram [versus] his enlistment audiogram [in February 1998] reveals evidence consistent with no noise injury.” These opinions are inadequate because they rely on normal hearing at separation without consideration of the Veteran’s lay statements. At his December 2018 VA examination, the Veteran reported that his tinnitus began in 2005, which was on active duty. In September 2020, his former attorney stated that he had experienced tinnitus continuously since service. The Veteran’s assertion is both competent and credible. The lay statements are the most probative evidence of record. Service connection for tinnitus is granted. REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disability, to include PTSD In December 2014, the Veteran underwent a VA examination for PTSD. The VA examiner rendered diagnoses of PTSD, depressive disorder NOS, and alcohol use disorder, and concluded “it is at least as likely as not that stressor #2 (which occurred during active duty service in the Army) exacerbated or made worse [the Veteran’s] PTSD. Stressor # 2 was noted as the following: While operating a Bomag in Korea around 2000, he had an incident in which he got too close to the edge of a mountain cliff (about a 1000 feet above ground). One wheel was hanging off the cliff and he feared for his life for 15 [to] 20 minutes before he was rescued. Review of the record does not indicate that the December 2014 VA examiner addressed the etiology of the Veteran’s additional psychiatric diagnosis of depressive disorder NOS nor has considered the Veteran’s subsequent lay statement regarding the in-service incident near a cliff in Korea in 2000 as noted in a December 2016 correspondence. As a result, the Board finds that an addendum VA medical opinion is needed to determine the etiology of any current acquired psychiatric disability, to include PTSD and depressive disorder NOS. See 38 C.F.R. §§ 3.303, 3.304 (2019). 2. Entitlement to service connection for erectile dysfunction, to include as secondary to medications for an acquired psychiatric disability, to include PTSD While the Board remands the issue of entitlement to service connection for an acquired psychiatric disability, to include PTSD, for additional evidentiary development, as discussed above, that decision may impact this claim for erectile dysfunction on a secondary basis. As such, these issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 3. Entitlement to service connection for left knee disorder In December 2018, the Veteran underwent a VA examination for knee and lower leg conditions. The VA examiner rendered a diagnosis of left knee strain and provided a nexus opinion, including consideration of the Veteran’s acute left knee pain noted in service treatment records and no chronic knee condition until June 2011. Nevertheless, review of the claims file shows the Veteran’s assertions of continuous left knee pain since service. Specifically, a December 2005 VA treatment record notes the Veteran reported left knee pain since started working four months prior, which dates back to within one year of separation from active service in January 2005. Additionally, a September 2011 VA treatment record notes the Veteran reported aching pain in left knee since 2001. In light of such evidence, the Board finds that an addendum VA medical opinion is needed to properly adjudicate this claim at this time, to include consideration of the Veteran’s reported symptomatology of left knee pain since service. When VA undertakes to provide a VA medical opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board emphasizes that it is not determining whether or not the Veteran’s statement of left knee pain since service is credible at this time, as the additional development set forth in the directives below could impact that determination. 4. Entitlement to service connection for frostbite of the bilateral lower extremities, including a right toe During the course of the appeal, the Veteran was afforded a VA examination for cold injury residuals in December 2018. Following the clinical evaluation, the VA examiner rendered an impression of right fifth toenail onychomycosis. Review of the record does not indicate the December 2018 VA examiner addressed the etiology of the Veteran’s right fifth toenail onychomycosis, to include consideration of the Veteran’s reported exposure to cold weather in October 2000 while in Korea, as noted in a December 2017 correspondence. Specifically, he reported working on a fire range detail at which he was exposed to snow and ice, wore cold weather gear, needed to change his socks, and noticed a black nub or bump on his pinky toe after getting undressed. The Veteran is competent to report that he was exposed to such cold weather, and his assertion is credible. Moreover, review of his service personnel records documents his period of active service in Korea from February 2000 to February 2001. As a result, the Board finds that additional development for an addendum VA medical opinion is needed to determine the etiology of the claimed frostbite of the bilateral lower extremities, including a right toe. See 38 C.F.R. § 3.303. 5. Entitlement to a rating in excess of 10 percent for chronic lumbosacral spine strain During the course of the appeal, the Veteran was afforded VA examinations for back (thoracolumbar spine) conditions in April 2014 and December 2018. In a March 2021 written brief, the Veteran’s representative asserted that both VA examiners noted the Veteran using medication to address his back problems but neither discussed whether the medications had been taken in close proximity to the examinations and what involvement the medications would have caused with his performance at the examinations. In light of this assertion, the Board finds that a remand is necessary to obtain an addendum VA medical opinion to address the Veteran’s symptoms of his service-connected chronic lumbosacral spine strain without the impact of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). 6. Entitlement to a TDIU In a March 2021 written brief, the Veteran’s representative asserted that the Veteran’s back condition also impacts his ability to work. Additionally, the December 2018 VA examination report for back (thoracolumbar spine) conditions noted the impact of the Veteran’s condition on the ability to work is the interference with prolonged walking, prolonged standing, and repetitive bending and lifting. The Board finds that the issue of entitlement to a TDIU has been raised by the record in connection with the service-connected chronic lumbosacral spine strain on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Additional development is needed, such as asking the Veteran for information about his employment and income. The matters are REMANDED for the following actions: 1. Provide the Veteran and his representative with notice concerning how to substantiate the claim for a TDIU. Ask the Veteran to complete a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability) to obtain relevant education and employment information. 2. Then, determine whether the Veteran’s submission of a December 2016 correspondence provides adequate information for an additional attempt to verify the alleged in-service stressor event near a cliff while in Korea in 2000. 3. If so, then contact the Joint Services Records Research Center (JSRRC) and any other appropriate sources, in attempts to independently verify this alleged stressor event. Sequential requests must be made to cover a time period specified by the Veteran because the duty to assist is not limited by a requirement that a 60 day window be provided. If the search for corroborating records leads to negative results, the AOJ must notify the Veteran. The AOJ should also follow up on any additional action suggested by each appropriate source contacted. Any determinations made should be documented in the record and the Veteran and his representative should be notified. 4. Then, provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the Veteran’s acquired psychiatric disability, to include PTSD. And depressive disorder NOS. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. The examiner must opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s acquired psychiatric disability (other than PTSD), to include depressive disorder NOS (even if resolved since December 2014), began during active service, or is related to an incident of service, to include the Veteran’s alleged in-service stressor near a cliff while in Korea in 2000. (b.) Whether it is at least as likely as not that the Veteran’s PTSD (even if resolved since April 2019), began during active service, or is related to an incident of service, to include the Veteran’s alleged in-service stressor near a cliff while in Korea in 2000 (if verified). If a positive nexus was provided above, the examiner must also opine as to the following: (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s erectile dysfunction was proximately due to or the result of his medications for an acquired psychiatric disability, to include PTSD and depressive disorder NOS. (d.) Whether it is at least as likely as not that the Veteran’s erectile dysfunction was aggravated beyond its natural progression by his medications for an acquired psychiatric disability, to include PTSD and depressive disorder NOS. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 5. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the Veteran’s claim for left knee disorder. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. For the purposes of this remand only, and for the limited purpose of conducting the examination and providing a medical opinion, the examiner should assume that the Veteran’s assertion of left knee pain since service is true. If there is a medical reason to doubt its veracity, the examiner should explain why the Veteran’s recollection is inconsistent with the principles of medical science and/or the evidence in this case. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed left knee strain (even if resolved since December 2018) began during active service or is related to an incident of service, to include consideration of the Veteran’s assertion of left knee pain since service. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 6. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the Veteran’s claim for frostbite of the bilateral lower extremities, including a right toe. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. For purposes of this remand, the examiner must assume the Veteran had in-service exposure to cold weather while in Korea. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed right fifth toenail onychomycosis (even if resolved since December 2018) began during active service or is related to in-service exposure to cold weather while in Korea. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 7. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the severity of the Veteran’s service-connected chronic lumbosacral spine strain. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. Based on any examination findings and the Veteran’s documented medical history and lay assertions, the clinician should identify the nature and severity of any symptoms associated with the service-connected chronic lumbosacral spine strain during the appeal period since December 2012. For the purposes of this remand, the examiner must describe what the Veteran’s symptoms would be without the ameliorative effects of medications used during this period. If it is not possible to provide the requested opinion, the examiner must provide an explanation as to why. 8. Then, review all examination reports and medical opinions provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. 9. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Carter, 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.