Citation Nr: 21025565 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-15 157 DATE: April 28, 2021 ORDER Reopening of the previously denied claim for service connection for a heart condition, to include as a result of herbicide exposure, is granted. Entitlement to service connection for a heart condition (now claimed as ischemic heart disease and myocardial infarction), to include as a result of herbicide exposure, is denied. Entitlement to service connection for diabetes mellitus, type II, to include as a result of exposure to herbicides, is denied. Entitlement to service connection for hyperlipemia, to include as a result of herbicide exposure is denied. Entitlement to service connection for hypertension, to include as a result of herbicide exposure is denied. Entitlement to service connection for a seizure disorder, to include as a result of herbicide exposure is denied. Entitlement to service connection for a stroke, to include as a result of herbicide exposure is denied. Entitlement to service connection for dementia, to include as a result of herbicide exposure is denied. Entitlement to service connection for aphasia is denied. Entitlement to service connection for headaches is granted. Entitlement to service connection for asbestosis (claimed as lung cancer) is granted. REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. FINDINGS OF FACT 1. An unappealed October 2004 rating decision denied service connection for a heart condition, due to a lack of a nexus to service. 2. New and material evidence has been submitted to reopen the previously denied claim of service connection for a heart condition. 3. The Veteran did not serve in Vietnam or in the coastal waters of Vietnam; exposure to herbicides is not presumed. The evidence of record does not establish actual exposure to herbicides during service. 4. The Veteran’s heart condition did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 5. The Veteran’s diabetes mellitus did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 6. Hyperlipidemia, to include high cholesterol, is a laboratory measurement which by itself does not constitute a recognized disability for purposes of VA benefits entitlement. 7. The Veteran’s hypertension did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 8. The Veteran’s seizure disorder did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 9. The Veteran’s stroke did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 10. The Veteran’s dementia did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 11. The Veteran’s aphasia did not begin during active service, or is otherwise related to an in-service injury, event, or disease. 12. The Veteran’s headaches had its onset in service. 13. The Veteran was exposed to asbestos in service, resulting in a present diagnosis of asbestosis confirmed by a physician. CONCLUSIONS OF LAW 1. The October 2004 rating decision which denied service connection for a heart condition is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. The criteria for reopening of the previously denied claim for service connection for a heart condition, to include as a result of herbicide (herbicides) exposure have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement service connection for a heart condition (now claimed as ischemic heart disease and myocardial infarction), to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for entitlement to service connection for diabetes mellitus, type II to include as a result of exposure to herbicide have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for entitlement service connection for hyperlipemia, to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for hypertension, to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for entitlement to service connection for a seizure disorder, to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 8. The criteria for entitlement to service connection for a stroke, to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 9. The criteria for entitlement to service connection for dementia, to include as a result of herbicide exposure have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 10. The criteria for entitlement to service connection for aphasia have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 11. The criteria for entitlement to service connection for headaches have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 12. The criteria for entitlement service connection for asbestosis (claimed as lung cancer) have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty with the U.S. Navy from August 1972 to August 1975. This case comes before the Board of Veteran’s Appeals (Board) on appeal from a January 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran had a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is of record. Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a). These duties have been satisfied in this case.  Appropriate notice was provided in January 2012 and November 2014.  The RO associated the Veteran’s service and VA and private outpatient treatment records with the claims file. All released or submitted private treatment records have been associated with the claims file.  No other relevant records have been identified and are outstanding.  Appropriate and necessary examinations were afforded the Veteran, and are adequate for evaluation, as they include needed findings to permit application of the rating schedule and identification of current disability. Such includes the December 2014 examination. As such, VA has satisfied its duty to assist.  38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). New and Material In the January 2015 decision on appeal, the RO reopened the previously denied claim and considered the merits in confirming and continuing the denial of service connection for a heart condition. However, irrespective of the RO’s action, the Board must decide whether the Veteran has submitted new and material evidence to reopen the claim. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). Jackson v. Principi, 265 F.3d 1366 (Fed Cir 2001). Generally, a claim that has been denied in an unappealed Board or rating decision may not thereafter be reopened and allowed. 38 C.F.R. §§ 20.1100, 20.1103. The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence means evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence previously of record and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In an October 2004 rating decision service connection was originally denied for a heart condition based on findings that there was no nexus to service. The Veteran did not appeal this decision, and no relevant additional evidence was received within the year after notification of the decision. It became final. In January 2021, the Veteran testified before the undersigned Veterans Law Judge that he was exposed to herbicides through a leak on USS Newman K. Perry. He stated that his ship was near the coast of Vietnam. The Veteran’s testimony concerning his exposure is new and material, and the claim is therefore reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, 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 may also be granted for disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). For secondary service connection, it must be shown that the disability for which the claim is made is proximately due to or aggravated by a service-connected disability. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Organic diseases of the nervous system. Hypertension, diabetes mellitus, valvular heart disease, and myocarditis are listed chronic diseases, each subject to a one year presumptive period dating from separation from service. Regarding service connection due to herbicide exposure, VA laws and regulations provide that if a Veteran was exposed to tactical herbicides during service, certain listed diseases are presumptively service-connected. 38 U.S.C. § § 1116h(a)(1); 38 C.F.R. § 3.309(e). A Veteran who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975, is presumed to have been exposed to herbicide. 38 U.S.C. § § 1116(f); 38 C.F.R. § 3.307(a)(6)(iii). 38 C.F.R. § 3.309(e) lists the diseases covered by the regulation, which include diabetes mellitus, type II, and ischemic heart disease. Hypertension and stroke are not listed conditions, though the Veteran alleges herbicide exposure caused such. Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA’s policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran’s particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that “[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board”). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (2018). Moreover, the United States Court of Appeals for Veterans Claims (CAVC) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). Hyperlipemia The Veteran contends that he is entitled to service connection for hyperlipidemia, also known as high cholesterol. Symptoms or clinical findings, such as laboratory findings, are not disabilities within the law. Absent evidence of a current disability, a claim for service connection must be denied. Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Veteran’s hyperlipidemia represents only a laboratory finding, and is not a disability for which VA compensation benefits are payable. See 61 Fed. Reg. 20440, 20445 (May 7, 1996) (diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are actually laboratory results rather than disabilities, and are therefore not appropriate entities for the rating schedule to address). The evidence of record does not identify or suggest underlying diseases to which the claimed symptoms or laboratory findings may be related. Service connection for hyperlipidemia must be denied in the absence of a current disability for VA purposes. Heart Condition/ Diabetes Mellitus/ Hypertension/ Seizure/ Stroke/Dementia The Veteran asserts that while assigned to the USS Newman K. Perry from 1972 to 1973 he was exposed to herbicides. Specifically, he asserts that there was a leak on his ship, and he was exposed herbicides. The Veteran’s service personnel records establish that he was assigned to the USS Newman K. Perry from 1972 to 1975. In January 2021, the Veteran testified that he never left his ship or went onshore in Vietnam. Instead, he reported that the ship had been within the coastal waters of Vietnam while he was aboard, establishing his exposure as a Blue Water sailor. Alternatively, he has testified that he was exposed to herbicides through a leak aboard ship. The Board notes that due to his various disabilities, the Veteran has a great deal of trouble communicating. At his January 2021 hearing, the record was held open for 30 days to permit the Veteran, with the help of his daughter, to submit a written statement responding to and clarifying answers to questions raised at the hearing. The details of his exposure were specifically to be addressed. As of this date, no such statement has been received. The evidence, including official records, does not support his allegations, unfortunately. Service personnel records did not establish that he was exposed to herbicides. In December 2014, a VA formal finding of insufficient evidence to concede the Veteran’s exposure to herbicides was issued by the RO. The USS Newman K. Perry did serve off the coast of Vietnam, but only in the mid to late 1960’s, and not at any time the Veteran was aboard. The last notation of the ship being in Vietnam was April 1966. The Veteran reported the ship had left Guantanamo bay (Gitmo), sailed from the Atlantic to the Pacific and served off the coast of Vietnam, and then returned to Gitmo. Such is not consistent with ship’s records, nor with general knowledge of deployments. Moreover, the Veteran was not awarded any decoration indicating service in Vietnam. With regard to a leak, there is no evidence of such other than the Veteran’s statement. Further, even if the Veteran was exposed to fluids or water aboard ship from 1972 to 1975, there is no evidence or indication that potential exposures in 1966 would have remained to contaminate the ship so many years later. The Board acknowledges that the Veteran is competent to describe his duties and where he performed them. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). However, in this case he is effectively contradicted by official records. As such, the Veteran’s lay assertions of exposure are less credible and persuasive in light of the other evidence of record and are outweighed by this evidence. Since the evidence of record does not establish that the Veteran was exposed to herbicides while aboard the USS Newman K. Perry, he is not entitled to any presumption that would result from such exposure. As there is no evidence to support any finding of a nexus between service and his heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, stroke, and dementia. The Veteran may still seek service connection on a direct basis. The Veteran’s service treatment records (STRs) were negative for any treatment or complaints of a heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, stroke, or dementia. The Veteran reported that he had heart problems when he was discharged from service. He noted that he was diagnosed with an enlarged heart. However, a December 1978 radiology report documented that the Veteran had a normal chest x-ray and normal size heart. Post service treatment records demonstrated that the Veteran was diagnosed and treated for a heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, stroke, and dementia. The Board acknowledges that the Veteran has not been provided with VA examinations pertaining to the claimed disorders. VA has a duty to provide a medical examination where there is (1) competent evidence of a current disability or symptoms thereof; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability is associated with service; and (4) insufficient competent medical evidence to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); see 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). As explained above, the Board finds that there is no indication that his heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, stroke, or dementia are related to service, to include claimed in-service exposure to herbicides, as there was no such exposure. VA therefore has no duty to provide a medical examination. Current medical evidence shows that the Veteran has been diagnosed with a heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, and dementia. The record does not suggest that his heart condition, diabetes mellitus, hypertension, seizure disorder, stroke, and dementia began during active service, or during any applicable presumptive period for chronic diseases. As there is no evidence to support any finding of a nexus between service and a heart condition, diabetes mellitus, hyperlipemia, hypertension, seizure disorder, stroke, or dementia, entitlement to the benefits sought are not warranted. Aphasia The Veteran contends that his aphasia was related to his stroke. STRs were silent for any treatment, complaints, or diagnosis of aphasia. Post service treatment records demonstrated that the Veteran was diagnosed and treated for aphasia. The Veteran was not provided a VA examination. The evidence does not indicate an in-service event or injury or continuous symptoms, or even a theory of entitlement, a VA examination is not required for this claim on a direct basis. Further, there is no evidence indicating even a possibility that his aphasia is related to his military service. Specifically, the Veteran has not indicated how his claimed condition is related to service. The Veteran has only filed a claim stating that he has aphasia. Such statements are not sufficient to trigger the need for a VA examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010). The Veteran alleges his aphasia is secondary to his stroke. Unfortunately, as discussed above, residuals of a stroke are not service-connected at this time, and therefore no condition can be service-connected secondary to it. For these reasons, the Board finds that a preponderance of the evidence is against the claim of service connection for aphasia on a direct or secondary, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Headaches The Veteran contends that his headaches were related to his military service. STRs were silent for any treatment or diagnosis of headaches. Post service treatment records documented that the Veteran was treated for headaches. A December 1978 private treatment note documented that the Veteran was treated for throbbing headaches. The Veteran reported that since 1973 he had intermittent episodes of pounding throbbing headaches. The examiner noted that it appeared that the Veteran had vascular headaches. In January 2021, the Veteran testified that his headaches started while he was in-service. He indicated that he continued to have headaches since his military service. Review of the competent and credible evidence of the Veteran’s lay statements of headaches in service, and the progression of such since that time. This evidence of continuity and chronicity is sufficient to establish service connection. Asbestosis The Veteran contends that his current lung disease, to include asbestosis, is related to his asbestos exposure in service. STRs were silent for any treatment or diagnosis of asbestosis. Post service treatment records demonstrated that the Veteran was treated for asbestosis. An October 2003 VA treatment note documented that the Veteran had a history of asbestosis. A September 2004 private treatment note documented that the Veteran had asbestosis on the basis of chest x-ray abnormalities. The Veteran was diagnosed with asbestos-related pleural disease. In December 2014, the Veteran was afforded a VA respiratory condition examination. The Veteran was diagnosed with asbestos-related pleural disease with an onset date of 2004. In 2004, the Veteran was seen by a pulmonologist (Dr. S) who felt he had asbestosis related pleural disease and atherosclerotic cardiovascular disease. Dr. S records documented that the Veteran worked for 2 years in the engine room. He also worked for a hospital as a broiler tech around asbestos. The Veteran worked 9 years between 1980 and 1989 as a broiler tech with similar exposure and he did not wear a mask during his entire work history. The chest x-ray reviewed by Dr. S showed small irregular interstitial opacities in the mid and lower lung zones bilaterally as well as pleural thickening with no calcification. There was no sign of congestive heart failure or pleural fluid. The Veteran’s records documented that he had a smoking history ranging from 1 to 2 packs a day for many years. The examiner noted that the Veteran’s file was reviewed. The examiner opined that the Veteran’s claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran had 2 to 3 years of probable asbestos exposure in the military and more than 20 years of probable exposure to asbestos in his employment after his military service. He noted that there was likely a small minority of his exposure from his military service. The examiner indicated that it was not feasible to determine the clinical significance of that exposure compared to his other exposure. Additionally, the most recent x-rays show clear lungs and the spirometry shows only a mild restrictive lung defect. Further, he noted that the Veteran had a 50 plus pack a year history of smoking which confounds the examination and results. The Board acknowledges that the evidence suggests nonmilitary asbestos exposure in addition to conceded military asbestos exposure. However, as the Veteran’s service is consistent with asbestos exposure, the reasonable doubt with respect to this question is resolved in his favor. Furthermore, the VA examiner indicated that it was not feasible to determine the clinical significance of his military exposure compared to his other exposure. Here, the evidence of record shows that the Veteran has a current respiratory disability that is proximately due to conceded asbestos exposure in service. Accordingly, the criteria for service connection for asbestosis are met, and the appeal as to this issue is granted. REASONS FOR REMAND The Veteran seeks service connection for bilateral carpal tunnel. In April 2016, the Veteran testified during a RO hearing that his condition started during active service. He indicated that his hands would cramp up a lot when he was doing repairs. In January 2021, he testified that his condition was from the wear and tear from constantly working with his hands during active duty. Post-service treatment records documented that the Veteran was diagnosed and treated for bilateral carpal tunnel. The Board cannot make a fully informed decision on this issue because no VA examiner has opined whether any of the Veteran’s condition was related to his active duty service. Where there is evidence of a current disability or persistent or current symptoms of a disability and an in-service incident or injury, and the possibility of a nexus between them, remand is required to obtain an examination and medical opinion. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Arrange for a VA examination to address the etiology of the Veteran’s claimed bilateral carpal tunnel syndrome. The examiner must opine as to whether it is at least as likely as not that the disorder began in service, within one year of service separation, or is otherwise related to the Veteran’ service. In rendering this opinion, the examiner should consider the private and VA medical records available as well as the testimony of the Veteran. Please note that the Veteran had a stroke and has difficulty writing and talking. Please provide the Veteran ample amount of time to schedule his VA examination. The Veteran is asked to prepare his reported history of his bilateral carpal tunnel before his scheduled examination. 3. Thereafter, readjudicate the remanded issues. If any benefit sought remains denied, issue a supplemental statement of the case. The case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Baxter 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.