Citation Nr: A25093046 Decision Date: 10/28/25 Archive Date: 10/28/25 DOCKET NO. 210227-143525 DATE: October 28, 2025 ORDER The appeal as to the issue of service connection for tuberculosis is dismissed. Entitlement to a rating in excess of 20 percent for degenerative disc disease and degenerative joint disease, lumbar spine (lumbar spine disability) is denied. FINDINGS OF FACT 1. A March 2010 rating decision denied entitlement to service connection for a PPD converter, claimed as tuberculosis detection. The Veteran was notified of the decision but did not appeal within one year of notification. 2. There is no eligible AMA rating decision that adjudicated a claim for service connection for tuberculosis. 3. A December 2020 letter advising the Veteran of the proper form to file a claim for compensation is not an appealable decision to the Board. 4. The Veteran's lumbar spine disability has not manifested in forward flexion of 30 degrees or less or ankylosis. CONCLUSIONS OF LAW 1. The criteria for the dismissal of the appeal concerning the issue of service connection for tuberculosis have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.104(c). 2. The criteria for a rating in excess of 20 percent for lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5237. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Coast Guard from June 1980 to November 2009. His numerous awards and decorations include the Coast Guard Achievement Medal and 10 Good Conduct Medals. Evidence Windows This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2020 rating decision of an agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). In the February 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the October 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023). Procedural History In a June 2024 decision, the Board dismissed the Veteran's appeal. The Board determined that the Veteran's February 2021 VA Form 10182 did not identify an appealable rating decision. In addition, the Board found that the Veteran noted on the form that his service-connected lumbar spine disability had increased in severity but did not identify a rating decision with which he disagreed and, therefore, he did not appeal the issue of entitlement to an increased rating for lumbar spine disability. The Veteran appealed the Board's June 2024 decision to the United States Court of Appeals for Veterans Claims (Court). In February 2025, the Court granted the parties' joint motion for remand (JMR), remanding the matter to the Board for action. The case has been returned to the Board for review. Concerning the issue of entitlement to an increased rating for lumbar spine disability, the October 2020 rating decision on appeal, in part, denied a rating in excess of 20 percent. The February 2021 VA Form 10182, while timely to the October 2020 rating decision and containing a statement that the Veteran's lumbar spine disability had increased in severity, only identified a December 2020 VA letter, and not a rating decision. Moreover, in July 2023, the Veteran filed a requisite claim for an increased rating for lumbar spine disability which was subsequently adjudicated by the AOJ, see November 2023 rating decision, and that decision was not appealed to the Board. However, given the JMR and the argument that the Board had a duty to clarify whether the Veteran intended to appeal the October 2020 rating decision denying the increased rating for lumbar spine disability, see 38 C.F.R. § 20.202(f), the Board finds that the issue is on appeal. In Rice v. Shinseki, the U.S. Court of Appeals for Veterans' Claims (Court) held that entitlement to a total disability rating based on individual unemployability (TDIU) claim may be considered part and parcel of an increased rating claim. See Rice, 22 Vet. App. 447 (2009). The Court found in Rice that when entitlement to a TDIU is raised during the adjudicatory process of the underlying disability, it is part of the claim for benefits for the underlying disability. The issue of unemployability has not been raised by the Veteran or by the evidence of record in connection with the increased rating issue on appeal. Accordingly, TDIU is not an issue on appeal. 1. Entitlement to service connection for tuberculosis The Board may dismiss any appeal that fails to allege a specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. By way of background, in August 2009, the Veteran filed a formal claim of service connection for "TB + Detection." See August 2009 VA Form 21-526. In a March 2010 rating decision, service connection for PPD converter claimed as tuberculosis was denied. In March 2010, the Veteran was advised of the March 2010 rating decision and his appellate rights. A notice of disagreement was not received by VA within one year of notification of that March 2010 rating decision. In general, AOJ decisions that are not timely appealed are final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In the legacy system, to include the March 2010 rating decision in question here, a claimant must file a notice of disagreement within one year from the date that notice of a rating decision is mailed; otherwise, the rating decision will become final. 38 C.F.R. § 20.1103. The Veteran did not submit a notice of disagreement within a year of issuance of the March 2010 rating decision. In December 2020, the Veteran submitted a VA Form 21-526EZ form requesting service connection for tuberculosis. Also in December 2020, the Veteran was informed that his claim for tuberculosis was previously denied and that VA regulations required that a proper form was required to review the claim. The letter provided information on the available forms to file the claim; the letter stated that no further action would be taken until the completed form was received. In February 2021, the Veteran filed a VA Form 10182 requesting service connection for tuberculosis and identifying the December 2020 VA letter as the decision with which he disagreed. First, to the extent the Veteran is attempting to appeal the December 2020 letter, this correspondence does not constitute an adverse decision adjudicating entitlement to compensation for a particular disability. 38 C.F.R. § 20.202(a); 38 CFR § 3.151(c); see also Sellers v. Shinseki, 25 Vet. App. 265, 274 (2012) (the Board is unable to act on a matter absent an appealable, binding regional office decision that is adverse to the claimant). Rather, VA merely informed the Veteran that a proper claim form was required, and this is not an appealable decision that the Board may review. Next, there is no AMA-eligible rating decision that adjudicated the issue of service connection for tuberculosis. As to whether the Veteran's February 2021 notice of disagreement was intended to be an appeal of the March 2010 rating decision, the Board finds the appeal untimely. The Veteran received notice of his appellate rights as to the March 2010 rating decision, and he did not submit an appeal within one year of notice of that decision. As such, the March 2010 rating decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The Board also considered the applicability of any waiver that would permit extending the filing period but finds no such evidence. Ferko v. McDonough, 37 Vet. App. 262 (2024) (en banc) (holding the one-year deadline to file a legacy NOD is not a jurisdictional bar to Board review, but a mandatory claims processing rule); Hall v. McDonough, 34 Vet. App. 329, 332 (2022) (regulatory claims-processing rules may be waived without affecting jurisdiction to adjudicate appeal); Percy v. Shinseki, 23 Vet. App. 37, 45 (2009) (VA may implicitly or explicitly waive any issue of timeliness in the filing of a Substantive Appeal). Here, the Veteran did not move for an extension and no good cause has been shown to extend the filing period by over fifteen years. No other arguable waiver is applicable here. Additionally, the Board considered whether it waived its right to enforce the filing deadline by virtue of docketing the appeal. Percy, 23 Vet. App. at 46-47. The Veteran filed his NOD in February 2021 and in March 2021, the Veteran was sent a letter acknowledging receipt of the NOD and placement of the appeal on the evidence submission docket. He was also given quarterly updates that his appeal continued to be in docketing status. The Board finds that the letter acknowledging receipt, and the updates that the appeal had been docketed, and the mere administrative act of assigning the attempted appeal a docket in and of itself does not constitute a waiver of timeliness. Indeed, whether the Board has waived any objection to the timeliness of a VA Form 10182 should be based on all facts and circumstances of that case. Here, although the appeal was docketed as an automatic administrative action, unlike the circumstances of Percy, the Board did not continuously "engage in substantive and procedural development" of the appeal. There was no hearing held, and no action in which the Veteran would be under the impression that the merits of the case were examined and being developed in any substantive way. The facts herein are distinguishable from Percy, and the Board finds that there was not a waiver of the timeliness of a VA Form 10182. Finally, the Board acknowledges the notice provisions under 38 C.F.R. § 20.104(c) concerning the claims-processing defect at issue. An August 2025 VA letter informed the Veteran of how the procedural requirements were not met relating to his claim for service connection for tuberculosis. The letter informed the Veteran had 60 days to respond to the letter. However, the Veteran has not submitted any further information or response to this letter. In light of the above, the Board finds that there is a clear procedural defect as to the claims processing rules as there was no AMA-eligible adjudication of the Veteran's claimed tuberculosis for which an appeal is sought, the December 2020 letter is not an appealable decision, and there was no waiver of timeliness of an NOD concerning the March 2010 legacy rating decision. Because the proper claims processing rules have not been followed, the appeal as to service connection for tuberculosis is dismissed. 2. Entitlement to a rating in excess of 20 percent for lumbar spine disability Increased Ratings Disability ratings are based on a schedule of reductions in earning capacity from specific injuries or combination of injuries. The ratings shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. 38 U.S.C. § 1155. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, it is the intention to recognize painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis). Moreover, when evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton, 25 Vet. App. at 5. Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance," as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Thoracolumbar Spine Disability Rating Criteria Here, the Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5237 which is rated according to the General Rating Formula for Diseases and Injuries of the Spine. See 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases and Injuries of the Spine, with or without symptoms such as pain, whether or not it radiates, stiffness, or aching in the area of the spine affected by the residuals of injury or disease, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm or guarding or localized tenderness not resulting in an abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for disability of the thoracolumbar spine when there is forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine. Unfavorable ankylosis of the entire thoracolumbar spine is evaluated as 50 percent disabling, and unfavorable ankylosis of the entire spine is evaluated as 100 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243. In addition, the General Rating Formula for Diseases and Injuries of the Spine provides, in pertinent part, the following: Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. IVDS is rated either under the General Rating Formula or alternatively under the Formula for Rating IVDS Based on Incapacitating Episodes, whichever method results in a higher rating. The Formula for Rating IVDS Based on Incapacitating Episodes, Diagnostic Code 5243, provides for a 10 percent rating for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is awarded for a disability with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months, a 40 percent rating is in order. Finally, a maximum schedular rating of 60 percent is assigned for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). The Board notes that the criteria for Diagnostic Code 5243, unlike Code 5237, were substantially revised effective February 7, 2021. In this respect, Diagnostic Code 5243 now only applies when there is disc herniation with compression and/or irritation of the adjacent nerve root and Diagnostic Code 5242 is assigned for all other disc diagnoses. Here, the Veteran has a diagnosis of IVDS. However, there is no evidence of incapacitating episodes prescribed by bed rest to warrant application of the formula for rating IVDS. Therefore, the Board will evaluate the Veteran's disability under the general rating formula. Finally, with respect to the Veteran's scar of the lumbar spine, that matter has been granted by the AOJ and separately evaluated. The issue was not appealed by the Veteran, and that matter is not before the Board. Evidence and Analysis In September 2020, the Veteran filed a fully developed claim form requesting an increased rating for his lumbar spine disability. VA treatment records show reports of low back pain. In October 2020, the Veteran was provided a VA medical examination. The report shows diagnoses of degenerative disc disease and degenerative joint disease of the lumbar spine status post laminectomy and lumbar radiculopathy of the right lower extremity. The Veteran stated that he had low back pain all the time that was activity related. He treated his back with heat and Ibuprofen. He had a laminectomy to L4-5 in March 2002. He denied surgeries since. The Veteran stated that he had some sciatica to the right side. He denied flare-ups. Concerning functional loss or impairment, the Veteran explained that it hurt to stand or walk for long periods. On examination, the Veteran had 50 degrees of forward flexion; 15 degrees of extension; 20 degrees of right lateral flexion; 20 degrees of left lateral flexion; 30 degrees of right lateral rotation; and 30 degrees of left lateral rotation. The examiner noted that pain on examination caused functional loss. There was pain with forward flexion, extension, right lateral flexion, and left lateral flexion. There was no evidence with weight-bearing. There was tenderness to palpation over the lumbar paravertebrals. The Veteran was able to perform repetitive-use testing with no additional loss of function. Concerning repeated use over time, pain, weakness, fatigability, or incoordination, would not significantly limit functional ability over time. He did not have guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing was normal in all areas tested. He did not have muscle atrophy. Deep tendon reflexes were normal. There was no ankylosis. He did not use an assistive device. Concerning impact on work, the Veteran would have difficulty with prolonged standing, walking, weight-bearing, twisting, bending or lifting. He had no sedentary restrictions. A December 2020 emergency room record shows that the Veteran reported low back pain to the bilateral lower extremities. A December 18, 2020, record, shows that the Veteran reported low back pain for two months with pain at a 4/10. The pain radiated to his lower extremities and he reported urinary frequency. In another December 18, 2020, record, the Veteran reported persistent low back pain. He did not have stiffness in the morning and felt better as the day goes on. He denied any new urinary incontinence or fecal incontinence and had no new neurological deficit. The impression was low back pain and inner thigh pain. He was prescribed Diclofenac for pain. Physical therapy was recommended. There were no restrictions on discharge. An October 20, 2020 emergency record shows that the Veteran reported lumbar pain for 9 days. The Veteran stated that he had pain after a back bending episode. Pain was in the mid lumbar area, and he denied any new bowel or voiding issues. He had minor pain episodes with his back, but they persisted. The physician ordered several medications for the Veteran's pain. He was discharged the same day without restrictions. A February 2021 x-ray of the thoracolumbar spine shows multilevel mild to moderate degenerative changes in the lumbar spine. In a March 2021 VA medical treatment record, the Veteran reported low back pain. He stated that, a few months ago, he had acute exacerbation of back pain. His pain has improved a great degree with muscle relaxants and some sort of injection in the emergency room in December. He denied bowel or bladder symptomatology. The March 2021 VA treatment record indicated that the Veteran had experienced bilateral lower extremity pain, but the examination findings showed normal muscle strength, normal sensation, and normal reflexes. Here, the Board finds that the evidence does not support a rating in excess of 20 percent. The evidence does not reveal forward flexion of the thoracolumbar spine to 30 degrees or less, or ankylosis. Even considering additional limitation of motion or function of the thoracolumbar spine due to pain, the evidence does not show that his lumbar spine disability more nearly approximates the criteria for a higher rating at any time during this period on appeal. Even during periods of repeated use that result in additional functional loss or impairment, the VA examiner opined that the Veteran's forward flexion would be limited to 50 degrees but no less. There is no ankylosis or its functional equivalent as the Veteran has motion in his spine. It is not fixed in place or immobile, as would be required for ankylosis, even during his periods of repeated use. Chavis v. McDonough, 34 Vet. App. 1, 11 (2021) (a claimant may obtain "an evaluation based on ankylosis if [that] claimant's functional loss is consistent with that contemplated by ankylosis...."). Concerning any associated objective neurologic abnormalities, the Veteran is rated at 20 percent for radiculopathy of the right lower extremity, and that matter is not before the Board at this time. Though the Veteran reported pain radiating into his bilateral lower extremities when seen in March 2021, there was no objective finding or diagnosis. Indeed, the examination findings at the time showed normal reflexes, sensation, and muscle strength. In March 2021, the Veteran indicated urinary frequency when he was seen at the emergency room; however, in another record dated that same day, he denied bladder symptomatology. There was no objective finding or diagnosis made. Accordingly, the Board finds that a separate rating for any neurological complication is not warranted. Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). In making the above findings, the Board is cognizant of the fact that the Veteran has used medication, including Ibuprofen, to treat his lumbosacral strain. The Court has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56 (2012). More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities" and held that "Jones applies in the evaluation of musculoskeletal disabilities where the relevant [diagnostic code] does not reference medication as a factor in evaluation." Ingram v. Collins, 38 Vet. App. 130 (2025). The Board notes, however, that neither Jones nor Ingram address how the Board is to discount the beneficial effects of medication, particularly when used as treatment for musculoskeletal symptoms and where examiners do not reasonably have the ability to assess range of motion both with and without use of medication. Remanding this appeal to order an addendum medical opinion based on Jones and Ingram, and in the lens of the rating criteria under § 4.71a, would almost certainly require an examiner to engage in medical speculation and would result in a medical opinion that lacks the degree of certainty to ascertain, even under the benefit-of-the-doubt standard, the impact of the ameliorative effects of medication on the severity of a veteran's musculoskeletal disability in terms of range of motion. Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2005) (medical opinions that are speculative have "little probative value"). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's lumbosacral strain would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication of the Veteran's appeal to engage in likely unfruitful further development pursuant to Jones and Ingram. Moreover, the Board certainly cannot - and will not - direct the Veteran to stop taking medication to undergo an examination that would reflect the severity of his lumbosacral strain without the use of pain medication. This would not only be cruel and potentially damaging to the Veteran, but the undersigned finds it would be unethical to ask such. Finally, the Board notes that VA compensation does not contemplate hypothetical symptoms or impairment. Instead, the purpose of VA benefits is to compensate for decreased earning capacity - to compensate for actual symptoms or impairment that an individual experiences in the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran's manifestations of pain have been considered in rating his lumbosacral strain, but it remains the Board's obligation to rate the condition based on the application of the rating criteria found in the diagnostic codes to the objective medical evidence. The Board is sympathetic to the Veteran's assertions and grateful for his service, but the Board is bound and constrained by law, and its decision is dictated by the relevant statutes and regulations. Moreover, the Board is without authority to grant benefits simply because it might perceive such a grant to be equitable. 38 U.S.C. §§ 503, 7104; Harvey v. Brown, 6 Vet. App. 416, 425 (1994). "[N]o equities, no matter how compelling, can create a right to payment out of the United States Treasury that has not been provided for by Congress." Smith v. Derwinski, 2 Vet. App. 429, 432-33 (1992). (Continued on the next page) ? In conclusion, the evidence of record persuasively weighs against a rating in excess of 20 percent. The benefit of the doubt rule does not apply. Accordingly, the claim is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Colleen M. Glaser-Allen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Seay, Jessica M. 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.