Citation Nr: A25035755 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240528-444337 DATE: April 17, 2025 ORDER Entitlement to an initial evaluation in excess of 10 percent for left hip strain, prior to September 4, 2018, and a compensable evaluation thereafter, is denied. Entitlement to a compensable initial evaluation for limitation of flexion of the left thigh prior to September 4, 2018, and in excess of 10 percent thereafter, is denied. Entitlement to a compensable initial evaluation for limitation of extension of the left thigh is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran's left hip strain has been manifested by flare-ups after prolonged walking with abduction limited to 25 degrees, internal rotation limited to 20 degrees, and external rotation limited to 40 degrees by pain, weakness, fatigability, and lack of endurance. But these factors have never limited abduction to less than 10 degrees or internal or external rotation to less than 15 degrees. These factors have also never limited adduction to the point of preventing the Veteran from crossing his legs. 2. The Veteran's left hip strain has been manifested by flare-ups after prolonged walking with flexion limited by pain, weakness, fatigability, and lack of endurance to 80 degrees, but these factors have never limited flexion to less than 45 degrees. 3. The Veteran's left hip strain has been manifested by flare-ups after prolonged walking with extension limited by pain, weakness, fatigability, and lack of endurance to 10 degrees, but these factors have never limited extension to less than 5 degrees. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 10 percent prior to September 4, 2018, and a compensable evaluation thereafter, for left hip strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5253. 2. The criteria for a compensable initial evaluation prior to September 4, 2018, and in excess of 10 percent thereafter, for limitation of left thigh flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 3. The criteria for a compensable initial evaluation for limitation of left thigh extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1970 to February 1972, including service in Vietnam from January 1971 to December 1971, where he earned the Combat Infantryman's Badge. Following appeals in both the legacy and modernized systems, the VA agency of original jurisdiction (AOJ) awarded service connection for left hip strain with limitation of flexion and limitation of extension in a November 2023 rating decision. The Veteran now appeals the initial evaluations assigned in that rating decision. In his May 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 2023 rating decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the November 2023 rating decision cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence submitted since the November 2023 rating decision, 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 1. Entitlement to an initial evaluation in excess of 10 percent for left hip strain, prior to September 4, 2018, and a compensable evaluation thereafter. 2. Entitlement to a compensable initial evaluation for limitation of flexion of the left thigh prior to September 4, 2018, and in excess of 10 percent thereafter. 3. Entitlement to a compensable initial evaluation for limitation of extension of the left thigh. In his initial March 2011 claim for service connection, the Veteran reported back, leg, and hip problems over the prior few years. In a November 2020 statement and supplemental claim for service connection, he described managing pain in his back, hips, and neck over the years until a 2013 right hip replacement. His appeal of the AOJ's initial evaluations argued that the examiner failed to discuss flare-ups and the level of disability under the conditions of ordinary, everyday life, rending the examination that the AOJ relied on inadequate. Disability evaluations are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities (the Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. Although the Board must consider the Veteran's entire history when making disability evaluations, see Schafrath v. Derwinski, 1 Vet. App. 589 (1995), it is the present level of disability that is of primary concern where entitlement to compensation already has been established and an increase in the disability rating is at issue, see Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev'd in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). Additionally, the U.S. Court of Appeals for Veterans Claims has held that "staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). When assessing the severity of musculoskeletal disabilities that are at least partly evaluated on the basis of limitation of motion, as the left hip strain on appeal is, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. 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 VA examinations include joint testing for pain on both active and passive motion, 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 (2017), the Court found an orthopedic examination inadequate where the examiner declined to provide an estimate of the degree of additional loss of motion due to flare-ups because such would require resort to speculation. Id. at 29, 36. In the November 2023 rating decision awarding service connection for his left hip, the AOJ assigned a compensable initial evaluation for hip strain effective March 18, 2011, based on painful motion pursuant to 38 C.F.R. § 4.71a, DC 5253 for impairment of the thigh, and decreased that to a noncompensable evaluation based upon a showing of improvement effective the date of a September 4, 2018 examination. The AOJ also assigned a noncompensable initial evaluation for limitation of flexion effective March 18, 2011, and that increased to 10 percent evaluation effective September 4, 2018, pursuant to 38 C.F.R. § 4.71a, DC 5252. The AOJ further assigned a noncompensable initial evaluation for limitation of extension effective the date of a January 27, 2021, examination pursuant to 38 C.F.R. § 4.71a, DC 5251. Normal ranges of motion of the hip are from 0 degrees of extension to 125 degrees of flexion and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the hip or thigh may be rated under DC 5251 for limitation of extension, DC 5252 for limitation of flexion, or DC 5253 for impairment of the thigh. The Board notes that these diagnostic codes were not affected by the February 2021 regulatory amendments to 38 C.F.R. § 4.71a. DC 5251 provides a maximum 10 percent evaluation for limitation of extension of the thigh to 5 degrees. 38 C.F.R. § 4.71a, DC 5251. DC 5252 provides a 10 percent evaluation for flexion of the thigh that is limited to 45 degrees. A 20 percent evaluation is assigned for flexion of the thigh limited to 30 degrees. A 30 percent evaluation is assigned for flexion of the thigh limited to 20 degrees. Finally, a 40 percent evaluation is assigned for flexion of the thigh limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252 DC 5253 contemplates impairment of the thigh based on limitation of abduction, adduction, or rotation. A 10 percent evaluation will be assigned for limitation of rotation where the individual cannot toe-out more than 15 degrees on the affected leg or for limitation of adduction where the individual cannot cross the legs. A 20 percent rating will be assigned for limitation of abduction where there is motion lost beyond 10 degrees. At the time of his March 2011 claim, the Veteran had moved from Idaho to Nebraska several years prior and was receiving ongoing treatment for hip pain through VA there. In May 2010, he reported recently increased lower back and left hip pain. In September 2012, he reported increasing right hip pain with decreased range of motion, but did not similarly report decreased range of left hip motion. He eventually got a prescription for right hip pain, and had his right hip replaced in May 2013. The Veteran retired and moved to Arizona in 2014. He continued to use VA healthcare in Arizona, and these treatment records reflect his ongoing struggle with joint pain, including hip pain, but a September 2015 physician noted a normal range of motion in the ankles, knees, legs, and hips. A primary care provider also noted full range of motion in the upper and lower extremities in September 2021 and September 2022. Prior to filing his March 2011 claim for service connection for his hips, the Veteran had a December 2010 VA examination. Because the Veteran had not yet filed his claim, the examination was specific to his back rather than his hips, but the examiner noted a normal gait and full muscular strength in hip extension and flexion. The Veteran had further examinations in August 2015, September 2018, January 2021, and December 2022. The August 2015 and September 2018 examiners similarly found full muscle strength in left hip flexion, extension, and abduction. The January 2021 examiner found full strength left hip flexion. At the August 2015 VA examination, the Veteran reported intermittent pain since 2014, about twice per week. He specified that hip pain was brought on by prolonged walking and that he takes over-the-counter Tylenol as needed. The examiner recorded the Veteran's range of motion as 110 degrees of flexion, 30 degrees of extension, 40 degrees of abduction, 25 degrees of adduction, 20 degrees of internal rotation, and 60 degrees of external rotation. The examiner noted that the Veteran was able to cross his legs, and had pain with internal rotation, but did not have pain with weight bearing. The examiner found no additional functional loss on repetitive use testing and opined that the Veteran's left hip disability would impact his ability to perform occupational tasks by limiting his use of ladders and stairs. At the September 2018 examination, the examiner diagnosed left hip strain. The Veteran repeated that his intermittent left hip pain began in about 2014, has been occurred about twice per week, and is brought on by prolonged standing or walking. The examiner recorded the Veteran's range of motion as 105 degrees of flexion, 30 degrees of extension, 45 degrees of abduction, 25 degrees of adduction, 40 degrees of internal rotation, and 60 degrees of external rotation. The examiner found no additional loss of function or range of motion on repetitive use testing and opined that the Veteran's left hip disability would not impact his ability to perform occupational tasks. The examiner noted that the Veteran was able to cross his legs and had pain in passive motion, but did not have pain on weight bearing, or when not bearing weight. At the January 2021 examination, the Veteran reported that his hip pain and stiffness had worsened over the years. The examiner recorded the Veteran's range of motion as 110 degrees of flexion, 25 degrees of extension, 40 degrees of abduction, 20 degrees of adduction, 35 degrees of internal rotation, and 55 degrees of external rotation. The examiner noted that the Veteran was able to cross his legs and had pain in all ranges of motion and in weight bearing, but did not have pain in passive motion or when not bearing weight. The examiner found no difference between active and passive motion in each plane. The January 2021 examiner recorded the Veteran's range of motion on repetitive use testing as 100 degrees of flexion, 20 degrees of extension, 35 degrees of abduction, 15 degrees of adduction, 30 degrees of internal rotation, and 50 degrees of external rotation, but noted that the Veteran was able to cross his legs. The examiner indicated that the Veteran was not being examined immediately after repetitive use over time but opined that after repeated use over time pain and lack of endurance would further limit the Veteran's range of motion to 90 degrees of flexion, 15 degrees of extension, 30 degrees of abduction, 10 degrees of adduction, 25 degrees of internal rotation, and 45 degrees of external rotation. The examiner also estimated that the Veteran would still be able to cross his legs. As to the impact of the Veteran's left hip disability on his ability to perform occupational tasks, the examiner recorded the Veteran's description of hip pain limiting his ability to walk, stand, bend, lift, or sit for prolonged periods of time. At the December 2022 examination, the Veteran reported left hip pain with prolonged sitting or standing and limiting the distance he can walk. The examiner noted the Veteran's use of a cane and antalgic gait but attributed that altered gait to foot drop rather than left hip strain. The examiner recorded the Veteran's range of motion as 110 degrees of flexion, 20 degrees of extension, 40 degrees of abduction, 20 degrees of adduction, 35 degrees of internal rotation, and 55 degrees of external rotation. The examiner noted that the Veteran was able to cross his legs, and had pain with flexion and in weight bearing, but did not have pain in passive motion or when not bearing weight. The examiner found no difference between active and passive motion in each plane. The examiner found no additional function loss on repetitive use testing. However, the examiner indicated that the Veteran was being examined immediately after repetitive use over time and that pain, weakness, and fatigability significantly limited his functional ability. The examiner recorded the Veteran's range of motion after repeated use over time as 110 degrees of flexion, 20 degrees of extension, 40 degrees of abduction, 20 degrees of adduction, 35 degrees of internal rotation, and 55 degrees of external rotation, but noted that the Veteran was still able to cross his legs. As to the impact of the Veteran's left hip disability on his ability to perform occupational tasks, the examiner noted that the Veteran was retired and worked most recently as a supervisor. He recorded the Veteran's report that his hip would make it difficult to go out into the field to check on employees, unless he could get the truck close to the job site. The Veteran denied flare-ups at the August 2015, September 2018 VA, and December 2022 VA examinations, and despite the argument in his appeal that the examiner failed to discuss flare-ups, the Board finds no inadequacy in these examinations because information as to flare-ups would necessarily be unavailable in the absence of flare-ups. The Veteran's attorney did not specify which examiner failed to address left hip flare-ups, but he may have been referring to an April 2023 VA examination for the Veteran's right hip. The Veteran's right hip is also service-connected, but the evaluation for his right hip is not currently on appeal. The AOJ in the November 2023 rating decision on appeal did not rely on that examination, and the Board does not rely on that examination in this decision. The April 2023 examination report includes no potentially favorable evidence of more severely limited motion and does not suggest that the Veteran's left hip disability has increased in severity since the January 2021 and December 2022 examinations. The Board also finds that the January 2021 examiner addressed flare-ups. The examiner noted the Veteran's report of daily flare-ups lasting 2-3 hours, precipitated by physical activity and alleviated by motrin and changing position. The examiner opined that hip pain with prolonged walking, standing, bending, and lifting would limit the Veteran from sitting longer than one hour. The January 2021 examiner also opined that pain and lack of endurance during flare-up would cause additional functional limitation and estimated that, during flare-up, the Veteran's range of motion would be further limited to 80 degrees of flexion, 10 degrees of extension, 25 degrees of abduction, 5 degrees of adduction, 20 degrees of internal rotation, and 40 degrees of external rotation, but that the Veteran would still be able to cross his legs. The Veteran's range of motion was most at its most limited as estimated by the January 2021 examiner during flare-up. However, his flexion has never been limited further than 80 degrees, his extension has never been limited further than 10 degrees, his abduction has never been limited further than 25 degrees, limitation of adduction has never prevented crossing his legs, his internal rotation has never been limited further than 20 degrees, and his external rotation has never been limited further than 40 degrees. Despite the argument in the Veteran's appeal as to the examiner's failure to capture the Veteran's level of disability under the conditions of ordinary, everyday life, the Board notes that the December 2022 examiner measured the Veteran's range of motion after repetitive use over time and the January 2021 examiner estimated the Veteran's range of motion during flare-ups. Additionally, these examiners noted pain, weakness, fatigability, and lack of endurance as factors causing additional functional limitation. The Board finds these examinations particularly instructive as to the Veteran's level of disability under the conditions of ordinary, everyday life. The Board resolves all reasonable doubt in the Veteran's favor and assumes that the level of disability described by the January 2021 and December 2022 examiner has been present throughout the appeal period. As noted above, the Veteran has been assigned a 10 percent evaluation for painful motion under DC 5253 prior to September 4, 2018, a noncompensable evaluation thereafter; a noncompensable evaluation for painful flexion under DC 5252 prior to September 4, 2018, and 10 percent evaluation thereafter; and a noncompensable evaluation for painful extension under DC 5251, effective January 27, 2021. The Veteran's ranges of motion have never been severely limited enough to merit compensable evaluation under DCs 5251, 5252, or 5253. In order to award a separate or increased evaluation, there must be the functional equivalent of extension limited to 5 degrees, flexion limited to 45 degrees, abduction limited to 10 degrees, adduction so limited as to prevent crossing the legs, or rotation limited to 15 degrees. Because the Veteran's ranges of motion have never been so severely limited, even during flare-up or after repetitive use over time, separate or increased evaluations under multiple DCs is not warranted. Although the AOJ awarded a compensable evaluation under DC 5253, noted "improvement" as of September 4, 2018, reduced that evaluation to noncompensable, and awarded a 10 percent evaluation under DC 5252 effective September 4, 2018, a single 10 percent evaluation has always been merited for painful motion. 38 C.F.R. § 4.40, 4.45, 4.59; DeLuca. There has never been improvement, and the AOJ's "reduction for improvement," under DC 5253 was not a "rating reduction" requiring VA to follow the special procedures relating to rating reductions, as there was no reduction in compensation. VAOPGCPREC 71-91 (November 7, 1991). See also O'Connell v. Nicholson, 21 Vet. App. 89, 93 (2007) (discussing Congress' intent in enacting 38 U.S.C. § 5112(b)(1) in providing a Veteran time to adjust to a reduction of compensation and indicating that VA implementing regulation 38 C.F.R. § 3.105(e) furthered Congress's intent by requiring notification and time to submit additional evidence when there is a reduction in compensation). Rather, the AOJ used DC 5253 to award a 10 percent evaluation for painful motion prior to September 2018 and DC 5252 to assign the same 10 percent for painful motion thereafter. To the extent that the Veteran claims that his pain caused additional loss of movement, especially during flare-up, the Board finds that the Veteran's subjective complaints of pain have been contemplated in the current evaluation assignment. The clinical findings do not demonstrate that the Veteran's symptoms result in additional functional limitation to a degree that would support an evaluation in excess of the current, 10 percent disability evaluation based on additional functional impairment due to DeLuca factors. See Mitchell, 25 Vet. App. at 43 ("pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system"). The January 2021 and December 2022 examiners noted pain, weakness, fatigability, and lack of endurance, and estimated the Veteran's range of motion as limited by these factors. However, the Veteran's range of motion, even as limited by these factors during flare-up, does not exceed extension limited to 5 degrees, flexion limited to 45 degrees, abduction limited to 10 degrees, adduction so limited as to prevent crossing the legs, or rotation limited to 15 degrees. The extent that the Veteran contends that he is entitled to an evaluation in excess of 10 percent for left hip strain, the Veteran is competent to report symptoms such as pain, weakness, fatigability, lack of endurance, and limited motion. Layno v. Brown, 6 Vet. App. 465 (1994). The Veteran is also credible in these descriptions of his left hip disability. The Board, and the examiners, have considered those statements. The January 2021 and December 2022 examiners referenced the Veteran's descriptions in their estimates of range of motion as limited during flare-up or due to pain, weakness, fatigability, and lack of endurance. The Veteran's lay statements support his compensable evaluation for painful motion, but do not support increased evaluation because these statements have never alleged that his range of motion has been as severe as extension limited to 5 degrees, flexion limited to 45 degrees, abduction limited to 10 degrees, adduction so limited as to prevent crossing the legs, or rotation limited to 15 degrees. The Board has also considered whether the Veteran would be entitled to separate 10 percent evaluations based on painful noncompensable motion in separate planes, such as for flexion and extension. As noted, the AOJ in this case determined that the Veteran's left hip strain limits his range of motion in multiple planes. Although the examinations show this to be true, only a single 10 percent evaluation is warranted because 38 C.F.R. § 4.59 provides for the minimum compensable evaluation for the joint based on pain, not the minimum compensable evaluation for each plane of motion based on pain. In Petitti v. McDonald, the Court held that § 4.59 does not stand alone but instead works as a bridge with the limitation-of-motion diagnostic codes when a compensable rating under those diagnostic codes is not warranted. Thus, a claimant receives the minimally compensable rating for painful motion-here, a 10% rating-once per joint when he or she does not meet the range-of-motion requirements for a limitation-of-motion rating." Because the Veteran is receiving a compensable evaluation for his left hip prior to September 4, 2018, under DC 5253, and under DC 5252 thereafter, based on pain with noncompensable limitation of motion, he cannot receive a separate compensable evaluation under each DC for each plane of motion affected. Moreover, the selection of a particular diagnostic code "is a determination that is completely dependent upon the facts of a particular case," Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc) and for the reasons above, the AOJ's decision to assign a 10 percent rating under DC 5253 prior to September 2018 and under DC 5252 thereafter is not inconsistent with the evidence in this case. Specifically, the Veteran had pain with internal rotation at the August 2015 examination, and the AOJ used DC 5253 for left thigh impairment, which contemplates limitation of rotation, for the period prior to September 2018. At the September 2018 examination, the examiner noted pain on passive range of motion, including flexion, and the AOJ used DC 5252 for limitation of flexion, for the period since September 2018. Finally, the Board also notes that only the September 2018 examiner noted tenderness of the left greater trochanter bursa. No other examiner has ever found tenderness. None of the examiners found evidence of crepitus, muscular atrophy, ankylosis, flail joint of the hip, or impairment of the femur due to fracture or malunion. Therefore, the Board finds that no evaluation under DCs 5250, 5254, or 5255 is warranted. 38 C.F.R. §§ 4.71a, DCs 5250, 5254, 5255. Based on the foregoing, the Board finds that the evidence weighs persuasively against the assignment of an evaluation in excess of 10 percent on the basis of left thigh impairment prior to September 4, 2018, and on the basis of limitation of flexion thereafter. 38 C.F.R. §§ 4.71a, DCs 5252, 5253. The evidence also persuasively weighs against a compensable evaluation for limitation of extension. 38 C.F.R. § 4.71a, DC 5251. REASONS FOR REMAND Entitlement to TDIU. In this case, the August 2015, January 2021, and December 2022 examiners each noted that the Veteran's service-connected left hip strain would impact his ability to perform occupational tasks. The August 2015 noted that left hip strain would limiting the Veteran's use of ladders and stairs. The January 2021 examiner noted that hip pain would limit the Veteran's ability to walk, stand, bend, lift, or sit for prolonged periods of time. The December 2022 examiner opined that the Veteran's left hip disability would make it difficult to go out into the field to check on employees, unless he could get the truck close to the job site. Where a claimant, or the record, raises the question of unemployability due to a disability for which an increased rating is sought, then a claim of entitlement to a TDIU is part and parcel of that claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The AOJ has not undertaken any development to ascertain whether the Veteran is entitled to a TDIU as part and parcel of the claim for increased initial evaluation discussed above, nor has the AOJ adjudicated this issue. Moreover, the Veteran has not been provided the proper VA forms for filing a TDIU claim. In the interest of fairness and in order to ensure compliance with VA's duty to assist, this matter must be remanded. 38 C.F.R. § 20.802(a). The matters are REMANDED for the following action: 1. Provide the Veteran with the requisite notice regarding the matter of entitlement to a TDIU. Notify the Veteran that, if he wishes to pursue this claim, he should complete and submit a formal VA TDIU claim form (VA Form 21-8940). Then undertake any additional development deemed necessary to establish the Veteran's employment status and capacity. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Schonland, Avery 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.