MAJOR DEPRESSIVE DISORDER

KELLI A. KORDICH · 2024 · Case ID: 24022747

DENIED

Summary

The Veteran served in the Navy and Air Force from March 1988 to April 2002, with additional service in the Air National Guard until June 2008. The Veteran appeals the denial of service connection for an acquired psychiatric disorder, including PTSD and major depressive disorder, and for a headache disorder claimed as secondary to the psychiatric condition. The Board reviewed the Veteran's service treatment records, military medical reports, and statements from the Veteran and his girlfriend. Service treatment records from the 1990s did not indicate any psychiatric issues, with reports showing normal mental health and no significant complaints. Later treatment in the 2000s was linked to relationship issues and anger management problems, not service. The Veteran's statements regarding in-service stressors were found to be inconsistent and contradicted by earlier reports of no mental health issues. A VA examiner in July 2017 opined a 50% or greater probability of service connection for mental health conditions, but this opinion was based on stressors the Board deemed unverified and not credible. The Board found the Veteran's claims regarding in-service stressors lacked credibility due to inconsistencies and lack of corroboration. For the headache claim, service records were negative for headaches, and the Veteran consistently denied headaches during medical visits, despite a later vocational report mentioning occasional migraines during stress. A VA medical opinion found the headaches less likely than not caused by toxic exposure, citing risk factors outside of military service and the lack of documented headache complaints. The Board denied both claims, finding the evidence persuasively against service connection and the benefit of the doubt doctrine inapplicable.

Rationale

Service treatment records negative for psychiatric complaints.; Military reports indicated no depression, excessive worry, or nervous trouble.; Veteran's statements regarding stressors were inconsistent and contradicted.; VA examiner's opinion based on unverified stressors not found probative.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

19-22 147

Full Decision Text

Citation Nr: 24022747
Decision Date: 06/11/24 Archive Date: 06/11/24

DOCKET NO. 19-22 147
DATE: June 11, 2024

ORDER

Entitlement so service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and major depressive disorder, is denied.

Entitlement to service connection for a headache disorder, to include as secondary to an acquired psychiatric disorder, is denied.

FINDINGS OF FACT

1. The evidence is persuasively against a finding that the Veteran has an acquired psychiatric disorder that is etiologically related to his active military service.

2. The evidence is persuasively against a finding that the Veteran has a headache disorder that is etiologically related to his active military service or to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for an acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. § 3.303.

2. The criteria for entitlement to service connection for a headache disorder, to include as secondary to an acquired psychiatric disorder, have not been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active military service in the Navy from March 14, 1988 to June 22, 1997, and the Air Force from July 10, 2000 to April 28, 2001, September 17, 2001 to September 26, 2001, October 19, 2001 to November 2, 2001, December 1, 2001 to December 16, 2001, December 29, 2001 to January 27, 2002, and March 1, 2002 to April 1, 2002. The Veteran also had additional service in the Minnesota Air National Guard to June 16, 2008.

This case comes before the Board of Veterans' Appeals (Board) on appeal from August 2017 and January 2018 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran appeared for a hearing before the undersigned Veterans Law Judge in July 2022. The hearing transcript is associated with the claims file.

In September 2022, the Board remanded the Veteran's service connection claim for a right shoulder disorder as well as service connection claims for an acquired psychiatric disorder and a headache disorder to obtain the Veteran's complete service treatment records, including any outstanding records from the Fort Myer Army Clinic, as the Veteran testified in July 2022 that he injured his right shoulder at a softball game in October 1992 and was treated at the Fort Myer Army Clinic.

In January 2023, the RO sent a request to the Andrew Rader Army Health Clinic at Fort Myer, Virginia, for 1992 treatment records related to a right shoulder disorder. In May 2023, the National Personnel Records Center reported that a records search found no Fort Myer Army Clinic records for the Veteran. Thereafter, a May 2023 VA 21-3101 Request for Information reports that records from the Fort Myer Army Clinic has not been located. In July 2023, the RO sent a second request to the Andrew Rader Army Health Clinic at Fort Myer, Virginia, for 1992 treatment records related to a right shoulder disorder.

Although a response has not been received from the Andrew Rader Army Health Clinic at Fort Myer, the Board finds that the VA's duty to assist for the Veteran's service connection claims for an acquired psychiatric disorder and a headache disorder has been satisfied. At the Veteran's July 2022 Board hearing, the Veteran testified that he did not start getting mental health treatment until the early 2000s and that he had not sought treatment for his headaches. Moreover, military reports of medical history from April 1994, April 1997, and June 1998, document the Veteran's report that he did not have frequent or severe headaches.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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
0s and that he had not sought treatment for his headaches. Moreover, military reports of medical history from April 1994, April 1997, and June 1998, document the Veteran's report that he did not have frequent or severe headaches.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303.

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in a relative balance with the negative evidence. Therefore, the Veteran prevails in a claim when: (1) the weight of the evidence supports the claim, or (2) when the evidence is in equipoise. It is only when the weight of the evidence is against the claim that the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement so service connection for an acquired psychiatric disorder, to include PTSD and major depressive disorder, is denied.

The Veteran contends that he has an acquired psychiatric disorder, to include PTSD and major depressive disorder, that is related to an in-service injury, event, or disease.

A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for an acquired psychiatric disorder.

Military medical examinations from April 1994, April 1997, and June 1998, report the Veteran's psychiatric system was normal. Military reports of medical history, from April 1994, April 1997, and June 1998, document the Veteran's report that he had no depression, excessive worry, or nervous trouble of any sort.

In June 1998, the Veteran completed a health history questionnaire in which he reported he had not felt down, helpless, panicky, or anxious in the past few months. He also reported he did not have any medical problems or symptoms that bothered him.

The Veteran's last period of active military service was from March 1, 2002 to April 1, 2002

Pre-deployment health assessments completed in November 2006 and January 2007 document the Veteran's report that his health was good and that he had no medical problems.

A December 2006 psychiatric evaluation reports the Veteran's recent treatment was a result of chaotic fights between the Veteran and his girlfriend. About a year and a half ago, the Veteran's girlfriend called the police during one of their fights. The Veteran was charged with terroristic threats and other assault charges that were dropped. He plead guilty to terroristic threats and received a couple of years of probation. He was mandated as a condition of probation to either go to anger management or couple's therapy. The police have been called a couple of times since that incident. The Veteran reported he never had specific problems in the Navy and never saw a psychiatrist. He reported he developed more anxiety working on submarines for six years. After he was discharged from the Navy, he worked as a mechanic at the airbase. During the week, he works as a civilian and on weekends "he is Air Guard." The Veteran reported he is still involved in the relationship with his girlfriend, which is very dysfunctional. The Veteran was interested in medication to even out his moods. The Veteran reported he had never really seen a psychiatrist and denied any medical problems. He was on Tramadol for neck pain about a month ago but now is off and had no other medical problems. He was diagnosed with dysthymia, major depression, and mild to moderate generalized anxiety disorder. He was also diagnosed with an addictive severe chaotic relationship as an Axis IV diagnosis.

An April 2007 phone record reports the Veteran called to state that he had run out of Depakote samples and had a blow up at work, so he had not been to work for a couple days and wanted to talk to a doctor about everything as well as taking more time off from work.

An April 2007 service treatment record reports the Veteran missed a week of work because of a breakdown he had last Wednesday, on April 18, 2007. It was reported that he was
now is off and had no other medical problems. He was diagnosed with dysthymia, major depression, and mild to moderate generalized anxiety disorder. He was also diagnosed with an addictive severe chaotic relationship as an Axis IV diagnosis.

An April 2007 service treatment record reports the Veteran missed a week of work because of a breakdown he had last Wednesday, on April 18, 2007. It was reported that he was being treated for mood swings and anger.

An October 2007 memorandum from the Veteran's squadron commander provided a fitness determination. The commander reports the Veteran's physical condition has not hindered him in any way. He continued to excel in duty performance and remained current in all his training requirements.

A November 2007 private treatment record reports that, after reviewing the Veteran's history, it was determined that the precipitating event was an outburst at work where the Veteran threw something and said some things that concerned a coworker. The Veteran was diagnosed with moderate recurrent major depression. It was noted that, due to his medications, it would not be appropriate to deploy him to an austere environment.

A December 2007 aeromedical summary reports the Veteran had a history of anger management issues and a very dysfunctional relationship. The Veteran was treated by a physician with Effexor in 2004 as a result of fights between the Veteran and his girlfriend. It was reported that the police have been called to break up the couple's chaotic fights. The Veteran was diagnosed with dysthymia, major depression, generalized anxiety disorder, caffeine dependence, and rule out alcohol abuse. In March 2007, the Veteran was placed on new medication to help with his temper. It was reported that he missed an appointment in April 2007 and did not continue his medication. On April 23, 2007, the Veteran had a blow up at work in which he threatened a coworker. As a result, the Veteran took four weeks of leave from work.

A January 2008 private treatment record from the Veteran's treating psychiatrist reports that it was his opinion that the Veteran continued to be able to describe and process the precipitating event that occurred at his worksite as well as demonstrate a clear understanding of the consequences. He indicated the Veteran's prognosis was good and that he appeared capable of performing duties for 12 hours or more.

A June 2008 memorandum reports an Air Force informal physical evaluation board found the Veteran unfit to perform the duties of his office, grade, rank or rating due to his diagnosis of major depressive disorder.

A report of separation and record or service, NGB Form 22, indicates the Veteran was separated from Air Force Minnesota Air National Guard on June 15, 2008.

In June 2017, the Veteran submitted a VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD, in which he reported several stressors. In November 1991, some sailors threatened that they would accuse him of using a racial epithet after he directed them to perform duties. The two sailors later made the same threat to someone else, which was overhead by others. The sailors were written up and dishonorably discharged from the Navy. In July 1994, he got into an argument with a black sailor who called him a racist and reported the Veteran to his supervisor. An investigation was initiated and then dropped when others stated the Veteran never used any racist words. In October/November 1991, he was the standing topside petty officer when an intoxicated sailor threatened him and tried to lift him. After the duty chief intervened the sailor went below deck.

The Veteran was provided a VA PTSD examination in July 2017. The Veteran was diagnosed with PTSD and major depressive disorder. The Veteran reported three stressors: (1) being physically assaulted by another service member, (2) feeling grief and survivor guilt related to fellow service members being murdered or committing suicide, and (3) being accused of racism by fellow service members who were African American. The examiner determined that none of these stressors was related to the Veteran's fear of hostile military or terrorist activity. The examiner opined that "[i]t is my opinion that there is a 50% or greater probability that the veteran's mental health conditions were incurred in or caused by military service."

An April 2020 VA vocational rehabilitation counseling record regarding the Veteran's vocational impairments reports his neuropsychological condition of PTSD with depression results in flashbacks, anger, isolation, depression, and anxiety.
1) being physically assaulted by another service member, (2) feeling grief and survivor guilt related to fellow service members being murdered or committing suicide, and (3) being accused of racism by fellow service members who were African American. The examiner determined that none of these stressors was related to the Veteran's fear of hostile military or terrorist activity. The examiner opined that "[i]t is my opinion that there is a 50% or greater probability that the veteran's mental health conditions were incurred in or caused by military service."

At the Veteran's July 2022 Board hearing, the Veteran testified that he did not start getting mental health treatment until the early 2000s. The Veteran reported several stressful incidents during his active military service. He reported that, in 1989, a corpsman came grabbed him from behind and twisted and jerked his head violently to the left. The Veteran stated he did not report the incident. He reported that, in April 1991, he was standing topside as the deck watch when he was approached by an intoxicated sailor. The sailor kept refusing to leave the deck and telling the Veteran he was going to throw him off, so the Veteran took out his weapon. The sailor rushed the Veteran and the two of them fought. The Veteran stated he raised his weapon to shoot the person, but his duty chief told him not to fire. The Veteran stated he did not report the incident because he was told that both he and the other individual were needed to complete a top-secret mission.

He reported that, in May 1991, someone woke him from sleep by shining a flashlight in his eye that led to an argument and a chase. The person told the Veteran he was going to bash him over the head with the flashlight, so the Veteran grabbed the flashlight out of his hands. The Veteran stated, "[w]e had some more words and that was that incident." He also reported that, in August 1991, he told a lieutenant that he had to wait until the Veteran could arrange for somebody to escort him down to the submarine. The lieutenant proceeded towards the submarine hatch, so the Veteran took out his weapon and threatened to shoot him. The lieutenant stopped and did not go into the submarine.

In weighing the credibility of evidence, the Board may properly consider factors such as interest, bias, inconsistent statements, and consistency with other evidence of record. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996); Macarubbo v. Gober, 10 Vet. App. 388 (1997). The Veteran's statements have been inconsistent in reporting stressors related to his military service, as his statements regarding in-service stressful experiences have greatly varied and are contradicted by his own later reports that he had no depression, excessive worry, or nervous trouble of any sort.

As previously described, the Veteran's service treatment records do not reflect any complaints, findings, or treatment for an acquired psychiatric disorder. Military reports of medical history from April 1994, April 1997, and June 1998 document the Veteran's report that he had no depression, excessive worry, or nervous trouble of any sort. The Veteran's military performance evaluations from the 1990s indicate he had consistently had good performance. For example, an evaluation from March 1995 reports the Veteran was a truly stellar performer and continuously displays undaunted reliability and unparalleled effectiveness in accomplishing all tasks, no matter how complex or urgent.

The earliest documented evidence of a psychiatric disorder was in December 2006, more than 15 years after the Veteran claims to have experienced an in-person assault in 1991. A December 2006 psychiatric evaluation report indicates the Veteran's recent treatment was a result of chaotic fights between the Veteran and his girlfriend. He was diagnosed with dysthymia, major depression, and mild to moderate generalized anxiety disorder. He was also diagnosed with an addictive severe chaotic relationship as an Axis IV diagnosis. The December 2006 report indicates that, during the week, the Veteran works as a civilian and on weekends "he is Air Guard."

A December 2007 aeromedical summary reports the Veteran was placed on new medication in March 2007 to help with his temper. In April 2007, the Veteran had a blow up at work in which he threatened a
in-person assault in 1991. A December 2006 psychiatric evaluation report indicates the Veteran's recent treatment was a result of chaotic fights between the Veteran and his girlfriend. He was diagnosed with dysthymia, major depression, and mild to moderate generalized anxiety disorder. He was also diagnosed with an addictive severe chaotic relationship as an Axis IV diagnosis. The December 2006 report indicates that, during the week, the Veteran works as a civilian and on weekends "he is Air Guard."

A December 2007 aeromedical summary reports the Veteran was placed on new medication in March 2007 to help with his temper. In April 2007, the Veteran had a blow up at work in which he threatened a coworker. As a result, the Veteran took four weeks of leave from work. In June 2008, an Air Force informal physical evaluation board found the Veteran unfit to perform his military duties due to his diagnosis of major depressive disorder. He was separated from the Air Force Minnesota Air National Guard on June 15, 2008.

The Veteran first contended that he experienced an in-person assault in 1991 in June 2017, nine years after he was separated from the Minnesota Air National Guard. Moreover, despite receiving extensive psychiatric care in 2006 and 2007, the Veteran never mentioned an in-person assault or any other incidents that took place around 1991 as affecting his mental health. The Veteran's service records do not include any references to the stressor incidents described by the Veteran. Additionally, the Veteran himself reported that he had no depression, excessive worry, or nervous trouble of any sort in April 1994, April 1997, and June 1998 and his enlisted performance evaluations from the 1990s reflect good duty performance. Due to the Veteran's inconsistent statements regarding his claimed stressors around the early 1990s, the Board finds the Veteran's statements regarding in-service stressors are not credible.

While the July 2017 examiner diagnosed the Veteran with PTSD and major depressive disorder and opined that there was a 50 percent or greater probability that the Veteran's mental health conditions were incurred in or caused by military service, the examiner's opinion was based on stressors that the Board does not find to be verified or credible. Thus, the Board does not find the opinion to be probative.

Accordingly, the Board finds that the Veteran's claimed in-service stressors have not been verified or corroborated and do not support diagnoses of PTSD or major depressive disorder that warrant service connection. The evidence of record shows that the Veteran began receiving treatment for a psychiatric disorder as a result of chaotic fights between the Veteran and his girlfriend that happened years after his last period of active military service.

For the reasons and basis stated above, the Board finds that service connection for an acquired psychiatric disorder, to include PTSD and major depressive disorder, is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's service connection claim for an acquired psychiatric disorder, to include PTSD and major depressive disorder, is denied.

2. Entitlement to service connection for headaches, to include as secondary to an acquired psychiatric disorder, is denied.

The Veteran contends that he has a headache disorder that is related to an in-service injury, event, or disease, to include as proximately due to or the result of his acquired psychiatric disorder.

A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for headaches.

Military reports of medical history, from April 1994, April 1997, and June 1998, documented the Veteran's report that he did not have frequent or severe headaches.

A February 2001 private treatment record reports that the Veteran had no medical problems except knee pain.

A December 2006 psychiatric evaluation reports the Veteran denied having any medical problems.

In February 2018, the Veteran submitted a notice of disagreement to an August 2017 rating decision in which the Veteran expressed that he had a headache condition that was secondary to his PTSD.

VA treatment records from March 2018, April 2019, and June 2019 report that the Veteran denied having headaches.

An April 2020 VA vocational rehabilitation counseling record indicates the Veteran reported having migraine headaches once every four months when he is experiencing to much stress or feeling too hot.

VA treatment records from April 2021, June 2021, October 2021, April 2022, and April 2023 report that the Veteran denied having headaches.

At
2006 psychiatric evaluation reports the Veteran denied having any medical problems.

In February 2018, the Veteran submitted a notice of disagreement to an August 2017 rating decision in which the Veteran expressed that he had a headache condition that was secondary to his PTSD.

VA treatment records from March 2018, April 2019, and June 2019 report that the Veteran denied having headaches.

An April 2020 VA vocational rehabilitation counseling record indicates the Veteran reported having migraine headaches once every four months when he is experiencing to much stress or feeling too hot.

VA treatment records from April 2021, June 2021, October 2021, April 2022, and April 2023 report that the Veteran denied having headaches.

At the Veteran's July 2022 Board hearing, the Veteran's representative reported that the Veteran's headaches were secondary to his mental health condition.

A May 2023 toxic exposure risk activity (TERA) memorandum reports the Veteran had qualifying evidence of non-deployment related exposure as an aircraft mechanic.

The Veteran was provided a medical opinion for his headache disorder claim in July 2023. After reviewing the Veteran's claim file, the examiner opined that the Veteran's headaches condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activities after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. As rationale, the examiner explained that there is no documentation of headache complaints to medical providers. Based on the documentation in the records, the Veteran does have a diagnosis of a headache condition that was medically treated. The examiner noted the TERA memorandum indicates the Veteran participated in a TERA as an aircraft mechanic, which would include exposure to fuel as well as noise, both of which are risk factors for developing headache syndromes. The Veteran's headache condition has been noted to be in relation to mental health and the Veteran has a risk factor of mental health that outweighs the risk factors of the TERA. Moreover, the examiner explained that there are risk factors outside of military service, including smoking history and weight, that outweigh the factors identified in the TERA.

The Board notes that, although a medical opinion was provided, the Veteran was not afforded a VA examination for his service connection claim for a headaches disorder. In determining whether the duty to assist requires that a VA medical examination be provided, or medical opinion obtained with respect to a Veteran's claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumptive period; (3) whether there is an indication that the disability or symptoms may be associated with service or with another service-connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d) and 38 C.F.R. § 3.159 (c)(4). The third factor, in particular, is a low threshold. See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

In this regard, the Board finds that the Veteran has not submitted sufficient evidence to indicate that he has a headache disorder related to his military service or to a service-connected disability. A review of the Veteran's service treatment records does not reflect any complaints, findings, or treatment for headaches and military reports of medical history, from April 1994, April 1997, and June 1998, documented the Veteran's report that he did not have frequent or severe headaches.

Although an April 2020 VA vocational rehabilitation counseling record indicates the Veteran reported having migraine headaches once every four months when he was experiencing to much stress or feeling too hot, he consistently denied experiencing headaches during visits for medical treatment during the period on appeal. VA treatment records from March 2018, April 2019, June 2019, April 2021, June 2021, October 2021, April 2022, and April 2023 report that the Veteran denied having headaches. Accordingly, the Board finds that no further development of the claims for service connection for a headache disorder is required.

Because service connection for an acquired psychiatric disorder has not been established, and is denied on appeal herein, the secondary service connection theory of entitlement for a headache disorder must also be denied.

As described above, the first prong of a service connection claim is a current disability. The evidence of record does not demonstrate that the Veteran had a headache disorder during the pendency of the appeal. In the
2018, April 2019, June 2019, April 2021, June 2021, October 2021, April 2022, and April 2023 report that the Veteran denied having headaches. Accordingly, the Board finds that no further development of the claims for service connection for a headache disorder is required.

As described above, the first prong of a service connection claim is a current disability. The evidence of record does not demonstrate that the Veteran had a headache disorder during the pendency of the appeal. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

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For the reasons and bases stated above, the Board finds that service connection is not warranted for the Veteran's claimed headache disorder. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claims and the positive and negative evidence is not nearly in balance, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's service connection claim for a headache disorder is denied.

KELLI A. KORDICH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. Moore, Associate 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.

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