PARALYSIS OF SCIATIC NERVE

Summary

The Veteran, who served in the United States Air Force from October 1965 to February 1969, appeals a July 2025 rating decision concerning his neuropathy of the left and right lower sciatic nerves and arteriosclerotic heart disease. The Veteran sought higher ratings for bilateral peripheral neuropathy and the restoration of a 30 percent rating for his heart condition. The Board reviewed evidence including VA examinations from June 2025 and February 2026, private medical records, and the Veteran's testimony from a December 2025 Board hearing. The June 2025 VA examination, which led to the reduction of the neuropathy ratings and the heart condition rating, was found inadequate. The Board noted the Veteran's subjective complaints of severe pain, numbness, and reliance on a walker for mobility, which were more consistent with severe incomplete paralysis. The Board also found the reduction of the heart condition rating improper, as the VA examiner did not adequately address the continued need for medication, follow-up visits, or the impact on the Veteran's ability to function. Giving the Veteran the benefit of the doubt, the Board found the evidence weighed against the reduction. Consequently, the Board granted initial ratings of 40 percent for each lower extremity peripheral neuropathy and restored the 30 percent rating for arteriosclerotic heart disease.

Rationale

VA examination showed moderate incomplete paralysis; Veteran testimony indicated severe pain, numbness, and reliance on walker; Evidence supports 40% rating for moderately severe incomplete paralysis

Full Decision Text

Citation Nr: A26039731
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250717-565665
DATE: April 28, 2026

ORDER

An initial rating of 40 percent, but no higher, for left lower extremity peripheral neuropathy, sciatic nerve, is granted.

An initial rating of 40 percent, but no higher, for right lower extremity peripheral neuropathy, sciatic nerve, is granted.

Restoration of a 30 percent rating for arteriosclerotic heart disease (claimed as coronary artery disease) is granted.

FINDINGS OF FACT

1. The Veteran's neuropathy of the left lower sciatic nerve is manifested by moderately severe incomplete paralysis.

2. The Veteran's neuropathy of the right lower sciatic nerve is manifested by moderately severe incomplete paralysis.

3. At the time of the rating reduction in July 2025, the arteriosclerotic heart disease did not show actual improvement, or improvement in the Veteran's ability to function under the ordinary conditions of life and work.

CONCLUSIONS OF LAW

1. The criteria for an initial rating of 40 percent, but no higher, for left lower extremity peripheral neuropathy, sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8520.

2. The criteria for an initial rating of 40 percent, but no higher, for right lower extremity peripheral neuropathy, sciatic nerve have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8520.

3. The criteria for restoration of a 30 percent rating for arteriosclerotic heart disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344, 4.1, 4.3, 4.14, DC 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from October 1965 to February 1969. The Board of Veterans' Appeals (Board) is grateful to the Veteran for his honorable service.

These matters come before the Board on appeal from a July 2025 rating decision of the Department of Veterans Affairs (VA).

In July 2025, the Veteran filed a VA Form 10182, electing the Hearing docket under the Appeals Modernization Act (AMA). Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a).

In December 2025, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record.

Increased Ratings.

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1.

Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

A rating in excess of 20 percent for bilateral extremity peripheral neuropathy, sciatic nerve.

The Veteran is seeking a higher rating for his neuropathy of the right and left lower sciatic nerve.  By way of history, an August 202
 work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

A rating in excess of 20 percent for bilateral extremity peripheral neuropathy, sciatic nerve.

The Veteran is seeking a higher rating for his neuropathy of the right and left lower sciatic nerve.  By way of history, an August 2024 rating decision granted service connection for bilateral extremity peripheral neuropathy and assigned a 10 percent for each extremity effective April 4, 2024. The Veteran filed a timely form 10182 and in a March 2025 decision the Board remanded the issue to correct a predecisional error of not obtaining relevant private treatment record. A July 2025 rating decision increased each lower extremity peripheral neuropathy to 20 percent effective June 11, 2025. The Veteran timely filed a form 10182 in July 2025 and disagreed only with the evaluation of the peripheral neuropathy of the bilateral lower extremities from the July 2025 rating decision.

Under 38 C.F.R. § 4.124a, the schedules for rating diseases of the peripheral nerves include alternate diagnostic codes for paralysis, neuritis, and neuralgia of each nerve. See 38 C.F.R. § 4.124a, DC's 8205 to 8730. DC 8520 provides for ratings for paralysis of the sciatic nerve. Under DC 8520, complete paralysis of the nerve (the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost) is rated as 80 percent; 60 percent disability rating is for an incomplete paralysis with marked muscular atrophy. Disability ratings of 40 percent, 20 percent, and 10 percent are assignable for incomplete paralysis which is moderately-severe, moderate, or mild in degree. 38 C.F.R. § 4.124a, DC 8520.

The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When involvement is wholly sensory, the rating should be for mild, or at most, moderate degree. Note preceding DC 8510. 38 C.F.R. § 4.124a.

Words such as "severe," "moderate," and "mild" are not defined in the rating schedule. One possible source for such definitions would be the dictionary.  Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed July 2023), defines "mild," as relevant to a physical condition, as "not severe" or temperate; with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive."  "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect."  Id. "Severe" is defined as "very painful or harmful" or "of a great degree."  Id. The term "severe" is used throughout the rating schedule, including Diagnostic Codes 8520 and 8526, to indicate a very great degree of the specific listed disability, in order to differentiate between lesser (or sometimes greater) cases of that same disability within the specific diagnostic code. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 C.F.R. §§ 4.2, 4.6.

The Veteran was afforded a VA examination in June 2025. This examination demonstrated that the Veteran suffers from moderate incomplete paralysis of the sciatic nerve. Intermittent pain and paresthesias/dysesthesias were reported as moderate. The Veteran reported that about three years ago (2021) he started having pain, numbness and tingling in the feet. It had become much worse since onset and he was started on medication which helped. He also reported that the neuropathy interferes with walking and balance.

In February 2026,
, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 C.F.R. §§ 4.2, 4.6.

The Veteran was afforded a VA examination in June 2025. This examination demonstrated that the Veteran suffers from moderate incomplete paralysis of the sciatic nerve. Intermittent pain and paresthesias/dysesthesias were reported as moderate. The Veteran reported that about three years ago (2021) he started having pain, numbness and tingling in the feet. It had become much worse since onset and he was started on medication which helped. He also reported that the neuropathy interferes with walking and balance.

In February 2026, the Veteran was provided with a VA peripheral nerves examination. The subjective symptoms included bilateral mild constant pain, severe paresthesias and/or dysesthesias, and severe numbness. Strength was 5/5 throughout and reflexes were 2+. Light touch, position sense and vibration sense were normal. There was no atrophy. There was some skin discoloration, hair smooth and shiny skin. This examination demonstrated that the Veteran suffers from severe incomplete paralysis of the sciatic nerve. He reported progressive worsening of pain in his feet from "pin/needles" as well as increased numbness and tingling. He used a walker with increased peripheral neuropathy. 

A February 2026 statement from J.J.P., MD noted that the Veteran had severe peripheral neuropathy that required him to use assistive devices such as a walker to get from one place to another. He was unable to bear weight for extended periods of time. Medications were heavily dosed to maintain quality of life.

The Veteran also testified at a Board hearing. He indicated he had sharp excruciating pain that shoots down both legs and almost pinpoints the middle of the heel every night. It wakes him up at night and he has to walk around to try to alleviate the pain. He explained he gets pins and needles and sometimes feels like nails. He reported the pain was an 8 or 9 out of 10 in severity and was constant. He reported numbness in the feet and indicated that he previously took medication that helped a bit with the sharp pain but he had to stop the medication due to a side effect. He described the feet as dead like walking with cold ice where the foot was numb or with pins and needles and the feet did its own thing. He reported using a walker. He reported having trouble walking distances, if it was bumpy or uneven and having difficulty with steps. He described discoloration of the feet making it a reddish brown. He denied any ulcers. He indicated his feet were pretty much cold and there was swelling.

From the above, the Board finds that the Veteran's neuropathy of the feet is more akin to moderately severe, rather than severe, as the Veteran suffers from significant symptoms, to include "pin/needles" in his feet as well as numbness and tingling, in both feet consistently. See 38 C.F.R. § 4.123. Therefore, the higher 40 percent ratings are warranted.  

Although the 2026 examiner checked box indicating the symptoms were severe, the criteria for a higher rating also requires marked muscular atrophy. There is no evidence of record, however, showing the Veteran has muscular atrophy or complete paralysis in either lower extremity. As such, ratings higher than 40 percent are not warranted for either extremity under DC 8520.

The appeal for restoration of a 30 percent rating for arteriosclerotic heart disease, is granted; the 30 percent rating is restored.

By way of procedural history, the Veteran was initially granted service connection for arteriosclerotic heart disease in an August 2024 rating decision. At that time a 30 percent disability evaluation was assigned effective April 4, 2024. The Veteran filed a 10182 and appealed the rating. The Board remanded the claim in March 2025. In May 2025, the AOJ deferred the issue for additional development obtaining a VA examination. In June 2025, a VA examination was provided. In July 2025, the AOJ decreased the Veteran's rating from 30 to 10 percent, effective June 11, 2025. The Veteran appealed the reduction to the Board.

In general, prior to reducing a veteran's disability rating, VA is required to comply with pertinent VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. When reduction in the rating of a service-connected disability is contemplated and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary must be notified
2025, a VA examination was provided. In July 2025, the AOJ decreased the Veteran's rating from 30 to 10 percent, effective June 11, 2025. The Veteran appealed the reduction to the Board.

In general, prior to reducing a veteran's disability rating, VA is required to comply with pertinent VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. When reduction in the rating of a service-connected disability is contemplated and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary must be notified at his or her latest address of record of the contemplated action and furnished detailed reasons thereof. The beneficiary must be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at the present level. 38 C.F.R. § 3.105(i)(1).

The RO implemented the rating reduction of the Veteran's arteriosclerotic heart disease, from 30 percent to 10 percent, effective June 11, 2025, in a July 2025 rating decision. The RO did not issue a proposed rating decision or provide the Veteran with notice of this reduction. However, the Veteran's overall compensation was not reduced as a result of the rating reduction as the July 2025 rating decision granted increased ratings for other disabilities. Prior to the July 2025 rating decision implementing the reduction from 30 percent to 10 percent, the Veteran's combined disability rating was 80 percent, effective from May 6, 2025. Following the July 2025 rating decision, the Veteran's combined disability rating was 80 percent. As there was no reduction in overall compensation, the provisions of 38 C.F.R. § 3.105 do not apply. See 38 C.F.R. § 3.105(e); Stelzel v. Mansfield, 508 F.3d 1345, 1349 (Fed. Cir. 2007) (holding that VA was not obligated to provide a Veteran with sixty day notice before making a disability rating decision effective if the decision did not reduce the overall compensation paid to the Veteran); see also VAOPGCPREC 71-91 (Nov. 7, 1991) (where the evaluation of a specific disability is reduced, but the amount of compensation is not reduced because of a simultaneous increase in the evaluation of one or more other disabilities, section 3.105(e) does not apply). Accordingly, there is no error in the AOJ's notification procedures with respect to the reduction.

In certain rating reduction cases, VA benefits recipients are to be afforded greater protections, set forth in 38 C.F.R. § 3.344. Rating agencies will handle cases affected by change of medical findings or diagnosis to produce the greatest degree of stability of disability evaluations consistent with the laws and VA regulations governing disability compensation and pension. These considerations apply to ratings that have continued for long periods at the same level (five or more years), and not to disabilities that have not become stabilized and are likely to improve. In this case, at the time the rating reduction took effect for the Veteran's service-connected heart disability, the 30 percent rating was in effect for less than five years. See Brown v. Brown, 5 Vet. App. 413, 418 (1993) (finding that duration of rating is measured from effective date of actual reduction). Thus, the various provisions of 38 C.F.R. § 3.344, pertaining to stabilization of disability ratings, does not apply.

VA regulation 38 C.F.R. § 4.1 requires that each disability be viewed in relation to its history. Similarly, 38 C.F.R. § 4.2 establishes that "[i]t is the responsibility of the rating specialist to interpret reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present." These provisions impose a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon review of the entire history of the veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms.

Pursuant to these provisions, the RO and Board are required in any rating-reduction case to ascertain, based upon review of the entire recorded history of the condition, whether the evidence
 These provisions impose a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon review of the entire history of the veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms.

Pursuant to these provisions, the RO and Board are required in any rating-reduction case to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. See Schafrath, 1 Vet. App. at 594 ("[T]hese requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based on a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the level of disability and of any changes in the condition."). Finally, 38 C.F.R. § 4.10 establishes that "[t]he basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment" and 38 C.F.R. § 4.2 directs that "[e]ach disability must be considered from the point of view of the veteran working or seeking work." Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred but also that the improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. See Brown, 5 Vet. App. at 421; see also Stern v. McDonough, 34 Vet. App. 51, 56 (2021). A claim as to whether a rating reduction was proper must be resolved in the Veteran's favor unless the Board concludes that the evidence weighs against the claim. Id.

Turning to the substantive requirements, pursuant to VA's July 2025 Rating Decision Code sheet, the Veteran had been rated at the 30 percent rating for his heart disability, effective April 4, 2024, which is less than five years.  Accordingly, the expanded protections under the provisions of 38 C.F.R. § 3.344 (a) and (b) do not apply, which prohibits a reduction on the basis of a single examination.  

In the case at hand, the rating reduction was based on a single VA examination conducted in June 2025.  In addition, as explained below, the Board finds the June 2025 VA examination inadequate for rating purposes. Thus, the rating reduction was improper.

The question of whether a disability has improved involves consideration of the applicable rating criteria. The Veteran's coronary artery disease is rated under Diagnostic Code 7005. DC 7005 is rated under the General Rating Formula for Diseases of the Heart. Under this formula, a 10 percent rating is warranted where a workload of 7.1-10 METs results in heart failure symptoms, or where continuous medication is required to treat the disease. A 30 percent rating is warranted where a workload of 5.1-7.0 METs results in heart failure symptoms, or where evidence of cardiac hypertrophy or dilatation is confirmed by echocardiogram or its equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). A 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms. A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms. 38 C.F.R. § 4.104, Diagnostic Code 7005.

The Board notes that one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute.  When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used.  38 C.F.R. § 4.104, Note (2). For the purposes of the General Rating Formula for Diseases of the Heart, heart failure
.5 milliliters per kilogram of body weight per minute.  When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used.  38 C.F.R. § 4.104, Note (2). For the purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).  

In this case, the RO relied upon a June 2025 VA examination to reduce the Veteran's rating. On VA examination, the examiner noted arteriosclerotic heart disease, coronary artery disease, with a date of diagnosis in December 2021. The Veteran reported no cardiac interventions, and is stable with medication, however the medication is continuous. For MET testing, the VA examiner indicated that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. Thus, the VA examiner did not provide the results. The VA examiner also indicated that the Veteran's heart disability does not impact his ability to work. 

In December 2025, the Veteran testified at a Board hearing before the undersigned that his heart symptoms have not improved, but are slowly getting worse. The Veteran stated that he can't take more than 50 steps with a walker, without getting tired. He can't walk without a walker. He also noted that he would take him 5 to 10 minutes to walk up a flight of stairs. The Veteran testified that he cannot mow a law and relies on his wife to do chores because he feels fatigued. Notably, the Veteran states that he was last examined for a stress test three years ago and that he was not examined by the VA before his rating was reduced. The Veteran also stated that he is on blood thinners and is seen by a private doctor every six months. Additionally, the Veteran stated that the pain in his chest is becoming more frequent. 

Significantly, the July 2024 examination that was used to assign the initial rating noted the examiner reviewed the record and examined the Veteran. The Veteran reported that he treated with a private cardiologist and took medication. At that time he walked around the neighborhood for roughly 30 minutes daily and occasionally felt chest pain. He indicated he could help with chores around the house but that physical activity restriction was recommended by his doctor. An interview based METs test resulted in 5-7 METs. 

While the RO considered other evidence of record contemporaneous with the June 2025 VA examination report and, the July 2025 reduction of the Veteran's disability rating mostly relied on the findings of the 2025 VA examination. However, the Board finds the examination simply checked a box without providing further information or elaboration. Indeed, the 2025 examination continued to note the Veteran required continuous medication and records reflect continuous treatment with a private cardiologist. The private records reflect continuous medication, and continuous follow up visits, including imaging studies. 

For MET testing, the VA examiner indicated that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. However, the Board acknowledges that the Veteran at the December 2025 Board hearing expressed that he continued to have symptoms and his condition had not improved.

 Giving the Veteran the benefit of the doubt, the Board notes that the VA examiner did not address the Veteran's lay statements of record which indicate the Veteran's contention that the heart disease had not improved.  See Tucker, 11 Vet. App. at 373-74; see also Miller v. Wilkie, 32 Vet. App. 249 (2020).

The findings from the June 2025 VA examination does not demonstrate, by the persuasive weight of the evidence, material improvement in the Veteran's service-connected heart disability. The examination did not address the continued need for medication and follow up, discuss the private treatment records and indicate whether there was actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. Stern, 34 Vet. App. at 59; Brown, 5 Vet. App. at 421.

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Based on the foregoing, the requirements for reduction of the disability rating for a heart disability are not met, and as a result, the evidence persuasively weighs against a reduction. Accordingly, the reduction from 30 percent to 
 June 2025 VA examination does not demonstrate, by the persuasive weight of the evidence, material improvement in the Veteran's service-connected heart disability. The examination did not address the continued need for medication and follow up, discuss the private treatment records and indicate whether there was actual improvement in the Veteran's ability to function under the ordinary conditions of life and work. Stern, 34 Vet. App. at 59; Brown, 5 Vet. App. at 421.

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Based on the foregoing, the requirements for reduction of the disability rating for a heart disability are not met, and as a result, the evidence persuasively weighs against a reduction. Accordingly, the reduction from 30 percent to 10 percent for the Veteran's service-connected heart disability was not proper. The 30 percent disability rating for the heart disability is therefore restored.

 

 

H. SEESEL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Dourmashkin, Mark W.

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.