BVA9507960 DOCKET NO. 91-24 016 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Paul, Minnesota THE ISSUE Entitlement to service connection for post-traumatic stress disorder. REPRESENTATION Appellant represented by: James T. Hansing, Attorney at Law WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD Robert E. P. Jones, Associate Counsel INTRODUCTION The veteran served on active duty from October 1966 to October 1969. This matter came before the Board of Veterans' Appeals (Board) on appeal from a February 1990 rating decision by the St. Paul, Minnesota, Regional Office (RO). In February 1993 and again in May 1994 the Board remanded the veteran's claim to the RO for further development. On numerous occasions the veteran has stated he is unemployed and unemployable due to his disabilities. This infers a claim for pension benefits, but no clear claim for that benefit is of record and the issue has not been adjudicated. We note that the listed representative has an appointment limited to the post- traumatic stress disorder (PTSD) issue. The matter of a possible pension claim is referred to the RO for clarification and action as necessary. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he should be granted service connection for post-traumatic stress disorder. He asserts that he saw action in over 60 battles, that he was wounded in the right knee and that he received numerous combat related awards and decorations, including a Bronze Star. He asserts that he has the disorder and that it was due to his stressors in combat. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against service connection for post-traumatic stress disorder. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran does not experience symptoms characteristic of post-traumatic stress disorder. The preponderance of the medical evidence establishes that he does not have post-traumatic stress disorder related to his military service. CONCLUSION OF LAW Service connection for post-traumatic stress disorder may not be awarded as the preponderance of the credible evidence shows that he does not have such a disability which was incurred in or aggravated as a result of service. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. § 3.303 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION We note that we have found that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). That is, we find that he has presented a claim which is plausible. We are also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). The veteran contends that he is entitled to service connection for post-traumatic stress disorder due to his service in Vietnam. Service records reveal that the veteran served in Vietnam for 18 months and one day between July 1967 and March 1969. His military occupational specialty was radio operator. The veteran was awarded the Purple Heart, the Combat Infantryman Badge, and a Bronze Star. These records also show that between May 1967 and December 1968 the veteran underwent four Article 15 proceedings. In May 1967 at Ft. Gordon, Georgia he was awarded forfeiture of $23, and 14 days restriction and extra duties for failure to go to an appointed place of duty. Two of the proceedings were initiated because the veteran went absent without leave (AWOL). In September 1968 he was awarded reduction in grade from E-4 to E-3 and 14 days restriction and extra duty because he had been AWOL for 10 days in August 1968. The offense resulted from his failure to report to the overseas replacement station at Ft. Dix, New Jersey. In December 1968 he was reduced to E-2 because he had been AWOL for 5 days from his unit in Vietnam. In November 1968, also in Vietnam, he broke restriction and punishment of forfeiture of $25 was imposed. Upon discharge the veteran was an E-3. The veteran's service medical records show that the veteran contracted malaria in March 1968 while serving in Vietnam. After his infection was treated, the veteran experienced no residuals or again contracted malaria. The veteran received what was reported as a gun shot wound to the right knee on April 29, 1968. The records do not show how long he was hospitalized. On May 7 he reported to an aid station for a change of dressing. On May 11 the stitches were removed. On May 12 the wound was described as healed but the knee was painful and an ace bandage was applied. Cleaning and dressing on May 18 was also reported. An X-ray on May 16 showed no bony abnormality. On examination of the right knee in November 1968 there was no neurological deficit and x-rays were negative. There was some weakness of the quadriceps. For several months starting in December 1968 he was seen, evaluated and treated for gastrointestinal complaints with varying diagnoses being made. On discharge examination performed in September 1969, the veteran had numerous complaints including headaches, constant worrying, "nervous all the time" and frequent trouble sleeping. No abnormalities were found on clinical evaluation. The veteran received comprehensive Veterans Administration (now Department of Veterans Affairs) (VA) medical examinations in February 1970. On the special orthopedic examination it was noted that he had been wounded from "a piece of shrapnel or a piece of bullet" in the right lower thigh. On examination a 2 x ½ inch, well healed, nontender, nonadherent scar with no tissue deficit and no contracture was found. Some tenderness was elicited in the area. No atrophy or limitation of motion or neurological symptoms were found. On the surgical and gastrointestinal examination it was noted that he had had no recurrences of his malaria. A malaria smear was negative. His gastrointestinal complaints were reviewed and evaluated in detail. The diagnoses included malaria, from history, with no residuals and psychophysiological gastrointestinal reaction. In an April 1970 rating action the veteran was granted service connection for residuals of a gunshot wound to the right side of the knee, rated as 10 percent disabling, for psychophysiological gastrointestinal reaction, rated as 10 percent disabling under Code 9502, for amebiasis rated as no percent disabling, for a tonsillectomy, rated as no percent disabling and for malaria rated as no percent disabling. In November 1970 he was hospitalized for probable functional bowel syndrome. The veteran was afforded VA psychiatric, orthopedic and gastrointestinal examinations in March 1975. He was noted to have a psychophysiological intestinal reaction by history. In an April 1975 rating action the veteran's compensable disabilities were reduced to noncompensable. The veteran's next VA psychiatric examination was performed in October 1987. He reported chronic gastrointestinal complaints. The examiner elicited a history of drinking up to a case of beer a day, resulting in severe hallucinations of "war scenes and other unrealities." He had sleep problems related to back and leg pain. A variety of angry and aggressive behavior was described. The diagnoses included somatization disorder involving the upper and lower gastrointestinal tract. Also noted was a severe chronic generalized anxiety disorder and possibly underlying depression. The veteran's 10 percent rating for a psychophysiological gastrointestinal reaction was restored effective in June 1987. In September 1989 the veteran filed his initial claim for service connection for PTSD. The veteran was afforded a VA psychiatric examination and social and industrial survey in January 1990. The veteran reported that he felt that his combat experience improved his life because it enabled him to do things on his own. The veteran claimed that he had certain dreams soon after returning from Vietnam at which point he started choking his wife in his sleep in 1969. He stated that he had no further episodes of nightmares after that time. The veteran stated that he was unable to recall any specific troublesome traumatic incident from the war. The diagnoses were alcoholism, possibly in remission; paranoid personality disorder; and gunshot wound of the right knee. The social survey noted a work related injury in 1986 with a subsequent lawsuit. He also reported a history of domestic violence in April of 1989 when he hit his wife and was jailed. He stated it was "like reliving the war." He reported essentially continuous employment, with varying success, at a variety of jobs until 1986. The summary noted a complex history with marked employment and social instability and antisocial behavior. His history of instability and hostility resulted in minimal capacity for sustained satisfactory social or industrial adaptation. The rating action of February 1990 which denied service connection for PTSD granted a 10 percent rating for his wound residuals. The claims folder contains an October 1990 statement from Marcella Essen, a licensed psychologist. Ms. Essen noted that the veteran had been scheduled by the VA to have eight therapy sessions with her for the purpose of dealing with post-traumatic stress disorder. He stated that he would come but not participate since he felt he was being forced into therapy. The veteran was examined by a private psychiatrist, John Kluznik, M.D., in March 1991 at the request of his attorney. The veteran glossed over his past medical history and did not always respond to questions asked, but did not appear to be intentionally evasive. He reported that while in Vietnam he was involved in 60 campaigns. On one occasion, in fierce combat, his group was driven from a hill twice. He reported that he was injured at least on two occasions once with a gunshot wound to the right knee from an AK-47 and another time from a grenade explosion close to him which left him unconscious. The veteran stated that he began to experience bad dreams upon his return from Vietnam. He stated that one night he woke up, found himself choking his wife in his sleep. He decided at that time that he would not dream any longer. He said that he did not dream again for many years. He reported that he had difficulty sleeping from the time of his return to the United States and that he still had trouble sleeping. He stated that he had difficulty in seeing war movies, particularly Vietnam war movies. He said that until recently he would startle at explosions, backfirings, fireworks and etc. Dr. Kluznik was not able to determine whether or not that was still a problem with the veteran. The veteran stated that he felt no guilt. The veteran stated that he avoided things that he thought would make him anxious and that these were usually related to recollections of his combat experience but the veteran was unable to give any specific examples. The examiner could not tell whether the veteran continued to have distressing dreams. Likewise Dr. Kluznik was unable to get a clear understanding of whether or not the veteran was currently reexperiencing emotions that he experienced during combat. For example, the veteran seemed to have significant difficulty in recalling important aspects of the combat trauma which he experienced. On mental status examination the veteran did not always give a responsive answer to questions. Dr. Kluznik would ask about specific problems the veteran might have, such as sleep disorder, and the veteran would respond by talking about how difficult it was to sleep in Vietnam. It was difficult to get the veteran to answer specifics about that question. This pattern repeated itself throughout the examination. The veteran seemed to have been impaired to a significant degree by his experience in Vietnam. The veteran was tense during the examination but seemed to have no awareness of it. Previous examiners had found evidence for post-traumatic stress disorder. Dr. Kluznik noted that the effect of the veteran's experience in Vietnam was probably to aggravate an underlying personality disorder. The veteran seemed to play out personality factors, particularly in his dealings with the Government. The diagnoses were Axis I, post-traumatic stress disorder and Axis II, narcissistic personality disorder. The veteran testified at a hearing at the RO in May 1991. He reported that he was involved in 60 different campaigns, which he defined as a series of battles. The veteran testified that he had dreams and flashbacks of bad instances from when he was in Vietnam. He reported that he still did not sleep. He noted that his report of separation showed he had the Vietnam Campaign Medal with "60 devices" and stated this meant he was involved in 60 campaigns. He stated he had malaria seven times. The veteran's claims folder contains a May 1991 statement from Robert Neal, Ph.D., a licensed consulting psychologist. Dr. Neal reported that his testing and clinical skills showed that the veteran had post-traumatic stress disorder with both paranoid and narcissistic personality features. He noted that the veteran had all the usual post-traumatic stress disorder symptoms, including frequent wakening, flashbacks, uncontrollable anger and disorganized behavior. Dr. Neal was of the opinion that the veteran's industrial accident in 1986 triggered his decompensation. The veteran was described as extremely passive aggressive, with a frankly schizoid adaptation to daily living. The veteran was afforded a VA psychiatric examination in June 1991. The veteran reported that he had been "busted" seven times while he was in service, either for fighting or for going AWOL. He stated that he had been having dreams of combat one night and choked his wife because of a dream. He reported that he had dreamed of combat occasionally in the past two years. The veteran reported that he could not be comfortable at night and that he did not sleep more than 3 or 4 hours a night. The diagnoses included mixed personality disorder, questionable post- traumatic stress disorder, psychophysiological gastrointestinal reaction and cluster headaches. The examiner believed the veteran was basically depressed with poor self-esteem. The veteran testified at a hearing before a member of the Board in August 1992. He reported that he had been having flashbacks or nightmares of Vietnam since 1969. He stated that he would actually see the enemy coming out of the trees again and everything else like that. It could happen at any time of the day. He restated many of his previous statements with regard to his military service, and his activities since service. The veteran was afforded a VA psychiatric examination in April 1993. He reported that he went AWOL and would party a lot and play the black market while he was in Vietnam. The examiner referred to information in the claims file. During the interview the veteran talked about having shot women and children in Vietnam and cutting off the ears of dead enemy. He also spoke of taking captured enemy up in helicopters and, if they did not give information, throwing them out the door of the helicopter. He mentioned being jailed because he had a nightmare and slapped his wife. He stated that by force of will he had eliminated all dreaming until very recently. He seemed to have been very open about his war experience. He had been interviewed by youngsters about his war experiences. The examiner tried to delineate a precipitating event and the veteran mentioned seeing a bullet that nearly killed him fall to the ground. He also mentioned seeing maggots in the eye sockets of dead bodies and of children asking for chocolate and shooting at him. The examiner noted that there were some elements of post-traumatic stress disorder but he was unable to identify a specific traumatic incident or recurrent memory. The veteran was quite proud of his military prowess. The examiner could not substantiate post-traumatic stress disorder. He believed that the veteran had a mixed personality disorder with paranoid, narcissistic and psychopathic features. The veteran received another VA psychiatric examination in May 1993. The examiner had his records available for review. He reported being involved in over 60 campaigns with 2 or 3 encounters during each of those campaigns. The veteran also stated that while he was in Vietnam, he committed several atrocities and he had no remorse for having committed those. He reported after he got out of the service one night he thought his wife was Vietnamese and he was choking her while he was asleep. He reported that after that he decided he was not going to dream anymore and for the next 19 years he did not dream. The veteran reported that more recently he had begun to have nightmares but he did not describe what those nightmares were or what their content was. He stated that he had a flashback when he saw his wife and children as having slanted eyes and he thought they were both Vietnamese and they were the Government and that they were going to attack him. He reported that he had had trouble sleeping for a number of years. He stated that on occasion he would wake up in the middle of the night sweating. He did not report having a history of being jumpy or a heightened startle response. He stated that he was angry often. On mental status examination the veteran showed no signs of paranoia or hostility towards the examiner. He made several threats about the Government and people who were involved in Government. He denied any psychosis, obsessions or compulsions. He endorsed a conspiracy by the Government which was out to get him. In an extensive and detailed assessment, the examiner concluded that the veteran did not meet the criteria for post- traumatic stress disorder. There was no evidence that the veteran was disturbed by his experiences in Vietnam. During the examination the veteran was not focused on Vietnam. He did not show any distress when talking about it. He was easily distracted and lost track of his stories about Vietnam and thus did not show preoccupation with Vietnam. He clearly demonstrated a preoccupation with the Government and how the Government had discriminated against him. That would indicate that the veteran was not focused on traumatic experiences from Vietnam. He did not have startle response and he had only minimal complaints of occasionally waking up and sweating. He did not show any symptoms of panic. In fact, the veteran stated that he did not dream for 19 years because he was able to control this. Two examples of flashbacks happened when the veteran injured his wife. Both explanations appeared to be rationalizations for his domestic abuse as opposed to actual flashbacks and reenactments. He was not able to concretely describe what he saw in terms of a flashback. He was very vague in his description and he was not able to describe this violent action with very exact detail. He was not able to describe ever having sudden actions or feeling as if the traumatic event were recurring. The veteran did not describe any real serious psychological distress. The veteran stated that when he first saw the movie Platoon he had a hard time watching it but that he was able to watch it currently. The veteran made no efforts to avoid his thoughts or feelings associated with Vietnam. He made no effort to avoid activities that would arouse those recollections. The veteran did not show a decreased or diminished interest in previous activities. The veteran did not complain of feeling detached or estranged from others although he did state that he spent some time in West Virginia. The only physiological symptom that he had that was at all consistent with post-traumatic stress disorder was problems with chronic insomnia. His description of that insomnia was questionable since he took several naps during the day and engaged in very little physical activity to wear himself out so one would expect that he would have difficulty sleeping at night. The examiner suspected that the veteran's sleeping disorder was not related to post-traumatic stress disorder. He noted that the veteran met the criteria for an antisocial personality disorder. The veteran had met the full criteria for a conduct disorder before the age of 16. The veteran had a pattern of irresponsible and antisocial behavior since then. The veteran, himself, admitted that he had no regard for the truth and that he was a con artist. It was the examiner's opinion that the veteran did not meet the criteria for a post-traumatic stress disorder. The diagnoses included alcoholic dependence; antisocial personality disorder, narcissistic personality disorder, and malingering. The veteran's claims file contains a May 1990 psychological report by Marcella Essen, M.S., which was received in June 1994. When questioned about his experiences during the Vietnam war the veteran stated that he did not remember much about the war. He reported that in 1969 he had a nightmare and started choking his wife. He stated that after that he stopped dreaming. He stated that after the war he was unable to watch films about the war. He stated that he would break out into a cold sweat and have to leave. He reported that he had overcome this problem and could now sit through a film. Ms. Essen conducted a Minnesota Multiphasic Personality Inventory test with the veteran. The profile produced was invalid and uninterpretable. Another test was also inconsistent and considered indicative of brain dysfunction. The diagnoses included post-traumatic stress disorder and narcissistic personality disorder with paranoid features. Also received at that time was a June 1989 chemical dependency evaluation. The examiner noted that the test indicated that the veteran historically was involved in very severe alcohol abuse over a 15-year period ending approximately 3 or 4 years previously. It was the examiner's impression that the veteran's alcohol dependence was in remission since the veteran had demonstrated a significant degree of abstinence and control in the past few years. The examiner noted that the existence of post-traumatic stress syndrome should be aggressively examined. The veteran received a private psychiatric examination from Faris E. Keeling, M.D., in May 1990. Dr. Keeling found no evidence of thought disorder or mood disorder. He thought that the veteran's problems could be fully understood to be the result of his personality disorders. Dr. Keeling's diagnostic impression included probable post-traumatic stress disorder, history of alcohol abuse, paranoid personality disorder and narcissistic personality disorder. Dr. Keeling's report noted the military record reported by the veteran and his subsequent battles with "the system." Lack of trust and grandiosity were prominent. In September and October 1994 the veteran's claim file was examined by two VA psychiatric specialists who had not previously examined the veteran. They were asked to determine whether the diagnosis of post-traumatic stress disorder was supported in this case. After a review of the claims file, one of the VA psychiatric examiners noted that the evidence did not seem to be particularly supporting of a post-traumatic stress disorder diagnosis. There did not seem to be a clearly recognizable stressor and it seemed that the veteran enjoyed his time in Vietnam. He really didn't have recurrent dreams or other intrusive recollections. The veteran did not have numbing responses. His behavior and personality continued about the same before and after Vietnam and he didn't have guilt about surviving. As far as the examiner could see, the veteran did not have exaggerated startle response with any consistency. Sleep disturbance was probably unrelated to Vietnam and could be related to the veteran's alcohol and other personality problems. The veteran did not have memory impairment or trouble concentrating. The veteran did not seem to avoid activities or recollections of Vietnam and did not identify any particularly traumatic event. The examiner's diagnoses included history of alcohol dependence and mixed personality problem with strong antisocial tendencies. The other VA psychiatrist examined the veteran's claims folder in October 1994. The examiner noted that the various reports in the veteran's claims file indicated a consistent pattern of personality disorder traits. The reported post-traumatic stress disorder symptoms appeared to be quite inconsistent throughout the reports. The veteran's symptoms appeared most compatible with a severe mixed personality disorder with antisocial and narcissistic traits. The veteran also appeared to have ongoing alcohol dependence. The examiner noted that without the advantage of interviewing the veteran, it was very difficult to decide whether or not he experienced post-traumatic stress disorder. However, that appeared unlikely from the review of the veteran's records. Numerous psychiatric examiners have diagnosed the veteran to have a variety of psychiatric disorders other than post-traumatic stress disorder. These disorders include depression and various personality disorders. The veteran has not contended that any of these other disorders are a result of service or that his claimed PTSD is causally related to his service connected psychophysiological gastrointestinal reaction. In December 1992, the veteran's claims file was examined by a Board Medical Adviser, Eugene M. Caffey, M.D. Dr. Caffey was asked to clarify whether or not the veteran's service-connected psychophysiological gastrointestinal reaction was the same psychiatric entity as the veteran's claimed post-traumatic stress disorder or whether there were two distinct disorders. It was Dr. Caffey's opinion that there were two discreet entities present. He was also of the opinion that the veteran did not have stomach-bowel problems due to any psychiatric disorder and that only the possibility of post-traumatic stress disorder needed to be considered. The Board Medical Adviser opinion does not present an opinion as to whether or not the veteran experiences post-traumatic stress disorder. Since this opinion is not prejudicial to the veteran it does not violate the precepts of Austin v. Brown, 6 Vet.App. 547 (1994). The regulation, 38 C.F.R. § 4.126 (1994) provides that psychiatric disorders will be diagnosed in accordance with the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders and a diagnosis not in accord with that manual is not acceptable for rating purposes. Published diagnostic criteria provides that an essential diagnostic criterion for post-traumatic stress disorder is the existence of a recognizable stressor. Accordingly, service connection may not be granted for post-traumatic stress disorder unless the diagnosis is supported by a credible inservice stressor outside the range of usual human experience, which would be markedly distressing to almost anyone. While the veteran engaged in combat and received a Purple Heart and a Combat Infantryman Badge, it is not apparent that the combat stressors to which he was exposed led to the development of a stress disorder. He has made much of the fact that his report of separation shows that he received the Vietnam Campaign Medal with a "60" device. He believes this shows he was in 60 campaigns. However, detailed review of his personnel records shows he was credited with being in only three campaigns. Those records also show that the "60" device stands for 1960. Army Regulation 672-5-1, Military Awards, Chapter 4 confirms that the basic qualification for this award was six months service in Vietnam after 1959 and that all the awards include the "60" device. Chapter 3 of that regulation also indicates that the Bronze Star was awarded for heroism or meritorious achievement or service. Only if it includes the "V" device, which the veteran's award does not, does it indicate combat heroism. By clarifying these awards the Board does not imply that the veteran did not serve in combat. Clearly his other awards establish that. The point is made simply to confirm what many examiners have noted; that the veteran is prone to exaggeration and inconsistency in his statements. A review of the record reveals that the veteran has given an inconsistent history of stressors, and no examiner has related any such disorder to the documented combat stressor, his wound. Several times he stated that he could not remember many of the specific events that occurred in Vietnam. The initial VA examiner stated that the diagnosis of post-traumatic stress disorder was questionable. Two other VA examiners, one who examined the veteran in April 1993 and another who examined the veteran in May 1993, found that the veteran did not meet the criteria for post-traumatic stress disorder. They were unable to identify a specific traumatic incident or recurrent memory that was causing the veteran's current symptoms. While no one questions that the veteran was exposed to traumatic events in Vietnam, the examiners were generally unable to relate the veteran's current symptoms to the stressors, so as to establish the diagnosis. Overall, the examiners were of the opinion that the veteran's psychiatric symptoms were primarily due to a mixed personality disorder. The veteran's claims file was examined by a board of two psychiatric examiners in September and October 1994. Neither of these VA psychiatric examiners thought the evidence of record supported a diagnosis of post-traumatic stress disorder. One examiner stated that while a Dr. Keeling made a diagnosis of probable post-traumatic stress disorder, he noted that Dr. Keeling did not support this possibility very well. Dr. Keeling reported that the patient had nightmares, flashbacks, intense arousal and avoidance of Vietnam films. The VA examiner noted that he saw no record that the veteran could define any flashbacks about Vietnam. He did not seem to have intense arousal as he was able to talk about Vietnam rather freely. Neither did the report from Dr. Neal, Ph.D., provide details of the alleged post-traumatic stress disorder symptoms reported by the veteran. While a psychologist, Marcella Essen, made a diagnosis of post- traumatic stress disorder, she elicited no precipitating stressors from his military service. A psychiatrist, Dr. Keeling, found probable post-traumatic stress disorder. However, he did not provide details to support that conclusion and he did not relate the diagnosis to a specific stressor that the veteran experienced during his service in Vietnam. Another private psychiatrist, Dr. Kluznik, made a diagnosis of post- traumatic stress disorder. Yet Dr. Kluznik was unable to determine whether the veteran was experiencing symptoms compatible with post-traumatic stress disorder. Several VA examiners have found that the veteran does not have post- traumatic stress disorder. These examiners have given extensive analyses as to why the veteran does not meet the criteria for a post-traumatic stress disorder. The veteran has not presented consistent symptoms attributable to post-traumatic stress disorder. He has given inconsistent events, he has been unable to remember events, and it has been clear that potentially stressful events which occurred in Vietnam were not stressful to him. Accordingly, the Board finds that service connection for post-traumatic stress disorder is not warranted. The evidence is not so evenly balanced that there is doubt as to any material issue. 38 U.S.C.A. § 5107. ORDER Entitlement to service connection for post-traumatic stress disorder is denied. ROBERT D. PHILIPP Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.