BVA9504634 DOCKET NO. 92-02 740 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE Entitlement to an increased evaluation for Post-traumatic Stress Disorder (PTSD), currently rated as 70 percent disabling, to include a total disability rating based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Sandra L. Smith, Associate Counsel INTRODUCTION The veteran had active service from August 1969 to August 1972. This case is before the Board of Veterans' Appeals (the Board) on appeal from a November 1990 rating decision which denied an increased evaluation for PTSD. The case was referred to the Regional Office (RO) for further development by the Board in a November 1992 remand. The requested development was accomplished and the rating decision of May 1994 continued the denial of an increased evaluation for PTSD. The Board notes that a letter was received from the veteran, dated in January 1995, after the last Supplemental Statement of the Case. As the information therein is contained in the record, the Board finds that it unnecessary to remand the case to the RO for further adjudication. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the severity of his PTSD symptoms warrants an 100 percent rating. He asserts that he is currently unemployable as a result of his PTSD symptoms and the medications prescribed to control those symptoms. 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 the claim for an increased evaluation, in excess of 70 percent, for PTSD. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran is service-connected for PTSD, rated 70 percent disabling, and for residuals of shrapnel wound to the right hand and both calves, rated as noncompensable. 3. The veteran's PTSD is manifested principally by depression, anxiety, irritation, guilt and reported insomnia, startle response, avoidance, nightmares and flashbacks of war experiences. It is productive of not more than severe social and industrial impairment. 4. The veteran's work experience consists of gainful employment as a machine operator from 1972 to 1994, he has a high school education, and he last worked in April 1994 when he sustained an industrial injury. 5. The veteran's PTSD is not productive of more than severe social and industrial impairment and does not preclude him from substantially gainful employment. 6. Thee is no unusual or exceptional disability picture warranting the assignment of a 100 percent schedular evaluation or on an extraschedular basis or the assignment of a total rating based on individual unemployability. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 70 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107(West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.129, 4.130, 4.132, Code 9411 (1994). 2. A total rating based on individual unemployability is not warranted. 38 U.S.C.A. §§ 1155, 7104 (West 1991); 38 C.F.R. § 4.16(c) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS A person who submits a claim for benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107. After reviewing the evidence on file we conclude that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the claim presented is not inherently implausible. Furthermore, we conclude that all facts pertinent to the plausible claim have been developed and that as such, there is no further duty to assist in developing the claim as contemplated by 38 U.S.C.A. § 5107(a). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim must be denied. 38 U.S.C.A. § 5107(a); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Factual Background Historically, the record reveals that the veteran served as a rifleman mortarman from July 1970 to May 1971 in Vietnam. The veteran's service personnel records confirm that he was involved in several large combat operations while in Vietnam and received a citation on one occasion. He apparently received a superficial gunshot wound in approximately December 1970 for which he was awarded a Purple Heart. The service medical records only show several notes, dated in December 1970, of his bandage being changed. In addition, the service separation examination report, dated in August 1972, noted a 1 and one-half inch scar on the right elbow. Private medical records, dated in 1974, show that the veteran was treated for a gun shot wound to the abdomen with laceration of the right hemicolon, right kidney and liver. In a VA examination report, dated in September 1980, it was noted that the veteran had trouble sleeping and experienced nightmares several times a week of his Vietnam experiences. In addition, the examiner noted that the veteran gave an industrial history of having worked as a machine operator for the past eight years for one employer. The relevant diagnosis was anxiety disorder. A letter from a VA mental health specialist, dated in September 1983, indicated that he had been treating the veteran for PTSD for approximately one year. The veteran was afforded a VA psychiatric examination in November 1983. He related a military history of killing enemy soldiers and civilians while in Vietnam. He claimed recurrent dreams of events experienced in Vietnam. He allegedly drank to ward off the nightmares. He also took antidepressant drugs. The relevant diagnoses were PTSD and alcohol dependence. In a subsequent rating decision in January 1984, the veteran was granted service connection for PTSD and assigned a 50 percent disability rating. The veteran was afforded a VA psychiatric examination in January 1986. The examination report noted that the veteran had a poor memory for dates and events that took place in Vietnam. He seem preoccupied with the notion that he was suffering from Behcet's Syndrome as a result of Agent Orange poisoning. He did state that while in service he felt depressed and shot himself in the abdomen. The veteran gave an industrial history of having worked for ten years after discharge from service, but for the past four years he had not worked. The veteran denied hallucinations and no suicidal or homicidal impulses were present. The final diagnoses were major depression and chronic PTSD. In a subsequent rating decision, dated in April 1986, the disability evaluation for the veteran's PTSD was increased to 70 percent. This rating has remained in effect until the present time. In April 1988, the veteran was again evaluated by a VA psychiatrist. The examination report noted that the veteran recounted that at the time he was wounded in Vietnam 7,200 others were killed. He stated that he, himself, killed a lot of women and children. He suffered "deed guilt" and "survivor guilt". He had daily nightmares about Vietnam and would wake up in a cold sweat. In almost daily flashbacks he relived being caught in a trench for days. The veteran described how he began drinking after service; he still drank approximately one case of beer and a pint of whiskey a week. He averaged 6-7 hours of sleep. He reported symptoms of feeling shaky and had cold sweats. He also reported feelings of depression, irritability, restlessness, and suicidal thoughts. The veteran gave an industrial history of having his last regular job 5 years earlier. He stated that since discharge he had about 4 jobs, the longest being for 3 years. The diagnosis was PTSD, with disassociative psychosis, organic brain syndrome with defective recent memory. History of seizures. The veteran was noted to be severely industrially and socially impaired. A VA hospital summary report showed that he was hospitalized from October to November 1989 after an episode in which he shot at his mother and wife for "nagging" him to seek help for his drinking problem. The magazine was not in the gun. He admitted to drinking heavily since 1972, up to a half gallon of whiskey per day for the preceding five years. He claimed he drank this much to calm his nerves and alleviate his depression. Inpatient treatment records show that during his hospital stay he was observed to exhibit attention seeking and dependent behavior. He also seemed to become medication dependent. No violent behavior was observed. The veteran was observed to sleep well. The discharge diagnoses were PTSD, alcohol dependence, dependent personality disorder, and Behcet's Syndrome. A VA hospital summary report indicates that the veteran was again hospitalized from January 1990 to March 1990 for evaluation for alcohol and drug problems. The veteran claimed he had flashbacks on a continuous basis and had been on medication for over 5 years. He also admitted to drinking approximately a pint of whisky per night for sleep. He denied blackouts, delirium tremens or seizures. It was noted that the veteran was unemployed. Current exacerbations of the Behcet's syndrome were noted. At admission it was noted that he was in no visual distress despite his chronic complaint of not feeling well. He was oriented, alert and cooperative, and affect and mood were somewhat dysphoric. Judgment was somewhat tenuous but no suicidal or homicidal ideations were present. There was no evidence of hallucinations but preoccupation with somatic complaints to a delusional extent was noted. The veteran complained of nightmares, poor concentration, and impaired memory. The veteran was treated for dual diagnoses but he tended to minimize his ethanol dependency and presented more of a passive/dependent picture with constant need of reassurance and support. The veteran's symptoms of nightmares remitted somewhat during his stay. His mood improved dramatically with Prozac, impassivity and decreased concentration were helped with Tegretol. The March 1990 hospital report also noted that the veteran exhibited some symptoms of a bulimic-like syndrome. The veteran allegedly had been involved in body mutilation and cannibalism while he was in Viet Nam and it was believed these symptoms might be related to those events. The diagnoses at discharge were: Axis I: Poly substance dependency alcohol as well as opiate- like substances; PTSD Axis II Mixed personality disorder with borderline dependent features Axis III Behcet's syndrome; history of agent orange exposure The veteran was subsequently afforded a VA neuropsychiatric examination in April 1990. The examination report noted that the veteran stated he was wounded in an event in which he was only one of two survivors of 322 men. He also said he received the Vietnam Cross of Gallantry. He related that he was on a "Killer Team" which raided villages in search of information and murdered women and children. He complained of seizures since 1971. He stated that he heard voices at times. The veteran was on Thioridazine, Fluoxetine, Compazine and Benztropine. He estimated being hospitalized 10 to 5 times because of his nervous condition and that he had attempted suicide about 8 times. He had occasional nightmares about the suicide attempts. He claimed that he had cut down on his drinking since two years earlier and was currently drinking two beers every other day. He was withdrawn and had trouble controlling his anger. He related PTSD symptoms of nightmares 3 to 4 times a week, flashbacks, depression, cold sweats, restlessness, irritability, startle response, hyperalertness, and suicidal thoughts. During the April 1990 neuropsychiatric examination the veteran related an industrial history that he had graduated from high school and last worked in 1971; he claimed he had not been able to work since because of seizures and his nervous condition. Mental status examination revealed that the veteran was cleanly and appropriately dressed. His affect was blunted and seemed to be repressed, appeared flattened but not inappropriate. The veteran had auditory hallucinations which were dissociative in character and reflected his experiences in Vietnam as well as his guilt. He was oriented to time, place and person. Recent memory was affected by lack of concentration. Remote memory was intact. Judgment and insight appeared adequate. The diagnosis was PTSD with dissociative psychosis with hallucinations of a repetition of voices that he heard in Vietnam superimposed upon which were guilty feelings and depressive feelings for what he did in Vietnam. A VA hospital summary report showed that the veteran was hospitalized from May 1990 to July 1990 in the stress recovery ward. At admission the veteran reported being on a whole list of medications; however, a check with the pharmacy revealed that he was only active with Motrin. During his stay he was noted to not take his medications as prescribed. The final primary diagnosis was originally polysubstance abuse but subsequently was changed to PTSD with polysubstance abuse on Axis II of the diagnosis. VA outpatient treatment records indicate that the veteran failed to show for his scheduled outpatient treatment appointments with the stress recovery clinic and his file was subsequently closed in September 1990. The veteran was afforded a VA psychiatric examination in July 1991. The examination report indicated that the veteran complained of flashbacks, nightmares, guilt, lack of interest, withdrawal, and suicidal thoughts. He indicated he received 12 medals including 3 Purple Hearts and the Cross of Gallantry. The veteran indicated that he had not worked since his discharge from service on account of his psychiatric and medical condition. He was last hospitalized in the Stress Recovery Ward of the VA hospital in 1990; since then he allegedly had been under outpatient care. Mental status examination revealed that the veteran appeared very tense and irritable but otherwise in good rapport with the examiner. He had no overt hallucinations but occasionally verbalized unusual perceptional experiences (hearing gunfire and screaming during flashbacks). He was not overtly delusional but suspicious. He was very depressed with sad facial expression and fearfulness. He appeared overtly anxious with exaggerated startled response when talking about Vietnam. Intellectually he was functioning fairly well. Memory was noted to be well preserved and insight and judgment were slightly distorted. The psychiatric diagnosis was PTSD and he was noted to have major impairment in his psychosocial functioning. The veteran testified at a personal hearing in August 1991. He related how he had over 82 confirmed kills in Vietnam and over half of them were in hand to hand combat. He indicated that he was currently taking 100 mg. of Thorazine every day. He did not sleep at night but rather in the day time when he could see around him. He claimed to have been in the hospital for a total of about 6 out of the prior 20 years. He did not drive and avoided crowds. He would go to the store with his wife and stay in the car. In December 1992 it was noted that the veteran had no outpatient treatment records since 1990. In April 1993 the veteran was hospitalized for two days for observation and evaluation of his service-connected psychiatric disability. The discharge summary report noted that the veteran gave a history of his PTSD symptoms and suicide attempts. Mental status examination noted that the veteran took Thorazine for his sleeping problem and behavioral problems. There were no active suicidal plans although he was depressed. The examiner also noted there were no overt signs of any psychotic symptoms. He was oriented in three spheres with clear sensorium. In addition, his judgment and insight were not grossly impaired. He was observed to have some difficulty sleeping and had startle reaction at nighttime. The veteran, although depressed, did not show any significant suicidal thoughts nor even intricate plans to kill himself. The examiner concluded that the veteran was "considered UNEMPLOYABLE gainfully due to extreme marginal functioning. He was considered COMPETENT, however, to handle known assets and income." A VA outpatient treatment report, dated in May 1993, indicated that the veteran felt a little better with the Prozac. Ruminations about Vietnam were less but he was still anxious and having nightmares and intrusive thoughts with little motivation and depression. He was noted to sleep poorly but ate fairly well. He had a blunted depressed affect with clear sensorium. He was not suicidal. He was to continue his medications. In July 1993 the veteran submitted a claim for compensation based on unemployability. He indicated that he had been employed from September 1972 to the present as a machinist. He stated he was still working full time; however, he had been informed by his employer that he would be terminated due to his PTSD disability and his medication requirements. A VA outpatient treatment note, dated in August 1993, showed that the veteran complained of depression due to his wife being unable to work due to a medical problem. He talked of their finances and possibly selling their home. He complained of sleeping difficulty but no suicidal thoughts were noted. He talked of getting work twice a week selling clothes. He was tearful and depressed but in good contact. The assessment was financial crisis and PTSD. In October 1993 information was received from the veteran's employer which indicated that the veteran had been employed as a machine operator since September 1972. He had earned approximately $39,000 in the prior 12 months and had only lost 4 days due to his disability. It was noted that he worked 8 hours a day in a 40 hour workweek and was still employed with the company. The box on the form for indicating concessions made by reason of age or disability was marked not applicable. The veteran was hospitalized in a VA medical facility in November 1993 for three days for the purpose of observation and evaluation of his service-connected disability. He was evaluated by the same physician that had performed the April 1993 evaluation and who was currently treating him. Mental status at admission showed that he was very depressed, passive looking and talked very slowly in a monotone voice. He was oriented in three spheres. He was not overtly delusional but admitted having auditory hallucinations. His judgment and insight were not impaired. Although he was ruminating about suicide, no active plan was noted. He was also consistently thinking about his Vietnam experiences and his condition. Prior to admission the veteran claimed he spent his time trying to relax and watching television. He avoided people. He woke at night with night sweats from nightmares. During hospitalization he was noted to be withdrawn, not socializing with other patients. He reported several times to have had flashbacks and nightmares. He also reported sleeping difficulty despite medications. On the third day he requested discharge stating that his wife needed him at home. The examiner concluded that: "[h]e is considered competent to manage known assets and income, but not gainfully employable due to his very marginal functioning because of the severity of his PTSD symptoms. His industrial and social functioning had been profoundly impaired." The veteran was afforded a VA psychiatric examination in March 1994. The examination report indicates that the examining psychiatrist reviewed the claims folder before interviewing the veteran. The veteran provided a vocational history that he had last worked one year ago when he was fired because of taking medications and missing time because of his nervous condition. He stated that his VA doctor had told him not to work as she felt it was making his emotional condition worse. He had worked as a machine operator for the past 12 years. He claimed he didn't make over $18,000 a year. He also stated that in the last 12 months he was with the company he missed three months because of his nervous condition. The veteran listed his current medications as Prozac, Thorazine, Tegretol and Benadryl. The veteran related that he heard voices about once or twice a week. He claimed to have hallucinations several times a year, usually following a nightmare. The veteran related that he was wounded three times in Vietnam but only received one Purple Heart. He experienced nightmares two or three times a week. He relives combat experiences in his flashbacks. He had considerable guilt about killing people, women and children. He lived at home and stayed in his own room 95 percent of the time. He avoided crowds but would go to the store with his wife when it wasn't crowded. He believed that, without medication, he would "lose it" and become violent. He had trouble concentrating. The examiner's objective findings were that the veteran was cleanly and appropriately dressed but withdrawn. His hands were very unsteady. His affect was very blunted. There was considerable depression. He appeared full of self-loathing, guilt and self-incrimination. He cried throughout the interview. He had auditory and visual hallucinations of a mild degree. He was oriented to time and person. Ability to calculate was good but took a long time. He had minimal recent memory impairment which was due to lack of concentration, a symptom of his PTSD. The final diagnosis was: PTSD, with severe social and industrial impairment, due directly to PTSD. Ninety percent of the veteran's trouble concentrating and mild recent memory impairment are secondary to PTSD, 10 percent of it is due to organic brain syndrome, secondary to cerebrovascular accidents. All of the other diagnoses in his Claim File are part of his PTSD. The veteran has more than enough documentation for stressors. Whether the veteran's whole story is credible or not doesn't preclude the fact that he has PTSD, that he has grounds for it and has had a severe chronic disabling effect upon him. A statement from the veteran's employer, dated in April 1994, indicated that the veteran was still an employee of the company. However, due to an industrial injury of April 8, 1994, the veteran's last day of active work had been April 8, 1994. Legal analysis Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3. An extraschedular evaluation will be assigned if the case presents an unusual or exceptional disability picture with such related factors as marked interference with employment or frequent periods of hospitalization such as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). Under the rating schedule, a 70 percent evaluation is warranted for PTSD when the ability to establish and maintain effective or favorable relationships with people is severely impaired and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 percent evaluation requires that the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, with totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior, and demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132, Code 9411. To determine the proper disability rating, VA regulations require that the veteran's service-connected post-traumatic stress disorder must be considered in the context of the total history of that disability, particularly as it affects the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.129, and Schafrath v. Derwinski, 1 Vet.App. 589 (1991). The severity of a psychiatric disability is based upon actual symptomatology, as it affects social and industrial adaptability. Great emphasis is placed upon the full report of the examiner, descriptive of actual symptomatology. The record of the history and complaints is only preliminary to the examination; the objective findings and the examiner's analysis of the symptomatology are the essentials. 38 C.F.R. § 4.130. In light of the evidence of record and the above legal criteria, the Board finds that the veteran is not entitled to a 100 percent schedular or extraschedular rating. The objective findings of the veteran's recent psychiatric examinations contain no evidence that the veteran's symptoms are so incapacitating as to border on gross repudiation of reality. In each examination the veteran has been found to be oriented and capable of expressing himself in a logical cognizant manner. Furthermore, a review of all of the veteran's psychiatric examination reports shows that although he has always appeared depressed, and sometimes irritable, there has been no objective evidence of delusions, fantasy, confusion, panic or explosions of aggressive energy. In the veteran's case, it appears that the severity of his PTSD has been formulated more on his reported symptoms of flashbacks, nightmares and sleep problems. Yet, despite these reported symptoms, there is documented evidence that the veteran remained employed full-time as a machine operator until April 1994 when he suffered an industrial injury. In addition, the Board notes that, despite being gainfully employed at the same company since 1972, the veteran has consistently misrepresented his employment status for many years. He has also recounted differing accounts of his Vietnam experiences, some of which are directly contradicted by the records. Therefore, the Board finds that the veteran's account of his reported symptoms, which have not been objectively verified, to be less than credible. Thus, the Board concludes that the evidence does not show that the veteran is demonstrably unable to obtain or retain employment because of his psychoneurotic symptoms. Therefore, not more than a 70 percent rating is warranted. In reaching its conclusion, the Board notes that despite some significant psychiatric symptoms, the veteran's speech, behavior and manner are essentially appropriate, and his thinking is unimpaired. The Board also finds that the evidence discussed above does not suggest such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards, so as to warrant the assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b)(1). The veteran was hospitalized once in 1989 and once in 1990 for treatment of his PTSD. However, he had not been admitted for many years prior to 1989 and has not been admitted for treatment of PTSD since then. As noted above, the veteran continued to work full-time with his PTSD symptoms from September 1972 until April 1994 when he suffered an industrial injury. Thus, we conclude that his PTSD symptoms have not required frequent periods of hospitalization, nor do they present a marked interference with employment. The veteran and his accredited representative also contend that the veteran is entitled to a total disability rating based on individual unemployability. 38 C.F.R. § 4.16(c) provides that in cases in which the only compensable service-connected disability is a mental disorder assigned a 70 percent evaluation, and such mental disorder precludes a veteran from securing or following a substantially gainful occupation, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. In this case, as discussed above, the Board finds that the veteran's service-connected PTSD does not preclude him from securing or following a substantially gainful occupation. The Board has given careful consideration to the opinion of examiners, including the veteran's treating psychiatrist, who opined that the veteran was gainfully unemployable. However, at the very time that these opinions were formulated, the facts were that the veteran was gainfully employed, and had been for approximately 20 years. The opinions were in part based on false information as to employment, which compromises the credibility of the conclusion as to employability. In fact, the veteran's employer reported that he was employed on a full-time basis, at a salary reflecting gainful employment, and there were no concessions given by reason of any disability. In light of this factual background and the lack of objective findings of incapacitating psychoneurotic symptoms, the Board concludes that the evidence does not establish that there is total social and industrial inadaptability or that the veteran is unable to secure or follow substantially gainful employment due to his service- connected PTSD. In reaching this decision, it is the judgment of the Board that the credible evidence preponderates against the veteran's claim and, therefore, there is no doubt to be resolved in his favor under 38 U.S.C.A. § 5107(b). ORDER An increased evaluation for service-connected PTSD, to include a total rating based on individual unemployability, is denied. HOLLY E. MOEHLMANN 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. (CONTINUED ON NEXT PAGE) 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.