BVA9505164 DOCKET NO. 91-39 224 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for alcohol and drug abuse. 2. Entitlement to an increased rating for post-traumatic stress disorder with dysthymia, currently assigned a 10 percent evaluation. REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD R. P. Harris, Counsel INTRODUCTION The appellant had active service from August 1965 to August 1969. This matter came before the Board of Veterans' Appeals (Board) on appeal from a May 1990 rating decision of the Louisville, Kentucky, Regional Office (RO), which granted service connection and assigned a 10 percent evaluation for post-traumatic stress disorder with dysthymia. In a December 1991 remand, the Board stated that the issue of entitlement to service connection for alcohol and drug abuse appeared to be "inextricably linked" with that of an increased rating for post-traumatic stress disorder with dysthymia; and, therefore, the case was remanded to the RO to determine whether alcohol and drug abuse should be considered part of the service-connected psychiatric disability. By a rating decision in January 1992, the RO denied service connection for alcohol and drug abuse as secondary to the service-connected psychiatric disability. In a March 1993 remand, the Board indicated that the appellant's representative's November 1992 written statement apparently constituted a Notice of Disagreement with the January 1992 rating decision denying service connection for alcohol and drug abuse on a secondary basis, and again remanded the case for medical and procedural evidentiary development. By a rating decision in February 1994, the issue of service connection for alcohol and drug abuse was again denied as not secondary to the service- connected psychiatric disability, but rather due to the appellant's willful misconduct. Later that month, a Supplemental Statement of the Case was issued, which addressed this service connection issue. Subsequent statements from his representative are accepted in lieu of a formal Substantive Appeal as to this additional issue. Accordingly, the Board will render a decision on the issues as delineated on the title page of this decision. In a November 1994 informal hearing presentation, the appellant's representative requested that an independent medical expert (IME) opinion be obtained, to resolve alleged conflicting medical opinions. In support thereof, he contended that a Department of Veterans Affairs (VA) psychologic examination report dated in June 1992, which reflected a history of initial alcohol and illicit drug abuse in service related to the stresses of Vietnam, was contradictory to a medical opinion contained in a VA psychiatric examination report dated in July 1993, that stated, in essence, that the appellant's substance abuse disorder was not secondary to his service connected psychiatric disorder. However, the Board does not find these items of evidence contradictory, as will be explained in the decision herein. Therefore, a complex medical question as to warrant an IME opinion has not been presented. 38 U.S.C.A. § 7109 (West 1991); 38 C.F.R. § 20.901(d) (1994). Alternatively, since the Board finds that the service connection claim is not well grounded, as will be explained in the decision herein, the requested medical development would not be warranted. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that his substance abuse disorder is secondary to the service-connected psychiatric disability. He argues that he initially used alcohol and illicit drugs during service in a combat zone, and did so to alleviate associated stress. He asserts that he experiences post-traumatic stress disorder symptomatology, including nightmares, irritability, anxiety, and depression; and that since it results in definite social and industrial inadaptability, a 30 percent evaluation is warranted. It is requested that the benefit of the doubt doctrine be applied. 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 appellant'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 appellant has not met the initial burden of submitting evidence to justify a belief by a fair and impartial individual that the claim for service connection for alcohol and drug abuse is well-grounded. Additionally, the preponderance of the evidence is against allowance of an evaluation in excess of 10 percent for post-traumatic stress disorder with dysthymia. FINDINGS OF FACT 1. All available, relevant evidence necessary for disposition of the appeal has been obtained by the RO. 2. The appellant's abuse of alcohol or illicit drugs was for the enjoyment of their intoxicating effects. Illicit drug or alcohol abuse has not been shown to have been caused by or to be related to the service-connected psychiatric disability. 3. The appellant's service-connected psychiatric disability is manifested primarily by complaints of recurrent nightmares approximately twice a week, infrequent flashbacks related to Vietnam, occasional hypervigilence, insomnia, irritability, flattened affect, and a mildly depressed mood on occasion. His cognitive functioning is intact. His service-connected psychiatric disability does not prevent him from currently maintaining gainful employment as a maintenance man, a position held for many years. His service-connected psychiatric disability does not result in more than mild social and industrial impairment. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of a well-grounded claim for entitlement to service connection for alcohol and drug abuse. 38 U.S.C.A. §§ 105(a), 5107(a) (West 1991); 38 C.F.R. § 3.301(a),(b),(c)(2),(3), 3.310(a) (1994). 2. The criteria for an evaluation in excess of 10 percent for post-traumatic stress disorder with dysthymia have not been met. 38 U.S.C.A. § 1155 (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). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Alcohol and Drug Abuse The threshold question to be answered is whether the appellant has presented evidence of a well-grounded claim with respect to the issue of service connection for alcohol and drug abuse. A well-grounded claim is one which is plausible, meritorious on its own, or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78 (1990). In Tirpak v. Derwinski, 2 Vet.App. 609 (1992), the United States Court of Veterans Appeals (Court) held that the appellant in that case had not presented a well-grounded claim as a matter of law. The Court pointed out that "unlike civil actions, the Department of Veterans Affairs (previously the Veterans' Administration) (VA) benefits system requires more than just an allegation; a claimant must submit supporting evidence." Tirpak at 611. If a well-grounded claim has not been presented, the appeal with respect to that issue must fail. The Court in King v. Brown, 5 Vet.App. 19, 21 (1993) held that "evidentiary assertions [by the veteran] must also be accepted as true for the purpose of determining whether the claim is well grounded. Exceptions to this rule occur when the evidentiary assertion is inherently incredible or when the fact asserted is beyond the competence of the person making the assertion." In this case, the evidentiary assertions as to the claim of service connection for substance abuse disorder are either inherently incredible or beyond the competence of the person making the assertions, as will be explained. In pertinent part, an injury or disease incurred during service will be deemed to have been incurred in line of duty, unless it was the result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C.A. § 105(a); 38 C.F.R. § 3.301(a). In Gabrielson v. Brown, 7 Vet.App. 36, 41 (1994), the Court held that "Alcohol dependence is deemed by statute to be the result of willful misconduct and cannot itself be service connected", and referred to 38 U.S.C. §§ 105(a), 1110 as amended by the Omnibus Budget and Reconciliation Act of 1990, Pub.L. No. 101-508, § 8052, 104 Stat. 1388, 1388-1, 1388-351 (1990) (OBRA), applicable to claims filed after October 31, 1990. In the instant case, the claim for service connection for substance abuse disorder was received after that date. Additionally, in Gabrielson the Court stated that "the Secretary [of the VA] has yet to reflect the statutory change in the corresponding regulation, 38 C.F.R. § 3.301(c)(2)." In pertinent part, the provisions of 38 C.F.R. § 3.301(c)(2) state that: The simple drinking of alcoholic beverage is not of itself willful misconduct. The deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person's willful misconduct. In pertinent part, the provisions of 38 C.F.R. § 3.301(c)(3) state that: The isolated and infrequent use of drugs by itself will not be considered willful misconduct; however, the progressive and frequent use of drugs to the point of addiction will be considered willful misconduct. Where drugs are used to enjoy or experience their effects and the effects result proximately and immediately in disability or death, such disability or death will be considered the result of the person's willful misconduct.....where drugs are used for therapeutic purposes or where use of drugs or addiction thereto, results from a service- connected disability, it will not be considered of misconduct origin. Service connection may be granted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The appellant's service medical records do not reveal treatment for alcohol or illicit drug abuse, nor the presence of a contemporaneous, chronic, innocently-acquired psychiatric disorder. A chronic, innocently-acquired psychiatric disorder, including post-traumatic stress disorder, was initially manifested and diagnosed many years after service. See VA and State correctional institution clinical records dated in the 1980's. In a May 1990 rating decision, service connection was granted for post-traumatic stress disorder with dysthymia, effective March 10, 1989. In pertinent part, 38 C.F.R. § 3.304(f) (1994) provides: "Service connection for post-traumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor." Again, the medical evidence does not contain symptoms characteristic of or a clear diagnosis for post-traumatic stress disorder or any other chronic, innocently-acquired psychiatric disorder prior to the 1980's. However, the appellant has given a history, for clinical purposes, of inservice drug and alcohol abuse, relating it to stresses of service. See VA examination reports dated in March 1990 and January and June 1992. His statements as to onset of use of alcohol and drugs is within his personal knowledge, does not constitute medical opinion, and therefore is competent evidence. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Even his representative has conceded that this history of inservice drug and alcohol abuse is true. See informal hearing presentations dated in November 1992 and November 1994. There is simply no medical evidence or opinion of record that shows a causal or etiological relationship between the appellant's alcohol or illicit drug abuse and his service- connected psychiatric disability. Opinions by the appellant and his representative as to this question of etiology do not constitute competent evidence, since these individuals are not qualified to offer medical opinion or diagnosis. Espiritu. It is noteworthy that the examiner on VA psychiatric examination in January 1992 stated that he could not with certainty relate the appellant's alcohol abuse to his post-traumatic stress disorder, since he abused alcohol on weekends even though he experienced nightmares and other post-traumatic stress disorder symptomatology during the week; he enjoyed social drinking; and he had a strong genetic propensity for alcoholism, in that his parents were alcoholics. Additionally, on VA psychiatric examination in July 1993, the examiner opined, in essence, that the appellant's long-standing history of alcohol and drug abuse (which the appellant stated included marijuana and amphetamines) was not secondary to any other condition, but rather was a "free standing" illness. The Board therefore concludes that the evidentiary record shows that the appellant's substance abuse disorder preexisted his service-connected post-traumatic stress disorder with dysthymia. Since the substance abuse disorder preexisted his service- connected post-traumatic stress disorder with dysthymia, it necessarily follows that the alcohol or illicit drug abuse was primary and of willful misconduct origin; not secondary to a service-connected disability. Thus, there is no basis to warrant service connection for alcohol or illicit drug abuse as secondary to a chronic, innocently-acquired psychiatric disorder, and, consequently, the claim is not well-grounded. 38 U.S.C.A. § 105; 38 C.F.R. § 3.301, 3.310(a); Grottveit v. Brown, 5 Vet.App. 91 (1993); Grivois v. Brown, 6 Vet.App. 136 (1994). Parenthetically, while the Board, in its March 1993 remand, afforded the appellant VA examination for the purpose of determining the etiology of any substance abuse disorder, in hindsight this was unnecessary, and harmless error, since the claim was and remains not well-grounded. II. An Evaluation in Excess of 10 Percent for Post-Traumatic Stress Disorder with Dysthymia The Board finds that the appellant's claim with respect to the issue of an increased rating for post-traumatic stress disorder with dysthymia is "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a), in that he has presented a claim which is plausible. This being so, the Board must examine the record and determine whether the VA has any further obligation to assist in the development of his claim. 38 U.S.C.A. § 5107(a). After reviewing the record, the Board is satisfied that all relevant facts have been properly developed and no useful purpose would be served by again remanding the case with directions to provide further assistance to the appellant. A comprehensive medical history and detailed findings with respect to his psychiatric disability over the years are documented in the medical evidence. Recent VA psychiatric and psychologic examinations were conducted in 1992 and June and July 1993, and these are sufficiently detailed and comprehensive regarding the nature and severity of the disability in issue. The appellant and his representative have not indicated that there are more recent psychiatric treatment records or that his psychiatric disability has significantly worsened since these examinations were accomplished. Thus, the Board concludes that the duty to assist the appellant as contemplated by the provisions of 38 U.S.C.A. § 5107(a) has been satisfied with respect to this issue on appeal. Disability evaluations are determined by application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The Board will consider all of the appellant's psychiatric symptoms, regardless of etiology, for rating purposes, since differentiating whether psychiatric symptoms are due to the service-connected post-traumatic stress disorder with dysthymia versus substance abuse and personality disorders is immaterial, given the overall mild psychiatric symptomatology shown. The service medical records do not reveal any treatment or findings pertaining to a psychiatric disability. State correctional institution clinical records in 1983 revealed that he complained of depressive symptoms, sleep difficulty, feelings of alienation, poor self-esteem, and a history of alcohol and marijuana use. He reportedly had had a good work record prior to his imprisonment for child sexual abuse. He stated that after the Vietnam War, he had had some "bad" memories, but that these mostly had disappeared, and he did not consider himself to have residuals of that experience. See August and September 1983 State correctional institution clinical records. A September 1984 VA psychiatric examination report revealed that the appellant had been employed as a maintenance man since 1980. Clinically, he had a mildly depressed mood. A VA psychologic examination report dated in February 1990 reflected that he had completed high school and attended a few semesters of community college in the 1970's. Significantly, he reportedly got along well with his superiors and co-employees. He denied recent depression, but complained of anxiety, and post-traumatic stress disorder symptomatology including nightmares related to Vietnam. He reported that these symptoms occurred infrequently, but severe enough to interfere with psychological functioning. Clinically, there was no overt anxiety, his affect and mood were appropriate, and his memory was intact. Significantly, after psychologic tests were administered, the examiner concluded that the appellant had low frequency of post-traumatic stress disorder symptomatology, that he probably exaggerated these post-traumatic stress disorder symptoms, and that these were not frequent or severe enough to interefere with overall psychological functioning. Diagnoses included post-traumatic stress disorder, in partial remission. A March 1990 VA psychiatric examination report revealed that the appellant complained of frequent nightmares and startle reaction, and stated that he preferred to remain isolated and withdrawn. Nevertheless, he went out into public and reportedly had an excellent work record as a maintenance man for a transit authority. Clinically, a dysphoric mood, slightly blunted affect, and slight anxiety were reported. He had intact cognitive functioning. The impressions were alcohol and marijuana abuse, in remission; post-traumatic stress disorder, delayed onset; and dysthymia, secondary type, late onset. The examiner considered that the appellant's overall condition and prognosis were good. A VA psychiatric examination report dated in January 1992 revealed that the appellant was a full-time maintanence man, and had a good employment record. He stated that he experienced approximately three nightmares per month, of which only some related to Vietnam. Recurrent intrusive thoughts were indicated to be infrequent, and an exaggerated startle response was described as mild. Social isolation was indicated as mild, since he reportedly enjoyed socializing at parties and other places with his girlfriend. It was reported that he was an episodic "binge" drinker on weekends, and that the drinking periodically correlated with depressive episodes. Clinically, he had a good mood, euthymic affect, and intact memory. The examiner concluded that the appellant's post-traumatic stress disorder was no more than mild, and that these symptoms did not impair social or industrial adaptability. Sporatic alcohol abuse and cannabis abuse, in remission, were diagnosed as well. A VA psychiatric examination report dated in May 1992 reflects that the appellant reportedly had maintained full-time employment since military service, except for a period of imprisonment; and had had no psychiatric treatment. While he complained of an occasionally dysphoric mood concurrent with episodic dreams about war, he admitted that these did not affect employment or his relationship with his girlfriend. Clinically, he described his mood as good, and admitted that his episodic depression was sometimes related to alcohol use. He had a normal affect, and intact cognitive functioning. The diagnoses included very mild post-traumatic stress disorder; alcohol abuse/dependency; and antisocial personality traits. Significantly, the examiner indicated that many of the appellant's psychiatric symptoms might be related as much to his alcohol abuse and dependency and characterological pathology as to other causes; and that post- traumatic stress disorder symptomatology was mild and did not impair social or industrial adaptability. A VA psychologic examination report dated in June 1992 revealed essentially similar findings as the May 1992 examination. He reported infrequent nightmares generally occuring about twice a week, and reported post-traumatic stress disorder symptomatology, which included irritability, occasional hypervigilance, and infrequent flashbacks and intrusive thoughts. However, the examiner concluded that the appellant had maintained a good relationship with his girlfriend, had retained employment for the past decade, and that his post-traumatic stress disorder symptomatology had not increased since prior testing a couple years ago. Another VA psychologic examination was conducted in June 1993. He complained of some sleep difficulties, irritability, and depression. Clinically, he had an intact memory, and slightly depressed mood with a flattened affect. However, after administration of psychologic testing, the examiner concluded that the appellant's post-traumatic stress disorder was no more than minimal, and that major depression was mild. A personality disorder was diagnosed, in addition to mild major depression. On VA psychiatric examination in July 1993, the appellant admitted to continued heavy alcohol abuse (a case of beer per day and a couple of half pints of Vodka), but stated that he had not used marijuana and amphetamines for years. It was indicated that he had no history of psychiatric treatment, that he had maintained employment as a transit authority maintenance man for the past 12 years, and resided with his girlfriend. While he complained of occasional mood dysphoria, he divulged that this did not affect his employment or relationship with his girlfriend. Clinically, there was no anxiety, anger, hostility, or agitation. His affect and mood appeared unremarkable, and cognitive functioning was intact. He stated that he did not socialize much, and appeared somewhat guarded and suspicious. Significantly, the diagnoses included mild major depression. Additional diagnoses were alcohol abuse/dependency, cannabis/amphetamine abuse, in remission, and personality disorder with antisocial and avoidant traits. The examiner opined that post-traumatic stress disorder was no longer manifested, but rather the appellant's psychiatric symptomatology of occasional dysphoric mood, anhedonia, and social withdrawal were due to alcohol abuse. However, even assuming that these psychiatric symptoms were due to a psychoneurosis rather than alcohol abuse, the psychoneurosis was diagnosed as no more than mild in severity. It should be pointed out that post-traumatic stress disorder and major depression (without melancholia) are psychoneuroses, and are rated similarly. See 38 C.F.R. § 4.132. The VA's Schedule for Rating Disabilities provides a general rating formula for psychoneurotic disorders, including post-traumatic stress disorder (Diagnostic Code 9411), based upon the degree of incapacity or impairment: "Mild" social and industrial impairment warrants a 10 percent evaluation; "definite" warrants a 30 percent evaluation; "considerable" warrants a 50 percent evaluation; and "severe" warrants a 70 percent evaluation. A 100 percent evaluation requires that attitudes of all contacts except the most intimate be so adversely affected as to result in virtual isolation in the community and there be totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes (such as fantasy, confusion, panic, and explosions of aggressive energy) associated with almost all daily activities resulting in a profound retreat from mature behavior; and the veteran is demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132. In Hood v. Brown, 4 Vet.App. 301 (1993), the Court stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative," and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a Precedent Opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "Distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate, but less than rather large." VA O.G.C. Prec. Op. No. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c) (West 1991). Additionally, in Hood, the term "considerable" was declared as meaning "rather large in extent or degree." The recent clinical evidence reveals that the appellant has had overall successful industrial functioning, intact cognitive functioning, and absence of history of recent psychiatric treatment or hospitalizations. In addition to retaining effective and wholesome relationships with people, such as superiors and co-employees at work, and with his girlfriend over the years, he has shown efficient and reliable industrial adaptability despite his psychiatric symptomatology, as suggested by his having engaged in full-time employment in the same position for more than the past decade. Moreover, his mood and other behavioral responses have been essentially intact except for infrequent nightmares and other post-traumatic stress disorder symptomatology, and slight occasional depressive episodes arguably related to a psychoneurosis (versus substance abuse disorder for which service connection is not in effect). Of substantial evidentiary value is the fact that examiners on recent VA examinations have consistently concluded that his psychiatric impairment was no more than mild in degree, and did not significantly interfere with social and industrial adaptability. The fact that the appellant is currently gainfully employed and has maintained employment in a responsible position for at least the past decade has weighed heavily in the Board's decision, which is predicated in large part on the degree of industrial impairment caused by the psychiatric disorder. Even assuming that his psychiatric disability may adversely affect social adaptability to some extent, nevertheless, it does not more than mildly affect industrial adaptability. In pertinent part, the provisions of 38 C.F.R. § 4.129 state: ...in evaluating impairment resulting from the ratable psychiatric disorders, social inadaptability is to be evaluated only as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from the mental disorders contemplates those abnormalities of conduct, judgment, and emotional reactions which affect economic adjustment, i.e., which produce impairment of earning capacity. The Board, therefore, concludes that the recent clinical evidence does not show that the appellant's psychiatric disability results in more than mild social and industrial inadaptability, since he is well oriented, has essentially intact cognitive functioning, exhibits no more than occasional, slight depression and relatively infrequent nightmares (generally only two per week), and has maintained full-time employment for a substantial period of time, despite his psychiatric symptomatology. 38 C.F.R. §§ 4.129, 4.132, Part 4, Code 9411. The Board finds that the disability picture in question does not more nearly approximate the schedular criteria for the next higher evaluation, since the psychiatric disability does not more nearly approximate a degree of social and industrial inadaptability that is "more than moderate," for the aforestated reasons. 38 C.F.R. § 4.7; and VA O.G.C. Prec. Op., Id.. The clinical evidence does not show that the appellant's psychiatric disability presents such an exceptional or unusual disability picture with related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards, as is required for an extraschedular evaluation. 38 C.F.R. § 3.321(b)(1). Again, he maintains full-time employment, despite the psychiatric disability, and has not been frequently hospitalized therefor. Since the preponderance of the evidence is against allowance of an evaluation in excess of 10 percent for the psychiatric disability, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b) (West 1991). ORDER The appellant's claim of entitlement to service connection for alcohol and drug abuse is not well-grounded, and therefore, the appeal as to this issue is dismissed. An evaluation in excess of 10 percent for post-traumatic stress disorder with dysthymia 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. 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.