BVA9500049 DOCKET NO. 93-03 005 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to service connection for a skin disorder. 2. Entitlement to secondary service connection for ulcers of the mouth. 3. Entitlement to an increased evaluation for ankylosing spondylitis of the lumbar spine, currently rated 40 percent disabling. 4. Entitlement to an increased evaluation for ankylosing spondylitis of the cervical spine, currently rated 30 percent. 5. Entitlement to an increased evaluation for ankylosing spondylitis of the dorsal (thoracic) spine, currently rated 10 percent. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD Richard V. Chamberlain, Counsel INTRODUCTION The veteran served on active duty from June 1968 to June 1972 and from May 1974 to November 1976. This appeal arises from April 1989, September 1990, and March 1992 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania, that denied service connection for a skin disorder, denied secondary service connection for ulcers of the mouth, and denied ratings in excess of 40 percent for ankylosing spondylitis of the lumbar spine, in excess of 30 percent for ankylosing spondylitis of the cervical spine, and in excess of 10 percent for ankylosing spondylitis of the dorsal spine. The case was sent to the Board of Veterans' Appeals (Board) in February 1993. The September 1990 RO rating decision also denied service connection for an eye disorder and the veteran appealed. An October 1991 hearing officer decision granted service connection for an eye disorder. Since this benefit has been granted, the appeal for this benefit is now moot and will not be addressed by the Board. The 1991 hearing officer's decision also increased the evaluation for ankylosing spondylitis of the cervical spine from 20 to 30 percent, but statements from the veteran indicate that he is still dissatisfied with the rating assigned for this disorder. Under the circumstances, the Board will consider this issue. The veteran also requests service connection for a skin disorder due to residuals of Agent Orange. This matter was deferred by the RO in a March 1992 rating decision and is now referred there for such further action as is appropriate. It is not inextricably intertwined to the claim being considered in this appeal. Harris v. Derwinski, 1 Vet.App. 180 (1991). At his June 1993 hearing, the veteran raised a claim for a total disability rating based on unemployability. Specifically, he alleged that he lost his job as a VA laboratory technician because his service-connected disabilities no longer permitted lifting or bending, and prevented him from using a microscope. He stated that he was in a VA retraining program and, in effect, should be rated as 100 percent disabled until he secures new employment. Rather than remand the entire case for processing of this additional claim, I refer it to the RO. This is particularly appropriate because today's decision grants service connection for a new disability and increases the rating for another. Moreover, the total rating issue is not inextricably intertwined with the rating issues. See Holland v. Brown, 6 Vet.App. 443 (1994). CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has a skin disorder that began in service or is due to the service-connected ankylosing spondylitis. Additionally, he maintains that he has ulcers of the mouth due to debilitation caused by his service-connected ankylosing spondylitis. He requests service connection for a skin disorder and secondary service connection for ulcers of the mouth. He also asserts that the ankylosing spondylitis of the lumbar, cervical and thoracic spine is more severe than currently evaluated, and requests higher ratings for these disabilities. 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, and for the following reasons and bases, it is the decision of the Board that the evidence supports granting secondary service connection for ulcers of the mouth and a 20 percent rating for ankylosing spondylitis of the dorsal spine. It is also the decision of the Board that the preponderance of the evidence is against the claims for service connection for a skin disorder, and increased ratings for ankylosing spondylitis of the lumbar spine and ankylosing spondylitis of the cervical spine. FINDINGS OF FACT 1. Service connection is in effect for ankylosing spondylitis of the lumbar spine, rated 40 percent; ankylosing spondylitis of the cervical spine, rated 30 percent; restrictive lung disease, rated 30 percent; spondyloarthropathy of the right shoulder, rated 10 percent; spondyloarthropathy of the left shoulder, rated 10 percent; spondyloarthropathy of the right hand, rated 10 percent; spondyloarthropathy of the left hand, rated 10 percent; spondyloarthropathy of the right hip, rated 10 percent; spondyloarthropathy of the left hip, rated 10 percent; ankylosing spondylitis of the dorsal spine, rated 10 percent; and uveitis, rated 10 percent. The combined rating for the service-connected disabilities is 90 percent, including consideration of a bilateral factor of 4.7 percent. 2. A skin condition in service was acute and transitory, and resolved without residual disability. 3. The veteran's current skin disorder was not present in service or for many years later, and is not causally related to the skin condition treated in service, an incident of service or to a service-connected disability. 4. Recurring ulcers of the mouth are causally related to the service-connected ankylosing spondylitis. 5. The symptoms of the ankylosing spondylitis of the lumbar spine produce no more than favorable ankylosis. 6. The symptoms of the ankylosing spondylitis of the cervical spine produce no more than favorable ankylosis. 7. The symptoms of the ankylosing spondylitis of the dorsal spine produce no more than favorable ankylosis. CONCLUSIONS OF LAW 1. A chronic skin disorder was not incurred in or aggravated by active service, nor is a chronic skin disorder proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §§ 3.303, 3.310 (1993). 2. Aphthous ulcers are proximately due to or the result of the service-connected ankylosing spondylitis. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.310 (1993). 3. The criteria for a rating in excess of 40 percent for ankylosing spondylitis of the lumbar spine are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.59, Part 4, Codes 5002, 5289 (1993). 4. The criteria for a rating in excess of 30 percent for ankylosing spondylitis of the cervical spine are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.59, Part 4, Codes 5002, 5287 (1993). 5. The criteria for a 20 percent rating for ankylosing spondylitis of the dorsal spine are met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.59, Part 4, Codes 5002, 5288. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background Service documents show that the veteran had active service from June 1968 to June 1972 and from May 1974 to November 1976. The service medical records for his first period of active service reveal that he was seen for a fungal infection of the left arm in November 1971. "Legs, rash on arms" was noted on a report of this treatment. Mycosis was also noted. The service medical records for the veteran's two periods of active service do not show additional treatment for a skin problem, and a skin disorder was not found on examinations in 1972, 1974, and 1976. Ankylosing spondylitis was found during the second period of active service. The veteran submitted his initial claim for VA compensation in June 1978. In it, he reported no skin problems. A private medical report shows that the veteran was examined in September 1978. His skin was found warm and dry with no lesions present. A skin disorder was not found. A May 1979 RO rating decision granted service connection for ankylosing spondylitis of the thoracolumbar spine and assigned a 40 percent rating from June 1978. VA medical reports show that the veteran was treated for various disorders in the 1980's, including a skin problem and ankylosing spondylitis. A dermatological consultation in September 1984 notes that the veteran had a history of skin rash in the lateral lower right and left legs with itching that was worse at night. Erythema and scales were found. The assessment was lichen simplex chronicus. Another dermatological consultation in November 1974 indicates that the veteran had dermatitis of the skin in the legs and neck. An April 1987 rating decision assigned a separate 10 percent rating for ankylosing spondylitis of the dorsal spine and continued a 40 percent rating for ankylosing spondylitis of the lumbar spine. The combined rating for the service-connected disabilities was increased from 40 to 50 percent. Since then service connection was granted for various additional residuals of ankylosing spondylitis. These disorders and the ratings are: Ankylosing spondylitis of the cervical spine, rated 30 percent; restrictive lung disease, rated 30 percent; spondyloarthropathy of the right shoulder, rated 10 percent; spondyloarthropathy of the left shoulder, rated 10 percent; spondyloarthropathy of the right hand, rated 10 percent; spondyloarthropathy of the left hand, rated 10 percent; spondyloarthropathy of the right hip, rated 10 percent; spondyloarthropathy of the left hip, rated 10 percent; and uveitis, rated 10 percent. The combined rating is currently 90 percent, including consideration of a bilateral factor of 4.7 percent. VA medical records show that the veteran was seen for various disorders and underwent various examinations in the late 1980's and early 1990's. These records show that the veteran was seen primarily for ankylosing spondylitis and residuals of this disorder. The veteran underwent VA examination in November 1989. X-rays of the cervical spine showed focal arthritic changes involving the articular facets C3 through C5, more prominent on the left. Hypertrophic marginal spurring with incomplete fusion anteriorly was found at the C6 and C7 levels. X-rays of the lumbar spine showed solid ankylosis from the lumbosacral region and the sacroiliac joints. X-rays of the dorsal spine showed progression of the anterior fusion of the mid to upper dorsal region from D5 through D7 since previous studies. Increased sclerosis of degenerative disc change at the D 11 level was also found. Generalized osteoporosis and scoliosis of the dorsal spine were described. The diagnosis was ankylosing spondylitis in the lumbar and dorsal spine, and probable ankylosing spondylitis of the cervical spine. The veteran underwent VA examination in March 1990. He complained of pain in the back, neck, ribs, and peripheral joints, mainly the hips, shoulders, and fingers of the right hand. He complained of psoriasis and ulcers of the mouth and underwent dermatological consultation. He gave a history of psoriasis for 2 to 3 years on the forearms and chest that he treated with a cortisone cream. He stated that the psoriasis was intermittent, coming several times monthly. He gave a history of oral ulcers in the past that lasted for a few days, and that he began treating this problem with medication about one year previously. He reported that the mouth ulcers were infrequent. He also complained of scaly patches from the psoriasis. At the time of the consultation there were no scaly flakes and no oral ulcerations. A rheumatology consultation in the same month notes that the veteran possibly had psoriatic arthritis. The diagnoses were ankylosing spondylitis, including peripheral arthritis of the hips, shoulders, and hands; and history of mouth ulcers, etiology unknown. VA outpatient treatment reports show that the veteran was seen for ankylosing spondylitis on various dates in 1990 and 1991. A report of his treatment in May 1990 indicates that he had ankylosing spondylitis that was at times almost disabling. Symptoms included muscle spasms. A report of his treatment in October 1990 notes that X-rays in 1988 had shown solid fusion of the lumbar spine and sacroiliac joints, deemed characteristic for ankylosing spondylitis. It was noted that 1989 studies showed arthritic changes in the cervical spine with solid fusion of the dorsal and lumbar spines as well as the longitudinal ligament. It was noted that he continued to take medication in high dosage. A report of his treatment in January 1991 indicates the presence of dermatological problems. The veteran testified at a hearing at the RO in June 1991. He stated that he had pain in his back that radiated up his spine to his shoulders. He said that he had low back spasms and that he had pain in his legs at the knees. He stated that he could walk several blocks on level ground. He also said that he had a skin disorder that was related to his ankylosing spondylitis. The veteran underwent VA examination in November 1991. He had various complaints, including occasional skin rashes/eruptions, and occasional mouth sores/ulcers. He also complained of increased pain and stiffness in his back, neck, and various joints. He underwent a dermatological examination in November 1991. He gave a history of occasional patches on the arms and truncal areas since service in Vietnam in 1970. Over the years, he reported treating this disorder with triamcinolone cream with good success. On examination, there was one patch of erythema and scaliness on the left arm and one on the right arm, each measuring about 1 centimeter. The diagnosis was eczema nummulare. The veteran underwent dental examination in December 1991. He described lesions in his mouth that were painful and sometimes with red swelling around the lesions. There were no lesions present at the time of the examination. The diagnosis was recurrent aphthous ulcers. The veteran underwent VA examination in April 1992. X-rays of the cervical and upper dorsal spine showed solid fusion of the mid to lower dorsal spine, D4 through D12. There was localized fusion of the lower cervicothoracic junction, C7 through D2. There were radiographic changes of the extensive ankylosing spondylitis essentially unchanged since previous studies in 1988. On examination, it was noted that the veteran had ankylosing spondylitis that remained about the same with the exception of some involvement up into his neck. It was noted that he had no motion of his cervical spine. What motion he did have existed at the atlantooccipital joint. He could swivel his head back and forth, but had no motion of the cervical spine, clinically. He tended to walk in a drifted pattern and drifted approximately 30 degrees to the right. He also stooped forward approximately 20 degrees. He wore a heel lift on the right side to compensate for this. It was noted that he had total ankylosis of the lumbodorsal spine. The diagnosis was ankylosis with deformity due to ankylosing spondylitis, dorsal, lumbar and cervical part of the spine. A private medical report shows that the veteran was examined in December 1992. He had almost no thoracic motion with a Schober index limited to .5 centimeters. Head, eyes, ears, nose, and throat examination revealed almost complete absence of any lateral side bending. Rotator was only about 10 degrees and the chin to shoulder distance was 13 centimeters. Chin to chest distance was 2.0 centimeters. His skin was free of any rashes. The impressions included classical ankylosing spondylitis with fused thoracic and lumbar spine. It was noted that the cervical spine was nearing complete fusion, and that he may also have some peripheral joint manifestations with some wrist and knee synovitis. The veteran testified at a personal hearing before the undersigned in Washington, D.C., in June 1993. He stated that he had pain in his back that extended to his shoulders. He said that he had spasms in the lumbar area of his back that he treated with medication. He stated that he had pain in his leg and walked with an unsteady gait. He also testified to the effect that he had pain in his shoulders with activity. He said that he occasionally had ulcers in his mouth. He testified to the effect that while the symptoms of his ankylosing spondylitis were often severe they did not make him bedridden. Various medical records were received while the claims folder was at the Board and the veteran waived initial consideration of these records by the RO. These records show that the veteran was treated for various disorders in 1992 and 1993, including ankylosing spondylitis. A VA report of treatment in July 1993 shows that he had three ulcers in his mouth. It was noted that these ulcers were probably related to his ankylosing spondylitis. II. Legal Analysis The record shows that the veteran's claims are well-grounded, meaning they are plausible. The Board finds that all relevant evidence for equitable disposition of these claims has been obtained and that no further assistance to the veteran is required to comply with the VA duty to assist him. 38 U.S.C.A. § 5107(a) (West 1991). A. Service Connection for a Skin Disorder In order to establish service connection for a disability, the evidence must show the presence of the disability and that it resulted from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Secondary 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 service medical records show the veteran was seen in 1971 during his first period of service for a fungal condition. He received no further treatment for a skin problem in service, and a skin disorder was not found on various subsequent examinations in service. The post-service evidence does not demonstrate the presence of a skin disorder until around 1984, many years after his discharge from service, and the evidence does not relate any post-service skin problem to any skin problem treated in service or to another incident of service. While psoriatic arthritis was suspected at a VA examination in 1990, the evidence does not show the presence of this disorder and the overall evidence indicates that the veteran has a dermatitis or eczema nummulare, and the evidence does not causally relate such a disorder to a service- connected disability. The Board recognizes the veteran's testimony to the effect that his skin disorder is related to his service-connected ankylosing spondylitis, but this evidence is not reliable because the veteran does not have the competence to make conclusions concerning medical causation. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Nor has the veteran provided evidence which demonstrates continuity of symptomatology of the skin condition treated in service, which is a requirement for service connection when a condition noted during service is not shown to be chronic. Mense v. Derwinski, 1 Vet.App. 354 (1991). After consideration of all the evidence, including the veteran's testimony, the Board finds that the veteran's skin condition in service was an acute and transitory condition that resolved without residual disability and is unrelated to his current skin disorder. Since the evidence does not causally link the veteran's current skin disorder to an incident of service or to a service-connected disability, the Board must conclude that the preponderance of the evidence is against the claim for service connection for a skin disorder. Since the evidence is not in relative equipoise concerning the claim, he is not entitled to favorable resolution of this claim based on reasonable doubt and it must be denied. 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). This decision does not preclude action by the RO on the claim for service connection for a skin disability due to Agent Orange exposure. B. Secondary Service Connection for Ulcers of the Mouth The veteran testified to the effect that he has occasional ulcers in his mouth that are due to the debilitating effect of his service-connected ankylosing spondylitis. The VA dermatological consultation in 1990 and the report of his dental examination in December 1991 confirm the presence of recurring aphthous ulcers, and the VA report of his treatment in July 1993 indicates that these ulcers are probably related to the service-connected ankylosing spondylitis. The Board finds that the overall evidence favors the claim for secondary service connection for ulcers of the mouth. Service connection is therefore granted. C. Increased Ratings for Ankylosing Spondylitis of the Lumbar Spine, Cervical Spine, and Dorsal Spine In order to establish entitlement to a higher rating for a service-connected disability, the evidence must show symptoms of the disorder which meet or more nearly approximate the criteria for higher ratings under the appropriate diagnostic codes in the Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.7. A 100 percent evaluation is warranted for rheumatoid arthritis when it results in constitutional manifestations associated with active joint involvement which are totally incapacitating. Chronic residuals of rheumatoid arthritis may also be evaluated on the basis of limitation of motion or ankylosis under the appropriate diagnostic codes pertaining to disability of the specific joint or joints involved. When there are disabling chronic residuals as well as active disease present, the higher evaluation will be assigned. 38 C.F.R. Part 4, Code 5002. Ankylosis of the lumbar segment of the spine at a favorable angle warrants a 40 percent evaluation. A 50 percent evaluation requires fixation at an unfavorable angle. 38 C.F.R. Part 4, Code 5289. Ankylosis of the cervical segment of the spine at a favorable angle warrants a 30 percent evaluation. A 40 percent evaluation requires fixation at an unfavorable angle. 38 C.F.R. Part 4, Code 5287. Ankylosis of the dorsal (thoracic) segment of the spine at a favorable angle warrants a 20 percent evaluation. A 30 percent evaluation requires fixation at an unfavorable angle. 38 C.F.R. Part 4, Code 5288. The veteran's ankylosing (rheumatic) spondylitis may be rated based on limitation of motion, ankylosis, or an active disease process. The evidence, including the veteran's testimony, indicates that the ankylosing spondylitis does not result in constitutional manifestations that are totally incapacitating. Under these circumstances, a higher evaluation is assignable for the residuals of this disorder based on limitation of motion or ankylosis. The evidence also indicates that the veteran is already receiving the maximum schedular ratings for ankylosing spondylitis of the lumbar spine, cervical spine, and dorsal spine based on limitation of motion allowed by Diagnostic Codes 5292, 5290, and 5291, respectively. Thus, the Board will consider entitlement to higher ratings for the ankylosing spondylitis for the various segments of the spine based on ankylosis. The overall evidence, including the veteran's testimony, does not indicate that the ankylosis of the lumbar spine is at an unfavorable angle. Nor was such a finding made at the time of the veteran's VA examination in 1992. While the evidence indicates that the veteran has various functional limitations associated with his ankylosing spondylitis, numerous separate compensable ratings have been assigned for those residuals. The evidence does not show functional limitation of the lumbar spine due to pain to establish entitlement to a rating in excess of 40 percent. 38 C.F.R. §§ 4.40, 4.45, 4.59. Nor does the condition appear to more closely approximate the criteria for the unfavorable ankylosis rating. 38 C.F.R. § 4.7. The Board finds that the evidence is not in relative equipoise concerning the claim for a higher rating for the ankylosing spondylitis of the lumbar spine. Thus, the veteran is not entitled to favorable resolution of this claim based on reasonable doubt. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49. An extraschedular rating is not appropriate, as frequent hospitalization or marked interference with employment due to this specific disability that has not been contemplated in the assigned schedular rating is not shown. 38 C.F.R. § 3.321 (1993). The preponderance of the evidence is against the claim and it must be denied. The veteran's testimony and some of the medical evidence, such as the private medical report of his examination in December 1992, indicates that he has some motion of the cervical segment of the spine, but the overall evidence including the report of his VA examination in 1992 indicates that he essentially has no motion of this segment of the spine. Also, the VA X-rays of the cervical spine in 1992 indicate fusion of the lower cervicothoracic junction, C7 through D2. Under these circumstances, the Board finds that a 30 percent rating for ankylosing spondylitis of the cervical spine based on favorable ankylosis best represents the veteran's disability picture. The evidence does not show functional limitation associated with the ankylosing spondylitis of the cervical spine to warrant a rating in excess of 30 percent. 38 C.F.R. §§ 4.40, 4.45, 4.59. Nor is an extraschedular rating appropriate, as frequent hospitalization or marked interference with employment due to this specific disability that is not contemplated in the assigned schedular rating is not shown. 38 C.F.R. § 3.321. After consideration of all the evidence, including the veteran's testimony, the Board finds that the current 30 percent rating for the ankylosing spondylitis of the cervical spine best represents the veteran's disability picture and that the evidence is not in relative equipoise concerning the claim for a higher rating for this disorder. Thus, the veteran is not entitled to favorable resolution of this claim using the benefit-of-the-doubt doctrine. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49. The preponderance of the evidence is against this claim and it must be denied. The evidence, including the VA report of the veteran's examination in 1992, indicates total ankylosis of the dorsal spine. This evidence is consistent with the overall evidence of record and warrants a 20 percent rating for the ankylosing spondylitis of the dorsal spine based on favorable ankylosis. The evidence does not indicate fixation of the dorsal segment of the spine at an unfavorable angle. Nor does the evidence show functional limitation of this segment of the spine due to pain to establish entitlement to a rating in excess of 20 percent. 38 C.F.R. §§ 4.40, 4.45, 459. An extraschedular rating is not appropriate, as frequent hospitalization or marked interference with employment due to this specific disability is not shown. 38 C.F.R. § 3.321. The Board finds that a 20 percent rating for the ankylosing spondylitis of the dorsal spine would better reflect the veteran's disability picture. The evidence, however, is against the claim for a rating in excess of 20 percent. Thus, the Board finds that the preponderance of the evidence supports an increased rating of 20 percent, but no more. ORDER Service connection for a skin disorder is denied. Secondary service connection for ulcers of the mouth is granted. An increased evaluation for ankylosing spondylitis of the lumbar spine is denied. An increased evaluation for ankylosing spondylitis of the cervical spine is denied. A 20 percent rating for ankylosing spondylitis of the dorsal spine is granted. J. E. DAY 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.