BVA9502874 DOCKET NO. 92-20 158 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Manchester, New Hampshire THE ISSUES 1. Entitlement to service connection for a psychiatric disorder, claimed as "battle fatigue." 2. Entitlement to service connection for a right hip disability. 3. Entitlement to service connection for a left hip disability. 4. Entitlement to service connection for varicose veins of the right leg. 5. Entitlement to an increased rating for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII, currently assigned a 10 percent evaluation. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. P. Harris, Counsel INTRODUCTION The appellant had active service from July 1950 to August 1953. This matter came before the Board of Veterans' Appeals (Board) on appeal from a June 1991 rating decision of the Manchester, New Hampshire, Regional Office (RO), which denied service connection for a psychiatric disorder, claimed as "battle fatigue", a bilateral hip disability, and varicose veins of the right leg, and denied a compensable rating for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII. In November 1991 and May 1992 statements, he requested a hearing before a member of a traveling section of the Board; and he was notified that such a hearing was scheduled for October 1992. However, he failed to report for that hearing. In June 1994, the Board remanded the case to the RO for evidentiary development. Thereafter, in an August 1994 rating decision, the noncompensable rating for the service-connected left thigh disability was increased to 10 percent, effective February 5, 1991. Statements by the appellant dated in October 1993 and April 1994 are construed as an intention to request service connection for residuals of cigarette smoking, to include pulmonary and circulatory disorders. Since this issue has not been developed by the RO, it is referred to the RO for appropriate action. Kellar v. Brown, 6 Vet.App. 157 (1994). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that he has post-traumatic stress disorder/battle fatigue which is related to his service combat experiences. It is argued that he should be afforded an examination by a board of psychiatrists to render a psychiatric diagnosis. He asserts that he has a bilateral hip disability as well as varicose veins of the right leg. He appears to allege that the varicose veins of the right leg developed after the service-connected left thigh disability caused him to favor the right leg. Recent statements from his representative contend that an evaluation in excess of 10 percent is warranted for the left thigh disability; and that the disability is manifested by pain and muscle cramping. Also, they allege that Department of Veterans Affairs (VA) examinations are inadequate for rating purposes, since the examiners did not review the claims folder. 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 claims for service connection for a psychiatric disorder, claimed as "battle fatigue", a bilateral hip disability, and varicose veins of the right leg, are well- grounded. Additionally, the preponderance of the evidence is against allowance of an evaluation in excess of 10 percent for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII. FINDINGS OF FACT 1. All available, relevant evidence necessary for disposition of the appeal has been obtained by the RO. 2. A chronic acquired psychiatric disorder, including post- traumatic stress disorder, has not been shown by competent evidence. 3. A chronic bilateral hip disability has not been shown by competent evidence to have been present in service or proximate thereto, reasonably related to service, or causally or etiologically related to a service-connected disability. 4. Varicose veins of the right leg have not been shown by competent evidence to have been present in service or proximate thereto, reasonably related to service, or causally or etiologically related to a service-connected disability. 5. The residuals of a shell fragment wound of the appellant's left distal thigh are manifested primarily by a small, well- healed, nonadherent, but painful scar and radiographic evidence of a retained metallic fragment in the soft tissues. There is no evidence of muscle loss, herniation, or diminished muscle strength of the left distal thigh. The left distal thigh wound is no more than moderately disabling. CONCLUSIONS OF LAW 1. The appellant has not submitted evidence of well-grounded claims for entitlement to service connection for a chronic acquired psychiatric disorder, bilateral hip disability, and varicose veins of the right leg. 38 U.S.C.A. §§ 1110, 1154(b), 5107(a) (West 1991); 38 C.F.R. § 3.303, 3.304, 3.310(a) (1994). 2. The criteria for an evaluation in excess of 10 percent for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII, 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, 4.40, 4.56, 4.73, Codes 5313, 7803, 7804, 7805 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service Connection for Chronic Acquired Psychiatric Disorder, Bilateral Hip Disability, and Varicose Veins of the Right Leg The threshold question to be answered is whether the appellant has presented evidence of well-grounded claims with respect to the issues of service connection for chronic acquired psychiatric disorder, bilateral hip disability, and varicose veins of the right leg. 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 claims of service connection for the aforementioned disabilities are either inherently incredible or beyond the competence of the person making the assertions, as will be explained. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime service. 38 U.S.C.A. § 1110. In pertinent part, 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, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 3.303(d). In pertinent part, satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(d). A. Service Connection for Chronic Acquired Psychiatric Disorder The appellant alleges that he has post-traumatic stress disorder or "combat fatigue" related to military service. For informational purposes, without reliance thereon, the term "combat fatigue" is "an outmoded term especially common in World War II, now replaced by post-traumatic stress disorder occurring as a result of military combat." American Psychiatric Glossary, 22 (Evelyn M. Stone, ed., 1988). It is uncontroverted that the appellant was exposed to service stressors, as evidenced by his having been granted service connection for shell fragment wounds to the left lower extremity. A critical issue for resolution is whether there is competent evidence indicating that he has a chronic acquired psychiatric disorder in order to constitute a well-grounded claim. Neither the service medical records nor postservice clinical evidence reflect symptoms uniquely characteristic of or a diagnosis for a chronic acquired psychiatric disorder, to include post-traumatic stress disorder/"combat fatigue". Rather, several years after service, a state hospital report dated in 1957 reflects that the appellant's childhood had been chaotic, and he had a long-standing history of difficulties with family and authorities, including a recent prison sentence for theft. The hospital report referred to a psychological evaluation having been conducted. While the psychologic evaluation resulted in an impression of schizophrenic process, there were no complaints or findings of hallucinatory phenomenon or other psychotic behavior, and this impression was not confirmed. Instead, the final diagnosis was sociopathic personality disturbance, antisocial type, manifested by mild depression, long-standing difficulties with authorities, and failure to profit from experience. It should be pointed out that the provisions of 38 C.F.R. § 3.303(c) (1994) preclude a grant of service connection for personality disorders. On VA psychiatric examination in May 1991, the appellant reported that although he occasionally dreamt about the Korean War, this was "very infrequently and does not really bother me." Moreover, the examiner, after noting the appellant's expressions of boredom, avoidance of people, flattened affect, hostile, apathetic demeanor, and history of sleep difficulties, concluded that his physical limitations were likely frustrating to him, but "there is no real, significant psychopathology." It is of considerable import that the examiner neither found nor diagnosed a chronic acquired psychiatric disorder. Parenthetically, the majority of the appellant's symptoms were consistent with the sociopathic, antisocial-type personality he was previously diagnosed as having in the 1950's. Psychiatric nomenclature set forth in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (3rd ed. 1987) (hereinafter DSM-III), are referred to and adopted by 38 C.F.R. § 4.125 (1993). DSM-III states: People with Antisocial Personality Disorder tend to be irritable and aggressive....Despite the stereotype of a normal mental status in this disorder, frequently there are signs of personal distress, including complaints of tension, inability to tolerate boredom, depression,....Almost invariably there is a markedly impaired capacity to sustain lasting, close, warm, and responsible relationships....Id., 342-343. It is further significant that on VA general medical examination in February 1994, the examiner clinically noted that the appellant had no psychiatric problems, and a psychiatric disorder was not diagnosed. 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 a clear diagnosis of post-traumatic stress disorder/"combat fatigue" or any other chronic acquired psychiatric disorder. The appellant is not qualified to offer medical opinion or diagnosis. Espiritu v. Derwinski, 2 Vet.App. 492 (1992). Since there is no competent or credible evidence of a chronic acquired psychiatric disorder, including post-traumatic stress disorder/"combat fatigue" in service or proximate thereto, or reasonably related to service, the claim is not well-grounded. Grottveit v. Brown, 5 Vet.App. 91 (1993); Grivois v. Brown, 6 Vet.App. 136 (1994). As the Court aptly stated in Grivois: Section 5107(a) of title 38 unequivocally places an initial burden on a claimant to produce evidence that the claim is well grounded....This statutory prerequisite reflects a policy that implausible claims should not consume the limited resources of the VA and force into even greater backlog and delay those claims which--as well grounded--require adjudication. This policy is starkly clear when one reads the specific reiteration of that requirement in § 5107(b) of title 38. Therefore, since the appellant's claim is not well grounded, to afford him a VA psychiatric examination for the purpose of determining whether he might presently have a psychiatric disorder is unwarranted. B. Service Connection for Bilateral Hip Disability The appellant alleges that he has chronic bilateral hip disability. However, neither the service medical records nor postservice clinical evidence reflect the presence of definite chronic bilateral hip disability. While on VA examination in June 1991, more than three and a half decades after service, he complained of weakness of the hips with ambulation, x-rays of the hips were negative. Arthralgia of the hips was diagnosed. In Lichtenfels v. Derwinski, 1 Vet.App. 484, 488 (1991), the Court referred to the medical definition of arthralgia as "pain in a joint." Service connection may be granted for chronic disease or disability, not subjective complaints or acute symptoms. Rabideau v. Derwinski, 2 Vet.App. 141 (1992). Since there were no clinical findings of hip pathology, and arthralgia is a subjective complaint, not a disease or disability, his claim that he has chronic disease or disability of the hips is not shown to be well grounded based upon this examination. Subsequent private medical records dated in 1991 and 1992 and a February 1994 VA examination report reflect that the appellant complained of painful hips with ambulation, and clinical findings revealed bilateral peripheral vascular (atherosclerotic) disease. In particular, the February 1994 VA examination report related symptoms of claudication-type pain with ambulation, and diagnosed bilateral hip pain secondary to ischemia. It should be pointed out that service connection is not in effect for peripheral vascular (atherosclerotic) disease or ischemia. Since there were no clinical findings of hip pathology, and arthralgia is a subjective complaint, not a disease or disability, his claim that he has chronic disease or disability of the hips is not well grounded based upon this evidence either. While a July 1994 VA orthopedic examination report contained a diagnosis of mild degenerative joint disease of the left hip, the actual radiographic report of the left hip, as interpreted by the radiologist, made no reference to any bony pathology or arthritis of the hip. Rather, the report related some arteriovascular calcification and other incidental findings, but no bony pathology of the hip. In this regard, degenerative arthritis is required to be confirmed by x-ray findings, as the provisions of 38 C.F.R. Part 4, Code 5003 (1994) indicate. Arthritis is a disease which may be presumed to have been incurred in service, even though there is no indication of such disease during a period of service, if the disease becomes manifest to a degree of 10 percent within one year from date of termination of such service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1994). Service connection may be granted for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Assuming arguendo that arthritis of the appellant's left hip is manifested, it was initially shown more than four decades post service, at a time too remote to be reasonably related to service. Moreover, there is no medical evidence that links any chronic hip disease or disability to his military service, shows arthritis of the hip manifested within the one-year presumptive period post service, or shows a causal or etiological relationship exists between chronic hip disease or disability and his service-connected disability. The appellant is not qualified to offer medical opinion or diagnosis. Espiritu. Since there is no competent evidence of a chronic bilateral hip disability in service or proximate thereto, reasonably related to service, or causally or etiologically related to a service-connected disability, the claim is not well- grounded. Grottveit; Grivois. C. Service Connection for Varicose Veins of the Right Leg The appellant argues that varicose veins of the right leg developed after the service-connected left thigh disability caused him to favor the right leg. Neither the service medical records nor postservice clinical records for decades after service reflect any varicose veins of the right lower extremity. In fact, the earliest evidence of varicose veins of the right lower extremity was not shown until VA examination in February 1994, more than four decades post service. There is no medical evidence relating his varicose veins of the right leg to military service, or that shows a causal or etiological relationship between his varicose veins of the right leg and a service- connected disability. Even assuming for sake of argument that a service-connected left lower extremity disability produced gait impairment, causing him to favor the right leg, there is no competent evidence indicating that this was a causal or etiological factor in the development of his varicose veins of the right leg. Moreover, it appears from the evidentiary record that peripheral vascular disease of atherosclerotic etiology has been diagnosed, that his claudication-type pain involved both lower extremities and was medically attributed to circulatory problems, and that this appears to have been the primary reason for his gait impairment. See reports of VA examinations dated in June 1991 and February and July1994, and private medical records dated in October 1991 and March 1992. It is reiterated that there is no competent evidence indicating that the appellant's service-connected left lower extremity disability was a causal or etiological factor in the development of his varicose veins of the right leg. Again, the appellant is not qualified to offer medical opinion or diagnosis. Espiritu. Since the appellant's varicose veins of the right leg have not been shown by competent evidence to have been present in service or proximate thereto, reasonably related to service, or causally or etiologically related to a service-connected disability, the claim is not well-grounded. Grottveit; Grivois. II. An Increased Rating for Residuals of a Wound of the Left Distal Thigh The Board finds that the appellant's claim with respect to the issue of an increased rating for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII, 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 residuals of his left distal thigh wound over the years are documented in the medical evidence. The service medical records adequately detail the circumstances and nature of the left distal thigh wound and treatment therefor. In response to a request by the RO for any relevant treatment reports, in a March 1991 letter, the appellant informed the RO that there were no available private medical records from his physician, since he was deceased. However, in October 1991, the appellant sent the RO private medical records from other physicians dated in late 1991 and early 1992, which had been prepared in connection with a Social Security Administration disability claim or related matter. However, these medical records pertain primarily to disability for which service connection is not in effect. Pursuant to the Board's June 1994 remand, a VA examination was conducted in July 1994, which is sufficiently detailed and comprehensive regarding the nature and severity of the disability in issue. Whether the examiner on that examination or prior VA examinations actually reviewed the claims folder prior to their examinations of the appellant is unclear. Regardless, the examination reports are sufficently detailed and comprehensive regarding the current nature and severity of the left distal thigh wound residuals, and they provide a clear picture of all relevant symptoms and findings. As the Court stated in Francisco v. Brown, 7 Vet.App. 55, 58 (1994), "Where...an increase in the disability rating is at issue, the present level of disability is of primary concern." Given the rather minor wound to the left distal thigh that the appellant incurred in service, the subsequent evidence documenting a relatively static level of healing of the scar residuals thereof, and the absence of any evidence in this case that any assumed failure to review the entire claims folder prior to examination was material or precluded the examiner from providing an adequate examination to assess present level of disability for rating purposes, 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 under the VA's Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The Board has reviewed the entire history of the service-connected left distal thigh wound, particularly as it affects the ordinary conditions of daily life, including employment, as required by 38 C.F.R. §§ 4.1, 4.2, 4.10 and other applicable provisions. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). The appellant's service medical records reveal that in September 1951, he sustained a penetrating shell fragment wound to the left thigh and leg when struck by grenade fragments. The wounds were debrided and sutured. He was returned to duty approximately a month later. In September 1952, he was placed on physical profile for scar tissue residuals of those wounds, limiting strenuous activities. However, the report of examination for service separation dated in August 1953 noted a shell fragment wound scar of the lateral lower third of the left thigh, and described it as "virtually asymptomatic now save for slight pain and occasional stretching sensation." In his original application for disability benefits received in December 1957, the appellant made no mention of receiving any treatment post service for residuals of that wound. A VA examination report in June 1991 reflects complaints of pain and weakness of both lower extremities on ambulation, and he limped and used a cane. He did not have specific complaints regarding the left thigh wound itself. Significantly, the left thigh wound was clinically described as manifested by a well-healed, asymptomatic scar just above the knee. There was some evidence of atrophy of the left lower extremity at and below the knee. The left knee had normal range of motion, and the left hip no more than slight limitation of motion. See 38 C.F.R. § 4.71, Plate II (1994). Subsequent private clinical records in 1991 and 1992 and a VA examination in February 1994 primarily reported that peripheral vascular disease of atherosclerotic etiology had been diagnosed, and that his claudication-type pain involved both lower extremities and was medically attributed to circulatory problems. This circulatory disability for which service connection is not in effect appears to have been the primary reason for his gait impairment. In fact, on the February 1994 VA examination, he reportedly required use of a walker, despite the finding of a well-healed left thigh scar. In this regard, a disability for which service connection is not in effect may not be considered in evaluation of this claim. A report of VA orthopedic examination in July 1994 reflects that the appellant stated his left thigh wound was well-healed, but that he had pain and cramps in that extremity. Clinically, he ambulated with a slight limp favoring the left lower extremity. The left distal thigh wound scar was described as well-healed and nonadherent, although some pain on palpation thereof was reported. Significantly, the wound area had no muscle tissue loss or tendon damage; and there was no inflammation, swelling, or limitation of function attributable thereto. Moreover, the left knee had full range of motion, and normal muscle strength of the left lower extremity was reported. Radiographic findings were consistent with a retained metallic foreign body in the posterior aspect of the distal thigh. A 10 percent evaluation is the maximum evaluation assignable under Diagnostic Codes 7803 and 7804, respectively, for superficial, poorly nourished scars with repeated ulceration, or for superficial scars which are tender and painful on objective demonstration. Scars may be evaluated on the basis of any related limitation of function of a bodily part which they affect. 38 C.F.R. Part 4, Code 7805. Since the left distal thigh wound scar is well-healed and, although somewhat painful, has been clinically described as not productive of significant functional limitation, an evaluation in excess of 10 percent would not be warranted under these codes. A 10 percent evaluation may be assigned for moderate injury to Muscle Group XIII (posterior thigh group). A 30 percent evaluation requires moderately severe injury. A 40 percent evaluation requires severe injury. 38 C.F.R. Part 4, Code 5313. Since the service-connected left distal thigh wound is manifested primarily by a well-healed, nonadherent scar without evidence of residual muscle fascial defect or muscle tissue loss, or significant impairment of function attributable thereto, the left distal thigh wound residuals cannot be reasonably characterized as more than moderate in degree. 38 C.F.R. Part 4, §§ 4.7, 4.56, Code 5313. The present degree of pain reasonably attributable to the appellant's service-connected left distal thigh wound, to wit, basically pain on palpation of the residual scar, is contemplated by the 10 percent evaluation assigned. 38 C.F.R. Part 4, §§ 4.10, 4.40, Code 5313. Rating disabilities is not an exact science, as indicated by the Schedule for Rating Disabilities: The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disabilities. 38 C.F.R. § 4.1. The clinical evidence does not show that the left distal thigh wound residuals present 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). The residuals of the left distal thigh wound have not been shown to result in any significant functional impairment, have not required frequent hospitalizations, and, in and of themselves, do not markedly interfere with employability. See reports of VA examinations dated in June 1991 and February and July1994, and private medical records dated in October 1991 and March 1992, reflecting gait impairment with claudication-type pain involving both lower extremities medically attributed to circulatory problems, not the service-connected left thigh disability. Since the preponderance of the evidence is against allowance of an evaluation in excess of 10 percent for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII, the benefit of the doubt doctrine is inapplicable. 38 U.S.C.A. § 5107(b). ORDER The appellant's claims of entitlement to service connection for a psychiatric disorder, claimed as "battle fatigue," a bilateral hip disability, and varicose veins of the right leg are not well- grounded, and therefore, the appeal as to these issues is dismissed. An evaluation in excess of 10 percent for residuals of a shell fragment wound of the left distal thigh, Muscle Group XIII, 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.