BVA9503487 DOCKET NO. 92-52 875 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to an increased evaluation for service-connected right knee disorder, currently evaluated as 20 percent disabling. 2. Entitlement to an increased schedular disability rating for service-connected post-traumatic stress disorder (PTSD), currently evaluated as 10 percent disabling. 3. Entitlement to an increased (compensable) schedular disability rating for service-connected non-Hodgkin's lymphoma. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. L. Gann, Associate Counsel INTRODUCTION The veteran had active service from March 1966 to June 1969. This case arises on appeal from November 1990 and June 1991 rating decisions of the Louisville, Kentucky, Regional Office (RO). The veteran appeals the denial of an increased schedular disability rating for his service-connected right knee disorder, as well as the 10 percent and noncompensable schedular disability ratings respectively assigned for his service-connected post- traumatic stress disorder (PTSD) and non-Hodgkin's lymphoma. In May 1992 and July 1993, the Board of Veterans' Appeals (Board) remanded this case for additional evidentiary development. The claims folder was most recently returned and docketed at the Board in January 1995, and the veteran's appeal is now ready for review. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his service-connected right knee disability has increased in severity, resulting in recurrent joint instability and limitation of flexion which has progressively worsened. He asserts, therefore, that this service-connected condition warrants a schedular rating in excess of 20 percent. He also contends that his 10 percent disability evaluation for PTSD, with major depression, is inadequate in light of the nature and severity of his disabling symptoms. Furthermore, he does not understand how the noncompensable rating assigned for his service-connected non-Hodgkin's lymphoma "could be correct." 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 a schedular rating in excess of 20 percent for a service-connected right knee disability is not warranted, that a disability rating in excess of 10 percent for service-connected PTSD is not warranted, and that a compensable schedular disability rating is not warranted for service-connected non- Hodgkin's lymphoma. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The RO granted service-connection for a right knee disorder in August 1976; this disorder is currently evaluated as 20 percent disabling. 3. The veteran's right knee disorder is manifested by intermittent crepitus, swelling, effusion, the presence of at least minimal instability, and subjective complaints of pain. X- rays have noted the presence of degenerative joint disease consistent with traumatic arthritis. 4. The RO granted service-connection for PTSD in June 1991, and assigned a 10 percent schedular disability rating, which remains in effect. 5. PTSD is currently manifested by sleep disturbances, intrusive thoughts, and a hyperstartle response. The most recent Department of Veterans Affairs (VA) examination found no social or industrial impairment resulting from PTSD symptomatology. 6. The RO granted service-connection for non-Hodgkin's lymphoma in November 1990, and assigned a 100 percent schedular rating effective from May 4, 1990, until February 20, 1991, when a noncompensable disability evaluation took effect. 7. The veteran's lymphoma has been in complete remission since May 1990. Complaints of weakness and pain in his upper extremities have not been attributed by neurologists to either his radiation therapy or his lymph node biopsy. CONCLUSIONS OF LAW 1. A schedular disability rating in excess of 20 percent is not warranted for the veteran's service-connected right knee disorder. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5010-5257 (1994). 2. A schedular disability rating in excess of 10 percent is not warranted for the veteran's service-connected PTSD with major depression. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 9411 (1994). 3. A compensable schedular disability rating is not warranted for the veteran's service-connected non-Hodgkin's lymphoma. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7799-7709 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board notes that the veteran's claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). A well grounded claim is a plausible claim, one which is meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990). We are also satisfied that all relevant facts have been properly developed so that further assistance to the veteran is not required. The veteran claims that his service-connected right knee disorder, PTSD, and non-Hodgkin's lymphoma each warrant an increased schedular disability evaluation. His original claim for compensation was received at the RO in March 1976. Service connection for "Tears, medial collateral, anterior cruciate ligaments and medial meniscus right knee, PO with traumatic arthritis by x-ray and tender scar" was granted by the RO in an August 1976 rating decision. A 20 percent schedular disability rating was assigned pursuant to Diagnostic Code 5257, effective from March 18, 1976. In a November 1990 rating decision, the RO granted service connection for "Non-Hodgkin's lymphoma." A 100 percent schedular disability rating was assigned pursuant to Diagnostic Code 7799-7709, effective from May 4, 1990, to February 20, 1991, and a noncompensable rating was to thereafter take effect. This rating action also confirmed the 20 percent rating for the service-connected right knee disorder. The RO granted service connection for "Post-traumatic stress disorder with major depression, competent" in a June 1991 rating decision, and assigned a 10 percent schedular evaluation pursuant to Diagnostic Code 9411, effective from May 4, 1990. The 20 percent rating for a right knee disorder was confirmed. In rating decisions on remand, dated in January 1993 and April 1994, the schedular disability ratings assigned for these three service-connected disorders were confirmed. I. Right Knee Disorder The veteran's right knee disorder is rated pursuant to 38 C.F.R. Part 4, Diagnostic Code 5010-5257 (1994). Diagnostic Code 5010 addresses the disability arising from the presence of traumatic arthritis. Arthritis which is established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint involved. When, however, the limitation of motion of the joint involved is noncompensable under those rating codes, a rating of 10 percent will be applied upon objective confirmation of limited motion by findings such as muscle spasm, swelling, or satisfactory evidence of painful motion. In cases where these objective symptoms result in occasional incapacitating exacerbations, a 20 percent rating will be warranted. Diagnostic Code 5257 addresses general impairment of the knee joint. Slight symptomatology, including joint laxity and/or subluxation, will be granted a 10 percent schedular rating. Moderate symptoms of laxity or subluxation will warrant a 20 percent rating. Severe manifestations of laxity or subluxation will be awarded a 30 percent rating. We also note that pursuant to Diagnostic Codes 5260 and 5261, respectively, knee flexion which is greater than 45 degrees will not warrant a compensable disability rating, and knee extension which is less than 10 degrees will not be granted a compensable evaluation. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7 (1994) The veteran was originally granted service connection for his right knee disorder in August 1976. He submitted his claim for an increased rating for this disability in May 1990, requesting that the VA consider all record compiled since 1975. Although treatment records were obtained from the VA Medical Center (VAMC) in Louisville, these records did not indicate any treatment for the right knee. Private medical records compiled in conjunction with the veteran's treatment for non-Hodgkin's lymphoma do note a history of a right knee injury in service, but made no pertinent medical findings. In July 1990, the veteran did undergo a VA general medical examination, which found palpable effusion of the right knee, with limitation of motion to 120 degrees with crepitus. He also exhibited "minimal" lateral instability of the right knee. The diagnosis was a right knee injury, status postoperative, medial meniscectomy, with minimal lateral instability. He was afforded another VA general examination in March 1991. At that time, he complained of increased pain, frequent swelling, decreased mobility, increased nocturnal throbbing, and joint instability occurring approximately three times daily. Examination found that he ambulated well, without a limp, and completed heel and toe walking without difficulty. Flexion was 90 degrees and extension was zero degrees, with no crepitus or deformity found. McMurray's and Drawer's signs were negative. He did exhibit some medial and lateral instability. X-rays noted degenerative changes with narrowing of the medial compartment and spurring of the articular margins consistent with traumatic arthritis. Joint effusion was also indicated. The ultimate diagnosis was degenerative joint disease of the right knee. The most recent VA examination, conducted in August 1993, found mild swelling, but no obvious effusion of the right knee. There was a 2+ Lachman and a 1+ Drawer sign. The right knee joint was stable to varus and valgus stress, with no definite pivot shift. Extension was zero degrees and flexion was 115 degrees. X-rays indicated that the bony structures were well formed. There were, however, moderate to marked osteoarthritic changes in the knee joint, as well as narrowing of the medial joint compartment and the retropatellar space. Osteophytes arose from the distal femur and proximal tibia as well as the posterior aspect of the patella. Evidence of fluid was found within the suprapatellar bursa with evidence of an osteochondral loose body in the joint slight lateral to the more medially placed anterior tibial spine. Upon comparison to the March 1991 films, however, no significant change in appearance was found. After review of the entire record, including the more recent medical evidence, we conclude that a rating in excess of 20 percent is not currently warranted for the veteran's service- connected right knee disorder. We first note that in the course of his three VA examinations, his limitation of knee flexion was not less than 90 degrees, while his limitation of extension was not greater than zero degrees. In light of these findings, he is not eligible for compensable ratings pursuant to either Diagnostic Codes 5260 and 5261. 38 C.F.R. Part 4, Diagnostic Codes 5260, 5261 (1994). Moreover, while the x-ray evidence clearly demonstrates that the veteran suffers from degenerative joint disease of the right knee, he is not eligible for a schedular disability rating greater than 20 percent pursuant to 38 C.F.R. Part 4, Diagnostic Code 5010 (1994). This code provides for a compensable rating for traumatic arthritis, even where the other applicable rating codes for the affected joint, including those concerning limitation of motion, do not allow for a compensable evaluation. VA examiners have also objectively confirmed the presence of symptomatology consistent with limitation of motion, such as joint effusion, and crepitus. We note, however, that even with intermittent exacerbations of these symptoms, the highest schedular rating provided for by this Diagnostic Code is a 20 percent evaluation. The veteran's right knee disorder would warrant a schedular rating of 30 percent if the evidence demonstrates that he suffers severe instability, laxity, subluxation, or other symptomatology consistent with a severe disability pursuant to 38 C.F.R. Part 4, Diagnostic Code 5257 (1994). Such evidence is not presented, however. The July 1990 examination found only minimal lateral instability, crepitus and some palpable effusion. The March 1991 examination did indicate the presence of medial and lateral instability, but also noted that the veteran walked normally both on his heels and on his toes, and did not limp or exhibit any other ambulatory abnormality. In the most recent VA examination, the veteran's right knee joint was found to be "stable to varus and valgus stress" and no definite pivot shift was observed. He had mild swelling of the joint, but no obvious effusion or crepitus. Based upon these findings, we find that the veteran's right knee impairment more nearly approximates the level of a moderate disability. Thus an increase in the veteran's schedular disability rating for his service-connected right knee disability is not warranted. 38 C.F.R. § 4.7, Part 4, Diagnostic Code 5257 (1994). II. PTSD The veteran appeals the denial of an increased schedular disability rating for PTSD. The percentage ratings assigned to service-connected disabilities represent the average impairment in earning capacity resulting from such diseases or injuries, and their residual conditions, in common occupations. The basis of the disability evaluations is to determine the ability of the veteran to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.1, 4.2 (1994). With regard to applicable ratings for mental disorders, adequate reference must be made to social integration, as it provides valuable evidence concerning mental health and reflects the ability and desire to establish healthy and effective interpersonal relationships. However, in evaluating impairment resulting from a ratable psychiatric disorder, social inadaptability is to be evaluated only as it affects industrial adaptability. 38 C.F.R. § 4.129 (1994). Where the veteran's PTSD results in only mild impairment in social and industrial functioning, he will be awarded a 10 percent schedular evaluation. A 30 percent disability is demonstrated by definite impairment of the ability to establish and maintain social contacts and to obtain or retain employment as a result of the manifestations of PTSD. In cases where there is considerable impairment of interpersonal relationships and employability, a 50 percent rating will be warranted. Severe symptoms of social and industrial impairment indicate that a 70 percent disability rating should be conferred. In the situation where all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, and where the veteran suffers from totally incapacitating psychoneurotic symptomatology bordering on gross repudiation of reality, with demonstrable inability to obtain or retain employment, a 100 percent schedular rating will be granted. 38 C.F.R. Part 4, Diagnostic Code 9411 (1994). However, in Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 (1994) was "qualitative" in character, whereas the other rating terms were "quantitative" in character, 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. 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). With these considerations in mind, the Board will address the merits of the claim at issue. The RO's grant of PTSD was based upon the results of a VA psychiatric examination, conducted in April 1991, which initially diagnosed the presence of PTSD. The veteran complained of increasing social withdrawal and isolation, with periodic depression. Although he had a history of drug and alcohol abuse, he denied such use for several years prior to his evaluation. He also noted the presence of flashbacks, intrusive thoughts concerning Vietnam combat, increased irritability and anger, decreased tolerance for frustration, poor sleep patterns, and depression, which he noted was partially due to his battle against non-Hodgkin's lymphoma. He had also been unemployed since his diagnosis of lymphoma. He gave a history of working for several companies which install garage doors. However, due to his agitation and easy irritability, he would often become angry and walk off the job. He always felt that he was being abused by his co-workers and superiors. he also reported a history of more than 15 arrests for problems caused by alcoholism, marijuana abuse, and anger. Examination found that he was oriented times three, with judgment and memory intact. His insight, particularly with regard to his Vietnam experiences, was limited. Intellectual abilities were considered as above average. His affect was both blunted and agitated. The diagnoses were major depression, recurrent, PTSD, and alcohol and marijuana abuse by history. The veteran was afforded another VA psychiatric examination in August 1993. His primary complaints were poor sleep, nightmares, and increased anger. Prior to service, he had a long history of trouble in school, and was expelled. He also noted that he was in trouble "quite a few times" during service and was reduced in rank more than once. After discharge from service, he continued to have difficulties with authorities. He began abusing alcohol and drugs, particularly marijuana approximately one and half years after service. He was arrested at least seven or eight times on drug and alcohol related charges. He did begin seeing a psychiatrist at the Louisville VAMC Mental Health Clinic, but was eventually dropped as a patient due to multiple missed appointments. He indicated that his drug and alcohol abuse have been substantially reduced. However, despite statements to others that he is "off drugs", he acknowledged that his drinking and marijuana smoking continue. He reported that he was in school, studying engineering at the University of Louisville, taking courses in calculus and physics. Objectively, the veteran was fully oriented and alert. He did not display any psychomotor agitation, anger, hostility, or behavioral "dyscontrol." His language and speech were somewhat hostile and angry, but not bizarre or unusual. He was very hostile towards the government and stated that his "problem in life is the government which has screwed me over." He believed that he was not getting due entitlements from the government. His judgment was historically poor and his insight limited, although intellectual functioning was fully intact. The psychiatric diagnoses were: alcohol abuse; polysubstance abuse; PTSD; and a personality disorder, not otherwise specified with passive/aggressive features. In a discussion of his findings, the examiner found no manifestations of social or industrial impairment resulting from PTSD symptomatology, and, moreover, concluded that his findings during the course of the evaluation did not meet the diagnostic criteria for a diagnosis of PTSD. The veteran did display a long history of behavioral problems and trouble with authority figures which predated military service. The examiner opined that the veteran's problems with interpersonal relationships, problems with authorities, and problems with substance abuse, are behavioral or personality problems which clearly predated service and are "not in any way service connected." Although the RO did request the veteran to submit the names and addresses of the facilities where he has received psychiatric treatment, he failed to respond. He had earlier indicated, however, that records might be found at the Louisville VAMC Mental Hygiene Clinic. He admitted in his 1993 VA examination, however, that he had been dropped from treatment at this facility due to excessive missed appointments, and he stated that he had not sought any other psychiatric treatment. Inasmuch as the veteran has not apprised the VA of any other pertinent records or relevant information with regard to this claim, we have complied with our duty to assist him in the development of this issue. 38 U.S.C.A. § 5107(a) (West 1991). On review of the entire record, we find no basis upon which to award a schedular disability rating in excess of the current 10 percent evaluation. The evidence presented simply does not establish that the veteran suffers more than mild impairment of social and industrial functioning due to his PTSD symptomatology. His combat experiences in Vietnam appear to have resulted in sleep disturbances and nightmares, as well as recurrent intrusive thoughts. These symptoms are not, according to VA examiners, the reason for the veteran's long-standing difficulties with substance abuse and interpersonal conflict. According to the veteran's own subjective history, he experienced many problems with anger towards authority figures prior to service, including being expelled from the 8th grade. These difficulties continued both during service, when he was often in trouble with his superiors, as well as after service, when he eventually developed drug and alcohol addictions. He has had difficulty in maintaining employment, changing jobs and relocating on a periodic basis. He has been arrested more than half a dozen times on alcohol and drug related charges, and has resisted treatment at every turn. By his own admission, the statement he made to the 1991 VA examiner that he no longer used drugs and alcohol was false, inasmuch as he has continued to "drink a few beers and smoke a few joints." Despite the most recent VA examination report, which did not find any evidence consistent with the diagnostic criteria for PTSD, we will not dispute the subjective symptoms which the veteran attributes to the presence of this disorder. The most recent examination report makes clear, however, that the veteran's social and industrial impairment is almost entirely attributable to behavior problems and/or a personality disorder which developed years before his entry into service. Moreover, the examiner concludes that the history of drug and alcohol abuse is also the result of these behavior patterns, rather than manifestations of PTSD. The findings of the 1993 examiner are not inconsistent those noted in the 1991 VA examination report. At that time he noted a long history of employment problems and interpersonal difficulties with co-workers and supervisors due to agitation and easy irritability. This statement is consistent with the 1993 examiner's impression of long-term authority-related problems. We also note that, according to the veteran, he had not been employed for many months due to the diagnosis of non-Hodgkin's lymphoma. He also attributed at least part of his recurrent depression to this diagnosis, rather than his PTSD symptomatology. Thus even by the veteran's own admission, his industrial impairment at the time was primarily unrelated to his PTSD. We conclude therefore, that an increased schedular disability rating is not warranted. In light of the most recent VA examination which found no social and industrial impairment resulting from PTSD, coupled with the 1991 examination which found relatively little impairment resulting from this disorder, we find that the veteran's current disability picture in no way approaches the level of a "definite" impairment in functioning required for the award of a 30 percent schedular rating. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 9411 (1994). III. Non-Hodgkin's Lymphoma Non-Hodgkin's lymphoma is rated pursuant to 38 C.F.R. Part 4, Diagnostic Code 7799-7709 (1994), which states that a 100 percent rating is warranted where the disease is an acute (malignant) type or a chronic type with frequent episodes of high fever or febrile episodes with short remissions, generalized edema, ascites, pleural effusion, or severe anemia with marked general weakness. In cases of general muscular weakness with loss of weight and chronic anemia, or secondary pressure symptoms such as marked dyspnea, edema with pain and weakness, or other evidence of severe impairment of the general health, a 60 percent evaluation will be granted. Where the veteran experiences occasional low grade fevers, mild anemia, fatigability, or pruritus, a 30 percent rating will be awarded. A 100 percent rating will be continued for one year following the cessation of surgical, chemical, or radiation therapy. If, after this period, there has been no local recurrence or invasion of other organs, the rating will thereafter be based upon residuals. The veteran's non-Hodgkin's lymphoma was first diagnosed in October 1989, when enlarged lymph nodes were noted in his left neck. A biopsy revealed the presence of an atypical, parafollicular B-cell lymphoma, and this diagnosis was confirmed by a bone marrow examination. CAT scans revealed that the disease was limited to the left neck and he was referred for radiation therapy, which commenced in January 1990 and continued for approximately one month. All lymph nodes from the base of the skull to the subclavicular area on the left were treated, as well as the axillary nodes and supraclavicular nodes. Follow-up reports dated in May 1990 found no residual disease in the lymph nodes and concluded that the cancer was in complete remission. Based upon these findings, the RO assigned a 100 percent schedular disability rating for the veteran's lymphoma from May 4, 1990, the date his claim was received, until February 20, 1991, one year following the cessation of his radiation therapy. A noncompensable rating was thereafter to take effect, as the RO found no residual disability upon which to base a compensable schedular rating for the veteran's lymphoma. We first note that the veteran's non-Hodgkin's lymphoma appears to have remained in total remission since his course of radiation therapy in 1990. Both a VA oncology examination in July 1992, and a VA lymphatic examination in December 1992, confirmed that he had suffered no relapse, nor had any cancerous abnormalities spread to other organs. No evidence has been presented which demonstrates that he suffers from anemia, marked edema, marked weight loss, or other significant impediments to his general health . Thus the record provides no basis upon which to grant the veteran a compensable disability rating based upon the actual presence of lymphoma. In May 1990, however, the veteran reported that he was suffering from residual pain and weakness in his upper extremities, particularly on the left, which he attributed to his radiation therapy or his biopsy scar. He was examined by Dr. M. Grimaldi, a private physician, in May 1990, who arranged for several CT scans and a nerve conduction study to be performed at Baptist East Hospital in Louisville. A cervical CT scan found a bulging of the C4-5 disc posteriorly, and there was a questionable protruding disc at the C5-6 on the right, although some imaging problems precluded certainty of this findings. No central canal stenosis, foraminal narrowing, or paravertebral soft tissue masses were seen, however. The nerve conduction study was performed bilaterally in the upper extremities found abnormalities consistent with bilateral carpal tunnel syndrome, right equal to left. A VA neurology examination, conducted in October 1992, found that sensory, motor system, and reflex testing produced completely normal results, and there was no evidence of any neural radiculopathy emanating from the left side of the veteran's neck. Upon his review of the Baptist Hospital records, the VA examiner ruled out the presence of any compressive neuropathy or radiculopathy, and found that the results were more consistent with entrapment neuropathy at the carpal tunnel level. Although this evidence does establish some medical basis for his complaints of bilateral weakness and pain the upper extremities, these reports do not indicate that the cause of these symptoms is related to radiation therapy received for his non-Hodgkin's lymphoma. The physicians at the Baptist East Hospital found no presence of any neurological abnormality involving the site of his radiation therapy, and also found medical evidence of cervical spine abnormalities, and neurological abnormalities at the carpal tunnel level in both wrists. These findings were confirmed by the VA examiner, who also found no radiculopathy or neuropathy attributable to the veteran's treatment for lymphatic cancer. Therefore, in the absence of evidence demonstrating that the veteran currently suffers from any residual disability associated with non-Hodgkin's lymphoma, or his treatment of this disease, we find no basis upon which to award a compensable disability rating for this condition. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4, Diagnostic Code 7799-7709 (1994). ORDER Entitlement to an increased schedular disability rating for a service-connected right knee disorder is denied. Entitlement to an increased schedular disability rating for PTSD is denied. Entitlement to a compensable schedular disability rating for non- Hodgkin's lymphoma is denied. BETTINA S. CALLAWAY 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.