BVA9503603 DOCKET NO. 92-20 529 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for an acquired psychiatric disorder, to include Post Traumatic Stress Disorder (PTSD). 2. Whether the decision of the Board of Veterans' Appeals of December 1989, denying service connection for a psychiatric disorder was clearly and unmistakably erroneous. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Sandra L. Smith, Associate Counsel INTRODUCTION The veteran had active service from June 1943 to December 1945. This appeal is before the Board of Veterans' Appeals (the Board) from a July 1992 rating decision of the Regional Office (RO) which reopened the veteran's claim and denied service connection for an acquired psychiatric disorder, to include PTSD. In a decision of the Board of December 1989, service connection was denied for a psychiatric disorder. That decision did not specifically discuss PTSD. The veteran has applied to reopen a claim for service connection for an acquired psychiatric disorder, including PTSD. The RO, while not fully articulating this fact, has apparently found that new and material evidence has been submitted to reopen the claim as the RO undertook de novo review of the claim. See 38 U.S.C.A. § 7105; 38 C.F.R. § 3.156; Manio v. Derwinski, 1 Vet.App. 140 (1991); Colvin v. Derwinski, 1 Vet.App. 171(1991). In view of this apparent determination of the RO the Board will also render de novo consideration of this issue. Based on arguments made during the course of the appeal, it was concluded that a claim for clear and unmistakable error in the December 1989 Board decision was being raised. That issue was administratively Remanded to the RO. The case has now been returned to the Board for appellate resolution of the issues set forth on the title page. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that a psychiatric disorder, to include PTSD, was acquired as a result of his active military service. The veteran reports that he experienced mental anguish and stress during service, particularly during the Battle of the Bulge. He continued to experience psychiatric symptoms following his discharge from service which initially prevented him from working. He has continued to suffer with this condition to the present time. The veteran further contends that the December 1989 decision of the Board contains clear and unmistakable error. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claim for service connection for an psychiatric disorder, to include PTSD. It is the further decision of the Board that the claim for clear and unmistakable error must be dismissed for lack of legal jurisdiction. FINDINGS OF FACT 1. All relevant available evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The service medical records contain no evidence of an acquired psychiatric disorder. 3. The veteran was treated for psychiatric symptoms approximately 4 years after his discharge from service. 4. The veteran has never had a clear medical diagnosis of PTSD. 5. The veteran's acquired psychiatric disorder is currently diagnosed as bipolar disorder, mixed type, severe degree. 6. The veteran does not have an acquired psychiatric disorder, to include PTSD, which is related to any in-service event or occurrence. 7. Final decisions of the Board are not subject to collateral review for clear and unmistakable error under 38 C.F.R. § 3.105(a). CONCLUSIONS OF LAW 1. An acquired psychiatric disorder, to include PTSD, was not incurred in or aggravated during service, and may not be presumed to have been incurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1994). 2. The claim for clear and unmistakable error is without legal merit. 38 C.F.R. § 3.105(a) (1994); Smith v. Principi, 3 Vet.App. 378 (1992), reversed sub nom., Smith v. Brown, 35 F.3d 1516 (Fed. Cir. 1994); Sabonis v. Brown, 6 Vet.App. 426 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Claim of clear and unmistakable error in prior decision of the Board The claims folder contains a number of written statements in which the veteran has alleged that the Board's decision, dated in December 1989, contained a number of mistakes of fact which affected the ultimate decision of the Board. In an administrative Remand, dated in June 1993, the Board recognized these statements as claim(s) of clear and unmistakable error in a prior Board decision under 38 C.F.R. § 3.105(a). 38 C.F.R. § 3.105(a) provides, in pertinent part, that Previous determinations which are final and binding, including decisions of service connection, degree of disability, age, marriage, relationship, service, dependency, line of duty, and other issues, will be accepted as correct in the absence of clear and unmistakable error. Where evidence establishes such error, the prior decision will be reversed or amended. . . In a recent decision, the United States Circuit Court of Appeals held that this regulation did not apply to prior final decisions of the Board, but applied rather to RO determinations. See Smith v. Brown, 35 F.3d 1516 (Fed. Cir. 1994). Thus the veteran's claim for clear and unmistakable error in a Board decision is without legal merit and should be dismissed. Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). Entitlement to service connection for psychiatric disorder A person who submits a claim for benefits has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. 38 U.S.C.A. § 5107. After reviewing the evidence on file we conclude that the veteran's claim for service connection for a psychiatric disorder is well grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the claim presented is not inherently implausible. Furthermore, we conclude that all facts pertinent to the plausible claim have been developed and that as such, there is no further duty to assist in developing the claim as contemplated by 38 U.S.C.A. § 5107(a). The Board must determine whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either case, or whether the preponderance of the evidence is against the claim, in which case, service connection must be denied. Gilbert v. Derwinski, 1 Vet.App. 49 (1990). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. § 1110. Service connection may also 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. § 1113(b); 38 C.F.R. § 3.303(d). In addition, where a veteran served ninety (90) days or more during a period of war, and a psychosis becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113; 38 C.F.R. § 3.307, 3.309. With chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 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). In addition to the above, service connection for PTSD requires medical evidence establishing a clear diagnosis thereof, credible supporting evidence that the claimed in-service stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed in-service stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that he was awarded a combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed in-service stressors. 38 C.F.R. § 3.304(f). A review of the veteran's service medical records, including the service separation examination report dated in December 1945, revealed no evidence of any psychiatric disorder or disease. The veteran is not shown to have incurred any wounds in service. In February 1946 the veteran filed a claim for VA benefits noting problems with his nerves since 1944. A letter from a private physician, dated in February 1946, indicated that he had treated the veteran for inflammatory rheumatism and myocarditis as a complication. The veteran had been extremely nervous all the times that the doctor had treated him. The veteran submitted an affidavit in February 1946 that he had served principally as a radar operator in World War II but had also been attached to a gun outfit in December 1944. He recalled that during December 1944 he was under great strain for days at a time. He claimed that in approximately October 1944 his nerves had begun to bother him so that he could not sleep well. Service connection was denied for nervousness by rating decision of April 1946. It was held to be not shown by the evidence of record. A summary of private treatment, dated in May 1948, shows that the veteran's physical findings were rather indefinite. An X-ray study of the stomach did not demonstrate any ulcer. The colon appeared to be spastic. The diagnosis was "apparently a functional disturbance." A VA hospital summary shows that the veteran was hospitalized from April 1949 to June 1949, with complaints of weakness, headache, pains in the chest and legs, spots before his eyes, sour stomach, and post prandial vomiting for approximately three years. He had a burning sensation in the epigastric region with nausea and vomiting soon after eating for the past two years. He had seen various doctors, some of whom had diagnosed "nervous stomach", others had diagnosed ulcer. It was noted that he was never in actual combat while in service. The veteran explained that while he was overseas he knew that he had made a woman pregnant. When he returned home after service he was "persuaded to marry this woman." He and his wife had three children; the youngest was a few months old. He had a negative physical examination with normal x-ray and gastrointestinal series. He was treated with subshock insulin therapy. It was noted that after a period of time he began to get a good sedation affect from the insulin, but remained tense, sensitive, and definitely non-communicative. He improved slowly but remained unwilling to discuss his life situation. The final diagnosis was a moderate chronic anxiety reaction with somatization features. Significantly, no clinical findings on this hospital summary attribute an nervousness to military service or any experience therein. A more comprehensive "Admission History and Physical Examination" is also on file. The clinical history was reported. Again, no reference was made to nervousness since wartime experiences. The veteran was a farmer. He thought his life situation was improving at the present time. He was described as obviously neurotic. The impression was of an anxiety reaction, moderately severe, with asthenic and conversion features. A VA hospital summary, dated in October 1951, noted that the veteran was hospitalized for a few days for treatment of hypertrophy of tonsils, due to infection. The report contained no information as to any complaints or findings of a psychiatric disorder or disability. Medical records from a private hospital, dated in July 1969, show that the veteran was hospitalized with complaints of a nervous stomach and abdominal pain. The final diagnosis was mucous colitis. An anxiety state was also noted, the veteran reportedly was taking his brother-in-law's nerve medication. Hospital records from a private hospital show that the veteran was hospitalized from August 1984 to September 1984. For three weeks prior to admission the veteran had reportedly had a marked increase in activity, speech, speed of speech, and energy, along with a rather marked decrease in his sleep. The family denied any previous similar behavior, other than a period of depression in about 1947 which resulted in inpatient psychiatric treatment and shock therapy. He had been inclined to be somewhat depressed and a chronic worrier over the years, but always subclinical. At the time of admission the veteran appeared obviously somewhat grandiose and to be perceiving himself as having some special relationship with God which suggested delusions of a grandiose nature. His mood was obviously euphoric. Psychological testing was felt to be consistent with bipolar affective disorder (manic phase), possible presenile dementia, rule out organic affective disorder and dysthymic disorder. He was treated with various psychotropic drugs and seemed to do well with Lithium Carbonate at the end of his hospitalization. The final diagnostic impression was bipolar affective disorder, manic phase. Another private hospital discharge summary showed that the veteran was again hospitalized from October to November 1984 for depression with multiple vegetative problems. Electric shock treatment was performed. The veteran responded very well. The final diagnostic impression was bipolar affective disorder, depressed phase, with mood congruent psychosis. A statement from the veteran's private psychiatrist, dated in February 1987, indicated that the veteran had been under his care since the August 1984 admission. He had required continued treatment with Lithium Carbonate as well as with the tricyclic antidepressants. The veteran had related that the genesis of his depression was in the 1940's and described how during the latter part of his military service he became increasingly depressed and anxious. This continued and eventually led to treatment with shock therapy. The doctor further stated that: Personally I do believe that from what I have learned from the [veteran] and his wife about his past, and what I have personally witnessed in my own work with the gentleman in recent years, he truly does have a bipolar affective disorder which is manifested in both periods of severe depression and in periods of mania. The events of the 1940's I believe did represent the first appearance of his affective problems in significant form and probably did represent a depressed phase of his bipolar disorder. A letter from the veteran's private physician, dated in March 1987, indicated that the veteran allegedly had trouble with his stomach, colon, and nerves while in service. He was first seen by this physician in July 1970, at which time he was having depressive symptoms and irritable bowel symptoms with persistent nervousness and depressive symptoms. He had retired at age 60 because of the severity of the symptoms. The doctor had last seen the veteran in February 1987 when he seemed quite tense. It was his opinion that the veteran still had bipolar affective disorder though partially controlled. Two written statements from a sister and friend, dated in May 1987, indicate that the veteran was different when he returned from service. He seemed to be very nervous and had trouble with his stomach. A written statement from the veteran, dated in July 1987, indicated that he was on the waiting list for one year before he was finally admitted to the VA hospital in 1949 for psychiatric treatment. In the interim he was treated by local doctors, now deceased. In a letter, dated in August 1987, the veteran's wife stated that the veteran was a normal young man prior to service, but an entirely different person after his return. She reported that he had a nervous condition with ringing in his ears, racing heart, headaches, hyperventilation and stomach problems. He had worked for a company before service but was not physically or mentally able to return to work following service. He reportedly went from 195 pounds to 155 pounds. They sought treatment from private and VA medical facilities. After being hospitalized for two months at the VA hospital his weight returned and he was able to retain food. He was also able to return to his pre-war employment. However, his nervous condition and colitis never changed. Two written statements from friends of the veteran, dated in September 1987, indicated that the veteran had appeared normal prior to his service and seemed nervous afterward. The veteran testified at a personal hearing held in March 1988, that he was trained as a radar operator in the service but was subsequently assigned to a 90-millimeter antiaircraft gun. He described his participation in the Battle of the Bulge, in which he fired on enemy troops and missiles. He described viewing dead soldiers and destroyed equipment. He stated that throughout his military service, he was homesick, scared and nervous. He related that his nervous condition and stomach problems began toward the end of his service; however, he did not seek treatment during service because he was in a hurry to return home. Following service he tried working on a small farm but would lose his food after working for an hour. His pre-service employer initially did not accept him back to work after service. He was not rehired by the company until approximately 4 years after service. His nervousness increased after his discharge from service and he finally saw a local physician who prescribed some medication. The doctor also recommended hospitalization which the veteran refused. The veteran was afforded a VA psychiatric examination in June 1988. The examination report noted that the veteran claimed his nervous problem began during his World War II service. He related that he had received four battle star medals. During service he experienced feelings of tense and jittery, with his stomach knotted, cold sweats, palpitations and numbness around his lips. He stated that he had later developed a stomach ulcer and was advised to go through surgery. His symptoms had continued to the present time. He related periods of depression. After he returned to work for his pre-service employer he remained there until retirement 34 years later. He reportedly last worked in 1983. The veteran also related during the VA examination how, four years earlier, before lithium treatment was begun, he had hyperactivity when he went without sleep for days. During that period he went out on one occasion and just bought a car without concern for the price. On mental status examination, he was alert, oriented, cooperative, normative, and talkative. His affect was broad ranged, stable and normal, with appropriate mood. Rate of speech was normal. Concentration was somewhat impaired, but recall was intact. the psychiatric diagnosis was bipolar affective disorder, mixed, in remission. In a written statement from the veteran, dated in August 1988, he stated that when he returned from World War II, he had to spend all the money he had saved on doctors' bills for treatment for his nerves and stomach problems. He couldn't work. He had to eat a very bland diet. When he first returned he thought just being home would solve his problems; he tried to avoid all doctors. He remembered seeing a destroyed German tank with the severely burned body of a German soldier tied to the front of the tank with barbed wire. In a written statement, dated in September 1988, a neighbor reported that the veteran was very nervous and had lost a tremendous amount of weight after service. He became easily upset and could not handle any pressure. He seemed to do better after the shock treatments until approximately 1971. Since then, the veteran had been unable to handle any little problem, no matter how minor. A letter from a private chiropractor, dated in September 1988, indicated that the veteran was first treated in June 1948 for complaints of low back and left hip pain. He also complained of nervousness, indigestion and colitis which he said was from World War II. He returned for treatments for his nervous condition in June 1951 and August 1966. In September 1988 he returned again for treatment of nervousness, indigestion, and colitis. It was his opinion that the veteran suffered "some form of shock or damage to his nervous system" while in service. Three written statements from the veteran's neighbors, dated in January 1990, indicated that there had been a drastic change in the veteran since service and in recent years, his nervous condition had worsened to the point he became very upset about any little incident. One of the individuals also related how he had also had a nervous problem when he returned from World War II; he remembered seeing the veteran at the doctor's office where he went for treatment. Each time he talked to him the veteran would complain of feeling as if he would explode. A written statement from the veteran, dated in July 1989, indicated that he had been employed at a local industry for approximately 20 months prior to service; he had experienced no medical problems during that time. After discharge from service he was examined by the company doctors and denied re-employment due to his physical and nervous condition. He was treated prior to the VA hospitalization in 1949; however, the doctors are deceased and their medical records unavailable. A written statement from the veteran, dated in January 1990, indicated he was involved in combat during World War II during the Battle of the Bulge. He also described his current symptoms and treatment. He further stated that his psychiatric symptoms were definitely present within one year of his discharge from service. A written statement from the veteran's pastor, dated in August 1991, indicated that he had known the veteran for five years. During that time he had noticed that the veteran was unable to sit through the one-hour church service. A psychiatric evaluation report, dated in March 1992, from a private psychiatrist, indicates that he interviewed the veteran and his wife in March 1992. The veteran gave a history of returning from World War II unable to work and depressed. He had recurrent bouts of fearfulness with nausea and vomiting and developed a syndrome of abdominal pain an diarrhea. He was seen by a family practitioner until he ended up as a psychiatric inpatient at a VA hospital from April to June 1949. He returned home improved. He was employed as a member of the janitorial service for a company from 1950 or 1983 when he retired. The veteran stated that he never really recovered and tended to feel chronically depressed, worrisome and inadequate. He described chronic colitis symptoms for the past 45 years. He stated his current condition as feeling sick, depressed, and emotionally labile. The private psychiatrist noted that during the interview the veteran's presentation was disorganized and he appeared emotionally labile. He was very preoccupied with his wartime experiences and attributed his nervous problems to being involved in the Battle of the Bulge. The examiner's clinical impression was that the veteran carried a diagnosis of major affective disorder, and chronic depression. He now showed evidence of chronic psychiatric defect state consistent with a diagnosis of chronic depression. The veteran gave a clear history of anxiety, depression, insomnia, panic attacks, and phobic reactions onsetting at the time of his service discharge. His symptoms then became more severe and he developed chronic depression and psychophysiologic reactions of colitis. The physician concluded that: It would seem reasonable to classify [the veteran] as suffering from a stress disorder related to his World War II experiences. Commonly, stress disorders at that time were described as psychoneurosis and his condition appears well described by Dr. Hawkins in his letter of July 11, 1948. The veteran was afforded a VA psychiatric examination in May 1992. The examination report indicated that the examiner reviewed the veteran's claims file prior to the interview. The examiner noted that the veteran seemed quite hyper-excitable during the evaluation. His mood was very depressed; his affect was very emotionally labile. There was no evidence of any form of thought disorder. The examiner noted that he had been previously determined to suffer form bipolar disorder, presently treated with Lithium with fair results. The examiner found that the veteran did not describe any symptoms compatible with true PTSD, nor was there any evidence that his bipolar disorder originated while he was in the service. The final diagnosis remained bipolar disorder, mixed type. Private hospital records, dated in March 1993, show that the veteran was admitted and treated for an organic mental disorder NOS and bipolar disorder, manic phase. It was suspected that the veteran's recent treatment with psychotropic medications had led to the impairment in his higher cognitive functioning. The treating physician indicated that prior to admission he had last seen the veteran in 1991; it was reported that the veteran had stopped taking his Lithium in January 1991 and thereafter had a recurrence of mania. The hospital records contained no information as to the original manifestation of the veteran's psychiatric disorder. As stated above, Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service, or when it may be presumed to have occurred in service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113; 38 C.F.R. §§ 3.303, 3.307, 3.309. In addition, service connection for PTSD requires a medical diagnosis, in-service stressor(s), and medical evidence linking the in-service stressor(s) to current symptomatology. The Board finds, based on the evidence of record, that service connection is not warranted for PTSD. The Board finds that there has been no clear medical evidence or diagnosis of PTSD. It is noted that the March 1992 report of the private psychiatrist contained no diagnosis of PTSD although the physician did opine that "it would seem reasonable to classify [the veteran] as suffering from a stress disorder" related to his war experience. In light of the consistent diagnosis of bipolar disorder for many years and the subsequent findings of the VA examiner in June 1992, the Board finds that the evidence fails to show a clear diagnosis of PTSD. Thus, service connection is not warranted for PTSD. The examiner was making the finding apparently based largely on the history provided by the veteran. It is significant that virtually none of the medical records of earlier psychiatric treatment refer to the reported war experiences as a causative agent in the psychiatric disorder now found. That psychiatric disorder is not, by any valid evidence on file, PTSD. The Board further notes that service connection is not warranted for any other acquired psychiatric disorder. The service medical records contain no evidence of any psychiatric disorder or disability. The veteran was hospitalized and treated in 1949 for anxiety reaction and again in 1984 and 1993 for bipolar disorder. There is medical evidence that the veteran might have actually been suffering with bipolar disorder when he was treated in 1949. Nonetheless, there is no clinical evidence or medial opinion in the contemporaneous medical records from the 1940's that the psychiatric disorder was present in service or manifested itself to a compensable degree within one year of his discharge from service. In addition, the Board notes that following his hospitalization in 1949, the veteran was employed for over 30 years and there is no clinical evidence of record of any psychiatric disorder during that time period. The veteran was reportedly seen for non-specific "nervousness" in 1946. This is not, in and of itself, diagnostic of a psychiatric disorder. Nervousness may have many causes, here, it is not shown that the findings were the onset of a psychiatric disorder related to service. When seen in 1949, and again in the 1980's the clinical history provided did not show a nexus between the veteran's wartime service and the onset of psychiatric pathology. In 1949, economic and family matters were deemed to be at issue in the onset of the veteran's complaints. In the 1980's the family noted the episode of depression in the 1940's, but reported no continuing instances of psychiatric impairment leading up to the current change in personality. Similarly, the chiropractor noting a "shock" to the veteran's nevous system does not make a diagnosis, does not provide pertinent findings, and does not provide clinical records to support the recollection. Again, there is no acquired psychatric disorder clinically establshed by this opinion that is related to service. In fact, the VA examiner, reviewing all the records in June 1992 ruled out a service relationship to any psychiatric impairment present. We have reviewed the numerous lay statements on file. Those statements do not provide a basis for allowing this claim. While these people may have the qualifications to report observing personality changes, they do not have the expertise to attribute these changes to an acquired psychiatric disorder, nor do they have the expertise to establish a medical relationship to service. See Espiritu v. Brown, 2 Vet.App. 492 (1992); Grottveit v. Brown, 5 Vet.App. 91 (1993). Morover, many of these recollections are made years after the events in question. In that regard, the records dated proximate to the events in question are considered more credible. In summary, the evidence does not show an acquired psychiatric disorder during service, a psychosis with in 1 year following separation from service, or the presence of PTSD or other psychiatric disorder that can be related to any incident or occurrence in service. Therefore, the Board finds the preponderance of the evidence is against the veteran's claim for service connection for a psychiatric disorder, to include PTSD. As such, the record does not present an approximate balance of positive and negative evidence with respect to the merits of the veteran's claim. Accordingly, the benefit of the doubt is not for application in this case. ORDER Service connection for an acquired psychiatric disorder, to include PTSD, is denied. The claim for clear and unmistakable error in a prior Board decision is dismissed for lack of legal jurisdiction. MICHAEL D. LYON 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.