BVA9500871 DOCKET NO. 91-42 281 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES Entitlement to service connection, including secondary service connection, for an eye disorder. Entitlement to service connection for periodontal disease for the purpose of Class II outpatient dental treatment dental treatment from the Department of Veterans Affairs (VA). Entitlement to service connection for adenitis of the left inguinal area. Entitlement to an increased evaluation for hypertension, currently rated as 10 percent disabling. Entitlement to an increased evaluation for a right foot disorder characterized as metatarsalgia with bunionectomy, fourth metatarsal neck osteotomy, degenerative joint disease and calluses, currently rated as 10 percent disabling. Entitlement to an increased evaluation for a left foot disorder characterized as metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty, degenerative joint disease and multiple calluses, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD Richard V. Chamberlain, Counsel INTRODUCTION The veteran served on active duty from September 1964 to December 1984. This appeal arises from December 1990 and February 1991 rating decisions by the VA Regional Office (RO) in Waco, Texas, that denied service connection for an eye disorder, periodontal disease, and adenitis of the left inguinal area; a rating in excess of 10 percent for hypertension; a rating in excess of 10 percent for a right foot disorder; and a rating in excess of 10 percent for a left foot disorder. The case was remanded to the RO by the Board of Veterans' Appeals (Board) in December 1991 and March 1994 for additional development. The RO returned the case to the Board in November 1994. The Board in its remand in 1991 instructed the RO to adjudicate the veteran's application to reopen claims for service connection for residuals of sebaceous cysts of the left armpit and residuals of boils of the left inner thigh. A January 1993 RO rating decision granted service connection for axillary adenitis and determined that no new and material evidence had been submitted to reopen the claim for service connection for residuals of a boil of the left inner thigh. The veteran was notified of the determinations and did not submit a timely substantive appeal with the determination that he had not submitted new and material evidence to reopen a claim for service connection for residuals of boils of the left inner thigh. 38 C.F.R. §§ 20.202, 20.302(c) (1993). Since one of the two requested benefits was granted, and the second requested benefit was not timely appealed, these matters are not subject to appellate consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has visual problems that are related to his service-connected hypertension, and that he has periodontal disease and adenitis of the left inguinal area that began in service. He requests service connection for an eye disorder, periodontal disease for dental treatment purposes, and adenitis of the left inguinal area. Additionally, he maintains that he has constant pain in his feet and has to take a higher dosage of medication for his hypertension, and requests higher ratings for the hypertension and service-connected foot disorders listed on the first and second pages of this decision. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claims for service connection for an eye disorder and adenitis of the left inguinal area; an increased rating for hypertension; an increased rating for a right foot disorder characterized as metatarsalgia with bunionectomy, fourth metatarsal neck osteotomy, degenerative joint disease and calluses; and an increased rating for a left foot disorder characterized as metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty, degenerative joint disease and multiple calluses. It is also the decision of the Board that the preponderance of the evidence is against the claim for service connection for periodontal disease for the purpose of Class II VA outpatient dental treatment. FINDINGS OF FACT 1. A chronic eye disorder, other than myopia with presbyopia, was not present in service or found after service. 2. Myopia and presbyopia are refractive errors of the eyes and not diseases or injures for VA compensation purposes. 3. Periodontal disease treated in service was not found post- service; the veteran did not apply for periodontal dental treatment within 90 days of discharge from service. 4. Adenitis of the left inguinal area was not present in service or for many years later, and was not caused by an incident of service. 5. Hypertension is manifested primarily by diastolic pressure that is predominantly 100 or more; diastolic pressure of predominantly 110 or more with definitive symptoms is not found. 6. The right foot disorder produces no more than moderate impairment. 7. The left foot disorder produces no more than moderate impairment. CONCLUSIONS OF LAW 1. A chronic eye disorder was not incurred in or aggravated by active service, nor is a chronic eye disorder proximately due to or the result of a service-connected disability. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. §§ 3.303(c), 3.310 (1993). 2. Service connection for periodontal disease for the purpose of Class II VA outpatient dental treatment is not warranted. 38 U.S.C.A. §§ 1110, 1131, 1712 (West 1991); 38 C.F.R. §§ 3.303, 17.123 (1993). 3. Adenitis of the left inguinal area was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1993). 4. The criteria for a rating in excess of 10 percent for hypertension are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, Part 4, Code 7101 (1993). 5. The criteria for a rating in excess of 10 percent for a right foot disorder characterized as metatarsalgia with bunionectomy, fourth metatarsal neck osteotomy, degenerative joint disease and calluses, are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.59, Part 4, Codes 5283, 5284. 6. The criteria for a rating in excess of 10 percent for a left foot disorder characterized as metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty, degenerative joint disease and multiple calluses, are not met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.7, 4.40, 4.45, 4.59, Part 4, Codes 5283, 5284. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran had active service from September 1964 to December 1984. The service medical and dental records show that the veteran was treated for various disorders in service. The report of his medical examination for enlistment into service in September 1964 shows that he had uncorrected visual acuity of 20/20, bilaterally. In October 1965, he complained of a swollen left inguinal node since the prior day. There was also a small amount of whitish ureteral discharge. It was noted that the veteran had acute gonococcal urethritis. In August 1966, he was seen for complaints of boils on the inner left thigh. The boils were noted to be too small to drain at that time. He was advised to treat with hot soaks and return to the clinic if needed. The veteran underwent periodic medical examination in July 1969. His uncorrected visual acuity was 20/20, bilaterally. A dental record shows that the veteran was seen in January 1980 for complaints of bleeding from gums for about a month that had ceased. He was found to have a generalized slight periodontitis with moderate involvement of the maxillary posterior teeth. A dental record, dated in July 1982, notes that the veteran began periodontal treatment plan. Another dental record, dated in July 1982, notes that he had generalized moderate periodontitis. The service medical records show that the veteran underwent physical examination in May 1983. At that time, his right eye uncorrected visual acuity was 20/30 and his left eye uncorrected visual acuity was 20/20. An ophthalmology consultation in December 1983 shows that the veteran was seen for verrucous vulgaris of the left eye. At that time, his corrected visual acuity was 20/20, bilaterally. In November 1984, he underwent medical examination for retirement from service. An eye disorder, periodontal disease, and adenitis of the left inguinal area are not noted on the report of that examination. The service medical records also show that the veteran underwent surgeries to both feet in service and was found to have hypertension. A service department document (DA Form 664) shows that the veteran was advised that he had 90 days from the time of discharge from service to apply for needed dental treatment, and that in December 1984 he signed a statement acknowledging receipt of this notice. The veteran submitted his initial claim for VA compensation in January 1985. In it, he reported no problems with his eyes, teeth or inguinal area. The veteran underwent VA examination in February 1985. He complained of a skin rash in the groin area and of bleeding gums. His skin was normal. His eyes were normal. The diagnoses were hypertension under very good medical control; status postoperative right bunionectomy with decreased motion, but well healed; status postoperative right fourth metatarsal osteotomy, neck, well healed, but with limited motion, shortened; status postoperative left fourth metatarsal osteotomies (twice), neck, well healed, but with limited motion and deformity; status postoperative arthroplasty, left fifth toe, well healed; postoperative degenerative joint disease right fourth metacarpophalangeal joint and left fourth metacarpophalangeal joint; and metatarsalgia of both feet, postoperative. An April 1985 RO rating decision granted service connection for metatarsalgia with bunionectomy, fourth metatarsal neck osteotomy, degenerative joint disease, and multiple calluses, right foot; granted service connection for metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty, degenerative joint disease, and multiple calluses of the left foot; granted service connection for hypertension; and granted service connection for tinea pedis with onychomycosis, bilaterally. The ratings assigned to these disorders were: 10 percent, 10 percent, 10 percent and zero percent, respectively. The ratings were assigned from January 1985 and have remained unchanged since then. A service department record shows that the veteran was seen in April 1990. At that time, his blood pressure was 130 (systolic)/100 (diastolic). In September 1990, the veteran requested service connection for periodontal disease. In the claim for this benefit, he stated that he had had periodontal disease for a long time in service and this disease was again causing him severe dental problems. The veteran underwent VA examination in December 1990. He said that he had visual problems secondary to hypertension, and cysts under the left arm and in the left groin. He complained of headache and fatigue secondary to his hypertension. H said that he had to wear reading glasses and had worn bifocals at work for the last two years. He was not particularly disturbed about the changes in his vision. He stated that he had had a cyst in the left groin that was excised earlier in the year. He complained of difficulty with both feet. On examination of his eyes, the lids, conjunctivae and corneas were normal. Pupillary reaction, ocular movements and field of vision were within normal limits. Optic fundi of undilated eyes appeared to be normal. There were no hemorrhages and no exudate seen. His corrected distant vision of the right eye was 20/30 and the corrected distant vision of the left eye was 20/25. His blood pressure was 152/106, sitting; 150/104, recumbent; and 142/110 standing. Examination of his genitourinary system showed a faint surgical scar in the left groin from excision of inguinal adenitis. Examination of the musculoskele-tal system showed a 5.5-centimeter surgical scar in the dorsum of the right great toe extending down the metatarsal. There was a 4.5-centimeter scar in a similar place on the left fourth toe. The scars were well healed and not tender. No functional defects were noted. His feet and ankles were of normal configuration. There was normal range of motion of the ankle joints. Structure and flexibility of the toes was otherwise normal. Skin, color and temperature, and texture of the feet were normal. There was a marked onychomycosis of almost all the toenails. No warts or calluses were seen. The diagnoses included arterial hypertension; inguinal adenitis; metatarsalgia bunionectomy and fourth metatarsal head osteotomy, degenerative joint disease and multiple calluses of the right foot; metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty and degenerative joint disease and multiple calluses of the left foot; and visual problems secondary to hypertension, not found. X-rays of both feet were compatible with history of previous bilateral surgery as described above, otherwise the radiographs of both feet were negative. The veteran also underwent eye and podiatry consultations at the time of his VA examination in December 1990. At the time of the eye consultation, he complained of visual problems secondary to hypertension. His uncorrected right eye visual acuity was 20/40 plus, correctable to 20/25. The left eye uncorrected visual acuity was 20/30, correctable to 20/20. The assessments were myopia and presbyopia. The VA podiatry consultation in December 1990 noted the veteran's complaints of painful feet. It was noted that various insoles were issued to him with no relief. On examination, he said he had pain in both heels and both fifth toes. He had no complaints in the area of his previous surgery. Examination showed he had low arches with well-healed dorsal medial scars over the first metatarsophalangeal joint of the right foot and over the fourth metatarsophalangeal joint of both feet. There was a clavus formation over the dorsolateral aspect of both fifth toes at the level of the proximal phalangeal head. Pain was elicited on the plantar medial aspect of both heels. Vascular examination revealed the dorsalis pedis and posterior tibial pulses were 4/4. Skin color, temperature, and texture were all within normal limits. Neurological examination revealed no sensory loss. There was no indication of a Morton's neuroma. Musculoskeletal examination showed that the range of motion in the first metatarsophalangeal joint of the right foot was limited, and the range of motion in the fourth metatarsophalangeal joint of both feet was limited, but with no pain in the joints. There were no keratotic lesions under the metatarsal heads that were operated on. When asked to walk, the veteran ambulated easily without a limp. The diagnoses were calcaneodynia or heel pain of both feet, and hammertoe deformity, fifth toe, both feet, with no evidence of metatarsalgia. He was recommended for an extra depth shoe with a Plastizote insole to relieve the heel pain and osteoplasty of the fifth toes to relieve the formation of the clavus formations on both of his fifth toes. A private dental record, dated in March 1992, notes that the veteran was previously seen for emergency treatment. It was noted that an endodontic procedure was completed that had been initiated elsewhere in 1988 on the maxillary left central incisor which at that time supported a three-unit fixed bridge. It was noted that the tooth was also periodontally involved. The veteran underwent VA dental examination in September 1992. He gave a history of no treatment for periodontal disease since discharge from service. He stated that he had been treated for periodontal disease for the last five years of service and that he had no current periodontal problems. Examination showed evidence of previous periodontal surgery. Sulcus depth ranges were from .5 to 1.5 millimeters. There was no bleeding on probing. Tissue color was normal. A bridge replacing tooth number 8 was serviceable, although tissue recession below pontic was approximately 3 millimeters. There was generalized horizontal bone loss of 2 to 3 millimeters of most teeth. The diagnoses included controlled periodontal status. The dentist could not determine if the veteran's current condition of gingiva and bone loss were related to a condition in service. It was noted that his periodontal status was under control. Service department medical records show that the veteran was seen for various disorders in 1992 and 1993. These records show that the veteran was primarily seen for noninsulin-dependent diabetes mellitus. His blood pressure was also recorded on various dates. In 1992, his blood pressure was 150/108. It was noted that his essential hypertension was out of control. Dental records show that his blood pressure was recorded at 145/101 and 140/96 in November 1992. In March 1993, his blood pressure was 150/100. In July 1993, his blood pressure was 152/90. In October 1993, his blood pressure was 180/118. In November 1993, his blood pressure was 182/118. It was noted that he had not taken his medication for hypertension and he was instructed on the importance of complying with his medication program. II. Legal Analysis The veteran's claims are well-grounded, meaning they are plausible. 38 U.S.C.A. § 5107(a) (West 1991). The Board finds that all relevant evidence has been obtained and that no further assistance to the veteran is required to comply with the VA duty to assist him. Id. A. Service Connection for an Eye Disorder In order to establish service connection for a disability, the evidence must show the presence of it and that it resulted from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(b), (d). Secondary service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). The service medical records do not show the presence of a chronic eye disorder, but a physical examination in 1983 showed uncorrected visual acuity of 20/30 in the right eye. The only other problem noted with the eyes in service was an acute skin condition of the left eyelid that was found on ophthalmology consultation in December 1983, but at the 1983 ophthalmology consultation, the veteran's corrected visual acuity was 20/20, bilaterally (normal), and at the VA examination in 1985, shortly after discharge from service, his eyes were again found to be normal. It was not until 1990 that myopia and presbyopia were found. At the 1990 VA examina-tion, it was unequivocally stated that the veteran did not have visual problems due to his service- connected hypertension. Myopia and presbyopia are refractive errors of the eyes. See Dorland's Illustrated Medical Dictionary 742 (hyperopia), 1012, 1253 (25th ed. 1974). As such, they are not diseases or injures for VA compensation purposes. 38 C.F.R. § 3.303(c). Since the evidence does not demonstrate the presence of any other chronic eye disorder, service connection cannot be granted for such a disorder. Rabideau v. Derwinski, 2 Vet.App. 141 (1992). The veteran claims that records of the Scott and White Clinic show he does not have refractive error, but has hypertensive problems. This claim is rebutted by the VA findings, and is not supported by the cited records. The Board, therefore, concludes that the preponderance of the evidence is against the claim for service connection for an eye disorder. Since the preponderance of the evidence is against the claim for service connection for this disorder, the veteran is not entitled to favorable resolution of this claim using the benefit-of-the-doubt doctrine. 38 U.S.C.A. § 5107(b) (1993); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). This claim must be denied. B. Service Connection for Periodontal Disease While the veteran was treated for periodontal disease in service, this disease was not found on VA dental examination in 1992. At the 1992 VA dental examination the veteran reported no periodontal problems and none were found. Since this disease is not currently demonstrated, service connection for it may not be granted. Rabideau, 2 Vet.App. 141. In any event, periodontal disease may only be service-connected for determining entitlement to VA dental examination or outpatient dental treatment. 38 C.F.R. § 4.149, 59 Fed. Reg. 2530 (Jan. 18, 1994). In order to qualify for Class II VA dental examination or outpatient dental treatment for periodontal disease, the veteran had to apply for this benefit within 90 days of discharge from service which he did not do. 38 U.S.C.A. § 1712; 38 C.F.R. § 17.123(b)(1). The evidence indicates that he was advised of this requirement by the service department at the time of his discharge from service, and that he signed a statement acknowledging receipt of this notice. See Mays v. Brown, 5 Vet.App. 302 (1993). Under the circumstances in this case, the Board finds that the evidence is not in relative equipoise concerning the claim for service connection for periodontal disease for Class II VA outpatient dental treatment. Therefore, he is not entitled to favorable resolution of this claim based on reasonable doubt. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49. The preponderance of the evidence is against the claim for this benefit, and it must be denied. C. Service Connection for Adenitis of the Left Inguinal Area The service medical records do not reveal the presence of adenitis of the left inguinal area, and the post service records do not demonstrate the presence of this disorder until the veteran's VA examination in 1990, many years after the veteran's discharge from service. At the 1990 VA examination, the veteran reported that he had a cyst in the groin area excised earlier in 1990, and on genitourinary system examination there was only a faint surgical scar in the left groin area from excision of an inguinal adenitis. There is no reliable evidence linking the veteran's adenitis of the left inguinal area found after service to any incident of service. Since adenitis of the left inguinal area was not present in service or for many years later, and there is no reliable evidence linking this disorder to an incident of service, the Board concludes that the preponderance of the evidence is against the claim for service connection of this disorder. Thus, the veteran is not entitled to favorable resolution of this claim based on reasonable doubt. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49. D. Increased Evaluation for Hypertension In order to establish entitlement to a higher rating for a service-connected disability, the evidence must show symptoms of the disorder which meet or more nearly approximately the criteria for higher ratings under the appropriate diagnostic codes in the Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.7. A 10 percent evaluation is warranted for hypertensive vascular disease (essential arterial hypertension) where the diastolic pressure is predominantly 100 or more. A minimum 10 percent evaluation is also assigned when continuous medication is shown necessary for the control of hypertension and there is a history of diastolic blood pressure of predominantly 100 or more. A 20 percent evaluation requires diastolic pressure of predominantly 110 or more with definite symptoms. 38 C.F.R. Part 4, Code 7101. The evidence indicates that the veteran treats his hypertension with medication and that this medication is not always timely taken. His blood pressure in the 1990's has been predominantly less than 110, and occasionally over 110, but the overall evidence does not indicate the presence of diastolic blood pressure of predominantly 110 or more with definite symptoms. Under these circumstances, a 20 percent rating is not warranted for hypertension under Diagnostic Code 7101. An extraschedular rating is not appropriate for the hypertension, as frequent hospitalization or marked interference with employment is not shown due to this disorder. 38 C.F.R. § 3.321. Accordingly, the Board finds that the current 10 percent rating for hypertension best represents the veteran's disability picture and that the evidence is not in relative equipoise concerning the claim for a higher rating for this disorder. Thus, he is not entitled to a favorable resolution of this claim based on reasonable doubt. 38 U.S.C.A. § 5017(b); Gilbert, 1 Vet.App. 49. The preponderance of the evidence is against the claim and it must be denied. E. Increased Rating for a Right Foot Disorder Characterized as Metatarsalgia with Bunionectomy, Fourth Metatarsal Neck Osteotomy, Degenerative Joint Disease and Calluses; and a Left Foot Disorder Characterized as Metatarsalgia with Fourth Metatarsal Neck Osteotomies, Fifth Toe Arthroplasty, Degenerative Joint Disease and Multiple Calluses Moderate malunion or nonunion of the tarsal or metatarsal bones warrants a 10 percent evaluation. A 20 percent evaluation requires moderately severe malunion or nonunion. 38 C.F.R. Part 4, Code 5283. Moderate residuals of foot injuries warrant a 10 percent evaluation. A 20 percent evaluation requires moderately severe residuals. 38 C.F.R. Part 4, Code 5284. The evidence shows that the veteran has constant pain in his feet and that he has obtained no relief from various insoles that were issued to him by VA. A VA podiatry consultation in 1990, however, indicates no significant problems with his feet other than heel pain and clavus formation on both of his fifth toes. While he has scars on his feet, they are well healed and not tender. The report of his VA examination in 1990 indicates normal range of motion of the ankle joints and no significant limitation of the toes. Nor does the evidence indicate any significant functional defects, such as a limp, attributable to the painful feet. While marked onychomycosis of almost all the toenails was found at the 1990 VA examination, this symptomatology may not be considered in evaluating the right and left foot disorders because service connection has been granted for a skin disorder of the feet and a separate evaluation assigned for this disorder. 38 C.F.R. § 4.14 (1993). The evidence does not indicate any malunion or nonunion of the tarsal or metatarsal bones of either foot. After consideration of all the evidence, the Board finds that the symptoms associated with the right and left foot disorders do not produce more than moderate impairment of either foot. Thus, a higher rating for the disabilities of the right and left feet are not warranted under Diagnostic Codes 5283 or 5284. Nor does the evidence show functional limitation of either foot due to pain to establish entitlement to ratings in excess of 10 percent for these disorders. 38 C.F.R. § 4.40, 4.45, 4.59. An extraschedular rating is not appropriate, as frequent hospitalization or marked interference with employment is not caused by the above-noted disorders of the feet. 38 C.F.R. § 3.321. The Board finds that the current 10 percent ratings for the right and left foot disorders best represent the veteran's disability picture and that the evidence is not in relative equipoise concerning the claims for higher ratings for these disorders. Thus, he is not entitled to a favorable resolution of these claims based on reasonable doubt. 38 U.S.C.A. § 5107(b); Gilbert, 1 Vet.App. 49. The preponderance of the evidence is against these claims and they must be denied. ORDER Service connection, including secondary service connection, for an eye disorder is denied. Service connection for periodontal disease for the purpose of Class II VA outpatient dental treatment is denied. Service connection for adenitis of the left inguinal area is denied. An increased evaluation for hypertension is denied. An increased evaluation for a right foot disorder, characterized as metatarsalgia with bunionectomy, fourth metatarsal neck osteotomy, degenerative joint disease and calluses, is denied. An increased evaluation for a left foot disorder, characterized as metatarsalgia with fourth metatarsal neck osteotomies, fifth toe arthroplasty, degenerative joint disease and multiple calluses, is denied. J. E. DAY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.