’WPC¬  
      »     ųLZāA„čļwSUŽ½ŠćŲ!Å/*-ś“Nl¼}ŽODéÕ!øĮ§ĄHS9v§ł«„r”(;Ćė2OģĒ)’ŹCx[7@£”’qYQhw2źļĻn~?±ģ1¦3ĖŅ„U~c\ķIaeł,@0ŪĆĖXÅ±”u\:yź!t>ŪźŲ¼²1"ż¾ł|iDŪ-&}ŗ"ŁäŪć*Å4 ŅO“Ō*Yng8XŅ}Ŗ§ĪæsÓŲ?wŪR\yU;¢å’	š
xĒ#÷ŃćSEs½æ3ł0Ę¹žŪn8ŃŻ±Ļa!óLźgµ&ļ=ø#¼­ś<Ø2±õõXįµź£µ¼ųuHh>ńŻY”;ĆPéųĀÕéræ4Įē ńżŪŁ^ŪlÖ¬ü]Ēō$„N“+o ;ÖOq|ōEļ×ć„@5»©YµŹXT	é2ŗ¢ćĢ?ķā¹Uåå°·C($·ÖKlÜP¢<o1ä0?OR!ē]wZUēĆ32Ń_åé“AyĆI!LÜŚÆ/
2Šųcźń§y¹PÓ2 &            U        #     ,   U      7  	%      O        U  0   (   W  	m           ~     	               0   C   "        e       q        y  	1   m     0   c   ö   !      Y   !     é   !     ł      Ü   	   	      å  w   @   ė  "   ģ  +   !       	)   
   '  4      1   	      E   U   N   K   	         	         U   >   „            „            „            „   U   N   ć   U ! N   1     -     <              ` (     H P   L a s e r J e t   5 / 5 M   -   E n h a n c e d                     HPBXLA       Č Č Č Č Č Č Č Č 0                                                                                                                                                               < 
  9 p` (      X     (                    $ ”   ”               ’U’  ĄĄĄ    O P I N I O N                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
            Ķ8   
 '           U S C V A    0    U S C V A   
 .      
       
       
         Čn      ’S t e i n b e r g ’  ’O ' B r i e n ’  ’H o l c o m b ’  ’M y o r e ’  ’K r a m e r ’  ’I v e r s ’  ’B V A ’  ’S M R s ’  ’S a c a t o n ’  ’P i m a ’  ’E n f o c e m e n t ’  ’M a r i c o p a ’  ’S c h u r z ’  ’S a b o r i ’  ’R e y n o l d ’  ’R a m i r e z ’  ’7 p m ’  ’2 5 t h ’  ’5 : 1 5 a m ’  ’2 6 t h ’  ’e v a c ’  ’5 p m ’  ’S h e t t e r ’  ’E . M . S . ’  ’6 : 0 3 a m ’  ’r [ i g h t ’  ’l [ e f t ’  ’c a l [ i b e r ’  ’E a g l e m a n ’  ’H u ’  ’K a m ’  ’S a b o n i ’  ’a ] s ’  ’l ] i t t e r ’  ’n ] o ’  ’g ] u n s h o t ’  ’R O ’  ’G S W ’  ’D I C ’  ’U . S . C . ’  ’C . F . R . ’  ’i ] t ’  ’C y n t h i a ’  ’D e r w i n s k i ’  ’V e t . A p p ’  ’I ] n ’  ’B r ’  ’t ] h i s ’  ’f ] r e s h ’  ’r e a ’  ’E l k i n s ’  ’c o n n e c t a b l e ’  ’S ] e c t i o n ’  ’E M S ’       (                  2 E$ ©   ©   Ż
    ! ŻŻ    Żh   µ]  r      ’S t e i n b e r g ’  ’O ' B r i e n ’  ’H o l c o m b ’  ’M y o r e ’  ’K r a m e r ’  ’I v e r s ’  ’B V A ’  ’S M R s ’  ’S a c a t o n ’  ’P i m a ’  ’E n f o c e m e n t ’  ’M a r i c o p a ’  ’S c h u r z ’  ’S a b o r i ’  ’R e y n o l d ’  ’R a m i r e z ’  ’7 p m ’  ’2 5 t h ’  ’5 : 1 5 a m ’  ’2 6 t h ’  ’e v a c ’  ’5 p m ’  ’S h e t t e r ’  ’E . M . S . ’  ’6 : 0 3 a m ’  ’r [ i g h t ’  ’l [ e f t ’  ’c a l [ i b e r ’  ’E a g l e m a n ’  ’H u ’  ’K a m ’  ’S a b o n i ’  ’a ] s ’  ’l ] i t t e r ’  ’n ] o ’  ’g ] u n s h o t ’  ’R O ’  ’G S W ’  ’D I C ’  ’U . S . C . ’  ’C . F . R . ’  ’i ] t ’  ’C y n t h i a ’  ’D e r w i n s k i ’  ’V e t . A p p ’  ’I ] n ’  ’B r ’  ’t ] h i s ’  ’f ] r e s h ’  ’r e a ’  ’E l k i n s ’  ’c o n n e c t a b l e ’  ’S ] e c t i o n ’  ’E M S ’   3| @  	                   #0e   3 7 = C I Q Y a g ­   ­   1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )       (       ;           ³¼$ “   “   Ō2  0e  ŌŚ    Ś0Ś
   
 Ś.Ō3
   
 Ōą0     ą ž’" @ H O Z q   ’’’’’’ ’’’’’’ć³E?’’’’’ž’ĄĢ 0³ Ļ0ĄĻüĄü 004      /’’’’’’N·’ūą  «õš                  šmpĻž	 @      ü2RQ@LL        " ’’ ³ µ ’’ą ’’’’’’’’’’’’’’’’’’^4@@d¼¤0LLdØ0@0ddddddddddd88ØØØdÄ |¤¤HX¼ x l¤Ä@d@dd0dlXld@`l84h8¤llllLL@l\XXXdddØ/                                               d Č)     dd            d  ll               d ¤$                                    @            " ’’ ³ µ ’’ą ’’’’’’’’’’’’’’’’’’^4@@d4LLdØ0@0ddddddddddd88ØØØ`ÄxPd¼|t|øTdTdd4hlXpX@`p<@l<¤pdplTTDp\`XXdddØ/                                               d Č)     dd            d  ll               d ¤$                                    @          < Ō6X  9  ` +   C o u r i e r         t* ī\	  	 p`   T m s R m n     P r o     * ō4	  	 p  " T m s R m n   B o l d   P r o      ( ī*f9	 p` & T m s R m n   I t a l i c   P r o        Čn  
    Ę Ź  D  Ź  Ź   	 Ź 
   D  Ź y  ? x x x , ,    Xx ģž’ž’ž’ž’ž’ž’ž’’’ž’’’’’’’ž’’’’’ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’ž’ž’ž’ž’ž’’’n  7 T C T , , /  XT Qž’ž’ž’ž’ž’ž’ž’’’q’’’’’’ö ’’’’ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’ž’ž’ž’ž’ž’’’T\  7 T C T , , b  XT ,ž’ž’ž’ž’ž’ž’ž’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’ž’ž’ž’’’’’’’6  5 P C P , ,   XP DĪž’ž’ž’ž’ž’ž’ž’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ž’’’’’’’’’’’’’ž’’’’’’’’’’’  " ’’ ³ µ ’’ą ’’’’’’’’’’’’’’’’’’^4<Dd¼0LLdØ0D0ddddddddddd88ØØØ\Ä| LL°xl|°|TdTdd0hhXhX<Tl48d4¤lhhd@H8lXTPPdddØ/                                               d Č)     dd            d  ll               d ¤$                                    @               ę¬"    ² D ³ U   Hy  ( uH  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           Čx    Č`  ) ō\	  	   `   & T m s R m n       L e g a l   P r o   ( uH  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r                             Ō 6 T i m e s   N e w   R o m a n   R e g u l a r          
   #   Ń# $  m $ X’’         d  # ŃŻ
    ! ŻŻ    ŻŌ #  X1 X  X X   ŌÓ     ÓŃ7   »Ś X  X       dā                  dČ 7 ŃŃ    
 Ńņņń ńÓ=    2ų    Š   X       d     Š            d= Óńńń ńńńŌ%     ŌńńńńŃ %  ’~  Ńń ńńńŌ% 	    Ōńńńńą@    s
s
; ģ ąUNITEDSTATESCOURTOFVETERANSAPPEALSóóŠ   	 °      ŠĢĢą@    %%J ģ ąNo.96573ĢĢą@    aaA ģ ąņņRaymondS.Drosky,Appellantóó,Š   	 .	~   ŠĢą@    N ģ ąņņv.óóŠ   	 ś
J   ŠĢą@    ««I ģ ąņņJesseBrown,óóŠ   	 Ę	   Šą@    ; ģ ąņņSecretaryofVeteransAffairs,Appellee.óóŠ   	 ¬ü
   ŠĢĢą@    ee9 ģ ąOnAppealfromtheBoardofVeterans'AppealsĢĢĢÓ    Ó(Decidedń
ńMay14,1997ń
ńń ńńńń ńńńńńŌ%     Ōńń)ĢÓ    ÓĢĢĢą     ąņņJamesW.Stewartóó(nonattorneypractitioner)wasonthebrieffortheappellant.Š   	 Øų   ŠĢą     ąņņMaryLouKeener,óóGeneralCounsel;ņņRonGarvinóó,AssistantGeneralCounsel;ņņCarolynF.Š   	 tÄ   ŠWashingtonóó,ActingDeputyAssistantGeneralCounsel;andņņJohnD.Lindsay,Jr.,óówereontheŠ   	 ZŖ   Špleadingsfortheappellee.ĢĢą     ąBeforeNEBEKER,ņņChiefJudgeóó,andHOLDAWAYandSTEINBERG,ņņJudgesóó.Š   	 \   ŠĢÓ         Óą     ąSTEINBERG,ņņJudgeóó:Theappellant,VietnameraveteranRaymondS.Drosky,appealsaŠ   	 Ų(   ŠFebruary7,1996,BoardofVeterans'Appeals(¢BVA£orBoard)decisiondenying(1)anincreasedĻratingforserviceconnected¢pericarditis£,currentlyratedas10%disabling;(2)anextensionofaĻtemporarytotalevaluationunder38C.F.R.šš4.30beyondJuly31,1992,forconvalescenceĻfollowingsurgeryfortreatmentofserviceconnected¢pericarditis£;and(3)an¢extraschedular£ratingĻunder38¢C.F.R.£3.321(b).Record(R.)at14,16.TheappellantseeksreversaloftheBoard'sĻdecisionastothedenialofanincreasedratingforpericarditis;theSecretaryseekspartialremandĻoftheBoarddecision,inordertopermitfurtherdevelopmentand¢readjudication£astothatclaim¢£.ĻInhisbrief,theappellantdidnotraiseissue2,andastoissue3statedspecificallythathewasnotĻseekingan¢extraschedular£rating.ReplyBrief(Br.)at5.TheCourtconsidersthoseissuestohaveĻbeenabandoned,andthuswillnotaddressthem.ņņSeeóóņņMcCayv.Brown¢óó,8Vet.App.378,381(1995),Š   	 R+¢&0   Šņņaff'dóó,106F.3d1577(Fed.Cir.1997);ņņBucklinger£v.Brownóó,5¢Vet.App£.435,436(1993).FortheŠ    «,ū'2    ŠŃ  % ’~  ŃŃ7 $  1$ X X       dę  X  X       dā 7 ŃŃ
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 Ńńńreasonsthatfollow,theCourtwillreversetheBoardfindingthatthecriteriafora30%ratingforĻserviceconnected¢pericarditis£havenotbeenmet.ĢņņĢą@    iiH ģ ąI.BackgroundóóŠ   	 »   Šą     ąTheveteranservedonactivedutyintheU.S.¢AirForce£fromApril1967toJanuary1971.ĻR.at45.AJanuary1967preinductionexaminationreportednorelevantabnormalities.R.at2024.ĻServicemedicalrecordsincludedaDecember1970entrynotingtheveteran'scomplaintsofchestĻpainsafterliftingheavyobjects.R.at39,41.Ģą     ąImmediatelyfollowingdischarge,theveteranwastreatedinFebruary1971byaprivateĻcardiologistforaheartconditiondiagnosedasrecurrent¢pericarditis£.R.at5152,77.(PericarditisĻistheinflammationofthepericardium;thepericardiumis"thefibroseroussacthatsurroundstheĻheartandtherootsofthegreatvessels,comprisinganexternallayeroffibroustissue...andanĻinnerserouslayer....",Ō   Xj X X# Xj ŌņņDorland'sIllustratedMedicalDictionaryóóņņ(Dorland's)óó1257,1258Š   	 Ü,   Š(28thed.1994).)Ō# #  Xj X X Xj\  # Ō£InJuly1971,aVeterans'Administration(nowDepartmentofVeteransAffairs)Š   	 5   Š(VA)regionaloffice(RO)decisiongrantedtheveteran'sapplicationfordisabilitycompensationforĻ¢pericarditis¢£andassigneda10%rating.R.at79,10203.Ģą     ąAnApril1992privatemedicalrecordfromDr.RaonotedthattheveteranhadhadchronicĻ¢pericarditis£since1970,thatarecentattackwasnotrelievedwithmedication(Prednisone),andthatĻhehadpaininhisrightarm.R.at117.Thephysicianalsonotedthattheveteran'sheartwasnotĻenlarged,thattherewerenoheartmurmurs,thathiselectrocardiogram(EKG)wasnormal,andthatĻtherewasnocardiomegaly.R.at117,129.(Cardiomegalyishypertrophyoftheheart;hypertrophyĻis"theenlargementorovergrowthofanorganorpartduetoanincreaseinsizeofitsconstituentĻcells",ņņDorlandóó'sat268,802.)AnechocardiographyreportpreparedatthetimerevealedŠ   	 V"¦,   Š"[p]ericadialthickeningandcalcificationwithoutevidenceofpericardialeffusionorrestriction"andĻalsorevealed"evidenceofirregularpericardialthickeningandpunctatepericardialcalcification."ĻR.at120.Thatsamemonth,theveteransoughtaratinggreaterthan10%forhisserviceconnectedĻpericarditis,statingthathehashadincreasedchestpainsandnotingthathiscardiologisttoldhimĻnottowork.R.at123.Healsorequestedthatatemporary100%ratingbeassignedintheeventheĻwashospitalizedforsurgeryrelatingtohiscondition.R.at124,133;ņņseeóó38C.F.R.šš4.30(1996).Š   	 l*¼%8   Šą     ąOnMay28,1992,theveteranunderwentapericardiectomyataprivatehospital.R.at136.Š   	 Å+':   Š(Apericardiectomyistheexcisionofthepericardium,ņņDorland'sóóat1257.)Areportofchestx-rays,Š   	 °      Šwhichhadbeentakenaftertheoperation,noted:"Theheartsizeisattheupperlimitsofnormal.ĻThereismoderatewideningofthemidmediastinum,predominantlyaorta."R.at212.(ThemiddleĻmediastinumis"thedivisionofthemediastinum[,themassoftissuesandorgansseparatingthetwoĻpleuralsacs,]containingtheheartenclosedinitspericardium,theascendingaorta,thesuperiorvenaĻcava,thebifurcationofthetracheaintobronchi,thepulmonaryarteriesandveins,thephrenicĻnerves,alargeportionoftherootofthelungs,andthearchoftheazygosvein,"ņņDorland'sóóat998.)Š   	 Ę   ŠTheimpressionwas"[n]ovisibleactivedisease."ņņIbidóó.Š   	 o	   Šą     ąANovember1992ROdecisiongrantedatemporary,total100%ratingforpericarditisdueĻtoposthospitalizationconvalescencefromMay28,1992,throughJuly31,1992,andrestoredtheĻ10%rating,effectiveAugust1,1992¢£.R.at29293.InJanuary1993,theveteranfiledaNoticeofĻDisagreementastobothclaims,andthereafterperfectedhisappealtotheBoard.R.at29596,305.ĻAtaJuly1993hearingbeforetheRO,hegavesworntestimony,relatingsymptomsofhisservice¼connectedconditionandcontendingthathehasanenlargedheartasaresultofthesurgery.R.atĻ310,312.Herelatedthat"accordingto...Dr.Sha[v]eranytimeyoutakethepericardiumofftheĻheartithastoenlargebecausetherestrictionsfromthepericardiumisgone."ņņIbidóó.HestatedthatŠ   	 ē7   ŠDr.Shaveralsohadtoldhimthathisheartwasenlarged.R.at316.Ģą     ąTherecordonappealcontainsthreemedicalreportsfromhisprivatephysician,Dr.Shaver.Š   	 é"   ŠAJune1992medicalreportfromDr.Shavernoted:ĢÓ         Óą8     ąCardiacexamwasessentiallywithinnormallimits.TherewasņņņņnoevidenceofŠ   	 K&   Šcardiomegalyóóóó.ThechestxrayshowsaņņņņslightincreaseintheoverallcardiacŠ   	 1'   Šsilhouetteóóóóņņņņandprominenceoftheleftatrialappendageóóóó.OnthelateralviewthereŠ   	  g(   ŠisjustalittlebitoftentingonthediaphragmandalittlebitofbluntingattheĻcostophrenicangles.Š    Š Š   ŠĢÓ         ÓR.at322(emphasisadded).Dr.Shaveralsonotedthattheveteran'sEKGshowed"normalsinusĻrhythm,andoccasionalectopicbeat"andthathewas"doingverywell."ņņIbid.óóInOctober1992,Dr.Š   	 %X .   ŠShaverreportedthattheveteran'sphysicalexaminationincludedthefollowingresults:ĢÓ         Óą8     ąHelookedwell.HisBP[bloodpressure]was110115/7080.CarotidswereofĻnormalupstrokewithoutbruits.ThelungswereclearexceptforaslightdecreasetoĻthebreathsoundsattheleftbase.Therewasņņņņnoevidenceofcardiacenlargementóóóó.Š   	 )Ö$4   ŠTherewasnoevidenceofpericardialrub.Hehadasoftejectionmurmur....TheĻEKGwaswithinnormallimits.APAchestxrayshowsņņņņasuggestionofminimalŠ   	 R+¢&6   Šcardiomegalyóóóó.Thereņņņņmaybeabitofprominenceoftheleftatrialappendageóóóó.TheŠ   	 8,'7   Šcostophrenicanglesareclear.Thelateralfilmisessentiallywithinnormallimits.Ļ[Theveteran]hasdoneextremelywell.HeisoffhisPrednisone.I'veencouragedĻhimtocontinuetobeactive....Š    Š Š   ŠĢÓ         ÓR.at323(emphasisadded).AJuly1993medicalreportfromDr.ShavernotedthefollowinguponĻphysicalexamination:ĢÓ         Óą8     ąHiscardiacexamwasperfectlynormal....AnEKGwasentirelywithinnormalĻlimits.APAandlateralchestxrayofthechestņņņņshowedborderlinecardiacŠ   	 ą0	   Šenlargementóóóóasonewouldexpectfollowingpericardiectomy.TherealsoseemedtoŠ   	 Ę
   Šbeashadowattheupperwaisttotheheartwithsomeresidualcalcium.TherewasĻnoevidenceofcongestiveheartfailure.TherewassomeprominenceoftheleftatrialĻappendageaswouldbeexpectedwithapericardiectomy.Š    Š Š   ŠĢÓ         ÓR.at324(emphasisadded).Ģą     ąIntheFebruary7,1996,BVAdecisionhereonappeal,theBoard,findingthatthecriteriaforĻa30%ratinghadnotbeenmet,denied,interalia,theveteran'sclaimforaratinggreaterthan10%Ļforhisserviceconnectedpericarditis.R.at7.ĢĢą@    ééI ģ ąņņII.AnalysisóóŠ   	 Q   Šą     ąAclaimforanincreasedratingisanewclaim,notsubjecttotheprovisionsof38U.S.C.Ļšššš5108and7104(b)prohibitingreopeningofpreviouslydisallowedclaimsexceptuponnewandĻmaterialevidence.ņņSeeProscellev.Derwinskióó,2Vet.App.629,63132(1992).AclaimforanŠ   	 \   ŠincreasedratingisgenerallywellgroundedwhenanappellantindicatesthathehassufferedanĻincreaseindisability.ņņIbidóó.Inthiscase,theveteransoughtaratinggreaterthan10%forŠ   	 ¾#   Šservice-connectedpericarditis,statingthathehashadincreasedchestpainsandnotingthathisĻcardiologisttoldhimnottowork.R.at123.BasedonhisstatementsthathisdisabilityhasĻincreasedinseverity,theCourtholdsthattheveteran'sclaimiswellgrounded.Ģą     ąTheBoardfoundthattheveteranwasnotentitledtoaratinggreaterthanhiscurrent10%Ļratingforpericarditisunder38C.F.R.šš4.104,DiagnosticCode(DC)7000(1996),whichistheDCĻthatcorrespondstorheumaticheartdisease.PursuanttoDC7002,pericarditisisratedasrheumaticĻheartdisease.Ō   XÉį X X# Xj ŌA10%disabilityratingunderDC7000iswarrantedforinactiverheumaticheartŠ   	 -(}#1   Šdisease"[w]ithidentifiablevalvularlesion,slight,ifanydyspnea,theheartnotenlarged;Ļfollowingestablishedactiverheumaticheartdisease."A30%disabilityratingrequiresinactiveŠ   	 ż*M&5   Šrheumaticheartdisease"[f]romtheterminationofanestablishedserviceepisodeofrheumaticĻfever,oritssubsequentrecurrence,withcardiacmanifestations,duringtheepisodeorrecurrence,Ļfor3years,ņņņņoróóóódiastolicmurmurwithcharacteristicEKGmanifestationsņņņņordefinitelyenlargedŠ   	 Š   Šheartóóóó."38C.F.R.Ō# #  Xj X X XÉįń.  # ŌššŌ   XÉį X X# Xj Ō4.104,DC7000(emphasisadded).Š   	 č8   ŠŌ# #  Xj X X XÉįÓ1  # Ōą     ąIntheBVAdecisionhereonappeal,theBoard,indenyingaratinggreaterthan10%,madeŠ   	 P
    ŠthefollowingfindingswithrespecttoDr.Shaver'sreports:ĢÓ         Óą8     ąHisEKGwaswithinnormallimits.ThoughhischestXraysrevealedņņņņaminorŠ   	 a   Šprominenceoftheleftatrialappendageandborderlinecardiacenlargementóóóó,Dr.Š   	 ÷G	   ŠShaverremarkedthatsuchfindingsweretobeexpectedfollowingapericardiectomy,Ļanddidnotindicatethattheyweresignificant,abnormal,ordisabling,ashestatedĻthattheveteranwasdoingverywell.Basedonthesefindings,theBoardconcludesĻthattheveteran'sconditiondoesnotmeetthecriteriafora30percentdisabilityĻevaluation,asadiastolicmurmurwithcharacteristicEKGmanifestations,ņņņņwithóóóóaŠ   	 uÅ   Šdefinitelyenlargedheartattributabletoactivepericarditis[,]hasnotbeenĻdemonstratedbytheevidence.Š    Š Š   ŠĢÓ         ÓR.at1314(emphasisadded).Ģą     ąTheSecretarycontendsthatthiscaseshouldberemandedtotheBoardbecauseit(1)Ļcommittederrorwhenitnotedthepresenceofcardiacenlargementbutthenfailedto"articulateĻsufficientreasonsorbases[under38U.S.C.šš7104(d)(1)]foritsdeterminationthattherecordfailedĻtodemonstratedefinitecardiacenlargementasrequiredbythepertinent[DC]fortheassignmentofĻa30[%]rating"(Secretary'sMotionforPartialRemand(Mot.)at4);(2)erredwhen,inapplyingtheĻratingcriteria,it"misstatedthelanguagesetforthin[DC]7000"andrequiredthattheveteranhaveĻ"bothdiastolicmurmurwithEKGmanifestationsņņandóóadefinitelyenlargedhearttoqualifyforaŠ   	 |Ģ$   Š30[%]rating"(Mot.at5(emphasisinoriginal));and(3)failedtociteindependentmedicalevidenceĻinsupportofitsconclusionthattheminorprominenceoftheleftatrialappendageandborderlineĻcardiacenlargementdidnotconstitutedefinitecardiacenlargement(Mot.at6).Inessence,theĻSecretaryconcedestheexistenceofclinicalevidenceofcardiacenlargementbutcontendsthataVAĻmedicalexaminationisrequiredtodeterminewhethertherewas"definite"cardiacenlargement.ĻMot.at7.Ģą     ąTheappellantseeksreversaloftheBoard'sfindingthattheconditionsfora30%ratinghaveĻnotbeenmet.Br.at11.HecontendsthatDr.Shaver'sreportsestablishthattheveteran'sheartisĻenlargedandthathethusmeetsoneofthethreeindependentrequirementsfora30%rating.Br.atŠ   	 +ķ&6   Š911.Additionally,heassertsthattheBoarderroneouslyconsideredfactors"whollyoutsidetheĻratingcriteriaprovidedbytheregulations"whenitdenieda30%rating.Br.at11.HemaintainsĻthatDr.Shaver'smedicalreportscontainsufficientdetailforratingpurposesandthattheBoarddidĻnotfindotherwise;thatafindingofenlargementmeetsthe30%ratingrequirementfor"definitelyĻenlarged";thatthereisnojustificationforanotherexaminationasproposedbytheSecretary;andĻthataremandisthusnotrequiredhereforfurtherdevelopmentoranadequatestatementofreasonsĻorbases.ReplyBr.at34.Asdiscussedbelow,theCourtagreeswiththeappellant.Ģą@    @ ģ ąņņņņA.ApplicationofDCCriteriaóóóóŠ   	 o	   Šą     ąTheCourtconcludes,asbothpartiesagree,thattheBoardincorrectlyappliedthe30%ratingĻcriteriainthiscase.TheBoardššsfindingthatthe30%criteriahadnotbeenmetwasbasedonitsĻhavingappliedratingrequirementsthatexceededintworespectsthoseprescribedintheDCĻregulation.First,theBoarderredinreadingoneoftherequirements(adefinitelyenlargedheart)asĻconjunctive,ratherthandisjunctiveascontemplatedbytheword"or"beforeš šdiastolicmurmurššandĻbefore"definitelyenlargedheart".38C.F.R.šš4.104,DC7000.Theuseoftheword"or"providesĻforanindependentbasisratherthananadditionalrequirement.ņņSeeóóņņZangv.Brownóó,8Vet.App.246,Š   	 Ž   Š25253(1995)(notingthatregulation,aswrittenin38C.F.R.šš3.354usingtheterm"or",Ļ"appear[ed]toprovideforthreeindependentinstancesofinsanity");ņņseealsoóóņņJohnson(Gary)v.Š   	 @    ŠBrownóó,7Vet.App.95,97(1994)Ō   XÉį X X# Xj Ō(agreeingwithmemorandumbySecretarysuggestingthatcriteriaŠ   	 é"   Šlistedin38C.F.R.šš4.132,DC9411,for100%ratingareeachindependentbasesforgrantingĻsuchrating)Ō# #  Xj X X XÉįoC  # Ō.TheCourtholdsthatitisclearfromthefaceoftheregulationthat,astheSecretaryŠ   	 i¹&   Šconcedes,a"veteranneedonlyprovetheexistenceofanyoneofthosecriteriatosatisfytheĻrequirementfora30[%]evaluation."Mot.at56.Ģą     ąSecond,theBoardfound,ineffect,thatanenlargedheartisnotsufficienttomeetthe30%ĻcriteriaofDC7000wheresuchenlargementwas"expectedfollowingapericardiectomy";whereĻsuchenlargementisnot"significant,abnormal,ordisabling";orwheretheenlargementexistsbutĻtheveteran"wasdoingverywell".R.at1314.TheratingcriteriarequireadefinitelyenlargedĻheart;theydonotalsorequirethattheenlargedheartbeunexpected,significant,abnormal,orĻdisabling.TheBoard,inessence,impermissiblyrewrotetheDC7000criteria."TheBoard'sĻconsiderationoffactorswhicharewhollyoutsidetheratingcriteriaprovidedbytheregulationisĻerrorasamatteroflaw."ņņMasseyv.Brownóó,7Vet.App.204,208(1994)(citingņņPernoriov.Š   	 ņ+B':   ŠDerwinskióó,2Vet.App.625,628(1992)).Š   	 °      Šą     ąAccordingly,theBoard'sconclusionsinthiscasewerelegallyerroneous,andcannotstand,ĻbecausetheywerebasedoncriteriaotherthanthosespecifiedinDC7000.ThatisnottheendofĻthematter,however.Ģą@    wwE ģ ąņņņņB.ReverseorVacateóóóóŠ   	 
d   Šą     ąInthepresentcase,itisundisputedthatthereisevidencethattheveteranhasanenlargedĻheart;thequestionbeforetheCourtiswhetherthatevidencemeetsthecriteriasetforthintheDCĻthattheenlargedheartbe"definite"orwhethertheCourtmustremandforfurtherdevelopmentandĻanadequatestatementofreasonsorbases,astheSecretarycontends.ThecrucialevidenceofrecordĻconsistsofDr.Shaver'sJune1992,October1992,andJuly1993,cardiacexaminationreports.TheĻJune1992reportnoted,withsomeapparentinconsistency,thattherewas"noevidenceofĻcardiomegaly"but"aslightincreaseintheoverallcardiacsilhouetteandprominenceoftheleftatrialĻappendage."R.at322.TheOctober1992reportnoted"noevidenceofcardiacenlargement"but,Ļalsosomewhatinconsistently,thattherewas"asuggestionofminimalcardiomegaly"andthatthereĻ"maybeabitofprominenceoftheleftatrialappendage".R.at323.Finally,themostrecentreport,ĻfromJuly1993,found"borderlinecardiacenlargementasonewouldexpectfollowingĻpericardiectomy",andstatedthat"[t]hereseemedtobeashadowattheupperwaisttotheheartwithĻsomeresidualcalcium"andthatthere"wassomeprominenceoftheleftatrialappendageaswouldĻbeexpectedwithapericardiectomy".ņņIbidóó.Š   	 ņB$   Šņņņņ1.Meaningofš šdefinitešš.óóóóInņņHoodv.Brownóó,theCourtremandedaclaimforanincreasedŠ   	 K&   Šrating,greaterthantheassigned30%,formanicdepressivepsychosisinorderfortheBoardtoĻprovideanadequatestatementofreasonsorbasesunder38U.S.C.šš7104(d)(1)explainingwhytheĻappellant'ssymptomsdidnotfitthecriteriaforahigherratingthatis,specifically,"why[the]Ļappellant'simpairmentis'definite'andnot'considerable,''severe,'or'total,'"under38C.F.R.šš4.132.ĻņņHoodóó,4Vet.App.301,302(1993).TheCourtnotedthattheBoardinņņHoodóóhad"simplyconcludedŠ   	 %X 0   Šthat'thecurrentrating,whichcontemplatesdefinitesocialandindustrialimpairment,isseenasĻadequatelyencompassingthesymptomatologydisplayed.'"ņņIbidóó.TheCourtexplained:Š   	 ŗ'
#4   ŠÓ         Óą0     ąTheterms"total","severe","considerable",and"mild"[in38C.F.R.šš4.132,DC9210,]Ļareallquantitativeinnature;theydescribethedegree[ofimpairment]....ThetermĻ"definite",ontheotherhand,isqualitativeinnature.Tosaythataveteranhas"definite"ĻimpairmentofsocialandindustrialadaptabilityistosaythattheveteranisunmistakablyŠ   	 Å+'9   Šimpaired.ItdoesnotdescribethedegreeoftheimpairmentastheotherquantitativetermsĻdo.Forexample,aveteranwhois"mildly"or"totally"impairedisalso"definitely"Ļimpaired,becausethecharacteristicswhichconstituteapsychoticdisorderare,withoutĻdoubt,present.Š    (#(#  ŠņņĢÓ         ÓIdóó.at303.TheCourtnotedthatņņWebster'sThirdNewInternationalDictionaryóó(1986)Š   	 .	~   Š"defines'definite'as'real,actual'or'markedbyabsenceofthe...doubtful.'"ņņIbidóó.TheCourtnotedŠ   	 
×   ŠtheconfusionintheDCcriteriastemmingfromtheuseofquantitativetermsforthe10%("[m]ildĻimpairment")and50%("[c]onsiderableimpairment")ratingsbutaqualitativetermforthe30%Ļrating("[d]efiniteimpairment").Inremandingthematter,theCourtconcludedthattheBoardwasĻ"freetoconstruetheterm'definite'in[38C.F.R.šš]4.132inawaythatquantifiesthedegreeofĻimpairmentandnotthemerefactthatimpairmentexists."ņņIdóó.at30304;ņņseealsoRomeov.Brownóó,Š   	 D   Š5Vet.App.388,396(1993)(applyingņņHoodóóanddirectingBoardonremandtoquantifyveteran'sŠ   	 ķ   Šdegreeofimpairmentresultingfromserviceconnectedposttraumaticstressdisorder(PTSD),andĻnottorefertolevelofimpairmentas"definite"merelytoindicatethatsuchPTSDactuallyexisted).Ļą     ąUnliketheDC9210criteriaatissueinņņHoodóó,itisclearthatthecriteriaidentifiedinDC7000Š   	 Øų   Šformeetingthe30%,60%,and100%ratingsdoņņņņnotóóóócontainquantitativetermsastoanenlargedŠ   	 Q   Šheart;thatis,allthreeratingsdescribeaheartthatis"definitelyenlarged".(TheCourtnotesthatĻunderDC7000onlythecriteriafora100%ratingalsorequirethattheenlargementbe"confirmedĻbyroentgenogramandclinically".)TherearenorequirementsthattheenlargementbeofacertainĻsizeordegreetoqualifyforaparticularrating.Theheartiseitherenlargedoritis"notenlarged",Ļandthelatterterminologyisactuallyoneofthecriteriafora10%ratingunderDC7000.ThelackĻofaquantitativetermfortheenlargedheart30%ratingcriterioninDC7000ismademoreclearĻwhencomparedtothe60%ratingcriterionof"markedenlargementoftheheart"inDC7007Ļ(hypertensiveheartdisease).38C.F.R.šš4.104,DC7007(1996).Accordingly,theCourtholdsthat,Ļhoweverslighttheenlargementmightbe,allthatDC7000requiresissomeenlargement.Ģą     ąņņņņ2.Clearerrorinratingdecisionóó.óóAdecisionastotheseverityofadisabilityisafactualŠ   	 {%Ė /   Šdetermination.ņņSeeGleicherv.Derwinskióó,2Vet.App.26(1991).AstosuchfactualdeterminationsŠ   	 Ō&$"1   ŠmadebytheBVA,thisCourtmaynot,ofcourse,substituteitsjudgmentforthatoftheBVAifthereĻisaplausiblebasisforthedecision.ņņSeeóó38U.S.C.šš7261(a)(4);ņņGilbertv.Derwinskióó,1Vet.App.Š   	 )Ö$5   Š49,5253(1990)."Wheretherearetwopermissibleviewsoftheevidence,thefactfinder'schoiceĻbetweenthemcannotbeclearlyerroneous."ņņId.óóat52(quotingņņAndersonv.CityofBessemerCityóó,Š   	 8,'9   Š470U.S.564,57374(1985)(citingņņUnitedStatesv.YellowCabCo.óó,338U.S.338,342(1949))).Š   	 °      ŠConcomitantly,wherethereisonlyonepermissibleviewoftheevidenceandtheBoarddidnottakeĻthatview,itsfindingmustbereversed.ņņCfóó.ņņGilbertóó,ņņsupraóó.Š   	 b²   Šą     ąBecausethedecisionastotheseverityofadisabilityisafactualdetermination,theCourtĻmustdecidewhether,basedontheevidenceofrecord,theBVAwasclearlyerroneousinnotĻassigninga30%schedularrating.ThatquestionturnsonwhethertheevidencecanplausiblysupportĻonlyonefindingthattheveteranhasanenlargedheartinwhichcaseremandtotheBoardforĻittomakeafindingonthatquestionisnotinorder.AreviewoftherecordshowsthattheBVA'sĻdeterminationtodenya30%ratingwasnotsupportedbyaplausiblebasisintherecord.Ģą     ąInitsdecision,theBoardfocussedonthemostrecentmedicalreportfromDr.Shaver,fromĻJune1993,andstated:"ThoughhischestXraysrevealedaminorprominenceoftheleftatrialĻappendageandborderlinecardiacenlargement,Dr.ShaverremarkedthatsuchfindingsweretobeĻexpectedfollowingapericardiectomy,anddidnotindicatethattheyweresignificant,abnormal,orĻdisabling,ashestatedthattheveteranwasdoingverywell."R.at1314.AlthoughtheBoarddidĻnońńtńńń	ńŌ%     Ōń	ńuseń ńņ
ņńń,asitshouldhave,ń ńó
óńńtheDCtermof"definitelyenlargedheart"initsfindingsanddiscussionĻofthisevidence,itisclearfromthecontextoftheBVAdecisionthatintheabovequotedlanguageĻ(andespecially,itsuseoftheword"[t]hough"ń ńņ
ņńń,definedas"inspiteofthefact",ņņWebster'sNewŠ   	 @    ŠWorldDictionary,ThirdCollegeEditionóó1393(1988)ń ńó
óńń)theBoardfoundthatacardiacŠ   	 é"   Šenlargementexisted.Otherwise,theBoard'stackingonoftheunauthorizedelementsinadditiontoĻtherequirementofanenlargedheartinorderforaclaimanttoqualifyfora30%ratingwouldmakeĻnosense.Certainly,theBoardmadenofindingthatDr.Shaver'sJune1993reportofaminorĻprominenceoftheleftatrialappendageandborderlinecardiacenlargementdidņņņņnotóóóóconstituteŠ   	 ż M*   Šdefinitecardiacenlargement.Indeed,thatwouldhavebeenamostquestionablefindinginviewofĻthemandatesof38U.S.C.šš5107(b)and38C.F.R.šš3.102(1996)thatthebenefitofthedoubtĻ(reasonabledoubt)onanymaterialissueberesolvedinaclaimant'sfavor.Moreover,asnotedĻabove,theSecretaryconcedesthattheveteranhadcardiacenlargement:Inhismotionforremand,ĻtheSecretarystatesthat"somecardiacenlargementwasnotedonatleastthreeoccasionsfollowingĻAppellant'ssurgery(R.at322,323,324)".Mot.at6.TheSecretaryalsostates:"GiventheexistenceĻofclinicalevidenceofcardiacenlargement,properadjudicationofthisissuerequiredadditionalĻdevelopment...todeterminewhethertherewasdefinitecardiacenlargement".Mot.at7.TheŠ   	 Å+':   ŠCourtdisagreesthatsuchadditionaldevelopmentisrequiredhere.Asnotedabove,oncethereisĻclearevidencethatcurrentcardiacenlargementexists,theterm"definite"hasbeensatisfiedandaĻ30%ratingmustbeawarded.ņņSeeHood,supraóó.Š   	 Ń
   Šą     ąAlternatively,evenifitweretobeconcludedthattheBoarddidnotfindthattheveteranhadĻanenlargedheart,reversalwouldnonethelessfollowonthisrecord.AlthoughDr.Shaver'sJuneandĻOctober1992reportsappearequivocalontheissuewhethertheveteranhadanenlargedheartĻbecauseoftheirapparentinconsistentstatements,themostrecentreport,theJune1993report,Ļprovidesclearevidencethatanenlargedheartexists.Basedonthisreport,thereisnoplausiblebasisĻforafindingthatanenlargedheartdidnotexist.And,asnotedabove,theBoarddidnotsofind.ĻĢĢą     ąą@    NNG ģ ąņņIII.ConclusionóóŠ   	 Ę   Šą     ąOnthebasisoftheforegoingandconsiderationoftheparties'pleadingsandtherecordonĻappeal,theCourtreversestheFebruary7,1996,BVAdecisionthatthecriteriafora30%ratingĻunder38C.F.R.šš4.104,DC7000,fortheveteran'sserviceconnectedpericarditishavenotbeenĻmetandremandsthematterń ńņņfortheBoardńüńtoassignńüńóóņ
ņńńtotheBoardwithadirectionńūńthatittakeactionnecessaryforńūńń ńó
óńńń žńtńžńń żńoassignńżńń žńńžńa30%Ļratingń ńń’ńņ
ņń’ńńńń ńtobeassignedń ńń ńń’ńó
óń’ńńńandń ńńńņņńńtońńóóńńńńproceedń ńņ
ņńńexpeditiouslyń ńó
óńńinaccordancewithsection302oftheVeterans'ĻBenefitsImprovementAct,Pub.L.No.103446,šš302,108Stat.4645,4658(1994)(foundatĻ38U.S.C.šš5101note)(requiringSecretarytoprovidefor"expeditioustreatment"forclaimsĻremandedbyBVAorCourt).ņņSeeAlldayv.Brownóó,7Vet.App.517,533-34(1995).Š   	 ³",   Šą     ąREVERSEDANDREMANDED.ń ńńńŌ%     Ōńńńń