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A. a.(1)(a) i) a)S ($0 ($0 0 (($0 0 0   A_ekqwDocumentDocument StyleI.1.A.a.(1)(a)i)a)jo4Tech InitInitialize Technical StyleS #  1 .1 .1 .1 .1 .1 .1 .1 S CuyTechnicalTechnical Document Style11.11.1.11.1.1.11.1.1.1.11.1.1.1.1.11.1.1.1.1.1.11.1.1.1.1.1.1.1xF82PleadingHeader for numbered pleading paper %Ka:; s &(  X XXX XX>3''*d>>3''*d>H1H2H3H4H5H6H7H8H9101112131415161718192021222324252627 P-0*6 Ї28"    '"(2J$ 2.!DXXXX    7KKXXdd7  PB0HeadingChapter Heading@..  2I.3  Ԁ   Ԉ tO 4Right ParRight-Aligned Paragraph Numbers.. 2I.3  Ԁ  0..L=6SubheadingSubheading 2A.3  ..    &$1&$2&$4&$3)\  `&TmsRmnLegal Pro<6X9`(CourierXx6X@8;X@)\  `&TmsRmnLegal ProXXt\  PPUXP(n.$DXXXX    7KKXXd0XXd7 dHP LaserJet 5P/5MP (HP)HPPCL5G,,,,,,0nLFk:\forms\panel.opn  ' USCVA0USCVA .   &4# e37=CIQYag1.a.i.(1)(a)(i)1)a)3|["@HOZqE?00004/Nmpϟ @2RQ@LL "^4@@d0LLd0@0ddddddddddd88dĘ|HXxlĘ@d@dd0dlXld@`l84h8llllLL@l\XXXddd/d)dddlld$@"^4@@d4LLd0@0ddddddddddd88`ĀxPd|t|TdTdd4hlXpX@`p<@l?<6X9`+Courier*\  p`TmsRmnPro*4  p"TmsRmnBoldProT)\  p`TmsRmnPro(*f9 p`&TmsRmnItalicPro L?xxx,,Xx N7TCT,,/XTQqTG7TCT,,bXT,Ty.D8D,,DQ{95PCP,,XPDdFull-PE LandLandLandLandGHLegalHProProProProProProProProZLandHGGLandGGProProProProProProProProProProLandProLandProLandProLandProLandProLandProLandProLandProLa(hH  Z 6Times New Roman Regular,gEhiEjkElmEnoDpqrEstEuvEwxEyNzD{| }D~ӀEEEDEEEEEEEEEEEEEDD[EEEEEEEEEDEED[ggggDDDEDEEEE  E  E DDDDDDDDD !"E#$E%&D'(E)*+,-./0D123D45D67D8D9:;[<=>?@ABCDDEFGDHIDJKLMENOPQRDSTUEVWUXDYP[D\]D^e_U`aPbUcde[fghEijkElmnEopDqUzE{|}E~//DD///DDDvo''Hg6Times New Roman Regular 2.!DXXXX    7KKXXdd7  =/gc/XXdd= f @ UNITEDSTATESCOURTOFAPPEALSFORVETERANSCLAIMS   @3No.971993  @*MelvynL.Roberts,Appellant, `  @7v. @  @/TogoD.West,Jr.,  p  @ $SecretaryofVeteransAffairs,Appellee. `  @e e "OnAppealfromtheBoardofVeterans'Appeals@)(DecidedNovember19,1999񀀀% H )  GeraldL.Millerwasonthebrieffortheappellant. p   LeighA.Bradley,GeneralCounsel;RonGarvin,AssistantGeneralCounsel;MichaelA. P Leonard,DeputyAssistantGeneralCounsel;andAdamK.Llewellynwereonthepleadingsforthe @ appellee.  BeforeHOLDAWAY,IVERS,andGREENE,Judges.b ` bbbb  bbHOLDAWAY,bcJudgecd,filedtheopinionoftheCourt.deddefIVERfhfSfhiS,ikjjUDGEjklJudgelm,filedacmnmumnooncurring @ opinion.oiffihg,ghlfflcbbc  HOLDAWAY,Judge:Theappellant,MelvynL.Roberts,appealstheJuly1997decision ! oftheBoardofVeterans'Appeals(BVAorBoard).TheBVAdeterminedthattheappellant'sclaimforsecondaryserviceconnectionofarthritisinmultiplejoints,notincludinghishandsandfeet,wasnotwellgrounded.TheappellanthadpreviouslybeengrantedserviceconnectionforarthritisofhishandsandfeetsecondarytofrostbitethathehadsufferedduringactivedutyinKorea.TheappellanthasfiledabriefandareplybriefarguingthattheBoard'sdecisionshouldberemandedforfailuretocomplywithitsremandorderforamedicalexaminationtodiscussanyetiologicalrelationshipbetweentheappellant'sfrostbitethatwasincurredinserviceandhiscurrentarthritis.TheSecretaryhasfiledamotionforsummaryaffirmancearguingthatbecausetheappellant'sclaimisnotwell -P(/ grounded,thedutyestablishedunderStegallv.West,11Vet.App.268(1998),isnotapplicable.  BecausetheCourtdistinguishesthiscasefromthefactspresentedinStegall,supra,andfurther h МdefinesthescopeoftheBoard'sandtheSecretary'sdutytocomplywitharemandorderforamedicalopinion,thiscaseisnotappropriateforsummarydisposition.SeeFrankelv.Derwinski, 8 1Vet.App.23(1990).TheCourthasjurisdictionofthecaseunder38U.S.C.7252(a).Forthefollowingreasons,theCourtwillaffirmthedecisionoftheBoard.@224 I.FACTS      TheappellantservedonactivedutyintheU.S.MarineCorpsfromMay1950toAugust1951,includingserviceinKorea.{{{񀀜R.at19.{In1952,theappellantwasgrantedserviceconnectionanda30%disabilityratingforresidualsoffrostbiteofhishandsandfeet.}||}|R.at121.|  InFebruary1992,theappellantfiledaclaimforserviceconnectionofarthritissecondarytofrostbitethathehadsufferedduringservice.~~~R.at154.~TheappellantwasaffordedaVAmedicalexaminationforhisjoints.R.at17797.Xrayexaminationsdemonstratedthathehaddegenerativearthritisinmultiplejoints,includinghishands,shoulders,feet,knees,hips,thoracicspine,andlumbarspine.R.at18996.Theexaminingphysicianopinedthattheetiologyoftheappellant'sarthritiswas"wearandtear"consistentwiththeappellant'sage.񀀜R.at179.TheVAregionaloffice(VARO)deniedtheappellant'sclaiminJune1993.R.at20509.TheappellanttimelyappealedthedecisiontotheBoard.HealsosubmittedacopyofatrainingletterϜdatedJanuary26,1993,fromtheVADirectorofCompensationandPensionServicesaboutcoldweatherinjuries.Theletterstatedthat"[v]eteranswhoareservice[]connectedforcoldinjury[will]faceanincreasedriskfordevelopingthefollowingconditionsatthesiteoforiginalinjury:peripheralneuropathy,squamouscellcarcinomaoftheskin...,arthritis,orbonychangessuchaslesions."R.at222.Theletteralsostatedthatserviceconnectioncouldbegrantedevenifthebodyasawholewasaffected.R.at22021.TheappellantalsointroducedaletterdatedNovember2,1992,fromtheVeteransHealthAdministrationthatspecificallynotedthatveteranswhosustainedcoldinjuriesinKoreacouldexperience"latesequelaeoftheinjuries,includingskincancersinscarsandarthritis."R.at222.Thatletterstatedthatveteranswitharthritisofjointsthathadbeenaffectedwithcoldinjuriesshouldbereferred toaveteransbenefitscounselorinordertoapplyforserviceconnection.Id. *%6   InMay1996,theBoardissuedaremandorderwhichsoughtamedicalopinionregardingthe etiologyoftheappellant'sarthritisinmultiplejoints.TheBoardstatedthatinlightoftheVAdatarelatingtolatesequelaeofcoldinjuries,"amedicaldeterminationbasedonalltheevidenceofrecordisrequiredbeforetheBoardcanadjudicatetheissueofsecondaryserviceconnectionforacquiredarthritisaffectingmultiplejoints,includingthehands,andanopinionfromanexaminingphysicianinthisregardwillbematerialandcannotbeignored."R.at272.TheBoardorderedthatamedicalexaminerϜshould(1)expressanopinionregardingtheetiologyoftheappellant'sarthritisinvolvingmultiplejoints,(2)makereferencetotheVAletterspreviouslydiscussed,and(3)reviewtheappellant'sclaimϜfolder.R.at273.TheBoardexplicitlyorderedtheVAROtoinsurecompliancewiththeorderandimplementanycorrectiveactionnecessary.R.at274.  TheappellantwasaffordedacompleteVAmedicalexaminationofhisjointsbyS.Hayat,M.D.,aVAstaffrheumatologist.R.at28082.Dr.Hayatnotedthat"[osteoarthritis]hasbeenfoundtobeassociatedwithtraumaasinathletes"andthat"thispatienthashada[history]offrostbite."R.atϜ288.Dr.Hayatwasalsorequestedtogivehis"opinionastowhether[theappellant's]arthritisofmultiplejoints[,]includingthehands[,]isduetoresidualsoffrostbiteof[his]handsandfeet."񀀜R.at283.Dr.HayatϜresponded:"Cannotsaywhetherrelatedtofrostbiteornot."Id.Henotedthattheappellanthaddegenerativejointdiseaseofmultiplejoints,includinghisshoulder,hands,ankles,knees,andfeet.Id.  InJanuary1997,theVAROgrantedtheappellantserviceconnectionfortraumaticarthritis " inhishandsandfeetsecondarytoresidualsoffrostbiteinthoseareas.R.at290.TheVAROdeniedtheappellant'sclaimforsecondaryserviceconnectionfordegenerativearthritisinhisremainingjoints.ϜId.  OnappealtotheBVA,theBoarddeterminedthattheappellanthadnotsubmittedevidence  ( ofawell-groundedclaimforsecondaryserviceconnectionofdegenerativejointdiseaseinjointsotherthanhishandsandfeet.@YY2 II.ANALYSIS  p&!0   Afteraclaimanthassubmittedevidenceofawellgroundedclaim,theSecretaryhasadutytoassisttheclaimantindevelopingthefactspertinenttotheclaim.See38U.S.C.5107(a); @)$4 Andersonv.Brown,9Vet.App.542,546(1996).TheCourthasheldthatthedutytoassistincludes *%6 athoroughandcontemporaneousmedicalexamination.SeeHicksv.Brown,8Vet.App.417,421 ,`'8 (1995);Greenv.Derwinski,1Vet.App.121,124(1991);38C.F.R.4.2(1998)(statingthatifa  medicalreportdoesnotcontainsufficientdetail,theratingboardmustreturnthereportasinadequateforevaluationpurposes).InStegall,thisCourtheld"thataremandbythisCourtortheBoard  confersontheveteranorotherclaimant,asamatteroflaw,therighttocompliancewiththeremandorders."11Vet.App.at271.TheCourtalsoheldthat"theSecretary...[had]aconcomitantdutytoensurecompliancewiththetermsoftheremand"andthat"theBoarditselferrsinfailingtoinsureϜcompliance."Id.InStegall,"nopsychiatricevaluationindependentofthe...hospitalization[for  p  post-traumaticstressdisorder]wasconducteddespitethe[BVA's]earlierremandorder."Seeid.at   М270.BecauseinStegallthespecificmedicalexaminationrequestedbytheBoardhadnotbeen @  completed,itwasclearthatthehospitalizationrecordswereinadequateforVAratingpurposesandthattheBVA'sremandorderhadnotbeencompliedwith.TheCourtheldthattheBoardhadcommittedprejudicialerror,inthatspecificcase,byfailingtoensurecompliancewithitsremandorderforamedicalevaluation.Id.at271.    Inthismatter,theBoardorderedtheSecretarytoobtainamedicalopiniondiscussingtheetiologyoftheappellant'sarthritisofmultiplejoints,includinghishandsandfeet.Theorderalsorequiredthephysicianto(1)refer+to+theVAmaterialsrelatingtolateeffectsofcoldinjuries,includingarthritisintheaffectedjoints,and(2)reviewtheappellant'sclaimsfile.TheappellantwasthenexaminedbyaVArheumatologist.Afterhisexamination,therheumatologiststatedthathecouldnotsaywhethertheappellant'sarthritiswasrelatedtoin-serviceinservicefrostbite.ThedoctordidnotdiscusstheVAissuancesregardingtheinterrelationshipofcoldinjuriesandlateroccurringarthritis.  ThiscaseisveryfactuallyverydifferentfromtheStegallcase.First,tTheappellant'sclaimforanincreasedratinginwaswell  ( groundedinStegall.Inthismatter,theappellant'sclaimforsecondaryserviceconnectionfor 8"* arthritisin,his,joints-,-otherthanhishandsandfeet.,.isnotwellgrounded.See38U.S.C.5107(a). #, Foraclaimtobewellgrounded,aclaimantmustsubmiteachofthefollowing:(1)amedicaldiagnosisofacurrentdisability;(2)medicalevidence,orincertaincircumstanceslayevidence,ofin++serviceinserviceincurrenceoraggravationofadiseaseorinjury;and(3)medicalevidenceofanexusbetweenthein++serviceinservice% 0 injuryordiseaseandthecurrentdisability.SeeCaluzav.Brown,7Vet.App. @)$4 498,506(1995),aff'dpercuriam,78F.3d.604(Fed.Cir.1996)(table).Theappellant'sclaimisnot *%6 wellgroundedbecausethereisnomedicalevidenceofanexusbetweentheappellant'scoldinjuries ,`'8 andhiscurrentarthritisofthejointsotherthanhishandsandfeet.Seeid.at505(holdingthata  BVAdeterminationregardingwhetheraclaimiswellgroundedisaquestionofthelawthattheCourtreviewsdenovo).  Itappearsthattheappellant'sclaimforsecondaryserviceconnectionforarthritis/inthejoints/ofhishandsandfeetwouldhavebeenwellgroundedatthetimeoftheBoard'sremandorderforanadditionalmedicalopinion.InWallinv.West,|Q11Vet.App.509Q\,514\Q(1998)Q|}],]}theCourtheldthatba"treatiseabcmedicaltreatiseinformationcdthat    deddiscussesdef"discussesgenericrelationshipswithadegreeofcertaintysuchthatfgf,fgh,underthefactsofaspehihficifhijcificcase,thereisaleastplausiblecausalitybasedonobjectivefactsratherthanonjanjunsubstantiatedlaymedicaljkjijklopilmlionlmnnionnon.nop,pn"nqthetreatisqrqqrseinformationcouldservstsistueascompetentmedicalnexuseviduvuneceuvwenceforawellwxwwxy-groundedclaim.y~11Vet.App.509,514(1998)~(quotingSacksv.West,11Vet.App.314,317 X  (1998)).znnQ(holdingthatmedicaltreatiseinformationspecificallydiscussingthelikelihoodofcausationwassufficienttowellgroundtheappellant'sclaim).Qz{{Becausetheclaimwaswellgrounded,theSecretaryhadadutytoassisttheveteranindevelopingthepertinentfactsofhisclaim.See:Anderson,supra:;;==<38U.S.C.5107(a)<;;.TheBoard0,therefore,011determinedthatit (x wouldremand foram   adic   edi   al   calexamination  of 2regardingarthritisinalltheappellant'sjointsbecause23relatingto  alltheappellant's34484the489his944claimsforsecondaryserviceconnection5ofarthritisinhis55joints5joinmul5becausetheissues56677wereinextricablyintertwined.However,onceserviceconnectionwasgrantedforthespecificjointsthathadbeendiagnosed affected withfrostbiteinservice,il.e.,hishandsandfeet,wasgranted,theclaimsregardingtheremainingjoints"!wasnotwell!"wasereawsleftwithoutlackedanymedicalevidenceofanexus#inordertowe#$#el#$%llground%[%the%[\thatseparate\]%%]%claim%^% 6 ^.Becausetheclaimwasnotwellgrounded,anyerroronthepartoftheSecretarywouldbenonprejudicial.theSecretarydihadnodutytoassitsisttheappellantindevelopintgthereamainingclaim.>>?SeeAnderson,supra?@.@?>>?idnotForthat " reason,additionalactionbytheBoardtoenforceitsreammadndorderwasnotrequiredunderStegall. P$   SecondFurthermore,theSecretarydidobtainamedicalopinionAitwasclearAintheStegallcaseB,themedicalevaluationorderedbytheBoardhadnotbeen h& performed.BCthCttheCattheBoard'sreCamCmandorderhadnotbeencompliedwithC,C.CDDInthiscase,theSecretarydidassisttheappellantinobtainingamedicalopinionfroma&doctorwhospecializesinjointandmus&l&clepain&'VArheumatologistabouttheetiologyofhisarthritis';itwasjustinconclusive,speculative,andinsufficientevidenceofanexus.ThefactthatthemedicalopinionwasinconclusiveE,Eregardingarelationshipbetweentheappellant'sarthritisandresidualsfromfrostbiteF,FdosesesnotmeanthattheeaxaminationwasGnotGHinHadequate.SeeTirpakv.Derwinski,2Vet.App.609(1992).Cf.Stegall,Hicks,andGreen,allsuparrea\\\ra.( p&!0 (**) %X . )Indeed,giventhefactthattheappellantsufferedfrostbitealmostfortyyearspriortotheVArheumatologist'sexamination,itis,perhaps,notsurprisingthattherheumatologistcouldnotdeterminewhetherthefrostbitehadcausedthearthritis.Therefore,tThIatIJeJportionoftheKBVAKremandorderLrequestingamedicalopinionLO,OLregardingtheetiologyoftheappellanLML'tLMNt'sarthritisNP,PNNwassubstantiallycompliedwith.TheBoarddoeshavethepowertoseekadditionalindependentmedicalevidence.See38U.S.C. @)$4 5109(a).However,inthismattertheBoarddeterminedinsteadthattheclaimwasnotwellgrounded.Forthatreason,additionalassistancewasnotstatutorilyrequired.Thelackofcomplianceinthismatterrelatestothedoctors'failuretodiscusstheVA ,`'8 lettersrelatingtocoldinjuriesandarthritis.However,thoseletterQsQRonlyallegeaRSassertedaSrelationshipUTonlyTUVsolelyVTTbetweenlaterdiagnosedarthritisandtheareasaffectedbyacoldinjury.Compliancewiththataspectoftheremandorderwouldnotassisttheappellant'sclaimforsecondaryserviceconnectionofthejointsthatwerenotaffectedbyfrostbite.WWXXY  YtheTheCourtholdsthttheattheBVA'sdecisionthattheappellant'sclaimforserviceconnectionofarthritisinhisjioointsotherthaanhishandsandfeetisnotwellgrounded.SeeWallinandCaluza,bothsupra.Forthatreason,    thedutytoassistwasnottriggeredinrelationshiptotheatclaimforVAbenefits,andanyadditionalactionbytheBoardtoenforceitsreamdamdmandorderwasnotrequiredunderStegall.failuterebytheBoardtoenforceitsremandorderwasnonprejudicialerror.   @0 III.CONCLUSION  X    Afterconsiderationofthepleadingsofthepartiesandareviewoftherecord,theCourtholdsthatthe% 9 July1997decisionoftheBoardisAFFIRMED.oo__oop__pqqaaa  a`IVERS,Judge,concurring:Attachedtotheveteran'soppositiontotheSecretary'smotion H forsummaryaffirmancewasacopyofVeteransHealthAdministration(VHA)DirectiveNo.98052(Nov.18,1998)(expiresSept.30,1999).ThisdocumentcouldnothavebeenbeforeeithertheSecretaryortheBoardasitwasnotissueduntilafterbothhadconcludedtheirreviewoftheclaim.Therefore,theCourtcannotcommentonwhateffectthedirectivemighthaveonwhethertheveteran,whoisreceivingmedicalcarefromVAforaserviceconnecteddisability,canobtainanopinionfromaVAmedicalprofessionalinanattempttowellgroundhisclaimforanincreasedevaluation.`z``z