WPC<  
      [     ƭP%U~z1#:c'ZAkGむN_Cyn(u
b C_ 'fptlgHoyuR%"dL.?=UhhYb2^oF] ,0J.c9?ϸu(Mp+fֆ$^ɁeVrS?&ui!M˺K!dw-|:S/uHDꁗ<w2Xu<3jJBC%	Hy8<b!=ڒe 
:ЪX4=uH&ͶbcRɵ>!.zida^	nn>D
zYwb>=Q6Oe.b»rSsq|[`k/v#,H9\o&_D>1 L           0   ~   (  0   x     0   k     0   k     0        0   ~     0      	  0      	  0      
  0      g  0   
  ^  0     h  0   1    0   C    0   V    0      P  0        0        0      g  0      *  0        0        0      z  0         U   .     	%        0   z     0      n  	      R  0   =   c  0   F     0   P     	1      6  0        	1       0           }  i  0      !   E      "  0      "  0      A#  0      $  0   &   $  0   &   $  0   &   $  0   &   %   U   >   9%   	      w%  n   X  }%  0      &  	B      k'  #     '     ~  (   	      +        +  	1   m   #+   	      +        +   !      +   !     6,   !     F-   !     V.   !     f/  	)      v0        0         1  "   ]  1   U   N   4  w     <5  4      H<        \<   	      d<            d<            d<   U   N   j<      V       &          8 D o c u m e n t [ 8 ]   D o c u m e n t   S t y l e   0    . .  8    `	. . `	      V                8 D o c u m e n t [ 4 ]   D o c u m e n t   S t y l e       . .  .    V                 8 D o c u m e n t [ 6 ]   D o c u m e n t   S t y l e   8    . .       V                 8 D o c u m e n t [ 5 ]   D o c u m e n t   S t y l e   0    . .       V       /         8 D o c u m e n t [ 2 ]   D o c u m e n t   S t y l e   2     A.3
   
 Ԁ
               V       &          8 D o c u m e n t [ 7 ]   D o c u m e n t   S t y l e   0    . .  0    `	. . `	      z       U          : R i g h t   P a r [ 1 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .  2       I.3
   
 Ԁ     . .  0    . .       z       h          : R i g h t   P a r [ 2 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. .  2      A.3
   
 Ԁ     . .  0    `	. . `	      V       ?         8 D o c u m e n t [ 3 ]   D o c u m e n t   S t y l e       . .  2     1.3
   
 Ԁ
               z       {          : R i g h t   P a r [ 3 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . . P
 2      1.3
   
 Ԁ     `	. . `	 0    . .       z                 : R i g h t   P a r [ 4 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . .      . .  2      a.3
   
 Ԁ     . .  0    . .       z                 : R i g h t   P a r [ 5 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . .      . .      h. .  2      (1)3
   
 Ԁ     . .  0    h. . h      z                 : R i g h t   P a r [ 6 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . .      . .      h. . h     . .  2      (a)3
   
 Ԁ     h. . h 0    . .       z                 : R i g h t   P a r [ 7 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . .      . .      h. . h     . .      . .  2      i)3
   
 Ԁ     . .  0    . .       z                 : R i g h t   P a r [ 8 ]   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . .      `	. . `	     . .      . .      h. . h     . .      . .      p. .  2      a)3
   
 Ԁ     . .  0    p. . p      V       X         8 D o c u m e n t [ 1 ]   D o c u m e n t   S t y l e        @    . . ^ 
      2      I.3
   
 Ԁ               Ԉ     l       2         : T e c h n i c a l [ 5 ]   T e c h n i c a l   D o c u m e n t   S t y l e       . .  2     (1)3
   
 Ԁ.    l       2         : T e c h n i c a l [ 6 ]   T e c h n i c a l   D o c u m e n t   S t y l e       . .  2     (a)3
   
 Ԁ.    l       /   %      : T e c h n i c a l [ 2 ]   T e c h n i c a l   D o c u m e n t   S t y l e   2     A.3
   
 Ԁ
               . .      l       ,   !      : T e c h n i c a l [ 3 ]   T e c h n i c a l   D o c u m e n t   S t y l e   2     1.3
   
 Ԁ
               . .      l      (   !      : T e c h n i c a l [ 4 ]   T e c h n i c a l   D o c u m e n t   S t y l e   2     a.3
   
 Ԁ
               . .      l       :   0      : T e c h n i c a l [ 1 ]   T e c h n i c a l   D o c u m e n t   S t y l e   
      2      I.3
   
 Ԁ                    . .      l       1         : T e c h n i c a l [ 7 ]   T e c h n i c a l   D o c u m e n t   S t y l e       . .  2     i)3
   
 Ԁ.    l       1         : T e c h n i c a l [ 8 ]   T e c h n i c a l   D o c u m e n t   S t y l e       . .  2     a)3
   
 Ԁ.< 6X  9   ` (   C o u r i e r           X    R       &          8 B i b l i o g r p h y   B i b l i o g r a p h y   0    . .       . .      f          p        2 D o c   I n i t   I n i t i a l i z e   D o c u m e n t   S t y l e        S 	!   	             I. 1. A. a.(1)(a) i) a)                 S                                     (                  $       0
    
  
    
     (                  $       0
    
 0
    
  
    
     (       (           $       0
    
 0
    
 0
    
  
    
    	         A _ e k q w    D o c u m e n t   D o c u m e n t   S t y l e   I .   1 .   A .   a .   ( 1 )   ( a )   i )   a )         j       o            4 T e c h   I n i t   I n i t i a l i z e   T e c h n i c a l   S t y l e   S 	#                      1 .1 .1 .1 .1 .1 .1 .1                  S                                        C u y       T e c h n i c a l   T e c h n i c a l   D o c u m e n t   S t y l e   1   1 . 1   1 . 1 . 1   1 . 1 . 1 . 1   1 . 1 . 1 . 1 . 1   1 . 1 . 1 . 1 . 1 . 1   1 . 1 . 1 . 1 . 1 . 1 . 1   1 . 1 . 1 . 1 . 1 . 1 . 1 . 1         x   F               82 P l e a d i n g   H e a d e r   f o r   n u m b e r e d   p l e a d i n g   p a p e r                      %         Ka:;  
   s  
 &  (        X  X  X X             X            X > 3 ' '                   *       d       > > 3 ' '                   *       d      >     H  1    H  2    H  3    H  4    H  5    H  6    H  7    H  8    H  9      10      11      12      13      14      15      16      17      18      19      20      21      22      23      24      25      26      27   	 P-0*6   Ї      28"              '      "     (                  2J$       
 2  .!  D  X X  X X             7 K  K X X       d                  d 7           P       B         0 H e a d i n g   C h a p t e r   H e a d i n g   @    . . 
  2      I.3
   
 Ԁ
            Ԉ    t       O          4 R i g h t   P a r   R i g h t - A l i g n e d   P a r a g r a p h   N u m b e r s       . . 
  2       I.3
   
 Ԁ     0    . .       L       =         6 S u b h e a d i n g   S u b h e a d i n g   2     A.3
   
     . .   
              &                    $ 1         &                    $ 2         &                    $ 4         &                    $ 3     ) \	  	   `   & T m s R m n       L e g a l   P r o        < 6X  9   ` (   C o u r i e r                                                                                                         Xx 6X   @ 8; X@) \	  	   `   & T m s R m n       L e g a l   P r o                                                                                   XXt \	    P PU XP    (   n               .$        D  X X  X X             7 K  K X X       d 0 X X       d 7                    d   H P   L a s e r J e t   5 P / 5 M P   ( H P )                             HPPCL5G      , ,,,,, 0                                                                                                                                                             nLF    k : \ f o r m s \ p a n e l . o p n                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
               
 '           U S C V A    0    U S C V A   
 .      
       
       
                &4                   # e   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )       3| [       " @ H O Z q    E? 0 0 004      /N                    mpϟ	 @      2RQ@LL        "     ^4@@d0LLd0@0ddddddddddd88dĘ|HXxlĘ@d@dd0dlXld@`l84h8llllLL@l\XXXddd/                                               d )     dd            d  ll               d $                                    @            "     ^4@@d4LLd0@0ddddddddddd88`ĀxPd|t|TdTdd4hlXpX@`p<@l<pdplTTDp\`XXddd/                                               d )     dd            d  ll               d $                                    @            "     ^,44P(@@P(8(TPPPPPPPPPP,,P|pttd<Hxh|d|Xl|||t4T4PP(PXHXP4PX,,T,XXXX@@4XHpHHHTPT/                                               P  )     PP            P  dd               T $                                    4            "     ^4<Dd0LLd0D0ddddddddddd88\Č|LLxl||TdTdd0hhXhX<Tl48d4lhhd@H8lXTPPddd/                                               d )     dd            d  ll               d $                                    @           ; < = > ? < 6X  9  ` +   C o u r i e r          * \	  	 p`   T m s R m n     P r o      * 4	  	 p  " T m s R m n   B o l d   P r o     T) \	  	 p`   T m s R m n     P r o     ( *f9	 p` & T m s R m n   I t a l i c   P r o      L  ? x x x , ,    Xx N  7 T C T , , / XT Q qTG  7 T C T , , b  XT ,T y . D 8 D , ,  D Q{ 9  5 P C P , ,   XP Dd  Full-PE Land  Land  Land  Land G  H Legal H  Pro  Pro  Pro  Pro  Pro  Pro  Pro  Pro  Z Land H  G  G Land G  G  Pro   Pro  Pro  Pro  Pro  Pro  Pro  Pro  Pro  Pro Land Pro Land Pro Land Pro Land Pro Land Pro Land Pro Land Pro Land Pro La( hH  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r         ,  g E h  i E j  k E l  m E n  o D p  q  r E s  t E u  v E w  x E y N z D {  |  } D ~       Ӏ                   E    E      E    D    E    E    E    E    E    E      E    E          E        E      E    E    E    D  D  [            E    E                E    E    E    E        E    E    E      D    E    E    D  [                  g g g g         D    D    D    E  D    E           E    E    E       	  
 E    E    D          D    D  D    D  D    D    D    D    !  " E #  $ E %  & D '  ( E )  *  +  ,  -  .  /  0 D 1  2  3 D 4  5 D 6  7 D 8 D 9  :  ; [ <  =  >  ?  @  A  B  C D D  E  F  G D H  I D J  K  L  M E N  O  P  Q  R D S  T  U E V  W U X D Y P [ D \  ] D ^ e_ U `  a P b U c  d  e [ f  g  h E i  j  k E l  m  n E o  p D q U z E {  |  } E ~                                       / / D  D  / / /   D  D      D   vo'          '       H                      g 6 T i m e s   N e w   R o m a n   R e g u l a r         
 2  .!  D  X X  X X             7 K  K X X       d                  d 7      = /  gc/ X  X       d                 d=     f @      UNITEDSTATESCOURTOFAPPEALSFORVETERANSCLAIMS   	       @    3  No.971993   	    @    *  MelvynL.Roberts,Appellant,   	 `	   @    7  v.   	 @   @    /  TogoD.West,Jr.,   	  p	   @    $  SecretaryofVeteransAffairs,Appellee.   	 `	
   @    ee"  OnAppealfromtheBoardofVeterans'Appeals@    )  (DecidedNovember19,1999 񀀀% H    )     GeraldL.Millerwasonthebrieffortheappellant.   	 p        LeighA.Bradley,GeneralCounsel;RonGarvin,AssistantGeneralCounsel;MichaelA.   	 P   Leonard,DeputyAssistantGeneralCounsel;andAdamK.Llewellynwereonthepleadingsforthe   	 @   appellee.     BeforeHOLDAWAY,IVERS,andGREENE,Judges.b   	 `   bbbb     bbHOLDAWAY,bcJudgecd,filedtheopinionoftheCourt.d eddefIVERf hfSfhiS,i kjjUDGEjklJudgelm,filedacm nmumnooncurring   	 @   opinion.o iffi hg,gh lffl cbbc              HOLDAWAY,Judge:Theappellant,MelvynL.Roberts,appealstheJuly1997decision   	 !   oftheBoardofVeterans'Appeals(BVAorBoard).TheBVAdeterminedthattheappellant'sclaimforsecondaryserviceconnectionofarthritisinmultiplejoints,notincludinghishandsandfeet,wasnotwellgrounded.Theappellanthadpreviouslybeengrantedserviceconnectionforarthritisofhishandsandfeetsecondarytofrostbitethat hehadsufferedduringactivedutyinKorea.TheappellanthasfiledabriefandareplybriefarguingthattheBoard'sdecisionshouldberemandedforfailuretocomplywithitsremandorderforamedicalexaminationtodiscussanyetiologicalrelationshipbetweentheappellant'sfrostbitethatwasincurredinserviceandhiscurrentarthritis.TheSecretaryhasfiledamotionforsummaryaffirmancearguingthatbecausetheappellant'sclaimisnotwell     -P(/    grounded,thedutyestablishedunderStegallv.West,11Vet.App.268(1998),isnotapplicable.   	       BecausetheCourtdistinguishesthiscasefromthefactspresentedinStegall,supra,andfurther   	 h   МdefinesthescopeoftheBoard'sandtheSecretary'sdutytocomplywitharemandorderforamedicalopinion,thiscaseisnotappropriateforsummarydisposition.SeeFrankelv.Derwinski,   	 8   1Vet.App.23(1990).TheCourthasjurisdictionofthecaseunder38U.S.C.7252(a).Forthefollowingreasons,theCourtwillaffirmthedecisionoftheBoard.@    224  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.Ϝ Id .      OnappealtotheBVA,theBoarddeterminedthattheappellanthadnotsubmittedevidence   	   (   ofawell-groundedclaimforsecondaryserviceconnectionofdegenerativejointdiseaseinjointsotherthanhishandsandfeet.@    YY2  II.ANALYSIS   	 p&!0        Afteraclaimanthassubmittedevidenceofawellgroundedclaim,theSecretaryhasadutytoassisttheclaimantindevelopingthefactspertinenttotheclaim.See38U.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).InStegall,thisCourtheld"thataremandbythisCourtortheBoard   	    confersontheveteranorotherclaimant,asamatteroflaw,therighttocompliancewiththeremandorders."11Vet.App.at271.TheCourtalsoheldthat"theSecretary...[had]aconcomitantdutytoensurecompliancewiththetermsoftheremand"andthat"theBoarditselferrsinfailingtoinsureϜcompliance."Id.InStegall,"nopsychiatricevaluationindependentofthe...hospitalization[for   	  p   post-traumaticstressdisorder]wasconducteddespitethe[BVA's]earlierremandorder."Seeid.at   	 	   М270.BecauseinStegallthespecificmedicalexaminationrequestedbytheBoardhadnotbeen   	 @   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'sarthritiswasrelatedto in - serviceinservicefrostbite.ThedoctordidnotdiscusstheVAissuancesregardingtheinterrelationshipofcoldinjuriesandlateroccurringarthritis.     Thiscaseis very factuallyverydifferentfromtheStegallcase. First,tThe appellant'sclaimforanincreasedrating inwaswell   	   (   groundedinStegall.Inthismatter,theappellant'sclaimforsecondaryserviceconnectionfor   	 8"*   arthritisin,his,joints-,-otherthanhishandsandfeet.,.isnotwellgrounded.See38U.S.C.5107(a).   	 #,   Foraclaimtobewellgrounded,aclaimantmustsubmiteachofthefollowing:(1)amedicaldiagnosisofacurrentdisability;(2)medicalevidence,orincertaincircumstanceslayevidence,of in ++ serviceinserviceincurrenceoraggravationofadiseaseorinjury;and(3)medicalevidenceofanexusbetweenthe in ++ serviceinservice% 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.InWallinv.West, |Q11Vet.App.509Q\,514\Q(1998)Q| }],]}theCourtheldthat ba"treatiseabcmedicaltreatiseinformationcdthat   	 
   d eddiscussesdef"discussesgenericrelationshipswithadegreeofcertaintysuchthatf gf,fgh,underthefactsofaspeh ihficifhijcificcase,thereisaleastplausiblecausalitybasedonobjectivefactsratherthanonjanjunsubstantiatedlaymedicalj kjijklopil mlionlmnnionn on.nop,pn"nqthetreatisq rqqrseinformationcouldservs tsistueascompetentmedicalnexusevidu vuneceuvwenceforawellw xwwxy-groundedclaim.y~11Vet.App.509,514(1998)~(quotingSacksv.West,11Vet.App.314,317   	 X   (1998)). znnQ(holdingthatmedicaltreatiseinformationspecificallydiscussingthelikelihoodofcausationwassufficienttowellgroundtheappellant'sclaim).Qz{{Becausetheclaimwaswellgrounded,theSecretaryhadadutytoassisttheveteranindevelopingthepertinentfactsofhisclaim.See :Anderson,supra:;;==<38U.S.C.5107(a)< ;;. TheBoard 0,therefore,011determinedthatit   	 (x   wouldremand	foram	 
	adic	
edi alcalexamination of2regardingarthritisinalltheappellant'sjointsbecause2 3relatingtoalltheappellant's344 84the489his944claimsforsecondaryserviceconnection 5ofarthritisinhis5  5joints5 join mul 5becausetheissues566 77wereinextricablyintertwined.However,onceserviceconnectionwasgrantedforthespecificjointsthathadbeen diagnosed affected withfrostbiteinservice,i l.e.,hishandsandfeet, wasgranted,theclaim s regardingtheremainingjoints "!wasnotwell!" w as ere a w sleftwithoutlackedanymedicalevidenceofanexus#inordertowe# $#el#$%llground% [%the%[\thatseparate\ ]%%]%claim% ^% 6    ^.Becausetheclaimwasnotwellgrounded, anyerroronthepartoftheSecretarywouldbenonprejudicial.theSecretary dihadnodutytoass it sisttheappellantindevelopin tgthere amainingclaim.>>?SeeAnderson,supra?@.@ ?>>? i dnotForthat   	 "   reason,additionalactionbytheBoardtoenforceitsre amma dndorderwasnotrequiredunderStegall.    	  P$         SecondFurthermore, theSecretarydidobtainamedicalopinion AitwasclearAintheStegall case B,themedicalevaluationorderedbytheBoardhadnotbeen   	 h&   performed.B C th C  tthe  CattheBoard'sreC am CmandorderhadnotbeencompliedwithC , C.CDDInthiscase, theSecretarydidassisttheappellantinobtainingamedicalopinionfroma &doctorwhospecializesinjointandmus& l &clepain&'VArheumatologistabouttheetiologyofhisarthritis' ; itwasjustinconclusive,speculative,andinsufficientevidenceofanexus.ThefactthatthemedicalopinionwasinconclusiveE,Eregardingarelationshipbetweentheappellant'sarthritisandresidualsfromfrostbiteF,Fdo se sesnotmeanthatthee axaminationwas GnotGHinHadequate.  SeeTirpakv.Derwinski  ,2Vet.App.609(1992) .Cf.Stegall,Hicks,andGreen,allsup ar rea\\\ra.    (   	 p&!0   (**)   	 %X .   )Indeed,giventhefactthattheappellantsufferedfrostbitealmostfortyyearspriortotheVArheumatologist'sexamination,itis,perhaps,notsurprisingthattherheumatologistcouldnotdeterminewhetherthefrostbitehadcausedthearthritis. Therefore,tTh IatIJeJportionoftheKBVAKremandorderLrequestingamedicalopinionLO,OLregardingtheetiologyoftheappellanL ML'tLMNt'sarthritisNP,PNNwassubstantiallycompliedwith. TheBoarddoeshavethepowertoseekadditionalindependentmedicalevidence.See38U.S.C.   	 @)$4   5109(a).However,inthismattertheBoarddeterminedinsteadthattheclaimwasnotwellgrounded.Forthatreason,additionalassistancewasnotstatutorilyrequired.Thelackofcomplianceinthismatterrelatestothedoctors'failuretodiscusstheVA   	 ,`'8   lettersrelatingtocoldinjuriesandarthritis.However,thoseletterQsQ RonlyallegeaRSassertedaSrelationship UTonlyTUVsolelyVTTbetweenlaterdiagnosedarthritisandtheareasaffectedbyacoldinjury.Compliancewiththataspectoftheremandorderwouldnotassisttheappellant'sclaimforsecondaryserviceconnectionofthejointsthatwerenotaffectedbyfrostbite.WW XXY     Y theTheCourtholds th tthe attheBVA'sdecisionthattheappellant'sclaimforserviceconnectionofarthritisinhisj ioointsotherth aanhishandsandfeetisnotwellgrounded.SeeWallinandCaluza,bothsupra.   Forthatreason,   	 
   thedutytoassistwasnottriggeredinrelation shiptoth eatclaimforVAbenefits,and anyadditionalactionbytheBoardtoenforceitsre amd amdmandorderwasnotrequiredunderStegall. failu te rebytheBoardtoenforceitsremandorderwasnonprejudicialerror.   	 	   @    0  III.CONCLUSION   	 X        Afterconsiderationofthepleadingsofthepartiesandareviewoftherecord,the Courtholdsthatthe% 9    July1997decisionoftheBoardisAFFIRMED. oo__ oo p__pqq aaa     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