**UNITED STATES COURT OF VETERANS APPEALS**

[No]{.smallcaps}. 96-1508

[Dolores L. Mattern, Appellant]{.smallcaps},

[v.]{.smallcaps}

[Togo D. West, Jr.,]{.smallcaps}

[Secretary of Veterans Affairs, Appellee.]{.smallcaps}

On Appeal from the Board of Veterans\' Appeals

(Argued November 19, 1998 Decided February 23, 1999 )

*Jacob Geesing* for the appellant.

*James L. Calis* argued, and *John H. Thompson*, Acting General Counsel;
*Ron Garvin*, Assistant General Counsel; *Carolyn F. Washington*, Deputy
Assistant General Counsel; and *Richard Mayerick* were on the brief for
the appellee.

Before KRAMER, FARLEY, and GREENE, *Judges*.

GREENE, *Judge*: The appellant, Dolores Mattern, widow of veteran James
Mattern, appeals from the September 26, 1996, Board of Veterans\'
Appeals (Board) decision that denied her claim for dependency and
indemnity compensation (DIC) as not well grounded because she had failed
to present evidence establishing that her husband\'s death was service
connected. The appellant has filed a brief, and the Secretary has filed
a brief in opposition. This appeal is timely and the Court has
jurisdiction of the case pursuant to 38 U.S.C. § 7252(a). For the
following reasons, the Court will reverse the Board decision and remand
the matter.

**I. FACTS**

Mr. Mattern served on active duty in the U.S. Marine Corps from March
1943 to December 1945 and participated in operations in the
Asian-Pacific theater (Ryukyu Island, Marianas Islands, and occupational
duty in the Qingdao Peninsula in Mainland China) during World War II. R.
at 73-76, 82. His service medical records do not reveal any diagnosis of
or treatment for liver problems and he was not service connected for any
disease or injury. R. at 11-56, 91. In December 1992, he was diagnosed
with hepatocellular carcinoma and died from this disease in January
1993. R. at 73, 120-24. He did not have hepatitis or a cirrhotic liver.
R. at 120-23. Hepatocellular carcinoma is malignant liver cancer, known
also as hepatoma. [Stedman\'s Medical Dictionary]{.smallcaps} 224, 28th
ed. (1994) \[hereinafter [Stedman\'s]{.smallcaps}\]. According to the
appellant, during her husband\'s treatment for his cancer, he was asked
by his physicians if he had ever been to China or Southeast Asia. He
replied that \"the only time in his life he had ever been there was
during World War II.\" R. at 133. She stated that they were told that
the cancer was \"very strange for the United States, the type of growth
they saw, very, very little if any of this type of growth in Lansing,
Michigan.\" *Id.*

The appellant applied for DIC in February 1993, alleging that the cause
of her husband\'s death was service connected. R. at 56-60, 66. In
support of her claim, she presented two letters from Dr. Bergman, one of
the veteran\'s private physicians. In a letter, dated February 1993, Dr.
Bergman stated:

> The cause of this disease is largely unknown, but there are several
> well-known risk factors including . . . traveling in South East Asia .
> . . . To the best of our knowledge the only risk factor \[the
> veteran\] had was travel in the service in South East Asia. It is
> certainly a distinct possibility that \[the veteran\] could have been
> exposed to the etiologic factor during his service and only recently
> did the clinical disease develop.

R. at 66b, 154, 166. In the other letter, dated August 1993, he stated
that it was his personal \"feeling that \[the veteran\'s\] malignancy
did originate from his activities in Southeast Asia.\" R. at 88. After
reviewing the claim, VA also requested an opinion regarding the cause of
the veteran\'s death. Based on his review of the veteran\'s medical
records, Dr. Jaszewski, Chief of Gastroenterology at the VA medical
center, opined:

\[A\]lthough the risk of being exposed to an agent(s) with the potential
to cause hepatocellular cancer is increased in persons traveling to or
living in southeast Asia, there is no clear evidence in the patients
records to indicate that he was exposed to such an agent nor suffered
from any condition that would predispose him to later developing
hepatocellular cancer.

R. at 79. In an October 1993 rating decision, a VA regional office
denied the appellant\'s claim for DIC, concluding that the cause of the
veteran\'s death was not service connected. R. at 90, 93. She filed an
NOD in March 1994 and appealed to the Board in May 1994.

In August 1994, the appellant presented a letter to VA, accompanied by
photographs, describing her husband\'s World War II experiences in the
Marine Corps. R. at 118. She explained that the pictures depicted him in
the civilian stockade, \"in very close proximity to native people.\"
*Id.* She also recounted that he \"frequently told tales of working on a
railroad on the Qingdao Peninsula where the Marines operated the train,
but native labor did the manual work.\" *Id.* She also considered this
to be \"close proximity and \'exposure\'.\" *Id.* At a personal hearing,
she testified again about her husband\'s living conditions in China and
repeated his reports of his experiences in the Qingdao Peninsula. R. at
131-37. Further, she stated that \"he commented many times on the
squalor, the filth, the disease, that were very apparent in the . . .
\'native quarter\' that was right next to where they were living.\" R.
at 132. In response to the hearing officer\'s question about whether her
deceased husband ate \"steaks and potatoes,\" she testified, \"No, nor
were they eating K-rations.\" R. at 134. She replied that he told her
that he ate only local food prepared for him by a native. *Id.*

The appellant also presented additional medical evidence. Another
statement by Dr. Bergman, dated April 29, 1994, concluded that the
veteran\'s

> service in Mainland China certainly is relevant-and his service in the
> Japanese occupied islands is direct exposure to carriers of hepatitis
> B . . . . It\'s quite difficult to prove that the initial exposure was
> during WWII but it\'s impossible to prove it wasn\'t . . . . Often no
> specific incident \[of exposure\] can be demonstrated.

R. at 140-41. Dr. Clarkson, one of the veteran\'s treating physicians,
provided a letter in which he stated that he \"totally agreed \[with\]
Dr. Bergman that direct or indirect exposure during \[the veteran\'s\]
military service was causative.\" R. at 139. He further opined that
exposure to East Asia is \"a common variable for many people who have
this grave disease,\" and that \"the medical literature is clearly in
support of \[the appellant\'s\] claim.\" *Id.* A statement by Dr.
Neiberg, another of the veteran\'s physicians, explained that
\"\[h\]epatocellular carcinoma is an unusual tumor in this part of the
world, having much more common representation in tropical climates
(Southeast Asia). . . . \[H\]epatocellular carcinoma can manifest itself
after a long latent period during which it can be totally
asymptomatic.\" R. at 66a, 166, 175. Finally, the appellant presented
excerpts from medical journals describing the epidemiology of
hepatocellular carcinoma. R. at 143-44, 160. Epidemiology is the study
of the prevalence and spread of disease in a community.
[Stedman\'s]{.smallcaps}, at 474. It was noted in one treatise that, in
the United States and Europe, this form of cancer

> is increasing in incidence but remains relatively uncommon . . . . In
> certain other areas of the world, including parts of sub-Saharan
> Africa, Southeast Asia, Japan . . . hepatocellular carcinoma is the
> most frequent or one of the most frequent malignancies and an
> important cause of overall mortality. . . . In most cases
> hepatocellular carcinoma develops in a cirrhotic liver. . . .
> Epidemiologic evidence has also suggested a link between
> hepatocellular carcinoma and ingestion of aflatoxins, mycotoxins
> produced by *Aspergillus flavins*, a mold that can grow in warm, moist
> areas and contaminate peanuts and stored grains.

R. at 143-44. Another excerpt from a medical treatise provided as
follows:

> Aflatoxin B~1~, the mycotoxin of the fungus *Aspergillus flavins*, is
> a well documented carcinogen in rats, fowl, and fish. \[It\] grows
> readily on improperly stored corn, grains, and ground nuts (peanuts).
> Epidemiologic studies have shown a correlation between the content of
> aflatoxin in the diet and the incidence of hepatocarcinoma in parts of
> Africa and Southeast Asia, and such findings strongly support a role
> for aflatoxins in the high incidence of hepatocarcinoma in these
> areas.

R. at 160. In September 1996, the Board concluded that the appellant\'s
service-connection claim for the cause of the veteran\'s death was not
well grounded. R. at 6. It determined that the veteran\'s service
medical records failed to present \"evidence of an in-service injury or
disease to which there could be a nexus with the cause of the veteran\'s
death.\" *Id.* This appeal followed.

**II. APPLICABLE LAW AND ANALYSIS**

DIC is paid to the surviving spouse, children, or parents of a
qualifying veteran who dies from a service-connected disability. *See*
38 U.S.C. § 1310; 38 C.F.R. § 3.5 (1998). For such a death to be
considered service connected, it must result from a disability incurred
in or aggravated by active service in the line of duty. *See* 38 U.S.C.
§ 101(16); *Pearlman v. Wes*, 11 Vet.App. 443, 445 (1998). As with any
other claim for service-connected benefits, a claimant seeking DIC has
the initial burden of establishing that the claim is well grounded. *See
Darby v. Brown*, 10 Vet.App. 243, 245 (1997); *Johnson v. Brown*, 8
Vet.App. 423 (1995); *see also* 38 U.S.C. § 5107(a) (\"\[A\] person who
submits a claim for benefits under a law administered by the Secretary
shall have the burden of submitting evidence sufficient to justify a
belief by a fair and impartial individual that the claim is well
grounded\"); *Carbino v. Gober*, 10 Vet.App. 507, 509 (1997). Whether a
claim is well grounded is a question that the Court reviews de novo
under 38 U.S.C. § 7261(a)(1). *See id.*; *Grivois v. Brown*, 6 Vet.App.
136, 139 (1994); *Grottveit v. Brown*, 5 Vet.App. 91, 92 (1993). A
well-grounded claim is defined as \"a plausible claim, one which is
meritorious on its own or capable of substantiation . . . \[that\] need
not be conclusive but only possible.\" *Murphy v. Derwinski*, 1 Vet.App.
542, 545 (1996); *accord Black v. Brown*, 10 Vet.App. 279, 283 (1997).
Where the determinative issue involves etiology or a medical diagnosis,
competent medical evidence that a claim is \"plausible\" or \"possible\"
is the threshold requirement for the claim to be well grounded. *Heuer
v. Brown*, 7 Vet.App. 379, 384 (1995); *Grottveit*, 5 Vet.App. at 93. A
well-grounded service-connection claim generally requires (i) medical
evidence (diagnosis) of a current disability; (ii) medical or, in some
circumstances, lay evidence of incurrence or aggravation of a disease or
injury in service; and (iii) medical evidence of a nexus between the
in-service injury and the current disability. *See* *Caluza v. Brown*, 7
Vet.App. 498, 506 (1995), *aff\'d per curiam*, 78 F.3d 604 (Fed. Cir.
1996) (table); *see also Epps v. Gober*, 126 F.3d 1464, 1468 (Fed. Cir.
1997) (expressly adopting the definition of a well-grounded claim set
forth in *Caluza*). For service connection for the cause of a veteran\'s
death, \"the first requirement, evidence of a current disability, will
always have been met\" (the current disability being the condition that
caused death); however, the last two requirements must be supported by
evidence. *Carbino*, 10 Vet.App. at 509; *Ruiz v. Gober*, 10 Vet.App.
352, 356 (1997). Evidence submitted to well ground a claim is generally
presumed credible. *See Robinette v. Brown*, 8 Vet.App. 69, 75-76
(1995); *King v. Brown*, 5 Vet.App. 19, 21 (1993).

The Secretary argues that the appellant\'s claim is not well grounded.
First, he asserts that the appellant has not pointed to a specific
causative factor or disease that the veteran contracted in service,
arguing that \"mere presence in a region of the world . . . is not a
causative factor.\" Secretary\'s Brief (Br.) at 5. Second, the Secretary
argues that there is \"no competent medical nexus\" evidence because the
medical statements of Dr. Bergman and Dr. Clarkson, offered in support
of the appellant\'s claim, fail to provide a causal relationship between
the veteran\'s cancer and service. Secretary\'s Br. at 4. Although the
Secretary purports to be advancing two distinct contentions in support
of his argument, they are in reality two sides of the same coin, namely
the absence of evidence of a nexus between the veteran\'s service and
his cancer. We disagree.

In this case, the appellant\'s uncontroverted evidence goes farther than
to just establish the veteran\'s \"mere presence\" in Southeast Asia.
She has offered sworn testimony, letters, and pictures that establish
that her husband lived and worked amongst the natives and ate the local
food. Thus, he was not merely present, but immersed in the local
environment. \"Service connection connotes many factors but basically it
means that the facts, shown by evidence, establish that a particular
injury or disease resulting in disability was incurred coincident with
service.\" 38 C.F.R. § 3.303(a) (1998). All that is necessary is
evidence of a relationship between the current, disabling disease or
injury and military service. This relationship need not be conclusive,
but only plausible. *See Black* and *Murphy, supra*. Thus, in this case,
to well ground her claim, the appellant need only show, through medical
evidence, a plausible relationship between her husband\'s hepatocellular
carcinoma and his military service.

The facts that form the predicate for resolving claims for benefits
generally are established by the process of induction. Adjudicators and
representatives\--even judges\--are familiar, and thus comfortable with
the common situations where statements and records serve as the basis
for factual findings, such as service incurrence and current disability.
If medical opinions or treatises sufficiently link the facts found, then
benefits are awarded. This case, however, presents a different situation
in that it calls not for inductive reasoning, but rather for deductive
reasoning. Neither § 5107(a) nor the relevant regulations preclude
establishment of a well-grounded claim by deduction if warranted by the
facts of a particular case. Likewise, they do not preclude a claim from
being well grounded on the basis of epidemiology as well as empirical
observations.

Dr. Bergman opined that it is \"a distinct possibility that \[the
veteran\] could have been exposed to the etiological factor during his
service.\" (R. at 66b, 154, 166) and that it was his personal \"feeling
that \[the veteran\'s\] malignancy did originate from his activities in
Southeast Asia\" (R. at 88). Dr. Clarkson stated that he \"totally
agreed with Dr. Bergman that direct or indirect exposure during \[the
veteran\'s\] military service was causative\" and that exposure to East
Asia is \"a common variable for many people who have this grave
disease.\" R. at 139. The Secretary asserts that these medical
statements are speculative and conjectural because they fail to identify
\"the causative factor that they \'guess\' the veteran contracted in
service that caused the cancer.\" Secretary\'s Br. at 5. Contrary to the
Secretary\'s position, however, \"use of cautious language does not
always express inconclusiveness in a doctor\'s opinion on etiology, and
such language is not always too speculative for purposes of finding a
claim well grounded.\" *Lee v. Brown*, 10 Vet.App. 336, 339 (1997). An
\"etiological opinion should be viewed in its full context, and not
characterized solely by the medical professional\'s choice of words.\"
*Id.*

Here, we are presented with a cancer where \"often no specific incident
\[of exposure\] can be demonstrated\" (R. at 140-41, 143-44, 160), a
cancer that can \"manifest itself after a long latent period during
which it can be totally asymptomatic\" (R. at 166, 175), and a rare form
of cancer that is statistically more prevalent in Southeast Asia and in
people who have traveled in Southeast Asia. In addition, there is ample
evidence that the veteran\'s service in the Marine Corps included living
under local conditions in that part of the world. From these facts
showing exposure, Dr. Bergman deduced that there is a distinct
possibility and that he felt the veteran\'s carcinoma was contracted
during his service tenure in Southeast Asia, with which Dr. Clarkson
conclusively concurred.

This Court has reviewed what constitutes acceptable medical opinions for
the purpose of establishing well groundedness and finds that our
jurisprudence is in accordance. In *Tirpak v. Derwinski*, 2 Vet.App. 609
(1992), a widow sought service connection for the cause of death of her
husband, who had died from a heart attack. He had suffered deformities
of the tongue and jaw as a result of service-connected injuries, and
these deformities had prevented paramedics and the treating physician at
the hospital from intubating him. The medical evidence suggesting that
failure to intubate him had caused his death consisted solely of a
statement from the treating physician that \"if intubation had been
successful, \[the veteran\] may or may not have survived the cardiac
arrest.\" *Id.* at 610. The Court, however, held that the physician\'s
statement, expressed as \"may or may not,\" was \"speculative\" and,
thus, insufficient to well ground the appellant\'s claim. *Id.* at 611.

In *Lathan v. Brown*, 7 Vet.App. 359 (1995), the appellant sought to
prove service connection for a heart disease, diagnosed as
cardiomyopathy. The medical evidence of record consisted of four
statements from treating physicians. One opined that \"one can in no way
rule out\" a relationship between the veteran\'s current heart condition
and his in-service injury. *Id.* at 363-64. Another physician stated
that \"\[s\]ince the etiology of congestive cardiomyopathy is unknown in
the vast majority of cases,\" a relationship between the veteran\'s
heart condition and service-connected injuries \"cannot be totally
excluded.\" *Id.* A third medical opinion explained that \"the
possibility at least exists that the cardiomyopathy may have been the
result of persistent cardiac insults occurring at the time of his many
surgeries.\" *Id.* Finally, a treating physician opined that the
veteran\'s \"cardiac condition could be secondary to his shrapnel
injury.\" *Id.* In determining that the appellant\'s claim was well
grounded, the Court distinguished *Tirpak*, finding that medical
opinions suggesting that a causal connection was possible, although less
than probable, could well ground a claim. The Court held that *Tirpak*
did not require that medical opinions be expressed in terms of
certainty. *Id.* at 366. Indeed, the medical statement to the effect
that medical science could not \"rule out\" an association between that
cardiomyopathy and the veteran\'s service-connected chest trauma was
sufficient to constitute plausible medical nexus evidence. *Id.*

Subsequent to *Lathan*, this Court decided *Watai v. Brown*, 9 Vet.App.
441 (1996). There, the appellant filed a service-connection claim for a
kidney condition, later diagnosed as glomerulonephritis. In support of
his claim, he submitted a letter from his physician stating, \"\[I\]f I
had to make a guess, I would guess that there very well might have been
a relationship between his hematuria in \[service\] and his present
kidney problems.\" *Id*. at 442. Another treating physician wrote: \"One
of the early symptoms of chronic glomerulonephritis is hematuria,\" and
\"when the appellant was younger, apparently he had gross hematuria
which was probably due to his underlying chronic glomerulonephritis.\"
*Id*. The Board concluded that the physician\'s statements were
\"speculative at best concerning relationship to service\" and denied
the claim. *Id*. at 443-44. The Court, however, held that \"\[t\]hese
statements, while not necessarily conclusive, are competent evidence
that the claim is plausible.\" *Id.* at 443.

In *Molloy v. Brown*, 9 Vet.App. 513 (1996), the appellant, seeking
service-connected disability benefits for a back condition, offered two
statements from treating physicians in support of his claim. The first
statement reported that \"it is possible that the original injury in
\[service\] predisposed him to earlier osteoarthritis.\" *Id*. at 515.
The second statement explained that the appellant\'s in-service injury
\"could be a contributing factor to his present symptomatology.\" *Id*.
On appeal to the Court, the Secretary argued that the physician\'s
opinion stated as \"could,\" was speculative and, thus, not well
grounded. The Court, however, concluded that the use of the word
\"could\" did not render the physician\'s opinion without any probative
value and was enough to make the claim plausible. *Id.* at 516.

Recently, the Court revisited physicians\' opinions stated as \"could\"
in *Bloom v. West*, \_\_ Vet.App. \_\_, No. 97-1463 (Feb 10, 1999).
Recognizing \"the almost infinite number of fact situations that can
arise\" in determining well groundedness, the Court found that, in the
facts of that case, a medical opinion that the cause of the veteran\'s
death \"could\" have been attributed to his time in a POW camp,
\"without supporting clinical data or other rationale,\" was
insufficient to well ground the claim. *Id.* slip op. at 4.

Additionally, this Court has addressed the relevance of medical treatise
evidence to the determination of well groundedness. Generally, an
attempt to establish a medical nexus to a disease or injury solely by
generic information in a medical journal or treatise \"is too general
and inconclusive\" to well ground a claim. *Sacks v. West*, 11 Vet.App.
314, 317 (1998) (citing *Beausoleil v. Brown*, 8 Vet.App. 459, 463
(1996)); *see Libertine v. Brown*, 9 Vet.App. 521, 523 (1996) (holding
that medical treatise evidence proffered by the appellant in connection
with his lay testimony was insufficient to satisfy requirement of
medical evidence of nexus to well-ground claim). Medical treatise
evidence, however, can provide important support when combined with an
opinion of a medical professional. *See Rucker v. Brown*, 10 Vet.App.
67, 73-74 (1997) (holding that evidence from scientific journal combined
with doctor\'s statements was \"adequate to meet the threshold test of
plausibility\"); *Bielby v. Brown*, 7 Vet.App. 260, 265-67 (1994).
Similarly, medical treatise evidence could \"discuss\[\] generic
relationships with a degree of certainty such that, under the facts of a
specific case, there is at least a plausible causality based upon
objective facts.\" *Wallin v. West*, 11 Vet.App. 509, 514 (1998) (citing
*Sacks*, *supra)*. Indeed, as stated in *Wallin*, \"in order for a claim
to be well grounded \[it\] need not be supported by evidence sufficient
for the claim to be granted. Rather, the law establishes only a
*preliminary* threshold of plausibility with enough of an evidentiary
basis to show that the claim is capable of substantiation.\" *Id.*
(citing *Robinette*, 8 Vet.App. at 76).

Thus, this case is consistent with our case law defining what
constitutes sufficient medical evidence to make a claim well grounded.
Dr. Bergman\'s and Dr. Clarkson\'s statements employ the same,
less-than-conclusive language held to support a plausible claim. Dr.
Bergman stated that \"often no specific incident \[of exposure\] can be
demonstrated\" and that it was impossible to prove that the veteran\'s
initial exposure to the carcinoma was not during his service, in other
words, saying that it could not be ruled out. *See Lathan, supra*. He
also stated that it was \"a distinct *possibility* that \[the veteran\]
*could* have been exposed to the etiologic factor during service\"
(emphasis added). *See Molloy and Watai, supra*. Both Dr. Bergman and
Dr. Clarkson conclusively state that the veteran\'s travel and
habitation in Southeast Asia during his service caused his fatal cancer.
Moreover, these medical opinions are combined with medical journal
articles that discuss a plausible epidemiological connection between the
veteran\'s service and cause of death. Therefore, based upon these
facts, *cf. Bloom, supra*, there is ample support for deducing a nexus
between the veteran\'s type of cancer and his exposure to certain
conditions rendering him susceptible to that cancer. The Secretary\'s
characterization of these medical opinions as guesswork (*see*
Secretary\'s Br. at 5) misapprehends both the substance of our law and
the statements themselves. *See Watai, supra* (holding that a
physician\'s opinion as to nexus to service expressed as \"I would
*guess* that there very well might have been,\" although not conclusive,
suffices to well-ground a claim (emphasis added)). Any failure of the
physicians to provide a basis for their opinions \"goes to the weight or
credibility of the evidence in the adjudication on the merits rather
than the threshold determination of well groundedness, a stage at which
the claimant\'s evidence is presumed credible.\" *Hernandez-Toyens*, 11
Vet.App. at 382; *see Robinette*, 8 Vet.App. at 76 (1995).

Consequently, the evidence of record, presumed credible, raises a
reasonable and plausible connection between the veteran\'s fatal
hepatocellular carcinoma and his residence and travel in Southeast Asia
during service. Accordingly, the Court holds, upon de novo review, that
the appellant has submitted a well-grounded claim.

As an alternate position, the Secretary argues that if the appellant\'s
claim is determined to be well grounded, \"the Court should find that
the Board rendered a de facto merits decision that should be affirmed
under the clearly erroneous standard of review.\" Secretary\'s Br. at 7.
This Court declines that offer. Because the claim is well grounded, the
Secretary\'s duty to assist remains unfulfilled. In that regard, it is
noted that at the time that Dr. Jaszewski, the VA physician, rendered
his opinion concerning a medical nexus, he found that there was no clear
evidence in the record to indicate that the veteran was exposed to an
agent or condition that would predispose him to later developing
hepatocellular carcinoma. The veteran\'s living conditions in Southeast
Asia were subsequently made available, but never provided to Dr.
Jaszewski for review. Such a referral would have been appropriate and
consistent with developing the claim, and is necessary for its
adjudication. Without it, the current reasons or bases are inadequate to
facilitate judicial review. *See Gilbert v. Derwinski*, 1 Vet.App. 49,
57 (1990).

On remand, \"the appellant will be free to submit additional evidence
and argument\" on the remanded claim. *Quarles v. Derwinski*, 3 Vet.App.
129, 141 (1992). Any subsequent Board decision shall provide an adequate
statement of reasons or bases, *see* 38 U.S.C. § 7104(d)(1), consistent
with law, regulation, and this opinion and in accordance with § 302 of
the Veterans\' Benefits Improvement Act, Pub. L. No. 103-446, 108 Stat.
4658 (1994) (requiring the Secretary to provide for expeditious
treatment of remanded claims). *See Allday v. Brown*, 7 Vet.App. 517,
534 (1995). The Court notes that \"a remand by this Court or the Board
confers on the \[appellant\], as a matter of law, the right to
compliance with the remand orders. . . . \[and\] imposes upon the
Secretary . . . a concomitant duty to ensure compliance with the terms
of the remand.\" *Stegall v. West*, 11 Vet.App. 268, 271 (1998).

**III. CONCLUSION**

Upon consideration of the record on appeal and the pleadings and oral
arguments of the parties, the September 26, 1996, Board decision is
REVERSED and the matter is REMANDED for further development and
readjudication consistent with this opinion and in accordance with all
other applicable law and regulation. *See* 38 U.S.C. §§ 1110, 5107(a),
(b), 7104(a), (d)(1).