UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

N O

. 08-4092

M I C H A E L J

. B A R T L E T T , A P P E L L A N T ,

V

. E R I C K. S H I N S E K I , S E C R E T A R Y O F V E T E R A N S A F F A I R S , A P P E L L E E

.
On Appea l from the B oard of Veter ans' Appea ls (Arg ued De cembe r 7, 2010 De cided Ma rch 10, 2011)

Jame s Pey ster , of Washington, D.C., for the appellant. Ja me s F

. McKeown, also of Washington D.C., was on the brief f or the a ppellant.
Mark M. McNabb, with whom W ill A. Gunn , General Counsel; R. Randall Campbell , Assi s t ant Gene ral Counsel; and Joan E. Moriarty , Deputy Assistant Gene ral Counsel, all of Washington, D.C., wer e on the br ief for the appe llee.

Be fore KASOL D, Chief Judge , and MOORMAN a nd DAVI S, Judges

. KASOL D, Chief

Judge : Michae l J

. Ba

rtlett appea ls throug h counsel a September 17, 2008, Boa rd of Veter ans' Appea ls (B oard) decision that denied his claim for disabi l i t y co m pensation pursuant to 38 U.S.C. § 1151 (providing for c ompensation for V A fault in certain cir cumstance s), beca use it wa s predic ated on injuries rec eived from an attack by another patient while Mr. Ba rtlett

was admitted to a VA hospital, which the Boa rd conclude d was outside the scope of section 1151. Mr. Ba rtlett disputes this understanding of the law. T h e S ec re t ary seeks aff irmance of the Boa

rd decision. For the rea sons set forth below, the decision of the Boa rd will be set aside and the matters

rema nded for further adjudication consistent with this decision.

I. F ACTS The Boa rd' s deter mination was based on VA hospital tre atment rec ords and the alleg ations of Mr. Ba rtlett, whi ch ar e as fol lows. Mr. Ba rtlett serve d on active duty in the U.S. Army fromAug ust 1968 to May 1971. On Aug ust 8 , 1 9 8 9, Mr. Ba rtlett was transfe rre d from the L arimer County jail to a lock-down psy chiatric war d at Fo rt L y on VA medical cente r, pursuant to a court order requiring a psy chiatric evalua tion before the expiration of his 30-day sentenc e for car ry ing a firea rm. On Aug ust 14, while standing in line at the hospital caf eter ia authoriz ed for lock-down
psy chiatric -wa

rd patients, Mr. Bar

tlett was shoved by

another psy chiatric -wa

rd patient. Althoug h nursing staff intervene d and returne d the ag g ressor to the line, the ag g ressor eluded them and shoved Mr. Bartlett a second tim e. Addi t i o n al l y , Mr. Bartlett consist ently has st ated that (1) he suffe red 1 back and neck injuries resulting from this a lterca tion, ( 2) he was require d to go to the c afe teria f or

m ea l s i f he wanted to be fed, and that (3) two hospital staff members wer e require d to escort t h e ag g ressor- patient, as VA

hospital personnel c onsidered him dang erous. Mr. Ba rtlett' s prese nt appea l arises fro m h i s Oc t o ber 2002 claim for benef its pursuant to section 1151. Ultimately , on administrative appeal, t he Board de nied compensation "a s a matter of law," concluding that "the fac t pattern as alleg ed by the veter an falls outside the curr ent scope of 38 U.S.C. § 1151." Record (R.) at 11. Specifica lly , the Boa rd deter mined that Mr. Ba

rtlett "w as not injured as a result of hospital car e. That is to say , his situation did not arise as a result of the provision of car e by the hospital specific ally , limit ed only to trea tment or examination rende red by VA." R. a

t 11. The Boa

rd also found that Mr. Ba rtlett "w as not injured as a result of hospital c are b ut rathe r as a result of an alterc ation with another patient," which was "me rely a coincidenta l event." R. at 10, 11. This appea l followed. Suc c in c tl y stated, the primary issue befor e the Court is whether the term "hospital car e" under section 1151 includes g ener al supervision of patients in a lock-down psy chiatric war d, or, more specific ally , protec ting a

patient from other

patients known to be potentially hostile.

II. THE P ARTIES' ARG UMENTS On appea l, Mr. Ba

rtlett arg ues that the Boa

rd err ed in holding that his injury fell outside the

T h e i n c i d e n t r e p o r t r e a d s a s f o l l o w s : " I n c i d e n t

- M D R

- W h i l e s t a n d i n g i n l i n e a t M D R [ u n d e c i p h e r a b l e t e r m ] 1

a b o u t 1 7 0 0 h r s t h i s p a t i e n t w a s s h o v e d b y a n o t h e r p a t i e n t

. N u r s i n g s t a f f i n t e r r e d [ s i c ] a n d o t h e r p a t i e n t g o t b a c k i n l i n e , t h e n s u d d e n l y r u s h e d f o r w a r d a n d s h o v e d t h e p a t i e n t a g a i n

. S t a f f r e p o r t t h e a t t a c k w a s n o t p r o v o k e d b y M r

. B a r t l e t t

. P a t i e n t r e t u r n e d t o u n i t a n d s t a t e d h e h a s a w h i p l a s h w i t h p a i n i n l e f t s i d e o f u p p e r s h o u l d e r a n d n e c k

. " R e c o r d ( R

. ) a t 5 1 1

. 2scope of section 1151, and that th e Bo ar d 's i n t erpr etation of "hospital car e" as "limited only to

tr ea t m ent or examination" (R. at 11) violates fundame ntal principles of statutory interpre tation. Rather, he asser

ts that "hospital car e" includes the supervision of dang erous patients in a lock-down

war d , and that section 1151 should at least encompa ss his circ umstances, wher e an injury results from hospital order lies' neg lige nce dur ing tha t supervision. Conversely , the Secre tary arg ues that the Boa rd corr ectly applied this Court's prec edent and did not err

. He arg ues that the Boa rd did not make any finding that the order lies wer e neg lige nt, and he also contends that Mr. B artlett' s injuries wer e cause d by another patient, not " hospital c are ." I n support of his arg ument, the Secre tary cites (1) Mangham v. Shinseki , 23 Vet.App. 284, 287 (2009), for the propositi o n t hat injuries resulting from acts occur ring coincidenta lly with "hospital car e, medical or surg ical trea tment, or an examination" are not sufficie nt bases for r e c e iv in g benef its under section 1151, and (2) Jack son v. Nicholson , 433 F.3d 822, 826 (F ed. Cir. 2005), for the notion that, as of October 1, 1997, section 1151 no longe r awards b en ef i ts for injuries occur

ring as a result of

a patient' s g ener al experience of hospitaliz ation. The Secre tary additionally arg ues that the Fe dera l Tort Claims Act (F TCA) is a more apt ave nue for providing Mr. B artlett a r emedy

.

III. ANALYSIS A. Section 1151 and F ault Section 1151 authorizes compensa tion for certa in disabiliti es i n the s am e m anner as i f t he disabiliti es wer e service connec ted. 38 U.S.C. § 11 5 1 (e n t itled "B enef its for persons disabled by
trea tment or vocational reha bilitation"). I t is well established that, post-October 1, 1 9 9 7 , s ection 1151 require s fault on the part of VA. See id. (aw arding compensa tion if, inter alia, "the disability

or death was cause d by hospital car e, medical or surg ical trea tment, or ex am i n at i o n " and "the proxi mate cause of the death or disability was

. . . car elessness, neg lige nce, lack of proper skill, err or in judgme nt, or simil ar instance of fault" ). There fore , if Mr. Ba rtlett wer e arg

uing that he is entitled 2

P r i o r t o O c t o b e r 1 , 1 9 9 7 , c o m p e n s a t i o n w a s a w a r d e d u n d e r s e c t i o n 1 1 5 1 f o r i n j u r i e s t h a t o c c u r r e d " a s t h e 2

r e s u l t o f [ V A ] h o s p i t a l i z a t i o n , m e d i c a l o r s u r g i c a l t r e a t m e n t , o r

. . . h a v i n g s u b m i t t e d t o a n e x a m i n a t i o n

. " 3 8 U

. S

. C

. § 1 1 5 1 ( 1 9 9 6 )

. T h e s t a t u t e w a s c h a n g e d b y , i n t e r a l i a , r e p l a c i n g t h e t e r m " h o s p i t a l i z a t i o n " w i t h " h o s p i t a l c a r e " a n d
a d d i t i o n a l l y r e q u i r i n g a p r o x i m a t e c a u s e o f V A f a u l t

. S e e P u b

. L

. N o

. 1 0 4

- 2 0 4 ( 1 9 9 6 )

. T h e l e g i s l a t i v e h i s t o r y i s c l e a r t h a t t h e c h a n g e w a s g e n e r a t e d t o o v e r t u r n t h e U

. S

. S u p r e m e C o u r t 's d e c i s i o n i n B r o w n v

. G a r d n e r , 5 1 3 U

. S

. 1 1 5 ( 1 9 9 4 ) , w h i c h h e l d t h a t f

a u l t w a s n o t a n e l e m e n t o f t h e n - s e c t i o n 1 1 5 1

. S e e 6 9 F e d

. R e g

. 4 6 , 4 2 6 , 4 6 , 4 2 9 ( A u g

. 3 , 2 0 0 4 ) ( f i n a l
3to section 1151 benef its simply beca

use he was in a VA hospital at the time another patient injured him, his arg ument would fail. See Jack son , 433 F.3d at 826 (noting that the term "hospital car e" in section 1151 "implies the provision of c are by the hospital specific ally , as opposed to the broade r,

more g ener al experience of a patient during the course of hospitaliz ation") ; Mangham , 23 Vet.App.
at 289 (" Congr ess repudia ted the notion that a coincidenta l event occur ring during ' hospitaliz ation' could lead to rec overy under section 1151, purposef ully repla cing that word with ' hospital car e.' ")

. This is beca

use, as our prec edents state, injuries resulti ng from acts purely coincident with VA hospital car e, trea tment, or examination are not entitled to compensa tion. S ee Mangham, 23 Vet.App. at 287 (holding that a mental distress injury resulting from a shooting at a VA domiciliary

"' was coincidenta l to residing at a VA domicil i ar y and

. . . not cause d by the actua l provision of hospital car e, medical or surg ical trea tment[ ,] or examination'" (quoting Johnnie R. Mangham , BV A 05-07615, at 10 (F eb. 7, 2007))) ; Loving v. Nicholson , 19 Vet.App. 96, 100 (2005) (holding that an i njury resulting from the fall of a ceiling g rate during a VA examination was "c oinciden t al t o t h e examination and was not

. . . cause d by it"); see also N E W O X F O R D A M E R I C A N D I C T I O N A R Y 337 (3d ed. 2010) [hereinaf

ter O X F O R D ] (def

ining "c oincidental" as, inter alia, "ha ppening by chanc e" )

. Howeve r, Mr. Ba

rtlett' s arg ument is not that rec overy is war rante d beca

use of the mere fac t that his injury occur

red while in a VA fac ility

. Rather, he arg ues that the supervision of hospital patients in

a lock-down psy chiatric fac ility constitutes "hospital car e" and the neg lige nt perf ormanc e o f that supervision ca

used his injury

. B. D efining "H ospital Care" Although our prec edents mention "hospital car e" i n conjunction with "tr eatment" and "e x amination," none have analy zed "hospital ca re " s pecif ically detac hed from "tr eatment" and "e x amination." I n Loving , the injury occur red during an outpatient examination at a VA clinic, and this Court' s analy sis c enter ed on whether the fa ll of the ce iling g rate during that examination " was

cause d by the VA examin at i o n , " n o t "hospital car e." Id. at 98, 100. I n Mangham , the injury

r u l e r e g a r d i n g 3 8 C

. F

. R

. § 3

. 3 6 1 ( 2 0 1 0 ) , t h e i m p l e m e n t i n g r e g u l a t i o n f o r s e c t i o n 1 1 5 1 ) ( " T h e l e g i s l a t i v e h i s t o r y m a k e s c l e a r t h a t t h e p u r p o s e o f t h e a m e n d m e n t w a s t o a d d a r e q u i r e m e n t f o r a s h o w i n g o f

f a u l t o r n e g l i g e n c e i n a d d i t i o n t o t h e c a u s a t i o n r e q u i r e m e n t i n t h e s t a t u t e

. " ) ; 1 4 2 C O N G

. R E C

. S 9 9 3 2 ( d a i l y e d

. S e p t

. 5 , 1 9 9 6 ) ( a m e n d e d s t a t u t e w o u l d

" r e q u i r [ e ] t h a t t h e r e b e a n e l e m e n t o f f a u l t a s a p r e c o n d i t i o n f o r e n t i t l e m e n t t o c o m p e n s a t i o n f o r a d i s a b i l i t y o r d e a t h
r e s u l t i n g f

r o m h e a l t h c a r e o r c e r t a i n o t h e r s e r v i c e s f u r n i s h e d b y [ V A ] " )

. 4occur

red at a domiciliary and the matter at issue involved domiciliary car e, which the Court deter mined was not a component of "hospital car e." Id. at 288. I n Jack son , althoug h the U.S. Court of Appea ls for the Fe dera l Circuit instructed that "hospital car e" was narr ower t han "the broade r,

more g ener al experience of a patient during the course of hospitaliz ation," it we n t n o fu rt h er in clar ify ing the meaning or scope of " hospital care ." Id. at 826. Thus, to determine w hether the supervision of hospital patients in a lock-dow n psy chiatric fac ility constitutes "hospital car e," we must beg in with the ordinary meaning of "c are ." Lee v. W est , 13 Vet.App. 388, 394 (2000) (" ' The starting point in interpre ting a statute is its lang uag e.' " (quoting Good Samaritan Hosp. v. Shalala , 508 U.S. 402, 409 (1993)) ); see Jones v. Brown , 41 F.3d 634, 638 (F ed. Cir. 1994) (" I n deter mining the plain mea n i n g of statutory lang uag e, ' leg islative purpose is expressed by the ordinary meaning of the words used.' " (quoting Ardestani v. INS , 502 U.S. 129, 136 (1991)) ). "Ca

re" is define d as, inter alia, "the provision of what is nece ssary for the health, welfa re, maintenanc e, and protec tion of someone or something." O X F O R D at 263; see also W E B S T E R ' S N E W W O R L D D I C T I O N A R Y 212 (3d ed. 1988) (" char g e; protec tion; custody " or "some thing to watch over

or attend to; a responsibility ")

. I n the leg al rea lm, " car e" is define d as "the conduct demande d of a person in a gi v en situation," t y pically in the contex t of "g iving attention both to possible dang ers, mistakes, and pitfalls and to way s of minimi zing those risks." B L A C K ' S L A W D I C T I O N A R Y 240 (9th ed. 2009). At oral arg

ument, Mr. B artlett ar g ued that " hospital care " is oc curr ing w heneve r the VA is providing hospital service s to its patients. We initially note that Mr. Ba rtlett' s definition, invoking the notion of providing for or having responsibility over another , acc ords with the plain meaning of "c are ." Conversely , the Secre tary arg ued that "hospital car e" should be limit ed to "me dical service s,"

as re fer ence d in 38 U.S.C. § 1701(5), to wit:

The ter m "hospital ca

re" includes – (A)( i ) m edical service s rende red in the course of the hospitaliz ation of any veter an, and (ii) trave l and incidental expenses pursuant to the provisions of section 111 of this title; (B ) such mental health service s, consultation, profe ssional counseling ,

5marria g e and family co u nseling , and training for the members of the i m m ed i at e family or leg al g uardia n of the veter an

. . . as the Secre t ar y considers appro p ri ate for the eff ective trea tment and reha bilitation of a veter an or de pendent or

survivor of a

veter an re ceiving car e . . . .
Howeve r, as is evide nt by the plain lang uag e, sec tion 1701(5)' s definition of "hospital car e" is not limit ed to medical service s. See Rock nel Fastener, Inc. v. United States , 267 F.3d 1354, 1360 (F ed. Cir. 2001) (noting that a definition using the term "inc ludes" is "ope n-ende d ")

. Fu rt h er, the

enumer ated examples of the section include "tr avel and incidental expenses," "ma rriag e and family counseling , and training for the members of the [veteran' s] immediate family ," and other terms that make lit tle sense when applied to section 1151, which we igh a g ainst implementing this definition of "hospital car e" for section 1151. See United States v. X-Citement Video, Inc. , 513 U.S. 64, 69-70 (1994) (assuming that Congr ess did not intend a statute to cre ate odd or absurd results). We also
note that, althoug h Mangham mentioned section 1701(5), it used the statute to ill u s t ra t e the differ ence betwee n "hospital car e" and "domiciliar y car e," not to adopt a definition of "hospital car e" limit ed to medica l service s. See 23 Vet.App. a t 288. Also at oral arg ument, the Secre tary reje cted the notion that the definition of "hospital car e," as provided by

38 U.S.C. § 1803(c) (4) (addre ssing care for the children of Vietnam veterans born with spina bifida), could aid in deter mining the meaning of "hospital car e" in section 1151 beca use, by its own terms, the definition is directly applicable only

to that section, see 38 U.S.C. § 1803(c) (" For the purposes of this section" ). Acknowle dg ing no direc t applicability , we neverthe less note that this definition may assist in evincing the meaning of "hospital car e" as used in section 1151 for
two rea s o n s

. First, unlike section 1701(5)' s open-e nded definition, which includes many terms clea rly not applicable to section 1151, section 1803(c) (4) provides a g ener al definition that cre ates

no friction with section 1 1 5 1 , t o wi t : "T he term ' hospital car e' means car e and trea tment for a disability furnished to a

n individual who has been admitted to a hospi tal as a patient." 38 U.S.C. § 1803(c) (4). Sec ond, the def inition of section 1803(c)(4) was int roduce d and passe d in the same bill that added "hospital car e" to section 1151, which may provide an indication of Congr ess' s intent in using those words. See Erlenbaugh v. United States , 409 U.S. 239, 243-44 (1972) (the rule that "a leg islative body

g ener ally uses a particula

r word w ith a consistent meaning . . . cer tainly makes the most sense when the statutes wer e enac ted by the same leg islative body at the same time") ; Pub.

6L . No. 104-204 (1996)

.

Acc ording ly , afte r considering the plain meaning an d other definitions of "hospital car e" provided in veter ans law, we ag ree with Mr. Ba rtlett that "hospital car e," at a minimum , includes the provision of services uniq u e t o t h e hospitaliz ation of patients. Such a definition acc ords wit h the plain meaning of "c are ," rese mbles section 1803(c) (4), and is in harmony with Jack son , 433 F.3d at 826 (" The term ' hospital car e' implies the provision of care b y t h e h o s pital specific ally

. . . .")

. Although we will not further define "hospital car e" or "pa tient" in the abstrac t, Edenfield v. Brown , 8 Vet.App. 384, 390 (1995) (re fusing to deal with abstrac t conce pts divorce d from fac ts of the case ), the deter mination as to wh et h er a situation involves "hospital car e" will depend on a varie ty of fac tors, including the nature of t he services, the degr ee of VA control over patient fr ee d om, the 3 4 mental and phy sical conditions of the patients, and the fore seea bility of potential harms. These are 5 6 fac tors best consider ed by the B oard in the f

irst instance. C. Application of L aw I n its d ecision on Mr. Ba rtlett' s claim, the Boa

rd found "a s a matter of law" that "the fac t pattern as al l ege d b y the veter an falls outside the curr ent scope of 38 U.S.C. § 1151." R. at 11.

S e e B o d i n v

. V

a g s h e n i a n , 4 6 2 F

. 3 d 4 8 1 , 4 8 9 ( 5 t h C i r

. 2 0 0 6 ) ( " A p r o v i d e r o f p s y c h o l o g i c a l s e r v i c e s h a s a 3 h e i g h t e n e d d u t y o f

c a r e t o i t s p a t i e n t s b e c a u s e o f t h e i r v u l n e r a b i l i t y a n d t h e r e s u l t i n g s p e c i a l r e l a t i o n s h i p

. " ) ; K a s t l e r v

. I o w a M e t h o d i s t H o s

p

. , 1 9 3 N

. W

. 2 d 9 8 , 1 0 1

- 0 2 ( I o w a 1 9 7 1 ) ( n o t i n g t h e d i f f e r e n c e s b e t w e e n r o u t i n e c a r e a n d p r o f e s s i o n a l c a r e )

.
S e e G a l l o w a y v

. B a t o n R o u g e G e n

. H o s p

. , 6 0 2 S o

. 2 d 1 0 0 3 , 1 0 0 8 ( L a

. 1 9 9 2 ) ( h o s p i t a l h a s d u t y t o p r o t e c t 4 p a t i e n t f r o m d a n g e r s " p e c u l i a r l y w i t h i n t h e h o s p i t a l 's c o n t r o l " ) ; B e c k e r v

. M a y o F o u n d

. , 7 3 7 N

. W

. 2 d 2 0 0 , 2 1 2 ( M i n n

. 2 0 0 7 ) ( h o s p i t a l 's d u t y t o p r o t e c t b a s e d o n t h e f a c t t h a t p a t i e n t s a r e " 'p a r t i c u l a r l y v u l n e r a b l e a n d d e p e n d e n t o n t h e [ h o s p i t a l ] , w h o i n t u r n h o l d s c o n s i d e r a b l e p o w e r o v e r t h e [ p a t i e n t s '] w e l f a r e '" ( q u o t i n g D o n a l d s o n v

. Y o u n g W o m e n ' s C h r i s t i a n A s s '

n , 5 3 9 N

. W

. 2 d 7 8 9 , 7 9 2 ( M i n n

. 1 9 9 5 ) ) ) ; N

. X

. v

. C a b r i n i M e d

. C t r

. , 9 7 N

. Y

. 2 d 2 5 2 , 2 5 3 ( N

. Y

. 2 0 0 2 ) ( h o s p i t a l 's " d u t y t o s a f

e g u a r d t h e w e l f

a r e o f i t s p a t i e n t s

. . . [ i s ] m e a s u r e d b y t h e c a p a c i t y o f t h e p a t i e n t t o p r o v i d e f o r h i s o r h e r o w n s a f

e t y " )

.
S e e J o h n s o n v

. G r a n t H o s

p

. , 2 9 1 N

. E

. 2 d 4 4 0 , 4 4 6 ( O h i o 1 9 7 2 ) ( " A h o s p i t a l o w e s a d u t y t o i t s p a t i e n t s t o 5

e x e r c i s e s u c h r e a s o n a b l e c a r e f o r t h e i r s a f

e t y a s t h e i r k n o w n m e n t a l a n d p h y s i c a l c o n d i t i o n m a y r e q u i r e

. " ) ; s e e a l s o H u n t
v

. B o g a l u s a C m t

y

. M e d

. C t r

. , 3 0 3 S o

. 2 d 7 4 5 , 7 4 7 ( L a

. 1 9 7 4 ) ; H a r d e r v

. F

. C

. C l i n t o n , I n c

. , 9 4 8 P

. 2 d 2 9 8 , 3 0 4 ( O k l a

. 1 9 9 7 ) ; M c G r a w v

. S t

. J

o s e p h ' s H o s p

. , 4 8 8 S

. E

. 2 d 3 8 9 , 3 9 6 ( W

. V a

. 1 9 9 7 ) ; H o f f l a n d e r v

. S t

. C a t h e r i n e ' s H o s p

. , I n c

. , 6 6 4 N

. W

. 2 d 5 4 5 , 5 7 2 ( W i s

. 2 0 0 3 )

.

S e e B e m b e n i s t a v

. U n i t e d S t a t e s , 8 6 6 F

. 2 d 4 9 3 , 4 9 8 ( D

. C

. C i r

. 1 9 8 9 ) ( " 'T r a d i t i o n a l l y , r e l a t i o n s h i p s t h a t w e r e 6

c o n s i d e r e d t o g i v e r i s e t o a d u t y o f o n e p a r t y t o p r o t e c t t h e o t h e r p a r t [ y ] f r o m f o r e s e e a b l e c r i m i n a l a c t s o f t h i r d p e r s o n s h a v e i n c l u d e d t h e r e l a t i o n s h i p [ ] o f

. . . h o s p i t a l t o p a t i e n t

. . . . '" ( q u o t i n g H a l l v

. F o r d E n t e r s

. , L t d

. , 4 4 5 A

. 2 d 6 1 0 , 6 1 1
n

. 4 ( D

. C

. A p p

. 1 9 8 2 ) ) ( s e c o n d a l t e r a t i o n i n o r i g i n a l ) ; C a b r i n i M e d

. C t r

. , 9 7 N

. Y

. 2 d a t 2 5 3 ( w h i l e a h o s p i t a l h a s n o d u t y t o k e e p e a c h p a t i e n t u n d e r c o n s t a n t s u r v e i l l a n c e , i t d o e s h a v e d u t y t o g u a r d a g a i n s t r e a s o n a b l y f o r e s e e a b l e h a r m s )

. 7Specifica lly , the Board d et er m i n ed that Mr. Ba rtlett' s "situation did not arise as a result of the provision of car e by the hospital specific ally , limit ed only to trea tment or examination rende red by VA." R. a

t 11. The Boa

rd also stated that Mr. Ba rtlett "w as not injured as a result of hospital c are but rathe r as a result of an alterc ation w ith another patient," which was "me rely a coincidenta l event." R. at 10, 11. Such statements reflect that the Board has applied the law incorrec tly and remand is

war rante d. See Tucker v. W

est , 11 Vet.App

. 3 6 9 , 3 7 4 (1998) (re mand is appropr iate "w here the Boa rd has incorrec tly applied the law, failed to provide an adequate s tatement of rea sons or base s for its deter

minations, or where the re cord is other wise inade quate" ). First, the Boa

rd clea rly err ed in finding the fac ts as alleg ed by Mr. Ba rtlett outside the scope of sec t i o n 1151. See Gilbert v. Derwinski , 1 Vet.App. 49, 52 (1991) (" ' A finding is "c lear ly

err oneous" when

. . . the revie wing court on the entire evidenc e i s l ef t wi t h the definite and firm conviction that a mistake has been committed.'" (quoting United States v. U.S. Gypsum Co. , 333 U.S. 364, 395 (1948)) ). Alleg edly , Mr. Bartlett was a hospi tal patient in a lock- down ps y chiatric war d wher e VA staff had total control over his movement and mandated his prese nce at the caf eter ia for meals. Alleg edly , the fac ility contained patients who wer e mentally unstable and dang erous in such

a fore seea

ble way that VA staff provi ded escor ts to those individuals. Considering the afor ementioned fac tors reg arding whether a s i t uation involves "hospital car e," we have the firm conviction that the alleg ed situation involved "hospital car e." See Gilbert , supra
. I f t h e Bo ar d adopts the alleg ed fa ct s o n rema nd, then the matters rema ining to be resolved are whether the "hos p ital car e" (1) was provided with "c are lessness, neg lige nce, lack of proper skill, err or in judgme nt, or simil ar instance of fault" and (2) was the "pr ox imate cause of the disability or death." 38 U.S.C. § 1151. Ad ditionally , the Boa

rd' s definition of "hospital car e" as "limited only to trea tment o r examination" is not in acc ordanc e with law. R. at 11. First, it does not acc ord with our holding above, that "hospital car e" inc lu d e s th e p r o v is io n of service s unique to the hospitaliz ation of patients. Second, the B oard' s definition, limi ting one enumer ated ter m in a st atute to two other e numera ted
t er m s i n a statute, violates the car dinal principal of statutory construction that Congr ess does n o t insert superf

luous, void, or insignifica nt w ords into its statute. TRW Inc. v. Andrews , 534 U.S. 19, 31 (2001) (citing Duncan v. W alker , 533 U.S. 167, 174 (2001) and United States v. Menasc he , 348

8U. S. 528, 538-39 (1955) (" I t is our duty ' to g ive eff ect, if possible, to ever

y clause and word o f a st at u t e'

. . . ." (quoting Montclair v. Ramsdell , 107 U.S. 147, 152 (1883)) )). Third, the Boa rd' s definition does not g ive eff ect to the plain meaning of the words "c are ," "tr eatment," and "e x amination," w hich ar e def initionally

distinct. 7
Moreove r, the Boa

rd' s s u gges t i o n that an injury resulting from an alterc ation with a third party cannot be an inj ury cause d by "hospital care " for the purposes of section 1151 i s misguided. There are circ umstances wher e a third-par ty attack is not a coincidenta l event, see O X F O R D at 337, and wher e that attack is indeed proxi mately cause d b y t h e n eglig ent provision of VA hospital service s to a hospital patient. We e x pressly reje ct the Secre tary ' s arg ument that Mangham broadly held that injuries due to third-par ty actions in all situations are intervening acts and per se not cause d by hospital car e, trea tment, or examination. 23 Vet.App. at 289. The attack in Mangham occur red in the caf eter ia of a domiciliary fac ility and involved no medically rela ted supervision of the veter ans prese nt at the time of the incide nt. Id. at 288. Finally , we also reje ct the Secre tary ' s arg ument that the availability of the FTCA as a reme dy
prec ludes the awa

rd of section 1151 benef

its to Mr. Ba

rtlett. Our prec edents neither state nor imply
any such prec lusion. See Mangham , 23 Vet.App. at 288 n.1 (citing Sweitzer v. Brown , 5 Vet.App. 503, 506 (1993)) ; Loving , 19 Vet.App. at 101 (same) ; Sweitzer , 5 Vet.App. at 506 (ac knowledg ing that veter an could have raised hi s claim " in a suit ag ainst the United States under the Fe dera l Tort Claims Act," but not pre cluding benef its on that ground) . Additionally , despite the fac t tha t faultbased claims ag ainst the United States are permitted under the FTCA, C o n gre ss never theless provided an additional avenue for veter ans' fault-ba sed claims in cer tain circ umstances, e.g ., when disability or death results from neg lige nt hospital car e, medical or surg ical trea tment, or examination furnished to a veter an u n d er l aw s administered by the Secre tary

. 38 U.S.C. § 1151. Providing multipl e avenue s of relief is not unusual with reg ard to veter ans benef its. Cf. Ribaudo v. Nicholson , 2 1 Ve t.App. 137, 144 (2007) (noting that veter ans are uniquely provided "multiple lay ers of VA decision revie w
. . . [ an d ] two separ ate lay ers of appea l of rig ht to independe nt judicial revie w" ) ;

" T r e a t m e n t " i s d e f

i n e d a s , i n t e r a l i a , " m e d i c a l c a r e g i v e n t o a p a t i e n t f o r a n i l l n e s s o r i n

j u r y
. " O X F O R D a t 7 1 8 4 4

. " E x a m i n a t i o n " i s d e f i n e d a s , i n t e r a l i a , " a d e t a i l e d i n s p e c t i o n o r i n v e s t i g a t i o n

. " I d

. a t 6 0 2

. " C a r e " i s d e f i n e d
a b o v e a t s e c t i o n I I I

. B , s u p r a
. 9Tril les v. W est , 13 Vet.App. 314, 332 (2000) (noting that 38 U.S.C. § 5107(a) provide s veter ans a "unique standard of proof [t hat] is unlike that available to any other civil plaintiff or claimant" ); see also Miles v. Apex Marine Corp. , 498 U.S. 19, 32 (1990) (" We assume that Congr ess is awa re of exis ting law

when it passes le g islation.").

IV. CONCLUSION Upon consideration of the fore g oing, the September 17, 2008, Boa rd decision is SET ASI DE and the matter i s R E M ANDED for further development and rea djudication consistent with this decision. On remand, M r. Ba rt l ett may also prese nt, and the Boa rd m ust consider, any additional evidenc e and arg ument in support of the matters rema nded. See Kay v. Principi , 16 Vet.App. 529, 534 (2002). The se matters are to be provided expeditious trea tment on rema nd. See 38 U.S.C. § 7112.

10