G ui l l ai n- B arre sy nd rom e: acut e i d i o p at hi c p o l y neuri t i s; i d i o p at hi c: of unkno wn cause or spo nt aneo us o ri gi n; 1 p o lyne u ritis: in flam m a tio n o f se v e ra l p e rip h e ra l n e rv e s a t o n c e . D OR L A ND ' S I L L US T R A T E D M E D I C A L D I CT I ON ARY 803, 9 0 5 , 14 8 2 (30 t h ed

. 20 0 3 ).

UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

N O
. 06-0312
AN G EL S. N I EVES -R ODRI GUEZ , A PP EL L ANT ,

v
. J A M ES B. P EA KE , M.D., S EC RE T A RY O F V ET ER A N S A FF A I RS , A PPEL L EE
. On Ap pe a l f ro m th e B oa

rd of Ve te ra ns ' Ap pe a ls

(De cided De cembe r 1, 2008) Mark R. Lippman , o f L a

Jolla , Ca lif

or nia , w a s o n th e br ie f f

or the a pp e lla nt. Paul J. Hutter , G e ne ra l Co un se l; R. Ra nd all Cam pb e ll , As sis tant G e ne ra l Co un se l; Joan E. Mo ria rty , Depu t y As s i s t ant Gene ral Counsel; and Savitri D. Persaud , Appellate A ttorney , all of Washington, D.C., wer e on the br ief for the appe llee.
Be fore HAGEL , DAVI S, and SCHOEL EN, Judges

. DAVI S, Judge : U .S. Ar

my ve te ra n A ng e l S. Ni e ve s- Rod

ri g ue z ap pe a ls thr ou g h c ouns e l a Nov e mbe r 1 7, 20 05 , B oa rd of Ve te ra ns ' Ap pe a ls ( B oa

rd ) d e c isi on

tha t de nie d e nti tle me nt t o disability compensation f

o r m aj o r depression seconda ry to Guillain-Ba

rre sy ndrome, and to a

1 disability rating in excess of 10% for his service -conne cted Guillain-B arr e sy ndrome. This Court has jurisdiction to review the Boa rd' s decision pursuant to 38 U.S.C

. §§ 7252(a) and 7266(a). F or the following rea sons, the Court will vacate the Boa rd' s November

2005 decision and re mand the matter for rea djudication consistent with this decision. Preliminarily , the Court notes that the appellant does not raise any arguments reg ardingthe disability rating for his ser

vice- connec ted Guillain-B arr e sy ndrome. Thus, the C o u rt deems a ny appea l with respec t to this issue abandone d. See F ord v. Gobe r , 10 Vet.App. 531, 535 ( 1997).2

Th e a ppell ant 's sole argume nt o n a pp e a l is that V A v iol a te d it s d uty to a ssi st b y

fa ili ngto advise him that his c laims f ile could be forwa

rded to the two phy sicians who pr o v i d ed m edica l op in io ns in s up po rt

of his c la im i n o rd e r t o a ssi st the se ph y sic ians in d e ve lop ingmor e c omp le te medical opinions. The a

ppellant re asons that a c laimant should be offe red the opportunity to provide the cl ai m s fi l e t o a phy sician fur nishing a medical opinion on his or her behalf , at least whe re the Boa rd attac hes more pr obative value to a VA medic al opinion on the b as i s the VA e x aminer revie wed the c laims file. The appellant asser ts that such a procedur e is, or should be, inher ently part of VA ' s d uty to a ssi st, c on sis te nt w ithc on g re ssi on a l inte nt t hat V A i s to "f

ull y and sy mpathe tic a lly de ve lop the ve te ra

n' s c la im t o it s o pti mum

be fo re de c idi ngit o n th e me ri ts. " Ap pe lla nt' s B ri e f at 5 ( c i t ing H. R. R EP . No. 100-963 (1988) ). He argues that the Court should vaca te and r emand the Boa rd' s decision. The Sec reta

ry responds that he has no duty , absent a reque st f rom a claimant, to forwa

rd the claims file to an opining private phy sician. He asserts t hat the B oard g ave a sufficie nt expl anation for a ssigningmore we ight to the VAexaminer' s opinion than to the opinions on which the appe llant relies, a nd argues for

aff irmance of the B oard de cision.

I. BACKG ROUND The a ppellant serve d on active duty in the U.S. Army from November 1954 to October 1956. During service he wa s treate d for Guillain-Bar re sy ndrome. I n April 1956, a ser vice medic al re cord (S MR) no te d th a t th e a

pp e lla nt ha d sit uatio na l ma la dju stm e nt b e c a us e of se pa ratio n f ro m hi s p a re nts and fa miliar surrounding s and the fac t that he dis liked the ki nd of food pr epar ed in the hospital. The appellant' s service separ ation examination noted a normal psy chiatric condition. I n Fe bruar y 1957, a VA r eg ional office (RO) g rante d service connec tion for Guillain-B arr e sy ndrome a nd assig ned a 1 0 % d i s ab i l i t y

ra t i n g. Yea rs later, the appellant beg an experiencing psy cholog ical difficulties for which he soug ht service connec tion. At a September 1970 psy chiatric examination at the VA hospital in San J uan, Puerto Rico, the appe llant complained of a nervous c ondition that had b egu n nine or ten months

e arl ie r, a lth ou g h he did no t know wh a t ca us e d it. The e xami ne r d ia g no se d th e a pp e lla nt w ithanxie ty

re a c ti o nb u t d id

n o t d is c u s s th e e ti o lo g y o f th e c o n d it io n
. I nN o v e mb e r 1 9 7 0 , th e RO denied3

e nti tle me nt t o s e rv ic e c on ne c tio n fo r anxie ty re a c tio n. Oc tob e r 1 99 5 tr e a tme nt r e c or ds re fl e c t a diag nosis of major depr ession. I n November 1998 , the RO denied the appellant' s claim for entitlement to se rvice connec tion for major de pression, including as sec ondary to Guillain-Ba

rre sy ndrome. The appellant perf ecte d an appea l of

the Novembe r 1998 rating de cision in J une 2000. The a ppellant obt ained medical opi nions from two phy sicians, which he adduces in support of his claim for se rvice connec tion. I n April 1999, Dr. Nor berto Pellot Moran submitted a letter stating that he had tre ated the a ppellant since 1995 a

nd that the appe llant "ha s the condition of Sever e Major De pression, sec ondary to Guill[ ain-] Ba

rre condition." Record ( R.) at 305. I n J uly 2000, Dr. Jose Ar tur o J uar be Or tiz [he re ina ft e r " Dr . Jua

rb e Or tiz" ] co mpl e te d a

VAF e e B a sis I nte ri m Sum mary in w hic h h e c on c lud e d th a t th e a pp e lla nt wa s " su ff

e ri ng fr om ma

jor de pr e ssi on a s a

re su lt of his phy sical ailment ser vice[-]con[n] ecte d condition." R. at 452. At an Oc tober 2000 RO hea ring , Dr. Juarbe Ort i z t es t i fi ed that he had re viewed the

a pp e lla nt' s c la ims fi le and

int e rv ie we d h im o n tw o o ccas io ns
. He fur the r t e sti fi e d th a t it

wa s h is opinion that the appellant had de veloped a d ep ressive disorder as a result of his Guillain-B arr e sy nd ro me . T he VAhe ari ngof fi c e r a sk e d D r. Juar

be Or tiz whe the r he ha d re a d the re c or ds fr om a VA hospital neurolog y depar tment as they

related to the appe llant's G uillain-Ba rre sy ndrome, a nd Dr . Juarb e Or

tiz r e pli e d th a t he ha d n ot. The a ppellant under

went VA psy chiatric examinations i n Dec ember 2000 and Apr il 2004. The same phy sician conduc ted both examinations. After re viewing the appellant' s claims file and

me dic a l r e c or ds , the e xami ne r no te d that pr e vio us VA ne ur olo g ic a l e va luatio ns sh ow e d " ve ry lit tle and very mild conseque nces from his Guillain-Ba rre " sy ndrome. R. at 488. The examiner opined that there was no e tiologica l relationship betwee n the appellant' s prese nt neuropsy chiatric condition, dy sthy mic disorder, a

nd sequela e of se rvice -conne cted Guillain-B arr e sy ndrome. I n th e de c isi on

he re on a pp e a l, t he B oa rd pla c e d mor e pr ob a tiv e we ig ht o n th e VA ps y c hiatr ic examinations. The Boa

rd found the VA e x aminer' s opinions "per suasive and suppor ted by medical evidenc e," and stated that the examiner had " provided a def initive opinion wit h rationale , which wa s supported by specific examples from the vete ran' s medical re cords." R. at 8. The princ ipal rea son the B oard g ave f

or discounting the evidenc e in the medica l opinions from Dr. Pellot Mora n and Dr

. J uarbe Ortiz, submi tted by the appe llant, was that " neither pr ivate psy chiatrist' s assessment linkingT he dut y t o as s i s t al s o i ncl udes as s i s t i ng t he cl ai mant t o ob t ai n v ar i ous document ar y r ecor ds, al t houg h t hat 2 sp e c ifi c d u ty i s n o t at issu e in this c a se
. See 3 8 U

. S.C

. § 5 1 0 3 A (b), (c)

. 4 the veter an' s depre ssive disorder to se rvice -conne cted Guillain-Ba rre sy ndrome is informed by

the in[ -]depth claims file re view as a re the assessments of the V A psy chiatrist." R. at 9.

II. AN AL YSI S A. Duty To As sis t At iss ue is wh a t ac tiv iti e s ar e e nc omp a sse d by the statut or y duty to " make re a so na

ble e ff or ts to a ssi st a c la ima nt i n o bta ini nge vid e nc e ne c e ssa ry to su bs tanti a te the c la ima

nt' s c la im. " 38 U. S.C. § 5 10 3A (a ). Th e du ty

to a ssi st und e r 38 U. S.C. § 51 03 A is ve ry br oa d, and VAha s d isc re tio n to decide how m uch deve lopment is necessa ry
. See Shoffner v . Principi , 16 Vet.App. 208, 213 (2002). Be y ond requiringthe Secr etar y to provide a me dical examination or obtain a medic al opinion "whe n
su c h a n e xami natio n o r o pin ion is nec e ssa

ry to m a ke a

de c isi on on the c la im, " 38 U. S.C. § 5 10 3A (d )( 1) ; McLendon v . Nicholson , 20 Vet.App. 79, 81 ( 2006); 38 C.F.R. § 3.159(c) (4) ( 2008), howeve r, neither

the statute nor its implementing r eg ulat i o n s pecif ies what fur

ther e videntiary development is require d once VA has de termined that the me dical evide nce that has bee n submitt ed is i ns uf fi c ie nt t o d e c ide the c la im. 2 I n this case, VAprovided two medic al examinations. See R. at 486-88 (De cembe r 2000 VA examination); R. at 556-64 (April 2004 VA e x amination). The appellant does not argue that either VA examination was inade quate in any respe ct, nor doe s he argue that VA' s intention in ordering the examinations was to develop neg ative evide nce, in violation of Mariano v. Principi , 17 Vet.App. 305, 312 (2003) ( "B eca

use it w o u l d not be per missibl e for

VA to under

take . . . a dditional development if [the] purpose was to obtain evidenc e aga inst an appellant' s case , VA must provide an ade quate state ment of re asons or ba ses for its decision to pursue furthe r deve lopment where such development r easona

bl y could be c onstrued as obta ining a dditional evidence for that pur pose." ). F ur the r, the B oa

rd state d that the VA me dic a l e xami natio ns we re pe rs ua siv e fo r m ult ipl e re a so ns , n o n e o f w h i ch h av e b ee nch al l en gedb y t h e ap p el l an t

. Ac co rd i n gl y , t h e C o u rt h o l d s t h at VA 's procur ement of the VA medica l examinations was a n adequate ef

fort to assist in developing the appellant' s claim. I n short, VA fulfilled its duty to assist.T he C our t not es t hat , he r e, D r
. P el l ot M oran conc l uded hi s l et t er wi t h t he st atem en t , "Fo r an y addi t i onal 3 i nf ormat i on i n t hi s mat t er , pl eas e com muni cat e wi t h us and we wi l l happi l y ans wer y ou. " R

. at 305

. T he C our t t ake s no posi t i on on wh et her t hi s i nv i t at i on r ai s ed a dut y of f ur t her i nqui r y o n t he part o f V A , as no s uch ar gu ment ha s been
ra ise d o r b rie fed to the C o u rt. 5 Neve rtheless, the a

ppellant ar g ues that VA ha s the duty to advise a c laimant that a copy of the cla im s f

il e c an , w it

h th e a p p r o p r iate a

u th o r iz a ti o n , b e f

o r w ar d e d to a p r iv a te p h y s ic ian who intends to render

an opinion on behalf

of the claimant. I f VA r eg ards a private me dical opinion as defic ient beca

use it is not based on a revie w of the claims file, the appellant rea sons, the Secre tary should offer

to furnish the cla ims file to that phy sician in or der to re nder a more c omplete opinion. I n the appe llant's vie w, this offer should be made be fore any merits deter

mination. Th e a pp e lla nt c ite s W ata i v . B ro wn , 9 Ve t.A

pp . 441 , 4 44 (1 99 6) , in

su pp or t of his argume nt. I n W atai , a private phy sician submitted a nexus opin i o n that, while g ener ally favor able to the

ve te ra n' s c a se , s ta te d: " Sin ce I do no t hav e a c c e ss t o h is m e dic a l r e c or ds , I wo uld no t be a ble to eval uat e th is asp ect[ nex us to ser vi ce eve nt s] of h is rena l p rob lem ." Id. a t 442. T he W ata i Court held that " the Secre tary was put on notice that the appellant neede d to de velop further the evidenc e pertinent to his claim. Under thesecircumstance s , the Secr etar

y had a duty

to inform the appe llant that the Secr etar

y , upon proper authorization . . . would furnish copies of the rele vant servic e medica l

reco rds to [ th e ph y si cia n] to enab le hi m to rend er a les s spec ul ati ve o pi ni on ." Id. a t 44 4 ( e mph a sis added)

. 3 At the outset, the Court notes that the fa cts of this case are distinguishable f rom those of W atai in at l east two important respe cts. First, in W atai , VA never aff

orded the veter an a me dical

nexus ex amination, basing its determination solely on the i nconclusivene ss of the private medical examination reports with respe ct to the ca usation issue. I n this case, howe ver, the appellant underw ent t wo VA psy chiatric examinations. S econd, unlike the private phy sician in W atai , neither of the phy sicians who provide d the appe llant's me dical opinions in this case expressed any sense of lim itatio n o n th e ir

a bil ity to r e nd e r a

n o pin ion ba se d u po n la c k o f a c c e ss t o the c la ims fi le . In f a c t, one of the phy sicians on whose opinion the appellant relies–Dr

. J uarbe Ortiz–appare ntly had a c opy of the c laims file, but incompletely revie wed it. W ata i is merely in a ccor d with othe r case s establishing that the content of infor mation and

e vid e nc e re c e ive d b y VA may re qu ir e an a

pp ro pr ia te re sp on se , c on sis te nt w iththe du ty to a ssi st.6

See, e.g., Dav es v. Nicholson , 21 Vet.App. 46, 51-52 (2007) (VA me dical examiner' s statement that the re qu e ste d o pin ion

c ou ld n ot b e pr ov ide d w ith ou t an a uto ps y tr ig g e re d th e Se c re tary ' s duty to in ve sti g a te wh e the r a

uto ps y c ou ld b e re a so na

bly ob ta ine d) ; Gree n v. De rwinski , 1 V e t. A p p
. 121, 12 3 (19 91 ) ("I t is

. . . im

po ssi ble to s qu are the Se c re tary ' s d uty to a ssi st .

. . wi th [V A' s] f a ilure to follow up the sug g estion b y the examining phy sician that a r eview of the veter an' s rec ords ' might help clar ify

the diag nostic doubt.'" ). All of these case s extend the S ecr etar y ' s duty to assist based on a stateme nt by

a medica l professional pl acing VAon notice that re view of the claims folder was
nece ssary in the particular case to rende r a thoroug h opinion. Even the most expansive rea ding of W atai does not e stablish a g ener al duty to point out the availability

of the claims file to ever

y claimant who se eks or pr ovides private me dical evide nce. T o fi nd that W ata i imposes such a g ener al duty , we must assume that VAwill sy stematically discount private me dical opinions where they are not based on re view of the claims file. In such a sc enar io, the a bs e nc e of the c la ims fi le wo uld be an au tom a tic pe na lty a g a ins t an opi nio n off e re d b y a pr ivate phy sician, and it would be supe rfluous whe ther the opinion expressly noted that the private phy sician was hampere d by

its absence . For

rea sons set fo rt h below, howe ver, the Court rejec ts that assumption. B. L aw a nd Practice of Evaluating Me dical Opinions We n ex t t u rn t o the question whethe r the B oard e rre d in discounting the opinions of Dr

. Pe llo t Mo ra

n a nd Dr . Juarb e Or

tiz, su bmi tte d b y

the a pp e lla nt i n s up po rt

of his c la im, me re ly beca use they wer e not base d on a revie w of his c laims f ile. As with a ll ty

pes of evidenc e, it is the Boa rd' s res p o n s ib il it

y to w e ig h th e c o n f

li c ti n g me d ic a l e v id e n c e to r e a c h a c o n c lu s io n a s to the

u l t i m at e g rant of se rvice connec tion. See W ood v. De rwinski , 1 V e t. A p p
. 1 9 0 , 1 9 3 ( 1 9 91). The Boa r d ma y f a v o r th e o p in io no f

o n e c o mp e te n t m e d ic a l e xp e rt o v e r an o th e r if it s s tate me n t of

rea sons and bases is adequate t o support that decision. Se e Ow e ns v . B ro wn , 7 Vet.App. 429, 433 (1995). Stated another way , the B oard de cides, in the fir st instance, which of the competingmedical opinions or examination reports is more probative of the medica l question at issue. This Court has here tofore issued only the most ge nera l guide lin es as t o what fa ctors contribute to the probative value of me dical opinions. Se e Gu e rri e ri v . B ro wn , 4 Vet.App. 467, 470- 7 1 (1 9 9 3 ) ( "T h e p ro b at i v e v al u e o f m ed i ca l o p i n i o n e v i d e n c e i s b as edo nt h e m ed i ca l ex p er t 'sV A m at eri al s ref er t o a "clai m s f

o l d er, " whi ch i s d ef

i ned as " [t ]he f

i l e co nt ai ni ng al l do cum ent s co ncerni ng 4
a v et er an ' s c l ai m or a ppea l

. " U n d ersta n d i n g t h e A p p ea l P ro ce ss (V A P a m p h le t 0 1 -9 5 -1 ) a t 2 7 (A p r. 1 9 9 5 ). 7 persona l examination of the patient, the phy sician' s knowledg e and skill in analy zing the data, a

nd the medica l conclusion that the phy sician re ache s.") . More rec ently , this Court held that a medical examination re port must c ontain not only clea r conclusions with suppor ting data, but also a re asoned medical ex planation connecting the two. See Ste fl v. Nicholson , 21 Vet.App. 120, 124 ( 2007) (" [A] medica l o p i n i o n . . . must support it s conclusion with an ana ly sis that the Boa rd ca n consider a

nd weig h ag ainst contrar

y opinions."). The question rema i n s wh ether the lack of

claims file re view

nece ssarily

reduc es the proba

tive value of

a medica l opinion subm itted on behalf of a cla imant. 1. Adequac

y of VA Me dical Examinations The Sec reta

ry ' s regulations provide that it is "esse ntial, both in th e ex amination and in the evaluation of disabili t y , t h at ea ch disability be viewe d in relation to its hist ory ." 38 C.F .R. § 4.1 (2008). F urther, "[i]f a diag nosis is not suppor ted by the finding s on the examination re port or if the repor t does not contain suffic ient detail, it is incumbe nt upon the rating board to r eturn the repor t as i n ad eq u at e f

o r r at i n g p u rp o s es
. " 3 8 C

. F. R

. § 4

. 2 (2 0 0 8 ). I t i s al s o we l l es t ab l i s h edi nt h i s C o u rt 's jur isp ru de nc e that a

tho ro ug h a

nd c on te mpo ra

ne ou s me dic a l e xami natio n is " on e wh ic h ta ke s in to

a c c ount t he re c or ds of pr ior me dic a l tre a tme nt, so that the e va luatio n of the c la ime d disa bil ity wi ll be a f ul ly in for med on e." Gree n , 1 Ve t.A pp . at 12 4. Thus , th e Se c re tary , whe n he unde rt a ke s to provide a medical examination or obtain a medical opinion, must ensure that the examiner providing the re port or opinion is fully cog nizant of the claimant' s past medical history

. B oth the Court and VAhave inv ok e d th e no tio n of re vie wi ngthe " c la ims fi le " a s a surr og a te f o r o b t a i n i n g ano v e r

v i e w o f t h e e n t i r e m e d i c a l h i s t o r

y. See Proscelle v . Derwinski , 2 Vet.App. 629, 4 632 (1992) ("The [VA] examiner should have the veter an' s full claims file ava ilable for r eview." ). Th e c la ims fi le , g e ne ra lly sp e a kin g , c on ta ins a ll d oc ume nts a sso c ia te d w ith a ve te ra n' s d isa bil ity claim , in c lu d in g n o t o n ly me d ic a l e xa mi n a ti o nr e p o r ts an d SM Rs , b u t a ls o c o r

r e s p o n d e n c e , r aw medical data, financ ial information, rating de cis ions of VA re g ional office s, Notices of Disag ree ment, such mater ials pertaining to claims for c ondit i o ns not curre ntly at issue and, of

ten, Boa rd dec isions dis posing of

ear lier cla ims.8

This Court, however , has not requir ed VA me dical examiners to pe rfor m a complete r eview of the e ntire cla ims file or state that they have d o ne so in eve ry

instance. See Snuffer v . Gober , 10 Vet.App. 400, 403- 04 (1997) ( revie w of claims file not require d wher e it would not chang e the ob je c tiv e and

dis po sit ive fi nd ing s ma de duri ng a me dic a l e xami natio n) ; see also D'Aries v. Pe ake , 22 Vet.App. 97, 106 (2008) (holding that it is not nece ssary for a VA medica l examiner to specify that he ha s r e a d th e e nti re c la ims fi le where it is cle ar fr om t he re po rt that he ha s d on e so a nd

is familiar with the c laimant' s ext ensive medic al history ). 2. Pr iv ateMe dic al O

pin ion s Th e c la ima

n t m ay s u b m i t h i s o w n m e d i c a l e v i d e n c e f r o m p r i v a t e p h y s i c ia ns
. 38 U. S.C. § 5125. Unlike ot her administrative benef its sy stems, however , this Court has ex pressly reje cted a

ru le that th e op ini on s of pr ivate tr e a tin g ph y sic ians are e nti tle d to pr e su mpt ive ly g re a te r w e ig ht i n evaluating ve tera

ns' claims. Se e Gu e rri e ri , 4 Ve t.A pp . at 47 3; see also D'Aries , 22 Vet.App. at 107- 08 . The re fo re , VA is statut or ily pe rm itt e d, bu t not re qu ir e d, to ac c e pt a re po rt pr ov ide d b y a pr ivate ph y sic ian a s su ff

ic ie nt to g ra

nt a c la im wi tho ut c on fi rm a tio n by a VAe xami natio n, " if the [pr ivate phy sician' s] report is sufficiently complete to be adequate for the purpose of adjudicating the c laim." 38 U. S.C. § 51 25

. Th is Court ha s no te d that w hil e thi s st a tut or y langua g e is p e rm iss ive , " c le a rl y it

wo u l d n o tp er m i tt h e B o ar d

t o ac ti nan ar

b i t ra ry an d cap ri ci o u s m an n er i n n o t cr ed i t i n g a c l ai m an t 's med ica l ev id ence. " Kowals ki v. Ni cholson, 19 Vet.App. 171, 177 (2005) (citing Str uc k v . B ro wn , 9 V e t.A pp . 1 45 , 1 55 (1 99 6) ); see also Mariano, supra. The Boa rd may attribute less probative va lue to a private opinion, however , if the B oard pr ovides an a dequate statement of rea sons or bases for doing so. Ow e ns , 7 Vet.App. at 433 ; Gabrielson v. Brown, 7 Vet.App. 36, 39-40 (1994) (holding that Board mu st p ro vid e a de qu a te state me nt o f r e a so ns or ba se s f or re je c tin g any

fa vo ra ble

e vid e nc e ); Stefl, 2 1 Ve t

. Ap p
. at 1 2 4 -2 5 (d i s cu s s i n g v al i d wa y s i nwh i ch l ay

ad j u d i ca t o rs ca n we i gh conflicting medical evidence ); see also Kowalski , 19 Vet.App. at 179 (" [T] he B oard ma y not disreg ard a

medical opinion so le ly

on the rationale that the medica l opinion was based on a history g iven by the veter an." ). C. The Dete rminants of Probative Va lue in Medica l Opinions Part of the B oard' s consideration of how much w eig ht to assign is the foundation upon which the medica l opinion is based. Kowals ki , s u p r a ; Re on al v . B ro wn , 5 Vet.App. 458, 461 ( 1993)9

(holding that the B oard ma y reje ct a medic al opinion that is based on fa cts provided by the veter an that ha ve pr e vio us ly

be en fou nd to be in a c c ur a te ); Swann v. Brown, 5 Vet.App. 229, 233 ( 1993) (s a me ); W

ils on v . D e rwi ns k

i, 2 Vet.App. 614, 618 ( 1992) (stating that the B oard must eva luate the

cre dibilit y

and we ight of

the history

upon which a me dical opinion is predicated). Both VA medical examiners and private phy sicians offe ring medical opinion s i n v eter ans benef its case s are nothing more or l ess t han ex pert witnesses. Whil e the Fe dera l Rules of Evidence

are not binding in this Court, nor on the Boa rd, the rule s on expert witness testimony provide usef

ul g uid anc e that ha s b e e n e xha us tiv e ly ve tte d by bo th t

he Rul e s A dv iso ry

Com mit te e and

by the U. S. Congr ess. I n U.S. district courts, expert testimony may be re ceive d from a suitably qualified e x pert under the following conditions: (1) The testim ony is based upon suff

icient fa cts or data ; (2) the testimony is the product of reliable principles and methods; and (3) the expert witness has applied the principles and methods reliably to the fac ts of the ca se. See F ED
. R. E V ID
. 702. The Court ag ree s that these a

re important, guiding factors to be used by the Board in evaluating the probative va lue of medi ca l opinion evidence , and that this Court's r eview of the B oard' s evaluation of competing

me dic a l op ini on s will be e nh anc e d b y the ir a pp lic a tio n. No tw ith sta

nd ingthat me dic a l pr of

e ssi on a ls of fe ri ngme dic a l o pi ni on s in ve te ra ns be ne fi ts c a se s d o n ot t y pic a lly te sti fy su bje c t to c ro ssexamination, the Court be lieves that these criter ia are important indicators of the pr obity of medica l op ini on s. Th e re fo re , w he re the B oa rd fa vo rs on e me dic a l op ini on ov e r a no the r, the Co urt wil l revie w the B oard' s decision to deter mine whether these criter ia have been met or proper ly applied. 1. Su ffi c ie nt F ac ts a nd Da ta Th e fi rs t in qu ir

y is w he the r t

he me dic a l e xpe rt is inf

or me d of suf

fi c ie nt f a c ts u po n w hic h to base a n opinion rele vant to the problem at hand. F ED
. R. E V ID . 7 02 . In th is i nq uir y , th e c la ims fi le is n ot a ma g ic a l or ta lis manic se t of do c ume nts , bu t rathe r a too l to a ssi st V A e xami ne rs to b e c ome familiar with the fac ts ne cessa ry to f orm an expert opinion to assist the adjudicator in ma k i n g a decision on a c laim. There are other mea ns by which a pr ivate phy sician ca n b ec o m e aware of critica l medical fa cts, not the least of w hich is by treating the c laimant for a n ex t en d ed p er i o d of time. See, e .g., Kowals ki , 19 Vet.App. at 179 (holding that the Boa rd may rely on a private me dical opinion that is based on an ac curate medica l history offe re d by

the veter an). Revie w of pe rtinent medical literature may

also furnish information releva nt to diagnostic a

nd nexus i ssues.10

Th e me re state me nt t

hat on e ph y sic ian d id o r d id n ot h a ve a c c e ss t o a c la ims fi le is o f l itt le use in pro v i d i n g ad eq uate r easons or bases f or a de cision where the B oard f ails to ex plain what information in the claims file wa s important and nec essar y for a competent a

nd persua sive medica l opinion, and why

the abse nce of

rec ord re view detr acts fr om the probative value of the opinion of

a p h y s ic ia

n
. I t f o ll o w s th a t r e v ie w o f a c la im s f il e b y a V A e xami n e r , w it h o u t mo r e , does not automatically rende r the examiner' s opinion c ompetent or pe rsuasive, se e Ste fl, su pra . Moreove r, the abse nce of cl ai m s fi l e re view by a private medica l expert does not categ orica lly exclude the possibili ty

that he is neve rtheless infor med of the re le v an t fac ts, see Snuffer, supra. There are even instances whe re c laims file revie w may be irrele vant to the medica l issue at hand. See, e .g., Fran c isc o v . B ro wn , 7 Vet.App. 55, 58 (1994) ( wher e entitlement to compensa tion has alrea dy

been established and an incre ase in the disability rating is at issue, the prese nt le vel of disability , not the medical history , is of primary conce rn). I n all case s, it is what an examiner lear ns from the c laims file for use in forming the expert opinion–and not just t he re ading of the file–that matters. When the Boa rd uses fa cts obtained fr om revie w of the c laims file as a ba sis for cr editing one expert opinion ov er an o t h er , it is i ncumbent upon the B oard to point out those fac ts a nd explain why they wer e nec essar y or important in forming the appr opriate me dical judg ment. Acc ording ly , the Court holds that claims file review, as it pertains to obtaining a n overvie w of the c laimant' s medical history , is not a requirement for private medical opinions. This Court has

never imposed a burde n of cla ims file reviewon all private phy sicians furnishing m edica l evidence

. B u t s ee D'Aries , 2 2 V e t. A p p
. a t 1 0 8 ( in a b il it y to d e te r mi n e w h e th e r a p r iv a te p h y s ic ia n r e a d the claims file g iven by

the B oard a s one of se vera l fac tors supporting weig ht assig ned to that opinion); Pr e je an v . W

est , 13 Vet.App. 444, 448- 49 (2000) ( upholding B oard de terminatio n that VA examination reports wer e more probative be cause they wer e more thoroug h and deta iled, they dis c us se d the c on fl ic tin g op ini on s, and e xami ne rs ha d a c c e ss t o th e c la ims fi le ); Sims v. Nicholson, 19 Vet.App. 453, 458- 59 (2006) ( aff irming Board finding that a private medica l opinion was not entitled to probative we ight be cause the ex aminer did not have the ve tera n' s claims file to revie w). I mp o s i n g o n a p h y s i c i an a r e qu i r e m e n t t h a t h e r e a d a c o mp i l a t i o n o f d o c u m e n t s t h a t c a n r un to thousands of pag es (many of which, a s n o t ed above, a re of ten irre levant to the issue bef ore theT he C o urt notes t hat , al t ho ugh V A phys i ci ans have mo re r ead y acces s t o a vet eran' s cl ai m s f i l e, t here are 5
r eg u l at or y pr ov i s i on s t h at e n abl e a v et er an t o obt ai n copi es of t h e cl ai ms f i l e i f h e or s h e s o ch oos es , a n d f u r t h er pr ov i de tha t t h e B o a rd w ill d e fer a c tio n o n a n a p p e a l p e n d ing su c h a re q u e st. See 3 8 C

. F.R

. §§ 1.57 7 ; 20

. 1 2 0 0 (20 0 8 ). 11 phy sician) in orde r that hi s or her opinion not be sum marily discounted, has no inhere nt value to the probity of the opinion. Fur

thermore , treatment of the cla ims fi l e as a surrog ate f or aw are ness of sig nif ic ant f a c ts i n a me dic a l hi sto ry

may le a d to er ro r. Th e Court is re luc tant t o e xpand the du ty to assist in a direction that see ms to countenanc e, and e ven instituti onalize, such prac tices. There fore , a p ri v ate medical opinion may not be discounted solely beca use the opining phy sician did not review

the claims file. L ikewise, the Court holds that the B oard m ay not prefe r a VA me dical opinion over a private me dical opinion solely beca use the VA e x aminer r eviewe d the claims file. This is not t o say

that particula

r m ed i ca l i n fo rmation containe d in a claims file mig ht not have sig nificanc e to the proc ess of for mulating a

medically

valid an d well-reasone d opinion. As wi th a ny e xpe rt op ini on , the f

a c tua l pr e mis e s o f a

me dic a l op ini on

are c e rt a inl y

su bje c t to examination. Many

times those fac ts c an be found in the information contained in the claims file. Critical piece s of information fr om a claimant' s medical history can le nd cre dence to the opinion of the me dic a l e xpe rt

wh o co ns ide rs the m and

de tr a c t f ro m th e me dic a l op ini on s o f e xpe rt s w ho do no t. T h er ef o re , a r ec i t at i o no f t h e m ed i ca l i n fo rm at i o no nwh i ch t h e o p i n i o ni s b as edca nai d t h e B o ar d 's

e va luatio n o f t

he su ff ic ie nc y of the op ini on . O f c ours e , a ve te ra n s ho uld take c are to p ers on ally provide those medic al fa cts of which a phy sician shoul d be aw are in formulating a medica l opinion on the veter an' s behalf. 5

2. Application of Reliable Principles and Methods Th a t th e me dic a l e xpe rt is s uit abl y qu alif

ie d a nd su ff ic ie ntl y inf or me d a re thr e sh old considerations; m ost of the probative value of a medica l opinion comes from its re asoning . Neither a VA me dical examination report nor a private medical opinion i s entitled to any weig ht in a service

connec tion or rating context if it contains only data a nd conclusions. See Ste

fl, 21 Vet.App. at 125 (holding that "a

mere conclusion by a medica l doctor is insufficient to allow the B oard to make an inf or me d de c isi on a s to what we ig ht to a ssi g n to a do c tor ' s o pin ion " ); Mi lle r v . W est , 11 Vet.App. 345, 348 (1998) (" A bare conclusion, even one rea ched by a health car e profe ssional, is not probative wi tho ut a fa c tua l pr e dic a te in t

he re c or d. " ); see also Dennis v. Nicholson , 21 Vet.App. 18, 22 (2007)12

(" Th e Court

ha s lo ng he ld t hat me re ly

lis tin g e vid e nc e be fo re statin g a c on c lus ion do e s no t c on sti tut e
an ad eq u a t e s t at em en to f r ea s o n s an d b as es
. " ( ci t i n g Abernathy v . Principi , 3 Vet.App. 461, 465 (1 99 2) )) ; but see Mc

Lendon, supra, (holding that a conc lusory opinion may

furnish enoug h evidenc e of cur rent disability

or medica l nexus so as to call for a VA me dical examination). I t should now be obvious that a re view of the claims file cannot compensate for lac k of the

rea soned ana ly sis required in a medical opinion. I t is the factually acc urate , fully

articulated, sound

rea soning f

or the c onclusion, not the mere f act that the c laims file was revie wed, that c ontributes probative va lue to a medica l opinion. The Boa rd must be able to c onclude that a medical expert has applied valid medica l analy sis to the significa nt fac ts of the par

ticular ca s e in orde r to rea ch the conclusion subm itted in the medical opinion. See Ste fl, supra. These sig nificant fa cts may or may not include matters e v i d ent from a revie w of the c laims file, g iven the natur e of the issue under consideration. D. Ap pli c a tio n to Pr e se nt C a se I n this case , the Board stre ssed that " [f] actor s for a ssessing the probative va lue of a medical opinion include the phy sician' s acc ess to the claims file a nd the thoroug hness and de tail of the opinion." R

. at 9 (c i t i n g Prejean , 1 3 V e t.A pp . at 44 8- 49 ). Ac c or din g ly , th e B oa rd state d th a t it assig ned more probative w eig ht to the VA opinions beca use the e x aminer had re vie we d th e ve te ra

n' s c la ims fi le . Sh e pr ov ide d a de fi nit ive op ini on

wi th rationale , which wa s supported with specif ic ex am ples from the ve tera n' s medical rec ords. Her

opinion is persuasive and suppor ted by the medica l evidence

. R. at 8. Th e Court

a g re e s and

c onclu des that th e B oa

rd ' s a ssi g nme nt o f m or e pr ob a tiv e we ig ht t o these VA opinions wa s based on more than just the state ment that the VA e x aminer ha d revie wed the claims file. The VA medica l examiner twice intervie wed and eva luated the a ppellant ac cording to Di ag no sti c an d S

tat ist ic al M

an ua l of Me nta l D iso rd

e rs (D SM- I V) c ri te ri a , r e nd e ri nga dia g no sis of dy sthy mia. She noted that hi s p re vious neurolog ical eva luations and servic e medica l rec ords

reve aled ve ry

littl e and ve ry

mild consequenc es of the Guillain-B arr e sy ndrome. She fur

ther noted that t h e re co rds re veale d that the appe llant beg an experienc ing sy mptoms of depression in 1995, some 39 y ear s after

separat i o n from service, a nd afte r a pr oductive wor king life

. See M

axon v. Gober , 230 F.3d 1330 ( Fe d. Cir. 2000) (evide nce of a prolong ed period without medic al complaint afte r ser vice c an be c onsidered a s a fa ctor in dete rmining a service -conne ction claim).13

Fur ther, the Court c oncludes that the Boa rd provided adequate re asons for r ejec ting the opinion of Dr. J uarbe Ortiz. The Boar d noted that, despite having a copy of the claims file to review , Dr. Juarb e Or t i z did not completely revie w the medica l information there in, and there fore overlooke d key

documents, par

ticularly the " repor

ts of VA neurolog ical examinations depic ting the nature and extent of Guillain-B arr e sy ndrome" since the appellant' s separ ation from service . R. at 8-9. As noted above , it is what an examiner le ar ns from the claims file that matter s, not merely the

re vie w i tse lf

. H e re , D r. Juar

be Or tiz' s f a ilure to f ull y re vie w the me dic a l in fo rm a tio n in the c la ims file re sulted in his overlooking pe rtinent repor ts reg ardingthe appe llant's me dical history , and the B oa rd a de qu a te ly

e xpla ine d that it wa s h is f a ilure to r e vie w tho se pa

rt ic ula r r e po rt s th a t r e nd e re d h is

o p i n i o nl es s p ro b at i v e th an t h e op i n i o n s o f th e VA m ed i ca l ex am i n er
. I n o t h er wo rd s , t h e B o ar d 's decision to reje ct Dr. J uarbe Ortiz's opinion wa s not based solely on his failure to c ompletely revie w the appe llant's c laims file, but rather on the fac t that his opinion lac ked foundation in that the portion of the c laims file he d i d n o t revie w containe d medical f acts important to the for

mulation of the op ini on so ug ht. I n co n t rast, the Boar d never expli citly

addre ssed the thoroug hness and de tail of Dr. Pellot Mo ra n' s o pin ion . Ins te a d, the B oa rd a ssi g ne d le ss p ro bativ e we ig ht t o th a t op ini on so le ly be c a us e it was not " in f

o r me d b y th e in [- ]d e p th c la im s f il e r e v ie w a s [w e r e ] th e a s s e s s me n ts o f th e VA psy chiatrist." R. at 9. The B oard state d only that Dr

. P el l ot Moran " made no r efe renc e to having revie wed the ve tera

n' s claim file" without f

urther disc ussion or analy sis of his opinion, and without explaining wh y

a re view of the claims file wa s nece ssary . R. at 8. Moreove r, the B oard did not

co n s i d er wh et h er , ev en i nt h e ab s en ce o f c l ai m s fi l e r ev i ew , Dr

. P el l o t M o ra nh adan y

kn o wl ed ge of the a ppellant' s medical h i s t o ry –which, as note d above, is ne cessa ry in many case s to render

an adequate medica l opinion–in l ight of the fac t that he had be en providing psy chiatric treatment to the appellant f

or nea rly five y ear s at t he ti me he rende red his opinion. Acc ording ly , beca use t he B oard

re j ec t edDr

. P el l o t M o ra n 's p ri v at e me d i ca l o p i n i o n s o l el y b ec au s e he d i d n o t re v i ew t h e ap p el l an t 's claims file (a

nd, by extension, concluded that he w as not familiar w ith the ap p ellant' s medical his tor y ), the Court

wi ll r e mand

thi s matte r t o th e B oa

rd for it t o a sse ss D r. Pe llo t Mo ra n' s p ri vate opinion in accor dance with the proce dures se t forth in this decision.14

On re mand, the appe llant is free to submit additional evidenc e and argument in acc ordanc e with Kut sc he ro us k yv . W est , 12 Vet.App. 369, 372- 73 (1999) ( per c uriam orde r). See Kay v. Principi , 1 6 V e t.A

pp . 5 29 , 5 34 (2 00 2) . T he Court re min ds the B oa

rd tha t " [a] re mand is m e a nt t o ent ail a cri ti cal ex ami nat io n o f t he j us ti fi cat io n fo r t he d eci si on ." Fletche r v. De rwinski , 1 Vet.App. 39 4, 39 7 ( 19 91 ). I n a dd iti on , th e B oa rd sh a ll p ro c e e d e xpe dit iou sly , in a c c or da nc e wi th 38 U .S. C. § 7112 (expedited treatment of rema nded cla ims).

IV . C ON CL USI ON The Boar d' s November 17, 2005, decision i s VACATED a nd the matter is REMANDED for

rea djudication consistent with this decision.