UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

No. 99-967
J OHN E. S HOFF NER , A PP EL L ANT ,

V
. ANTHONY J. P RI NCI PI , 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
(Argued De cembe r 17, 2001 Dec ided J uly 30, 2002 )

Sa nd ra E. Bo oth , o f C olumbu s, Oh io, fo r t he a pp e lla nt.
Er ic a M . D or nb ur g , w ithwh om John H. Thompson , A c tin g Ge ne ra l Co un se l; Ro n G arv in , As sis tant G e ne ra l Co un se l; Darryl A. Joe , Acting Deputy Assistant Gener al Counsel, wer e on the brief, a ll of Washington, D.C., for the appellee

. Daniel D. W

edem eye r , of Santa Ana, C al i fo rnia, wa s on the brief , for the N ational Org anization of Veter ans' Advocates as amicus c uriae

. Be fore FARL EY, I VERS, and STEI NB ERG, Judges

. I VERS, Judge , filed the opinion of the Court. F ARL EY, Judge , filed a c oncurr ing opinion in which STEI

NB ERG, Judge , joined in substantial part. STEI NB ERG, Judge , fil ed a dissenting opinion.
I VERS, Judge : The vete ran a ppeals the F ebrua

ry 12, 1999, d ec i s i o n of the B oard of Veter ans' Appea ls (B VA or Boa rd) that denied entitlement to service connec tion for c ardiova scular disease. T he Court' s jurisdiction to review this matter is established by 38 U.S.C. § 7252.

I. F AC TS Veter an Shoffne r ser

ved in the U.S. A rmy from September 1970 to F ebrua ry 1972. Record (R.) at 14. His servic e medica l rec ords (SMRs) show that he wa s hospitaliz ed and tr eate d as an outpatient, on thr ee s ep arate occ asions over a pproxi mately

two consec utive months, for bilatera l2

pneumonia with ple ural eff usion ( fluid in the lining around the lungs) (R. at 27-28); an d for my c op la sma

pn e umo nia

(m os t c omm on

fo rm of pr ima ry a ty pic a l ( ir re g ula r) pn e umo nia ) w ith

eos in o p h il ia ( s ta in in g o f c e ll s o r s tr u c tu r e s ) ; b o th o f u n kn o w n e ti o lo g y ( R. a t 3 1

- 3 3). See D OR L AND ' S I L L US TR ATED M ED I CA L D I CT I O N A RY [hereinaf ter D OR L AND ' S ] 531, 1307, 1317, 160, 563 (28t h ed

. 1994). His dischar g e phy sical prof ile rec ord following his final hospitaliz ation included the notation " resolving viral sy ndrome." R. at 38, 43. The ve tera

n filed a c laim f

or service connec tion f

or pneumonia 4 y ear s after his discharg e. R. at 60-63. The VA reg ional office (RO) responded with a rating decision and letter to the veter an, wh ic h in fo rm e d h im that he ha d a se rv ic e -c onne c te d d isa

bil ity , re sid

ua ls of pn e umo nia , b ut t

hat it was not compensa

ble beca use no residuals wer e indicated on his discha rg e examination in J anuar y 19 72 . R. a t 71 -7 3. Th e re c or d d oe s n ot c on ta in a ny e vidence that th e ve te ra

n a pp e a le d th e RO decision. I n Aug ust 1984, the vetera n suffe red a

my ocar dial infarc tion. SeeR. at 192. The re port of

a c on sult in g p hy sici an in c lud e s an im pr e ssi on of a the ro sc le ro tic he art

dis e a se , s tatus po st a c ute inferiolate ral wa ll my ocar dial infarc tion, and a Wencke bach he art b lo c k ( ty p e o f ir regular he art be at). Id. ; see D OR L AND ' S 208. I n April 199 2 , af t er re ceivinga diag nosis of ischemic ca rdiopathy (d e fi c ie nc y

of blo od su pp ly to h e art ), the a

pp e lla nt u nd e rw e nt a

he art tr ans pla

nt. R. at 16 4- 66 ; see D OR L AND ' S 269, 861. I n October

1995, in support of a c laim for ser vice c onnection for

his h ea rt condition, the veter an submitted letters fr om thr ee private phy sicians, ea ch var iously opining that, if

t h e v et er an 's in-servic e pneumonia ha d been vir al, i t was possible that his hear t condition was related to the pneumonia. R. at 255-57. I n J an u ar y 1996, the RO reque sted a VAmedical e x amination for "D iseases of

the Hea rt; Non TB Disease s/I njuries." R. at 407. The re quest is reproduc ed as aonepa g e do c ume nt i n th e re c or d o n ap pea l, w itha se c tio n f or g e ne ra l r e mark s th a t st a te d a s f oll ow s: "Ca rdiomy opathy , resulting in hear t transplant, claimed as secodnary [si c] to pneumonia in servic e. Hea rt and pulmonary

specia list, pl ease , to reviewCPFile, includ in g service meidcal [sic] records a nd letters fr om curre nt MDs. Give opinion as to etiology of the ve t's car d i omy opathy , as we ll as rat io nal e." Id

. The fir st of two separ ate VAexaminations conc l uded that, if the veter an' s in-service3

pneumonia had be en vira l, it could have contributed to his hear t condition. R. at 409. The sec ond did no t dr aw a

defin it e c on c lus ion , b ut o bs e rv e d a his tor y of se ve re vir a l sy

nd ro me in t he 19 70 s, leadingto post-viral ca

rdiomy opathy . R. at 412. A J anuar y 1996 RO decision denied se rvice connec tion for ca rdiovascula

r diseas e
. R. at 417- 19. The re asons and ba ses sec tion of the RO decision noted the sug g estions by the veter an' s three p r i v a t e p h ys i c i an s o f

a h yp o t h e t i c a l l i n k

b e t w e e nh i s i n - s e r

v i c e p n e u m o n i a

an d h i s c ar d i o m yo p a t h y. R. at 417. The reasons and bases section did not ref ere nce the later VA examination, but stated the fo l l o wi n g co n ce rn i n g t h e f i rs tVA ex am i n at i o n , co n d u ct edb y a d o ct o r n am ed

P i ck er i n g:
The e xami n e r

o p in e d th a t t h e r e is n o d o u

b t t h a t t h e v e te r an ' s 1971 pn e umo nia

may have be e n v ir a l in natur e , a lth ou g h th is i s im po ssi ble to d oc ume nt a

t th is t ime

. I f it w a s in de e d v ir a l in natur e , th e n it

c ou ld easily have be en a c o n t ri b u t ing f actor to the development of

viral c ar d io myo p a thy . Wh il e v ir a l in f e c ti o n o f th e c ar d ia c mu s c le can r e s u l ti nani n d o l e n tp r o c e s s t e r m i n a t i n g i nf

a t a l c ar d i o m yo p a t h y, there will be no residual phy sical fa ctors which w ould prove or disprove that hy

pothesis. The e x ami ner f urther stated that it was un c le ar h owthe id ea o f r e pe a te d myoc ard ia l in fa rc tio ns a lon g wi th by pass g raf ting a nd ang iopl as t i es ca

n relate to a pure ly

viral c ar d i o m yo p a t h y. R. at 418. Shortly afte r the RO dec ision was issued, the veter an filed a Notice of Disag ree ment (NOD ). R. at 421. Duringthe adjudication that followed the N OD, one of the veter an' s private phy sicians submit te d thr e e a d d it io n a l l e tt e r s
. R. a t 4 4 9 , 5 0 3 , 5 3 6

. I nth e f ir s t a n d th ir d le tt e r s , th e phy sician op ine d th a t th e ve te ra

n' s vir a l c ard iomy op a thy

wa s r e late d to the pn e umo nia tha t he ha d h a d w hil e
s er v i n g i n Vietnam. R. at 449, 536. The se cond letter stated that the ve tera

n' s condition was "pr o b a b le myc o p la s ma

in d u c e d c ar d io myo p a thy

in a d d it io nto s e v e r e a th e r o s c le r o ti c c o r o nary disease a nd an ische mic car diomy opathy ." R. at 503. I nJ u n e 1 9 9 7 , t h e R O s en t a l et t er t o t h e p ri v at e p h y s i ci an as k i n g h i m t o cl ar i fy t h e e t i o l o gy of the ve te ra

n' s h e art c on dit ion . R. a t 54 9; see R. at 552. The recor d does not include evide nce of

a re sp on se fr om t

he ph y sic ian. I n O c tob e r 1 99 7, the RO so ug ht "an opini on by a sp e c ia lis t in tropi c a l d is e a s e s an d b y a s p e c ia li s t in d is e a s e s o f th e h e art" ( s p e c ia li s t' s o p in io n ) r e g arding the4

etiology of the veter an' s hear

t c ondition. R. at 560- 62. A summary of the ve tera

n' s releva nt medical history was include d in the g ener al re marks section of t he request, wit h more de tail than that in the J anuar y 1996 reque st for a V A medica l examination. See R. at 40 7, 56 1- 62 . T he 19 97 re qu e st, in pe rt ine nt p art , w a s a s f

oll ow s: (1) What is the most likely diag nosis of t h e t y

pe of pne umonia the veter an had in 1971? (2) [The vete ra n 's private phy sician' s] opi nion seems to invert the prog ression of the ve tera

n' s hear t disease. T h e ev idence shows the prog ression of ASH D from the [ sic] 1984 on whith [ sic] c ard iomy op a thy

and c on g e sti ve he art

fa ilure de ve lop inglate r p ri or to the time of t he heart t ransplant. Do the phy sicians see any evidenc e of a c ardiomy opathy

at the time of t h e ea rl y

treatment in 1984 and 1985? Or did it deve l o p later? And if so what is its cause ? I s it as lik e ly a s n ot th a t th e art e ri os c le ro tic he art dis e a se fi rs t di a g no se d in 19 84 is d ue to t he bo ut o f p ne umo nia in 197 1 or it is [sic ] mor e lik e ly to be due to toher

[si c] independent c auses? An y o p i nion, one way or the other , must assess the fa ct u al situation in reg ard to the pneumonia in 1971, the abse nce of hear t problems until 1984, and the dia g no sis of

ASH D i n 1 98 4, and

la te r d e ve lop me nts

. R. at 561-62. A spec ialist phy sici an fr o m the VA outpatient c linic in Col umbus, Ohio, provided the respondingopinion, which conclude d that the veter an' s car diomy opathy was due to ischemia that

o c c u r r e d a f t e r h i s m yo c ar d i a l i n f

ar c t i o n , an d

t h a th i s p n e u m o n i a

h a d n o tc a u s e d t h e c ar d i o m yo p a t h y. R. at 557-58, 565. The RO then issued a Supplemental Statement of the Case reiterat i ng its prior denial of se rvice connec tion. R. at 564-73. I n Fe bruar

y 1998, the veter an, noting more than one conclusion as to the e tiology of his hear

t condition, reque sted that the B oard obta in an i n d ep en d en t medical opinion (I MO). R. at 575-76. T h e Bo ar d re qu es t ed t h e I M O i n a l et t er t h at p ro v i d edre l ev an tfa ct u al d et ai l co n ce rn i n g t h e v et er an 's in-servic e pneumonia a

nd subsequent heart conditions. R. at 596-597. The le tter soug ht an opinion

c on c e rn ing" the iss ue of

an eti olo g ic a l re latio ns hip be tw e e n pne umo nia and c ard iomy op a thy ." R. at 597. The B oard note d, in the Fe bruar y 1999 decision prese ntly on appea l, that the I MO provider5

"r eviewe d the complete c laims file and extensiv e m ed i ca l rec ords, as we ll as appropr iate medica l lit e ratur e and

re fe re nc e s. " R. at 6- 7. Th e re su lti ng I MO c on c lud e d that th e ve te ra n h a d a n is c he mic

car diomy opathy

due to cor onary

ather osclerosis, with no evidenc e of a ny ty pe of c ardiomy opathy prior to his acute inferior

latera l myocar dial infarc tion in Aug ust 1984, with its clinical appe ara nce on that date; and that the veter an had not ha d nonischemic c ardiomy opath y or a c hronic vira l my ocar ditis. R . at 600-06. After considering the I MO and all the evidenc e in the rec ord, the B oard c oncluded that the preponde ranc e of the evidenc e wa s ag ainst the veter an' s claim for service connec tion f or his heart

c on dit ion . It is that c on c lus ion that th e ve te ra

n n owa pp e a ls.

II. AN AL YSI S Th e B oa rd ' s d e te rm inatio n th a t the ve te ra n' s h e art c on dit ion

is n ot s e rv ic e c onne c te d w a s a fact ual fi nd in g, whi ch t he C ou rtca n n o t o v e r tu rn u nl ess it was "clear ly erro neo us ." See Swann

v . B ro wn , 5 Ve t.A

pp . 2 29 , 2 32 (1 99 3) ; W

ood v. De rwinski , 1 Vet.App. 190, 192 ( 1991). Unde r the "c lear ly err oneous" standard, " if there is a ' plausible' basis in the rec ord for the fac tual deter minations of the B VA , e ve n if thi s Cour t mig ht not have re a c he d the same fa c tua l de te rm inatio ns , [th e Court ]

cann ot ov erturn th em. " Gilbert v. De rwinski , 1 Vet.App. 49, 53 ( 1990). Whil e this case involves much fac tual evidenc e from seve ral diff ere nt sources, in pa

rticular the medical e vidence , the Court fi nd s th a t th e re is a

pla us ibl e ba sis fo r t

he B oa rd ' s con c lus ion

that th e e vid e nc e pr e po nd e ra te s a g a ins t the veter an' s claim for se rvice connec tion. The Boa rd stated that it ha d rea ched its c onclusion afte r "w eig hing competin g m ed i cal opinions." R. at 7. As indicated in the preceding summary of the fa cts in this case, the r ecor d befor e the B oard inc luded medica l opinions from severa l VA and non- VA phy sicians. The B oard note d that the final I MO, obtained at the reque st of the veter an, wa s more probative t h an the opinions of the veter an' s private tre ating phy sicians. Id . T he B oa rd po int e d o ut t

hat th e I MO inc lud e d c omm e nts
conce rning the prior opinions of the pr ivate and V A phy sicians. R. at 9. The ve tera

n has ar g ued that the medic al evidenc e b ef o re t h e R O at the tim e of its 1996 decision af

firmatively

supported his claim for

service connec tion. Appellant' s Br ief (Br.) at 11. The

v e t e r anw o u l d

h av e t h e C o u rtc h ar a c t e r i z e t h e m e d i c a l e v i d e n c e a s c o n c l u s i v e r e g ar d i n g e t i o l o g y,6

and r e v e r s e th e B o ar d ' s d e c is io n
. T h e r e me dy o f r e v e r s a l, h o w e v e r , is o n ly a p p r o p r ia te when

" ' [t]he re is a

bs olute ly no pla

us ibl e ba sis ' fo r the B VA ' s de c isi on a nd wh e re that de c isi on

' is c le arl y
err oneous in light of the uncontrove rted evi den ce i n t he ap pel lan t's f avo r.'" Hi c k

s v . B ro wn , 8 Vet.App. 417, 422 ( 1995), (q u o t i n g Hersey v. De rwinski , 2 Vet .App . 9 1, 95 (1 99 2) ) ( e mph a sis added)

. The Court has f

ound that there is a plausible basis in the re cord f or the B oard' s denial of servic e co n n ection. The Court cannot find, a s the veter an urg es, that the medic al evidenc e in the

rec ord at the time of the 1996 RO decis i o n wa s conclusively in favor of

service connec tion. The Boa rd discussed this med i ca l ev i d en ce, a nd found that it was " inconclusive a s to the etiologic al relationship between the [veter an' s in-service ] pneumonia and [his ] cardiomy opathy ." R. at 7. Nothing in the e vidence of record refute s these findings. The que stion of whether the evidenc e wa s uncontrove rted is not rele vant bec ause the evidenc e wa s not conclusive. The ve tera

n argues t hat the Secr etar y unlawfully

overde veloped the ve tera n' s claim by

s ee k i n g m ed i ca l o p i n i o n s b ey o n d t h o s e t h at we re b ef

o re t h e R O f

o r i t s 1 9 9 6 d ec i s i o n
. Ap p el l an t 's Br . at 11-15. This ar g ument i s wi t h o u t t he support of la w, contra ry to the veter an' s assertions otherwise. H e conte nds that the languag e of 38 C.F .R. § 3.304(c) limits VA' s development of

e vid e n c e
. I n f

a c t , t h a t l an g u a g e g i v e s V A t h e d i s c r e t i o n t o d e t e r m i n e h o w m u c h d e v e lop me nt i s
nece ssary for a deter minati o n o f s ervic e conne ction to be made. 38 C.F .R. § 3.304(c) ( "T he development of

evi d en ce i n connec tion with claims for servic e conne ction will be acc omplished whe n d e e me d n e c essa ry ." ( Emphasis added) ). Fur thermore , the RO complied with its statutory duty following rec eipt of the ve tera n' s NOD. See 38 U.S.C. § 7105(d)(1); 38 C.F.R. § 19.26. That is, the RO took "suc h development or revie w action as it dee m[ ed] proper under the provisions of regulations not inconsist ent with this ti tle." 38 U. S.C. § 7 10 5( d) (1 ). Af

te r re c e ivi ng dif

fe re nt le tte rs fr om on e of

the ve te ra

n' s p ri vate ph y sic ians , and findinginconsistent information in tho s e l ett ers c oncer ning the etiology

of the ve tera

n' s hear t condition, the RO soug ht c larifica tion f rom the private phy sician. See R. at 449, 503, 536, 549, 552. Rece iving no r esponse from the private phy sician, the RO soug ht a VA spe cialist' s opinion

conce rning etiology

. See R. at 557-62. The veteran acknowle dg ed in his brief that the l aw allows for an RO to request a n I MO when7

a claim involves medical c omplex ity or controve rsy
. See Appellant' s Br

. at 13; 38 U.S.C. § 5109; 38 C.F .R. § 3.3 28

. Al tho ug h the sp e c ia lis t' s opin ion that th e RO so ug ht w a s n ot a n I MO , b e c a

us e it was provided by

a VA phy sician, it was soug ht to clarify a ques tion of etiology

left open by

the non-VA me dical evidenc e of rec ord. Whether an I MO is neede d is left to the Secre tary ' s discretion. 38 U. S.C. § 5 10 9( a ). Simi larl y , th e B oa rd ha s disc re tio na

ry a uth or ity to re qu e st an

I MO . 3 8 U .S. C. § 7 10 9( a ); see 38 C.F.R. § 20.901(d). T h e v et er an h as a r g u e d t h at b o t ht h e R O r eq u es tfo r as p ec i al i s t 's o p i n i o nan d t h e B o ar d 's

re qu es tfo r a nI M O w er e t ai n t ed b ec au s e of ce rt ai n d et ai l s p ro v i d ed i n t h e re qu es t l et t er s
. Al t h o u gh this arg ument was not discussed in the Bo ar d d ecision, it is releva nt to the issue on appea l, i.e., wh e the r t he B oa rd c or re c tly de nie d se rv ic e c onne c tio n, and the Court wi ll a dd re ss the argume nt i n the first instance

. See Ma gg itt v . W est , 202 F.3d 1370 ( Fe d. Cir. 2000). T h e C o u rt fi n d s t h at t h e B o ar d 's s i l en ce co n ce rn i n g t h e R O l et t er re qu es t i n g a s p ec i al i s t 's opinion was not arbitra

ry or ca pricious. See38 U.S.C. § 7261(a)(3) . The RO made the re quest afte r the ve te ra n h a d s ub mitte d a

n N OD . A t th a t po int

in t he pr oc e ssi ng of

the ve te ra

n' s c la im, the RO exercised its statutory

authority in deemingit proper to issue a reque st f or a specia list's opinion. See 38 U.S.C. § 7105(d)(1); 38 C.F.R. § 19.26. The Secre tary has not promulg ated a

regulation g overningreque sts for a VA specia list's opinion, but has done so for RO re quests for I MOs. See 38 C.F.R. § 3.328(b) (re quest must be submitt ed in writing and must set forth in detail the r easons why the opinion is necessary ). Al t houg h the Court could dra w a pa rallel be tween the regulatory provisions for re questingan I MO and the request for a specialist's opini on in this case , we need not

a dd re ss t hat is su e to r e so lve thi s a pp e a l. Whether the RO' s reque st f or a specia list's opinion wa s tainted, as the veter an has alleg ed, or not tainted, t he only outcomes for the veteran at that time would have bee n (1) a g rant of se rvice

connec tion following the RO' s second look, or (2) the transfe r of his c ase to the Boa rd for a decision

conce rning his appea l. See38 U.S.C. § 7105(d)(1). The latter oc curr ed, and the Boa rd re quested an I MO, which it ult i m at el y relied upon a s the basis for its conc lusive decision conc erningthe

v et er an 's cl ai m fo r s erv i ce co nn ec t i o n
. As s u m i n g, ar gu en d o , t h at t h e R O r eq u es tfo r as p ec i al i s t 's op in io nw a s ta inte d , th e r e s u lt in g o p in io nw a s n o t a d e c is iv e f

a c to r in th e B o ar d ' s d e c is io n
. The Court must proceed, the n, to deter mine whether the Board' s reque st for a n I MO was tainted, a s the8

ve te ra n a rgue s it wa s. A l e tte r fr om the B oa

rd re qu e sti ng an I MO mus t " fu lly and a c c ur a te ly

re fl e c t[ ] the dis a

bil ity picture, inc luding both objec tively demonstrated disa

biliti es and subjec tively

claimed pa in or

other di sab il it y ." Bi e lby

v . B ro wn , 7 Vet.App. 260, 268- 69 (1994). "I f t h e e n gage m en tl et t er fa i l s t o s et fo rt hal l o f t h e c l ai m an t 's impairments, both objective and s u b j ective, or fails to set forth a ny other re levant fa ctual detail, such as the time per iod during which sy mpt omatol og y

manif e ste d itse lf

, th e [ind e pe nd e nt m e dic a l e xpe rt ] cannot r ender

an opin i on which is supported by a suff icient prior revie w of a

nd plausible basis in the rec ord."
Id .; see 38 U.S.C. § 7109(a); 38 C.F.R. § 20.901(d)

. The Court notes the B oard' s finding that the I MO it had reque sted was a "c lear and

u n eq u i v o ca l o p i n i o n , " t h e b as i s fo r w h i ch i n cl u d eda r ev i ew o f e ac ho f t h e v et er an 's p h y s i ci an 's opinions. R. at 7. Ba sed on the Board' s fac tual finding s conce rning the I MO, and the r equire ment that a letter re questing an I MO consist of suffic ient detailed infor mation, the Court concludes that the B oard did not ac t in an arbitra ry or ca pricious manner

by issuing the letter

reque sting a

n I MO. See 38 U.S.C. § 7261(a)(3)

. Th e ve te ra

n h a s a lle g e d fur

the r that the B oa

rd sh ou ld h a ve re tur

ne d h is c la im t o th e RO to
se e k f ur the r c om men ts f

ro m tw o V A d oc tor s w ho e xami ne d h im w he n h e ini tia lly su bmi tte d h is claim. Appellant' s Br

. at 19-21. He argues t hat t his action is require d pursuant to 38 C.F.R. § 4.2, which he a sserts oblige d the RO to return the doctors' repor ts f or clar ification. Appellant' s Br . at 20. The re g ulatory

provision relied upon by the veter an is inapp l i cable for this appe al. The provision a

p p e a r s in th e p a r t o f the regulations gove rning evaluation of service -conne cted disabilities for a ppropriate compensation. See38 C.F.R. § 4.1. The veteran' s appea l involves a denial of se rvice

connec tion, and his unde rlying claim had not r eac hed the thre shold of part 4 of the regulations. Cf. Ba re la v . W

est , 11 Vet.App. 280, 283 (1998) (question of servic e conne ction is separate and distinct from question of c ompensation). Fi n al l y , t h e S ec re t ary

h as ar gu edt h at a re m an d i s re qu i re d i n t h i s ca s e, i n l i gh t o f "th e C o u rt 's decision in [ Holliday v. Principi , 14 Vet.App. 280 ( 2001)], which interpre ted the provisions of the Veter ans Claims Assistance Ac t of 2000, Pub. L . No. 106-475, 114 Stat. 2 0 9 6 (Nov. 9, 2000)9

(V CA A) ." Se c re tary ' s B r. a t 17 -2 0. Th e ve te ra n ha s re pli e d to thi s argume nt by statin g that w hil e he " do e s n ot d isp ute tha

t, i f t he Court do e s no t re ve rs e , the n a VC AA re mand is a pp ro pr iate , it

is h is position t hat the Court may not gr ant a VCAArema

nd in lieu of addre ssing and deciding the leg al

err ors prope rly

prese nted for r eview in the [veter an' s] principal brief." Appellant' s Reply Br . at 12. B efor e the iss ua

nc e of thi s o pin ion , th e U. S. Co ur t of Ap pe a ls f

or the F e de ra l Cir c uit (F eder al Circuit) issued two dec isions relevant to whe ther a VCA A re m an d i s require d for the prese nt appea l. See Bernklau v. Principi , 2 91 F .3 d 7 95 (F e d. Cir . 2 00 2) ; Dyme nt v. Principi , 287 F.3d 1377 ( Fe d. Cir. 2002). In eac h decision, t he Feder al C ircuit held t hat the sec tions of the VCAA codified at 38 U.S.C. §§ 5102, 5103, and 5103A, conce rning notice and a ssistance VAis to provide to claimants, are not r etroa ctively applicable to proce eding s that were complete be fore VA and w ere on appea l to this Court or the Fe dera l Circ uit when the VCAA w as ena cted. See Bernklau , su pra . Th e B oa rd de c isi on on a

pp e a l in the pr e se nt c a se wa s is su e d o n F e br ua ry 12 , 1 99 9, a lmo st two y ear s befor e the November 2000 enac tment of t he VCAA. The Court conclude s, theref ore, that
a re mand for the Boa

rd to consider

the matters on a

ppeal in li gh t o f t h e s ections of the VCAA

c od if ie d at 38 U.S .C

. §§ 51 02 , 5 10 3, and 51 03 A i s not

require d. See Bernklau and Dyme nt , b oth

su pra . The re maining se ctions of the VCAA a re not implicated in this ap p ea l

. I n particula r, the appea l does not raise issues r eg ardingwell g roundedne ss or the bene fit-of-the -doubt doctrine. See , e.g. , 38 U. S.C. § 5 10 7; se e ge ne ra lly Dela Cruz v. Principi , 15 Vet.App. 143, 148- 49 (2001) ( finding that VC AAdid

no t c ha ng e be ne fi t- of

-t he -d ou bt d oc tr ine ); Luyster v. Gobe r , 14 Vet.App. 186 ( 2000) (r e c og nizi ngthat V CA A r e qu ir e d r e mand fo r r e a dju dication if

c la im h a d b e e n d e nie d a s n ot w e ll g rounded)

. The Court holds that the B oard' s denial of service connec tion for the veter an' s hear t condition

was no t "clear ly erro neo us ." See Swann , W ood , and Gi lbe rt , a ll su

pra . The Court is satisfied that the B oard ha s provided ade quate r easons or bases in support of its dec ision. See38 U. S .C. § 7 10 4( d) ; Gi lbe rt , 1 Vet.App. at 56-57.

III . C ON CL USI ON Ac co rd i n gl y , u

p o nco n s i d er at i o n o f t h e o ra l ar gu m en t , an d o f t h e r ec o rdan d

t h e p l ea d i n gs fi le d f or t h i s a p p e a l , f o r t h e r e a s o n s s t a t e d h e r e i n , t h e F e b r u ar y 1 2 , 1 9 9 9 , B V A d e c i s ionis AFF I RMED.10

FARL EY, Judge , with whom STEI NB ERG, Judge , joins in subs tantial part, concurring : Se c tio n 3 .3 04 (c ) o f t itl e 38 , Co de of F e de ra l Re g ulatio ns pr ov ide s: Th e de ve lop me nt o f e vid e nc e in c onne c tio n w ith c la ims fo r se rv ic e c onne c tio n w ill be a c c o mp li s h e d w h e n d e e me d n e c e s s a r y b u t it s h o u ld n o t b e u n d e rta k e n when evidenc e pre sent is sufficient for this determination. 38 C.F.R. § 3.304(c)

. When the RO rende red its initial decision in this matter, it had befor e it (1) the statements of thre e private phy sicians who opined that if the v et er an h ad suffe red f rom viral pneumonia, it was possible that his hear t condition was related to the pneumonia; and (2) two VA examination reports that also vaguely conclude d that viral pneumonia, if that is what the veter an
su ff e re d f ro m du ri ngse rv ic e , c ou ld p os sib ly have c a us e d h is he art c on dit ion

. As § 3 .3 04 (c ) l imi ts claim deve lopment to sit uations where the evidenc e pre sent is i n sufficie nt to determine ser vice

connec tion and beca

use the RO stated that the evide nce w as mere ly "spe culative," the RO had the authority , and arguably the obligation ( see 38 C.F.R. § 4.2), to furthe r deve lop the evidenc e at that point. Se e als o VA P ROCE DURE A DJ UDI C ATI ON M ANUAL , M21-1, Pt. 6, ch. 2, para . 2.09. I nstead, the RO denied service connec tion, finding the opi nions of rec ord to be " speculative at best." R. at 418. I t was er

ror f or the R O t o deny

service connec tion on the rec ord bef ore it. The ve tera

n
un de rs tand a

bly a pp e a le d th e de nia l, s ub mittin g a dd iti on a l le tte rs fr om one of his pr ivate ph y sic ians
. Although the se letters pr o v i d edfu rt h er s u p p o rt fo r t h e v et er an 's co n t en t i o nt h at h i s s erv i ce -c onnecte d pneumonia ca

used his hear

t condition, they

too were far

from conc lusive. Finding the evidenc e insufficient to wa

rra nt a g rant of service connec tion, the R O s oug ht the opi nion of a third VA doctor (D r. W u ) a s t o t h e e t i o l o gy o f th e ap p el l an t 's h ea rt co n d i t i o n
. Dr

. W uco n cl u d edt h at t h e v et er an 's pneumonia wa s not the cause of his hear t condition. On the basis of this evidence , the R O' s denial of ser vice c onnection wa s continued. R. at 564-73. The ve tera

n continued to dis agr ee wi th the RO' s decision, and the matter wa s sent to the Boa rd. I f the B oard h ad denied the claim on the same re cord that was bef ore the RO, the Court would have ha d to vacate the B oard' s decision and r emand the matter; the Board, howe ver, did not repe at or c ontinue the er

rors of the RO. I n fac t, and at the r equest a nd with the encour ag ement of the a pp e lla nt, the B oa

rd a tte mpt e d to re so lve the inc omp le te and inc on sis te nt m e dic a l op ini on s in11

the re cord by

obtaining a

complete, thoroug h, and we ll-rea soned I MO by Dr. He ndrix , which it was authorized to do pursuant to 38 U.S.C. § 7109. Se e als o 38 C.F.R. § 20.901(d); 38 C.F.R. § 19.9(b) (2001) ( Boa

rd may obtain I MOs wi t h o ut first remandingthe matter to the a g ency of orig inal jur isd ic tio n) . D r. He nd

ri x opin e d th a t the ve te ra n' s he art c on dit ion wa s n ot c a us a lly re late d to his service -conne cted pne umonia. Even a ssuming that the RO e rre d in initi ally denying the claim without further development and in the wa

y it developed e vidence , neither the RO nor t h e Board exc eede d its authority

or responsibility

in the development of evidenc e. Any

err ors committed b y t h e R O in the underdev elopment

of this case wer e cured by the I MO obtained by

the B oard a

nd the RO' s decision

wa s su bsum ed by

the B oa rd ' s d e c isi on . 3 8 C. F .R. § 2 0. 11 04 (2 00 1) . T his Cou rt ' s ju ri sd ic tio n is limit ed to the revie w of Board decisions , and Dr . Hendr ix ' s opinion constitut es a pla usible basis for the B oard' s decision deny ing se rvice connec tio n
. 3 8 U. S

. C

. § 7252(a) . For these re asons, the decision of the B oard must be a ffirme d and thus Iconcur
.

STEI NB ERG, Judge , dissenting: I cannot join in the majority opinion because , althoug h I agre e wi th t

he re su lt i t r e a c he s a s to the argume nts raised by the parties , I d o n o t a g r ee w ith the rationale used by

the majority to obta in this result; moreove r, I do not be lieve that this c ase is y et ripe for a panel de cision and thus ca n n o t agr ee that the Boa rd of Ve tera

ns' Appea ls (Boa

rd) de cision should be aff

irmed. I do, howeve r, j oin in all but the l ast two sentenc es of J udg e F arle y ' s excellent

concur ring opinion, which Ibelieve pr esents the pr o p er a naly sis as to the arguments raised by the parties. I cannot join, howeve r, in his conclusion ag ree ing w ith the majority ' s aff irmance beca

use, in my view, that conclusion i s premature in t hat there are two issues not addresse d by the par ties that

ne e d b ri e fi ngand

tho ro ug h a

na ly sis by the Court

.

I. Ef fe c t of V A Re gul ations Amend

ments First, althoug h the maj o ri ty corr ectly states the holding s of the Bernklau and Dyme ntBer nkl au v
. Pr i nci pi , 2 9 1 F .3 d 7 9 5 (F e d .C ir. 2 0 0 2 ); D ymentv
. Pr i nci pi , 2 8 7 F .3 d 1 3 7 7 (F e d .C ir. 2 0 0 2 ); s ee 1 als o St ephe ns (

J. B. ) v
. Pr i nci

pi , __ V et

. App. __, __, N o. 00- 1516, s l i p op. at 3- 5, 2002 W L 1470603, at * 2 ( Ju l y 10, 2002) (S te inb e rg , J., c o n c u rr ing in p a rt a n d d isse n ting in p a rt).

P u b . L . N o . 1 0 6 -4 7 5 , 1 1 4 S ta t. 2 0 9 6 (N o v . 9 , 2 0 0 0 ) (V C A A ). See 66 Fe d. Reg

. 45, 620, 45, 630- 32 ( Aug

. 29, 2 2 0 0 1 ) (" D u ty to A ssist" r e g u la tio n s, a m e n d ing 3 8 C .F .R . § § 3 .1 0 2 , 3 .1 5 6 , 3 .1 5 9 , 3 .3 2 6 ); se e a lso S te p h e n s (J.B .) , su

p ra . 12 opinions, it fails either to consider or to req u es t t h e p ar ties to consider the possible e ffe cts of the 1 De pa rtme nt o f Ve te ra

ns Af fa ir s (V A) " Duty to As sis t" re g ulatio ns a do pte d on Au g us t 29 , 2 00 1, in

connec tion with the enac tment of t he Vetera ns Claims Assistance Act of 2000. I have set forth the 2

re a so ns fo r the pr op ri e ty of se e kin g a dd iti on a l br ie fi ng fr om the pa rt ie s on thi s is su e in my

se pa rate statements in Stephens (

J.B.) v. Principi , __ Vet.App. ___, ___, No. 00-1516, slip. op. at 3-5, 2002 WL 1470603, at *2-3 (July 10, 2002), and K

u z ma v. Principi , __ Vet.App. ___, ___, No. 98- 295, slip op. at 1-5, 2002 WL 1581042, *1-3 (July 18, 2002) (e n banc) , and, for the re asons expressed there , Ibelieve that the Court should li kewise se ek brie fing in this case.

II. Ef fe c t of V A Ma nual

Prov isions Another matter that Ibelieve w arr ants furthe r brief ing a nd consideration is parag raph 2.01 b. of par t 6, chapter

2, of the VA Adjudication P roce dure Manual, M 21-1 [ here inafter Manual M21- 1], whic h d e fi ne s th e sc op e of the pa rt 6, c ha pte r 2 (" Ratin g Ac tiv ity " ), pr ov isi on s a s a pp lic a ble to "[r]ating de cisions

. . . on the foll owing major issues re lating to e ntitlement: [ S] ervic e conne ction fo r d ise a se s and

inj ur ie s" . Pa

ra g ra ph2. 09 the n g oe s o n to dir e c t a dju dic a tor s a s f oll ow s:
a. VAExam in atio ns. I f a V A re port of examination (including VA F orm 21-2680, " Ex am i n ation of Housebound Status or Pe rm ane nt Ne e d fo r Re g ula r Ai d a nd Atte nd anc e " ) i s in a de qu a te i nan y e s s e n t i a l p art i c u l ar , t h e r e a s o n s f o r i n a d e qu a c y will

be outlin ed and the re po rt returned

throug h channel s for a corr ecte d supplementary

repor t or for r eexamination. See also cha pter 1.
b. V A H o s p i t a l i z a t i on. I n the eve nt a VA r eport of h o s p i t ali zation is found to be inade quate in the f ollowing ty

pes of case s, re que

st the orig inal clinical re cords, includingnurses' and do c tor s' or de rs :

(1) Cases involving injury or ag g ravation of injury or death a s the result of hospitalization, medical or surg ical treatment[ ,] or ex amination.P at t o n v. W est , 12 V et

. A p p
. 27 2 , 27 7 (19 9 9 ) ( q uo t i ng Coh e n ( D ou gl as ) v
. Br own , 10 V et

. App 128, 139 3 (19 9 7 ), and ci t i ng Smi t h ( Be r na r d) v
. Br own , 1 0 V e t.A p p . 4 4 , 4 8 (1 9 9 6 ); H ayes v
. Br own , 6 V et

. A p p
. 66 , 67 (19 9 3 ); D i xon v. D er w i nsk i , 3 V et

. App. 261, 263 ( 1992) ; a n d F u g ere v. D er w i nsk i , 1 V et

. A p p
. 10 3 , 10 9 (19 9 0 ))

. 13 (2) De ath ca ses i f t he vete ran, who died from a non[-] service -co n n ec t ed ca u s e, h ad a s er v i ce -c o n necte d neuropsy chiatric disa

b i l i t y t h at re as o n ab l y

m ay h av e impeded, obstructed, or

otherwise inter fer ed with treatment for the c on dit ion tha t c a us e d d e a th, bu t th e re po rt do e s n ot c lari fy thi s issue.

c. No n- VA Faci litie s. If a r e p o rtf r o ma [ s ] t a t e , c o u n t y, mun ic ipa l, contra c t, o r r e c og nize d p ri vate ins tit uti on or ho sp ita l is inadequate in any

essential par

ticular, re que

st cl ar i fi cation, and if

a satis fa c tor

y c or re c te d re po rt c ann ot be ob ta ine d w ith in a re a so na ble period of time, aut

horize a VA e x amination. Manual M21-1, pt. 6, c h. 2, para . 2.09 (empha sis added)

. This Court has held that Manual M21-1 provisions that "a

re substantive r

ules are ' the equivale nt of [VA] regulations'" , have r egulatory forc e,
and mus t be c omp lie d w ithin t he VAa dju dic a tor

y pr oc e ss. 3 The above provisions a

ppear to se t f

orth unequivoca l c ommands to VA adjudicators rathe r than g ener al g uidance and ex hortation. I n this case , the Board described Dr. P atel' s repor t, inter alia,

as f o ll o w s : " T h e e xami n a ti o n r e p o rt w a s u n r e ma r k a b le an d th e e xami n e r o f f e r e d no opinion reg ardingthe etiolog y

of the vet er an 's car diovascular disability , other than to note the previous history , as re p o rt ed b y t he vete ran. The re is no indication that the se rvice medical r ecor ds were actua lly revie wed." Record (R.) at 5-6. The S ecr etar y notes in his brief the lack of any statement
re g ard inge tio log y

in Dr

. Pa te l' s re po rt and fu rt he r no te s that the re po rt fa ile d to pr ov ide a ratio na le to supp o rt i t s statement as to " post viral car diomy opathy ". Sec reta ry ' s Br ief at 23. Although the Secre tary argues t hat s ubsequent statements (R. at 503, 536) by the appe llant's pr ivate phy sician, Dr. Go uld e r, we re str on g e no ug h to ob viate the ne e d f or c lari fi c a tio n f

ro m D r. Pa te l ( ibi d .), such a rationale appea

rs questionable in lig ht of Manual M21-1 pa ra. 2.09' s directions and in lig ht of the fa c t th at th e RO ha d s ou g ht b ut h a d n ot r e c e ive d c lari fi c a tio n f ro m D r. Go uld e r ( R. at 54 9) . B e c a us e Dr. Patel appea

rs to ha ve conducte d the examination on the basis of a contra ct from VA( see R. at 411-12), Ma

nual M21-1 para. 2.09 c. appear s to be applicable and, if so, would require that the VAI r ec og n i ze t h at 38 C. F. R § 19. 9 doe s n ot i mpos e an a bs ol ut e o b l i gat i o n, b u t i t doe s r equ i r e t h e B oar d of 4 V et er an s ' Appea l s ( B oar d) t o e x er ci s e i t s j u dg men t a s t o w h et h er a "pr oce du r al de f ec t " mu s t be c or r ec t ed i n or der f or t he B o ard t o m ake " a p rop er ap p el l at e d eci si o n" o n t he f act s o f a p art i cul ar case. P erhap s i n t hi s case t he B o ard m i ght f i nd t hat D r
. H endr i x' s i ndependen t medi cal op i ni on ( I M O ) ob vi at ed t he nee d f or a r emand un der § 19

. 9 (i t appear s , as J u d g e F a rle y c o n c lud e s in h is c o n c u rr ing o p inio n , t h a t p a ra g ra p h (b )( 1 ) o f t h e re g u la tio n d o e s q u a li fy th e m a n d a te in para gr aph ( a) by per mi t t i ng t he B oard t o s eek an IM O under 3 8 C

. F. R

. § 2 0. 90 1 ( 19 97 ) rat her t han remandi ng ) , but t hat is a m a tter to b e a d d re sse d b y the B o a rd , an d no t t h e C o u rt, in the fi rs t i n sta n c e , see E l kin s v. G ob er , 229 F. 3d 1369, 1 3 7 7 (Fed

. C i r. 20 0 0 ) ( " [f ]act

- f i nd i ng i n vet erans cases i s t o b e d o ne b y the exp ert B V A , not b y t he V et erans C o urt " ); H en sl ey v. W

est , 212 F. 3d 1255, 1263 ( Fe d. Ci r
. 20 0 0 ) (noti ng " t h e g en er al r u l e t h at a ppel l at e t r i bu n al s a r e n ot a p p ro p ria te fo ra fo r in iti a l f a c t f ind ing " ); Neum an n v
. W est , 1 4 V et

. A p p
. 12 , 21 (20 0 0 ) ( q uo t i ng H ens l ey , su p ra , and concl udi ng t hat , al t ho ug h "t he C our t may r eve r s e a n i ncor r ect j udgment of l aw w hi ch i s bas ed upon proper f act ual find ing s, ' it sh o u ld n o t sim p ly [ m a k e ] fac tua l find ing s o n its o w n ' " ); T eten v. W

est , 13 V et

. A p p
. 56 0 , 56 4 (20 0 0 ), and he re the B o ard i n it s F eb rua ry 19 9 9 d ec i si o n no t o nly d id n o t a d d r e ss t he M 2 1

- 1 p ro visi o ns b ut als o d i d no t ad d ress § 1 9 .9

. 14 reg ional office (RO) invol ved "re quest clar ification, and if a satisfa ctory corr ecte d repor

t cannot be obtained withi n a re asonable period of time, a uthorize a VA e x amination". It appea rs unlikely

that Dr

. W u 's ex am i n at i o n(R

. at 5 5 7 -5 8 ) w o u l d b e t h e "c l ar i fy i n g" ex am i n at i o nas t o Dr

. P at el 's

e xami na tio n, be c a

us e it w a s r e qu e ste d a ft e r t he un a ns we re d req ues t for

c lari fi c a tio n f

ro m Dr . Goulder and made no ref

ere nce to D r. Patel' s examination. Also, i t does not seem at a ll clear that Dr. Wu ever

conducte d an examination of t h e v et eran. SeeR

. at 5 5 4 (r ef erra l l et t er

s t at i n g: "E x amination is not required" ). Fur thermore , if Dr. Patel is to be c onsidered to have conduc ted a VA examination, Manual M21-1 par a. 2.09 a. a

ppear s to apply

and would re quire e ither an o u tline of " the re asons for [the] inadequacy " of

the examination and a re turn of the r eport to Dr. Pate l or a re examination of the veter an. The rec ord on appea l does not appea r to contain a

ny such outline of re asons by the RO ( see R. at 1-614), a

nd it appear s that the repor t was not retur n ed to Dr. Patel for "a corr ecte d

su pp le me nta

ry re po rt " , a s r e qu ir e d b y

Ma nu a l M2 1- 1, pa

ra 2. 09 a
. F or

the same re a so ns se t f

or th above a s to Manual M21-1 par a. 2.09 c., the re a ppear s to be no indication that Dr. Wu's repor t was a Manua l M21-1 para . 2.09-re quired re examination. Moreover, D r. He ndrix ' s independe nt medical op i n i o n (I MO) likely

could not qualify

here beca

use, eve n if there wer e an outline, he did not conduct a n examination of the vetera n. R. at 596-98. When the case rea ched the Boa rd, o n ce it found that Dr. Patel' s repor t was inade quate the Bo ar d m ay we l l h av e ha d an o b l i gat i o n u n d er 3 8 C

. F. R

. § 1 9

. 9 (a ) (1 9 9 8 ) t o re m an d t h e ap p el l an t 's claim to the RO for corr ection of a "pr ocedur al defe ct" under Manual M21-1 para
. 2.09. Howeve r, 415

thi s and th e oth e r q

ue sti on s r a ise d a

bo ve c on c e rn ingc omp lia nc e wi th t

he Manu a l M2 1- 1 s ho uld proper ly be addr essed f

irst by the par ties and then e x amined fully by the Court. Be cause the Court has proc eede d to issue an opinion in this case without see king a dditional br ie fi ngor c on sid e ri ng fu lly the a bo ve iss ue s, Ic ann ot j oin in t he ma jor ity op ini on no r j oin fu lly in the c on c ur

ri ngop ini on . I

re sp e c tf ull y dis se nt.