UN ITED STA TES C OU RT OF AP P EA LS F OR VE TER AN S CL AI M S

N O . 00-669
M I CHEL L E C. J ONES , 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 Apr il 23, 2002 Dec ided Aug ust 7, 2002 )

Michae l P. Horan , o f Wa sh ing ton , D .C. , f or the a pp e lla nt.
Kat hy A. Ba nfi e ld , with whom Tim S. McC la in , G e ne ra l Co un se l; R. Ra nd all Cam pb e ll , Acting Assistant Gener al Counsel; and Darryl A. Joe , Ac tin g De pu ty As sis tant G e ne ra l Co un se l, a ll of Washington, D.C., we re on the pleading s, for the a ppellee.
Be fore FARL EY, HOL DAWAY, and STEI NB ERG, Judges

. STEI NB ERG, Judge : T h e ap p el l an t , t h e d au gh t er o f a Vi et n am v et er an , ap p ea l s t h ro u gh counsel a Marc h 15, 2000, decision of the Boa rd of Veter ans' Appea ls ( Boa rd or BV A) that de nied entitlement to her, a s a child of a Vietnam vete ran, f

or a D epar

tment of Vete rans Af

fairs ( VA) monetary allowanc e for a dis ability resulting from spi na bifida. Record (R.) at 6. The a ppellant filed a brie f and a reply brief, and the Secr etar y filed a br ief. Or al ar g ument was he ld on April 23, 2002. On April 25, 2 0 0 2 , t h e C o urt order ed supplementa l briefingfrom the pa rties. I n response to the Court's or der, the S ec re t ary filed a suppleme ntal rec ord on appe al (ROA) and a supple mental

me mor and

um of law, and the a

pp e lla nt fi le d a re ply to t

he Se c re tary ' s su

pp le me nta l me mor and

um. The Court has jurisdiction over the ca se under

38 U.S.C. §§ 7252(a) and 7266(a). F or the re asons set forth be low, the Court will vacate the B oard de cis i o n o n ap p eal and rema nd the matter f

or
rea djudication.2 I. Re le va nt Bac kgr ound The ve tera

n serve d in the U.S. Navy

from Jul y 1965 to November

1968 and fr om Dece mber 19 68 to Jul y

19 71 . R. a t 9, 13 0. He ha d s e rv ic e in Vi etn am and re c e ive d th e Natio na l D e fe ns e Service Medal with B ronze Star, the Vietnam Service Medal, and three Purple Hea rt Medals. R. at 9. The a ppellant was bor

n on J une 6, 1986. R. at 133. A Dec ember

1997 medical r eport fr om Dr. Mac Donald, a pri v at e p h y sician, re corde d that the appe llant was an " 11-y ear -old gi rl [who] is seen for neurolog ical follow-up of her

ence phaloce le" , and stated that he "w ould like to .

. . repe at her MRI [(Mag n et i c R es o nance I mag ing) ] scan of the poster ior fossa of the bra in and ce rvica l spine are a since she did ha ve a sy rinx in the past and we should f ollow that a

nd see if there is a

ny major change. " R

. at 145. (En ceph alo cel e is "hern ia o f p a r t o f th e bra in andmen in ges t hro ugh a s ku ll defe ct. " D OR L AND ' S I L L US TR ATED M ED I CA L D I CT I O N A RY 548 (28th ed. 1994) [here inafter D OR L AND ' S ]. Meninges a re "the three membrane s that envelop the br ain and spinal c ord" . D OR L AND ' S at 10 10

. A sy ri nx is "a tube or pipe . . . [or] a fistula . . . [or] an abnor mal cavit y i n t h e s p i n al cord in sy ring omy elia." D OR L AND ' S at 1647.) I n J anuar y 1998, the veter an filed a

n applica t i on for spina bifida benef its for his daug hter. R. at 137. I n a note attached to the a pplication, the veter an stated: M y d au gh t er , M i ch el l e C o l l ee nJ o n es , wa s b o rn o n6 -6 -8 6 at S t

. J o s ep h 's Hospital, Denve r[,] Colorado. Three & 1⁄2 wee ks prior to [b] irth, it was detec ted on ultrasound that the child would have an occ ipital encepha locele [here inafter OE], a sp ina l c or d d e fe c t, c a lle d a [n]e ur a l tu

be de fe c t. Along with this, sh e h as h y droce phalus, controlled by bilatera l shunts, and [i s] also [ d]i ag nosed with a Chiari I I[m ]alformation.
Her initial phy sician Dr. Pete r Hulac [,] a [n] eo-[n]atologist[ ,] . .

. and also Dr. L arr y Mc L e nn y [, a] pe diatr ic ne ur os ur g e on [,] inf or me d my wi fe [an d me ] that th is is in the [ s]pi na [b] ifida family in the superior pa

rt of the spine.
R. at 138. (OE is " an ence phaloce le in the occipital reg ion". D OR L AND ' S at 549. Occ ipital means

" lo c a te d n e ar th e o c c ip it a l b o n e , a s th e o c c ip it a l lo b e o f th e b r a in ". D O R L AND ' S at 1167.) A Fe bruar y 1998 letter fr om Dr. McL ellan, a private phy sician, described the appellant a s "a n 11-y ear old gir l with an ence phaloce le" and notes th at "[ t ] h i s is associated w ith hy droce phalus" and that3

"[o]ther anatomic a

nomalies co-e x istent with the ence phaloce le include a C h iari [m] alformation wh ic h invo lve s a

he rn ia tio n o f a

po rt ion of c e re be llum th ro ug h th e sk ull ou tle t[; s]h e [ also ] ha s a sy rinx in the cer

vical cor d". R. at 157. I n M arc h 1 99 8, a

VAre g ion a l of

fi c e (R O) de nie d the a

pp e lla nt' s c la im. R. at 16 2. Th e RO stated that " [c] urre nt regulations allow a gr an t of bene fits only wher e ther e is protrusion of the mening es throug h the ver tebra e or bony

enca sement" (R. at 161) (the C o u rt ca n find no VA

re g ulatio n w ithsu c h a

lim itatio n, and

the Se c re tary

wa s una ble to p ro vid e any ba sis fo r t he RO statement (Supplemental memorandum at 2-3) ), and the RO conclude d that "[b]y definition[,] an
ence phaloce le, which is the c ondition that Mi chelle is diag nosed w i t h , i s not spina bifida" (R. at 162). A Notice of Disag ree ment was filed on be half of the appellant ( R. at 165), and the RO issued a Statement of the Case (R. at 174- 78). An April 1998 letter f

rom Dr. Steidler, a

private ne urora diologist, stated:
T h i s l e t t e r

i s i nr e g ar d s t o M i c h e l l e C

. J o n e s ' d i a g n o s e s o f e n c e p h a l o c e l e , C h i ar i II ma lf or ma tio n, and

c e rv ic a l sy

ri nx a s it re la te s to sp ina

bif ida . N e ur al tube de fe c ts include multiple abnormalities, only one of w hich is spina bifida. Spina bif ida ca n b e v er y mild and incidental on ra diogr aphs, often at the lumbar re g ion, and of no clinical sig nificanc e. Howe ver, multiple other neu ra l tube closure defe cts at other levels of the spine as we l l as the bra in and skull can be seen w ith mult iple known associate d anomalies such a s Chia ri I Imalformation, sy ring ohy rdromy elia, hy rd oc e ph a lus , c a llo sa l dy sg e ne sis , etc . T he re fo re , th e ne ur a l tu be c los ur e de fe c ts, wi th s pin a bif

ida re fe rr ing to a fin din g wh ic h is of te n at th e le ss s e ri ou s e nd of thi s sp e c tr um[, ] ar e c on sid e re d to be a sp e c tr um o f r e la te d a

bn or ma lit ie s. R. at 18 6. A M ay 19 98 le tte r fr om Dr

. Ho us ton , a lso a pr ivate ne ur or a dio log ist , s ta te d: " [OE ] is a defe ct in the skull a

nd dura w ith ex trac rania l ext ension of the intra cra nial structure s located in the occipital re g ion. One etiolog y for c ephaloc ele is fa ilure of c losure of the sites of primary neura l tube

c los ur e ." R. at 18 7. I n a May 19 98 le tte r, Dr . M a c Do na ld s ta te d: " [Th e a pp e lla nt] h a d th e [OE ] wit

h seconda ry n eu ro l o gi c c h ro n i c p ro b l em s i n cl u d i n g t h e s h u n t , t ru n ca l i n s t ab i l i t y , esotrophia, a nd spinal cord c y st. I think they have to r ealize that this is a neura l tube defe ct and that an [OE] is a form of spina bifida or ope n spine" . R. at 189. A May 1998 letter fr om Dr. Yock, a private phy sician, stated that " it i s me dic a lly

re a so na ble to cons id er [ OE] in t he same c a te g or

y a s ' sp ina bif ida ' fr om b oth emry ologic and clinica l perspec tives." R. at 191.4

I n J u l y 1 9 9 8 , the VARO re quested a n advisory

opinion from the VA Dir ector of Compensation and Pension Service. R. at 193-94. This reque st w as then re lay ed to the VA U nder Secre tary for Hea lth. R. at 196. I n response , Dr. Mathe r, VA Chief Public Health and En vir on me nta l H a zar ds Of fi c e r, state d in

pe rt ine nt p art : [The a ppellant] wa s born with an [OE] associated with hy droce phalus and ArnoldChi a ri ma lf

or ma tio n. S he also ha s a

sp ina l c or d s y

ri nx. T he e nc e ph a loc oc e le is definitely a neur al tube def

ect, not by

embry ology

or sequelae. In Veter ans and Ag ent Ora

ng e: Update 1996, the National Acade my of Scienc es cited f

our vete rans stu d i es as the re ason for

their conc lusion that li mited or sug g estive evide nce of an association betwe en ag ent ora ng e and the birth defe ct, spina bifida, e x isted. Two of the four ve tera

ns studies (the Ranch H and and the Australian ve tera ns studies) ref

er specific ally

to neura l tube defe cts and not to spina bifida per se. (The Erickson a

nd C D C [ ( C e n t e r s f

o r D i s e a s e C o n t r o l ) ] s tu d i e s r e f e r t o s p i n a b i f i d a an d an e n c e p h a l y, ano the r n e ur a l tu

be de fe c t w hic h is inc omp a tib le wi th lif e .) Th e ne ur a l tu

be de fe c ts involving th e b r a in in s te a d o f th e s p in a l c o r d te n d to b e r ar e r b e c a u s e ma n y o f the inf ants so a ff

e c te d do no t surv ive

. Ho we ve r, it is our op ini on that the [OE ] d e fe c t is the equivale nt of spina bifid a an d i s clea rly within the intent of the leg islation g ra nti ngbe ne fi ts t o o ff

sp ri ngof Vi e tna m ve te ra ns
. R. at 198. I n M ay 1 999, the VA Ge nera l Counsel issued a prec edent opinion that held that, for purposes of 38 U. S

. C

. § 1 8 02, "the term ' spina bifida' ref ers to a de fec tive closure of the bony

e nc a se me nt o f the sp ina l c or d, bu t do e s no t inc lud e oth e r ne ur a l tub e de fe c ts su c h a s e nc e ph a loc e le and ane ncepha ly ." VA Gen. Coun. Pre c. 5-99 (May 3, 1999) [hereinaf ter G.C. Prec. 5- 99]. On May 25, 1999, the RO aff

irmed the prior

denial of be nefits. R. at 212. I n the Marc h 2000 BV A dec ision here on appea l, the Boa

rd found that, "[p]ursuant to [G.C. Prec.] 5-99, t he Board must find that [OE] is not a form of spina bifida " a n d d en i ed the appellant' s claim. R. at 5. The B oard note d: "The veter an and the appellant are advised t hat were they to file a timely appea l of this claim to the Court of Appe als for V eter ans Claims ( Court) the Court w ould not nece ssarily be bound by [G.C. Prec . 5- 99 ] ." Ib id

.

II. Ana lys is T h e a p p e ll an t a r g u e s tha t (1) G. C. Pr e c
. 5

- 9 9 " v io late s th e p la in la n g u a g e o f 3 8 U

. S. C. [] § 1 8 0 2 " an d

" r e n d e r s th a t p o rti o no f

[s e c ti o n ] 1 8 0 2 s tati n g th a t V A mu s t a w ar d s p e c ia l m onetary benef its ' for all forms and manifestations of spina bifida except spina bifida occ ulta' superf luous and5

wi tho ut f or c e by ig nori ng the wo rd

' manif e statio ns ' and

re a din g the statut e ou t of c on te xt" (Appe llant's B rief ( Br .) at 7); ( 2) G.C. Prec . 5-99 is "inva lid in ignor ing the Supreme Court's r ule of statutory interpre tation that the ag ency must resolve interpr etative doubt in favor of the ve tera n" ( Br

. at 8); (3) "[t]he [ G] en er al [ C ]ounsel promulgate d opinion 5-99 in contrave ntion of the Administrative Procedur e[] Act (' APA' ) rulemaking require ments by adopting this rule without the b en ef i to f p u b l i c p ar t i ci p at i o n " (Br

. at 8 ); an d (4 ) th e Bo ar d erre d b y fa i l i n g t o ad dre s s t h e ap p el l an t 's other c onditions i n order

to "d et er m i n e whether these conditions are ' forms and ma nifestations of spina bifida' " ( Br . at 7). The Sec reta

ry argues that (1) G.C. Prec. 5- 99 "c orre ctly interpre ted 38 U. S

. C

. § 1 8 02 as perta ining solely

to spina bifida, not all neura l tube defe cts[ and that t] he ordina ry meaningof the term [']spina bifida['] and the leg islative history of the statute overw helmingly support the Gene ral Couns e l' s c on c lus ion " (S e c re tary ' s B r. a t 5) ; ( 2) G. C. Pr e c . 5 -9 9 " c on sti tut e s a n in te rp re ta tiv e ru le and is exempt from [AP A notice a nd comment] provisions" (Secr etar y ' s Br. at 5 ); and (3) "[the a]ppellant' s argument for r emand f ail s b ec au s e, as a matter of law , she does not mee t the

re qu i re m en t s fo r b en ef

i t s p u rs u an tt o [ c] h ap t er

1 8 o f [ t ] i t l e 3 8 [ , ] Un i t e d S t a t e s C o d e", S ec re t ary 's Br . at 6. A. 38 U.S.C. § 1802 Generally and G.C. Prec. 5-99 Se c tio n 1 80 2 o f t itl e 38 , U .S. Cod e , p ro vid e s in pe rt ine nt p art : § 1802. Spi na bi fi da condi tions covere d This subchapter

applies with respe ct t o all forms and manifestations of spina bifida except spina bifida oc culta. Section 1805 provides for monetary benef its to be paid to "a

ny child of a V ietnam veter an for any dis a bil ity re su lti ngfr om s pin a

bif ida su ff e re d b y su c h c hil d. " 38 U. S.C. § 1 80 5; see also 38 U. S.C. §§ 1803 (hea lth care benef its provided to "a

child of a V ietnam veter an who is suffe ring from spina bifida" ), 1804 (same, as to vocational training and re habilitation). "'The st a r ti ng po in t i n i nt erpr eti ng a st atu te i s i ts lan guage.'" Le e ( Ra y mo nd ) v . W est , 1 3 Ve t

. Ap p
. 3 8 8 , 3 9 4 (2 0 0 0 ) ( qu o t i n g Go od Sa ma rit an Ho sp . v . S

ha lal a , 508 U.S. 402, 409 ( 1993)). The "pla in me aning [of a statute] must be g iven eff ect unless a

' literal application of [t he] statute [ or re g ulation] will produce a re s u l t demonstrably

at odds with the6

in ten ti on of i ts draf

ter s. '" Gardner v

. Derwi nski , 1 Vet.App. 584, 586- 87 (1991), aff 'd sub nom . G ar

dn e r v . B ro wn , 5 F.3d 1456 (F ed. Cir. 1993), a ff 'd , 513 U.S. 115

. . . ( 19 94 ); F

agan [ v . W

est ], 13 Ve t.A

pp . [48 ,] 52 [(1 99 9) ]; Cur tis [ v . W est ], 11 Vet.App. [129,] 133 [(1998)]. "I f the intent of Congr ess is c lear , that is the end of the matter ". Sk

inn e r v . B ro wn , 27 F. 3 d 1571, 1572 (F ed.Cir. 1994) (quoting Chevron, U.S.A., Inc. v. Natural Resources Defe nse Council, Inc. , 467 U.S. 837, 842 . . . (1984)) , aff' ing

4 Vet.App. 141 ( 1993) (mem.)

. Lee ( Raymond) , su

pra . Under 38 U.S.C. § 7104(c), the pr eced ent opi nions of the VA Ge nera l Counsel (GC) are bin din g on

the B oa rd . 3 8 U .S. C. § 71 04 (c ); see Cyc holl v. Principi , 15 Vet.App. 355, 360 ( 2000) (c i t i n g Herlehy

v. Principi , 1 5 V e t.A

pp . 3 3, 34 (2 00 1) (p e r c ur iam or de r) ); se e als o 38 C.F .R. § 20.901(c) (2001). He nce, the Boa rd was require d to follow G.C. Prec. 5- 99 to the extent that that op ini on a dd re sse d iss ue s pe rt ine nt to thi s a pp e lla nt' s c la im. Th a t GC op ini on fi rs t state d d e fi nit ion s, culled from various I nterne t World Wide Web sites, of "O E" and " spina bifida" , and the de finition

o f " s p i n a b i f

i d a " f r o m D OR L AND ' S . G.C. Prec 5- 99 at 1-2. The GC opinion then cited leg islative history , including the National Ac ademy of Scienc es Institut e of Me dicine (I OM) NAS re port, which it describes a s the impetus for t h e s p i n a b i fida leg islation. G.C. P rec . 5-99 at 3. The GC opinion state d a s f oll ow s r e g ard ingthe NA S r e po rt : As part of its discussion of t his possible association, the I OM noted, at pag e[s] 9-17, that cer tain epidemiolog ic studies "sug g est an association betwe en her bicide exposure and an incre ased risk of spina bifida in a ssociation with a nence phaly ." N ot on ly wa s th e c on c lus ion

re a c he d b y

the I OM lim ite d to " sp ina bif ida ," the I OM a lso c on c lud e d, a t pa g e [s] 9- 17 , th a t th e re was " ina de qu a te or ins uf fi c ie nt e vid e nc e to de te rm ine wh e the r a

n ass oc ia tio n exist s b e tw e e n e xpos ur e to t he he rb ic ide s and

a ll other birth def

ects."
G. C. Pr e c . 5 -9 9 at 3. I n ad dit ion , G.C . Pre c . 5-9 9 cit e d to sta te me nts ma de by U. S. Sen a tor s D a sc hle and Rocke feller , as we ll as a letter f rom the Secr etar

y of Ve tera

ns A ffa irs to the Speaker of the House a nd Pr es i d en t o f t h e Senate , for the pr oposition t hat " the fra mers of the leg islation were

conce rned only

with de fec ts of the spinal column[,] as opposed to neur al tube def ects in g ener al." G. C. Pr e c . 5 -9 9 at 3- 4. Th e op ini on the n c on c lud e d: The leg isla t i v e history

of cha pter 18 is consistent with the commonly [] acc epted meaningof the statutory terms in indicating Congr ess' intention to li mit the application of chapte r 18 to only those children of Vietnam veterans who suffer from7

sp ina l de fe c ts. We b e lie ve that, h a d Co ng re ss i nte nd e d to inc lud e ne ur a l tu be de fe c ts such as a nence phaly

and enc ephaloc ele, it would not have use d the term " spina b i fi d a. '
G.C. Prec. 5- 99 at 4. Significa ntly , howeve r, t he opini on did not specifica lly addre ss the meaning of t he words "a ll forms and manifestations" in section 1802, and in its conclusion did not mention "ma nifestations" . G.C. Prec. 5- 99 at 4 (unde r " HEL D" ). A re view of the pertinent leg islative history of sec tion 1802 revea l s a J u l y 26, 1996, letter from the Sec reta

ry of Ve tera

ns Affa irs to the Speaker of the U.S. House of

Represe ntatives dis c us sin g the I OM fi nd ing s in the NA S re po rt , and " de te rm in[i ng ] that a po sit ive a sso c ia tio n e xists betwee n exposure of a pa rent to her

bicides during . . . s er v i ce and the birth defec t spina bifida." Supplemental (Suppl.) R. at 64. I n that letter, the Secre tary asser ted t hat ena

bling leg islation was neede d in order to a l l o w VA t o compensate the off spring of Vietnam vetera ns for spina bifida

. Sup pl. R. at 65 . A tta c he d to thi s le tte r w a s d ra ft le g isl a tio n that, i nte r a lia , d e fi ne d " sp ina bif ida " to mean " all forms of spina bifida other than spina bif

ida occ ulta." Suppl. R. at 70. The leg islative h i s t o ry

also reve als other pe rtinent statements about the spina bif ida leg islation. First is a statem ent from Senator Dasc hle: "Spina bifida occur s when the spinal c ord does not c lose fully ear ly in preg nancy ." 142 C ONG
. R EC
. S9878 (daily ed. S ept. 5, 1998). S econd is a statement fr om Senator Rockef eller: Spina bifida, SB, mea

ns ' split spi ne.' I t is a defe ct o f the ne ural tube, the embry onic structure that evolves into the brain and the spinal cord. I t r esults fr om t h e f a i l u r e o f t h e s p i n e t o c l o s e p r o p e r l y i nt h e f i r s tm o n t h s o f

p r e g n an c y. There are three ty

pes of spina bifida, the most common of which is oc culta, wh ic h is no t di sa

bli ngand is n ot i nc lud e d in

the a me ndme nt b e fo re us
. What is covered in the proposed amendment are the two much more sever e fo rm s o f s p i n a b i f i d a
. I nt h e s e f

o r m s , a c y s th o l d i n g t h e s p i n a l c o r d m e mb r a ne s, n er v e r o o t s o f t h e s p i n al co rd , o r t h e co rd i t s el f, u s u al l y m al fo rm ed , p o k es t h ro u gh an open part of the s pine; or t here may be, in fac t, no cy st, but only a fully exposed se c tio n o f t

he sp ina l c or d a

nd the ne rv e s. 142 C ONG
. R EC . S9888 ( daily ed. Sept. 5, 1998). Howeve r, neither the above floor stateme nts nor G.C

. P rec. 5-9 9 addres sed th e reas on for th e in ser ti on in to th e le gisl ati on of "an d m ani fes tat io ns ", and the Court has be en unable to deter mine the re ason; furthe rmore, the Court is not satis fied that8

the words have no mea

ning. Se e Gl ov e r v . W

est , 185 F.3d 1328, 1332 ( Fe d. Cir. 1999) (stating that "w e attempt to g ive full eff ect t o al l wo rd s contained w ithin [ a] statute or regulation, thereby rende ring superf

luous as littl e of the statutory or re g ulatory

lang uag e as possible" ). B. Reasons or

Bases The B oard is re quired to consider all "pote ntially " a

pplicable pr ovi s i o n s o f law a nd regulation. Schafrath v. De rwinski , 1 Ve t.A pp . 5 89 , 5 93 ( 19 91 ) ( B oa

rd fa ilure to c on sid e r a

pp lic a ble regulation must be set aside). The Boa rd is also requir ed to include in it s d ec ision a written statement of the r easons or bases for i ts finding s and conclusions on all materia l issues of fa ct and law pre sented on the r ecor d; that statement must be adequate to enable an appe llant to understand the pre cise ba sis for the B oard' s decision, as we ll as to facilitate r eview in this Court. See 38 U. S.C. § 7 10 4( d) (1 ); A l ld

a y v . B ro wn , 7 Ve t.A

pp . 5 17 , 5 27 (1 99 5) ; Gilbert v. De rwinski , 1 Vet.App. 49, 56-57 (1990) . To comply

with this requirement, the B oard must ana ly ze the cre dibilit y

and probative value of the evidenc e, ac count for the evidenc e tha t i t fi n ds to be persua sive or unper suasive, and provide the rea sons for its reje ction of any materia l evidence favor able to the ve tera n. Se e Cal uz a
v . B ro wn , 7 Vet.App. 498, 506 ( 1995), aff' d per curiam , 78 F.3d 604 ( Fe d. Cir. 1996) (table) ; Ga br ie lso n v . B ro wn , 7 Ve t.A pp . 3 6, 39 -4 0 ( 19 94 ); Gi lbe rt , su pra . Dr

. M a c D o n a ld o p in e d in h is M ay 1 9 9 8 le tt e r th a t O E " is a f o r m o f s p in a b if

id a o r open spine" . R. at 189. Dr. Mather, VA's Chi ef Publ ic Health and Environmenta l Hazards Of fice r, opined that OE is "cl ea rl y within the intent of the leg islation" involved her e. R. at 198. The B oard acknowledged both me dical opinions in its de cision (R. at 4), but fa iled to dis c uss or ana ly ze either. R at h er , t h e B o ar d , re l y i n g s o l e ly o n t h e defi ni ti on of "s pi na b if id a" from G.C . P rec. 5-9 9 (i .e. , "a de fe c tiv e c los ur e of the bo ny e nc a se me nt of the c or d, . . . n ot i nc lud [ing ] oth e r n e ur a l tu be de fe c ts such as e ncepha locele a

nd anenc ephaly ") , conclude d that OE "i s n o t a form of spina bifida, notwithstanding the c onflicting medical e vidence of re cord." R. at 5. The Boar d err ed in rea ching this unsubstantiated conclusion. See ge nerally Smith ( George )

v . B ro wn , 8 Vet.App. 546, 553 (1996) (en banc) (althoug h "the Boa rd is not re quired to ac cept the medical a uthor i t y s u p p o rting a cla im, it m ust provide its reasons f or re jecting such evide nce a

nd,

mor e imp or

tantl y , mu st p ro vid e a me dic a l ba sis oth e r tha n its own un su

bs tanti a te d c on c lus ion s to support its ult imate dec ision"). The conclusion of G.C. Prec. 5-99 was that c onditions such as OE9

are not, them selve

s , spina bifida. See G.C. Prec. 5- 99 at 4. Howeve r, section 1802 states that the

" [s]pin a bif ida c on dit ion s c ov e re d" are " a ll f o r ms and manif esta tio ns of spina bifida e x cept spina bifida occ ulta". 38 U .S.C. § 1802 (e m p hasis added) . The only such " form" or " manifestation" excluded by the statute is "spina bifida occulta" . 38 U.S.C. § 1802. The Boa rd er red in its decision beca use it failed to re cog nize that, by the nature of the plain languag e of the stat u t e, t h e range of

s p i na bifida c ond

itions c o v e r e d

is p o te n ti a ll y

n o t l im it e d

to " s p in a

b if id a " p e r s e , b u t c ould, po ten ti all y , in clu de ot her "form s an d m ani fes tat io ns of s pi na b if id a ex cept for

sp in a bi fi da o ccul ta". Ibid. B y makin g the ba

re c on c lus ion that "f

or ms an d man if

e statio ns of sp ina bif

ida " me ans so le ly "spina bifida" , the B oard f

ailed to g ive a rea soned argument explaining why OE is not a "f orm" or

" manif e statio n" of

sp ina bif ida . Su c h a

n a na ly sis is c ri tic a lly imp or

tant to the a

pp e lla nt he re a nd

to the Court' s ability

to reviewthis Boar d decision, espe cial l y i n l i gh t of the fa ct that the B oard

c on c e de d th a t th e re c or d c on ta ine d " c on fl ic tin g me dic a l e vid e nc e " (R

. a t 5) , a pp are ntl y re fe rr ingto the medica l opinion from Dr. Mac Dona l d t h at OE i s a " form of spina bif ida" (R. at 189) a

nd the medical o p i n i o n fr om VA' s Dr. Mathe r (R. at 198), w hich could be r ead a s sugg esting that she

c on sid e re d O E a

fo rm or manif e statio n of spi na bif

ida

. Al so , the B oa

rd e rr e d by fa ili ngto a dd

re ss in any respe ct either

the sig n i fi ca nce of

the term " manifestations" as used in sec tion 1802 or the omission from G.C. P rec . 5-99 of a ny discussion of this term. Se e Sc ha fra th , su pra . The Court notes that it makes no stateme nt as to whether OE is, in fac t, a form or

manif e statio n o f spi na bif

ida

. Suc h a con c lus ion is within the purv ie w o f t

he Se c re tary

in t he fi rs t instance. F urthermor e, any such conc lusion by

the Court would nece ssarily entail fa ctfinding

. See Elkins v. Gobe r , 229 F.3d 1369, 1377 ( Fe d. Cir. 2000) (" [f] act- finding in vetera ns case s is to be done by the expert BV A, not by

the Vete rans Court" ); He ns le yv . W est , 212 F.3d 1255, 1263 (F ed. Cir. 2000) (noting "the g ener al rule that appellate tribunals are not a ppropriate fora for initial fac t fi nd ing " ); Te te n v . W

est , 1 3 V e t

. Ap p
. 5 6 0 , 5 6 4 (2 0 0 0 ). W e d o n o t e, h o we v er , t h e ap p el l an t 's argument that the B oard f ailed to addr ess the appe llant's othe r conditi ons and to determine whethe r any of these is a

form or ma

nifestati o n of spina bifida. See B r. a t 7. On re mand , th e B oa

rd mus t addre ss this question, j ust as it must addre ss the questi on whether OE i s a form or manifestation of spina bifida.10 C. A pp e lla nt's Arg uments As noted above , t h e ap p ell ant ar g ues that G.C. Prec . 5-99 is invalid beca use it ignor es the pla in l angua g e of se c tio n 18 02 , w a s p ro mul g a te d in c on tr a ve nti on

of the ru le makin g re qu ir e me nts of the APA , an d "i g no r[e d] the Sup re me Court ' s r ule s o f s ta tut or

y int e rp re ta tio n th a t th e a g e nc y mus t resolve inter

pretative doubt in favor of the veter an" . Br . at 7-8. B eca use, as noted a

bove, we are
vacating the B oard de cision and remanding the matter ba sed on the B oard' s rea sons-or-ba ses er ror found in part I I .B., a

bove, it is not y et ripe f

or us t o consider the validity of G.C. Prec. 5-99, and the Court will not addre ss the appellant' s arguments at this tim e. Howe ver, the Court reiterates that that GC op ini on

do e s n ot c on ta in a

ny ana ly sis a s to th e mea ni ng of " a ll f or ms a nd manif e statio ns " in

se c tio n 1 80 2 a

nd thu s p ro vid e s the B oa

rd wi th no bin din g ins tr

uc tio n re g ard ing tho se te rm s to a pp ly to this ca se on rema

nd in lig ht of the medical evidenc e from Drs. MacD onald and Mathe r in support of the c laim. The Court also notes that neither the Boa rd decision in this case nor G.C. Prec . 5-99 makes re fer ence to Brown v. Gardner , 5 1 3 U. S

. 1 1 5 , 1 1 7 (1 9 9 4 ) ( ci t i n g King v. St. Vincent's Hosp. , 50 2 U .S. 21 5, 22 0- 22 1 n .9 (1 99 1) ), in w hic h th e U. S. Su pr e me Co urt, inint e rp re tin g 38 U. S.C. § 1 15 1, no te d " the ru le that in te rp re tiv e do ub t is to be re so lve d in t he ve te ra n' s f a vo r" . T he Sup re me Co u rt a ls o n o te d th a t " [a ]m b igu it y is a c r e a tu

r e n o t o f d e f

in it io n a l p o s s ib il it ie s b u t of statutory context". Br own v. Gardne r , su pra ; cf. N OR MAN J. S I NGER , S UTHE R L AND O N S T A T U T O RY C ONS TR UC TI ON § 45:09 (6 t h ed

. 2 0 0 0 ) ("[k] nowing the purpose be hind the statute could help the court de code a

mbiguous text, but first there must be some ambigu i t y ") . On re mand, the B oard should address this issue independe nt from G.C. Prec. 5- 99 but may wish to seek a furthe r opinion fr om t he Ge ne ra l Co un se l.

III. Conclusi on On the basis of the above analy sis, the R OA, and the s ubmissions of the pa rties, the Court

vacates the Boa

rd decision and rema

nds the matter f

or expeditious further de velopment and issuanc e of a readjudicated decision supported by an ade quate state ment of re asons or ba ses, see 38 U. S.C. §§ 1802, 5107(a) , 7104 (a) , (d) ( 1994 & Supp. V 1999); 38 U.S.C. §§ 5103, 5103A, 5106, 5107, a s amende d by

the Vete rans Claims Assistance Act of 2000, Pub. L . No. 106-475, 114 Stat. 2096 (Nov. 9 , 2 0 0 0); 66 Fe d. Reg . 45,620, 45,630-32 (Aug . 29, 2001) (amending 38 C.F.R. § 3.159, as11

a pp lic a ble ); Fletche r v. De rwinski , 1 Vet.App. 394, 397 (1991), all consistent with this opini on and in acc ordanc e with sec tion 302 of the Vete rans' Be nefits I mpro v em en t s Ac t of 1994, Pub. L . No. 10 3- 44 6, § 3 02 , 1 08 Stat. 4 64 5, 46 58 (f ound at 38 U. S.C. § 5 10 1 n ote) (r e qu ir ingSe c re tary to p r o v i d e f o r " e x p e d i t i o u s t r e a t m e n t " o f c l a i m s r e m an d e d

b y B V A o rt h e C o u rt ) [ h e r e i n a f t e r V B IA § 3 02 ]; see Vargas-Gonzalez v. Principi , 15 Vet.App. 222, 225- 30 (holding that VB I A § 302 applies to all elements of a claim rema nded by Court or Boa

rd), a nd with all applicable la

w and r eg ulation. See A llday , 7 Vet.App. at 533-34

. On re m an d , the appe llant will be free to submit additional evidenc e and a

rg ument on the re manded c laim in accor dance with Kut sc he ro us k yv . W est , 12 Ve t.A pp . 3 69 , 3 72 -7 3 ( 19 99 ) ( pe r c ur iam or de r) (c on c lud ingthat an a pp e lla nt i s e nti tle d, un til 90 day s after

Boa rd mails postremand notice to appellant, to submit ad ditional evidence and

ar g ument or to reque st hearingon appea l at which appe llant may submit new evidenc e), an d a ll applicable law and r eg ulation. The Court notes that a r emand by this Court or by

the B oard c onfer s on an appe llant the rig ht to VA compliance with the terms of the remand order and imposes on the Secre tary a conc omitant duty

to ensu re co mpliance with those ter ms. Se e Ste

ga ll v . W

est , 11 Vet.App. 268, 271 (1998). A final decision by the Boa rd following the re mand her ein orde red will constitut e a new decision that, if adver se, may be appe aled to this Court only upon the filing of

a new Notice of Appea l with the Court not later than 120 day s after the date on w hich notice of the Boa rd' s new fina l decision is m ailed to the appe llant. Se e Ma rsh v . W est , 11 Vet.App. 468, 472 (1998). VACATED A

ND REMANDED

.