UN IT ED ST AT ES CO UR T O F A PP EA LS FO R V ET ER AN S C LA IMS

N O
. 04-0534 J A M ES P. B ARR , A P P EL LA NT ,

V
. R. J A M ES N I CHOL S ON , S ECR ETA RY OF V ETER A N S A FF AI RS , A PP ELL EE
.
On Ap pe al f rom the Bo ard

of Ve ter an s' Ap pe als (Decided June 15, 2007 )

Jen nyY. Tw

yfo rd, of W aterford, Virgi nia, for the appel lant.
Ti m S . Mc Cl ain , General Coun sel ; R. Ra nd all Ca mp be ll , A s s is ta

nt G e n e ra l C o un s e l; Ri ch ar d May eri ck, Deputy Assistant General Counsel; and Ralph G. Stiehm , all of Washington, D.C., for the appellee. Before GREEN E, Chief Judge , and KASOLD and HAGEL, Ju dges . GREENE , Chief Judge : Veteran Ja mes P. Barr appeals through counsel a Februa ry 17, 2004, decision of the Board of Veterans' Appeal s (Boar d) denyi ng enti tlement to service c onnection for
varic os e v ein s. He argu es, inter a lia , that th e B oard e rre d (1 ) in its de ter m inatio n th at n o e vid en ce demonstrated servic e incurre nce of his conditi on or supported a fi nding of continuity of sy m pto m ato log y sin ce se rvi ce; (2) byrely ing on aninad eq uate m ed ica l exam inatio n; an d (3) in it s determination thatthe Secret ary co mpl ie d with his noti fication duti es pursuant t o 38 U.S.C. § 5 10 3(a ) an d th e Ve ter an s Cl aim s As sis tan ce Ac t o f 20 00 (V CAA) , Pu b. L

. No . 1 06 -47 5, 11 4 S tat

. 2096. The Secretary argues that(1) a pla usible basis exis ts in the r ecord for the Board's decisi on; (2) he ha d n o d

uty to ob tai n a m ed ica l o pin ion in th is cas e; an d (3) M r. Barr wa s pro vid ed ad eq uate
no tic e . F o r t

h e re a s o n s s e t f

o rt hb e lo w , th e 2 0 0 4 B o ard d e c is io nw il l b e v a c a te d an d th e m a tt er remanded for further adjudicat ion.2 I. FACTS Mr. Barr se rved honor ably i n the U.S. Army f rom Septem

ber 1965 through Sept ember 1967. Re co rd ( R. ) at

14 . H is i nd

uc tio n m ed ica l ex am inatio n re po rt d oe s no t not e any ab no rm ali tie s o f h is
va scu lar sy ste m or l ow er e xtr em iti es. R. at 1 7. H is s ep aratio n m ed ica l ex am inatio n re po rts a h ist ory of leg cramps. R. at 34. In October 1996, Mr. Barr fil ed a claim for disabili ty compensation for
varic os e v ein s. R. at 6 2-6 3. He clai m ed that his co nd iti on

beg anin t

he summ er o f 1 96 6 a s a r esu lt of daily traini ng runs on hard sur faces while wearing boot s. Id . H e st ate d th at h e h ad be entre ate d in a fi eld ho sp ita l at Fort B ennin g, Ge org ia, durin g th e summ er o f 1 96 6, an d h ad als o re cei ve d private t reatment since his military dischar ge. Id . AJan uary 1 99 7 V A m ed ica l ex am ine r op ine d that Mr. Barr ha d vari cose ve ins a nd venous insufficiency of the legs, more marked on his left le g. R. at 76. The VA examiner note d that none of Mr. Barr 's m edical r ecords were ava ilable for r eview, but recounte d his histor y of onset during ser vice, and tr eatment since thatti me. R. a t 75. The examiner did not offer an etiology opi nion. A VA re gional office (RO) de nied the cl aim (R. at 79- 80 ), and Mr. Barr f

ile d a No tic e o f D isa gre em ent (R . at 82 -83 ). In D ece m be r 19 97 , M r. B arr submitted to VA a statem ent as ser

tin g th at h e f

ile d h is c lai m more than 30 years after his service be cause he "neve r had problems with the leg until very recent ye ars " an d b eca

us e h is " lef

t le g h as l oo ke d li ke he ll s inc e 1 96 6, but, t he pa in h as j us t st art ed ." R . at 88. He d esc rib ed

th e ve ins in

h is lef t l eg a s "er

up tin g" durin g the s um

m er of 1 966, causing
un sig htl y b ulg es f

rom ab ov e h is k

ne e d own to an d in clu din g h is f oo t. R. at 89. He stated

that, whil e in servic e, he was a medical supply clerk, and t hat his company included seve ral doctor s and "expe rie nc ed

m ed ica l sp eci ali sts " w ho , o n s ev era l oc cas ion s, ob ser ve d and consid ere d h is varicosi ties. Id . He reported t hat anothe r person in hi s company developed worse varicos e veins
an d h ad the m surgi cal ly s tri pp ed , b ut t

hat th e m ed ica l p ers onne l who h ad o bs erv ed h is c on dit ion

did not think he r equired medical tr eatment. Id. He als o s tat ed that he did no t re cal l re po rti ng to s ick call "t o file a formal com plaint" becau se i t wou ldhave se emed odd to have done so after having discussed hi s condi tion at l ength wit h the medical personne l wit h whom he worked closel y. Id . He reiter ated these same contentions in more detail during a Board hear ing in June 1997. R. at 114-32. At that ti me he also recounted seve ra l pr iv at e physicians whom he had seen over the previous 30 years for otherconditions, t o whom he had mentioned his varic ose veins. R. at 125- 29.3

In O cto be r 20 01 , th e B oard r em an de d th e ca se an d dir ect ed th e RO to (1 ) en sure c om

pli an ce wi th a ll V A n oti fi cat ion

req uir em ents; (2) req

ue st that M r. Barr ide nti fy a ll V A and

no n-VA m ed ica l treatment provider s and authori ze VA to attempt to obtain per tinent t reatment reco rd s; and (3) "sp eci fi cal ly i ns tru ct[ ] [ Mr. Bar r] to sub m it co m

pe tent evi de nc e to su

pp ort his a sse rti on s th at h e h ad de ve lop ed

vari co se ve ins duri ng serv ice ." R. at 13 7-3 8. Th e R O s ent Mr . B arr a le tte r in No ve m be r 20 01 with the st ate d purpo se, inte r alia , of adv isi ng him

of "what ev ide nc e is ne ces sar y to est ab lis h
en tit lem en t to the b en ef

it yo u want. " R. at 1 41

. T he le tte r r ef err ed to M r. B arr ' s cl aim

fo r se rvi ce
co nn ect ion

fo r varic os e v ein s an d s tat ed that in ord er to e sta

bli shentit lem ent th e ev ide nc e m us t show (1) an injur y or disease that began orwas made worse in service, or a n event in ser vice causi ng injury or di sease; ( 2) a curre nt disabil ity; and ( 3) a rela tionship bet ween the curre nt disabil ity and
aninj ury , d ise ase , o r ev ent in ser vic e. R. at 141 -42 . The lette r req ue ste d th at M r. B arr

sig n e nc los ed

m ed ic a l a u th o ri z a ti o nf

o rm s to e n ab le V Ato c o n ta c t t h e h e a lt h c are p ro v id e rs h e h a d

pre vio us ly referred to a nd attempt to obtain any r elevant medical re cords. Id . Fi na lly , th e le tte r al so advis ed Mr. Barr t o "s ub m it c om pe tent ev ide nc e to supp ort [h is] ass ert ion s th at [ he ] d ev elo pe d v ari co se
ve ins durin g ser

vic e. " R. at 1 43

. T he re co rd d oe s n ot d em on str ate that Mr . B arr res po nd ed

to t hat Novem ber 2001 notice . Following a n October2003 Supplemental Stat ement of the Case (R. at 146- 65 ), t he Bo ard iss ue d th e d eci sio n h ere on ap pe al. In d enyin g M r. B arr ' s cl aim , th e F eb ruary 17, 200 4, Bo ard ini tia llyfo un d th at V A h ad complied with all VCAA notification re quirements. R. at 6. Th e Boa rdthen de termined that the pre po nd eranc e o f t

he ev ide nc e w as a ga ins t th e cl aim fo r se rvi ce c onne cti on . T he Bo ard co ns ide red the Jan uary 1 99 7 d iag no sis of

varic os e v ein s, but f

ound : " [T ]h e m ed ica l e vid en ce do es no t sh owthat his curre ntl y d em on str ate d v ari co se v ein s w ere pre sent in s erv ice or f

or m any y ear s th ere af

ter or t hat
any s uc h c urr ent di sab ili ty w as c au sed byany inc ide nt or

event in se rvi ce. " R . at 8- 9. Th e B oard
co ns ide red

Mr. Barr' s te sti m ony re gardi ng the on set of his co nd iti on , b ut d en ied the cla im fo r la ck of evidence in supportof those assert ions. Se e R. at 9 ("The ser vice m edical r ecords do not se rve to confirm the onset of varicose ve ins . . . [and he] has s ub mit te d no competent evidenc e to show that the va ricose vei ns are due to di sease or i njury in se rv ic e . . . [no r] h as [he] subm itted . . .
ev ide nc e to s u

p p o rt th e s e a s s e rt io n s . . . . [ T h e ] B o ard h a s c o n s id e re d

th e v e te ran ' s arg um e n ts , particul arly in r egard to the onset of his curr en t di sa bi li ty

. However, the veter an is a layman and
no t co m pe tent to of

fe r an op ini on as to qu est ion s invo lvi ng m ed ica l di ag no sis or c au sat ion as4

pre sented in t his cas e. "). Th e B oard c on clu de d that t he re co rd co nta ins "n o co nv inc inge vid en ce t hat the ve ter an ' s cu

rre ntl y d em on str ated vari co se v ein s h ad the ir c lin ica l on set

in s erv ice ." Id . T his appeal followed.

II. SERVICE C ONNECTION A ND CO NT IN UI TYOF SY MP TO MA TO LO GY A. Ar gum ents o f t

he Parti es Mr. Bar r arg ue s that rev ers al of

the B oard' s dec isi on

is app rop riate be cau se hi s st ate m ents fr om 19 96 fo rw ard

co ns tit ute a "n oti ng " th at h is v ari co se v ein s st art ed in s erv ice an d h av e p ers ist ed continuously s ince 1966, and thus pr ovide competent eviden ce o f c ontinuity of symptomatology entitl ing hi m to servi ce conne ction pursuant to 38 C.F.R. § 3.303(b) (2006) and Sa vagev. Go be r , 10 Vet.App. 488 (1997). A s a basis for that ass ertion, he a vers thatvaricose ve ins are a c ondition capable of lay obser vation, and therefore, t he Board erred when i t rejec ted his la y statements as not
co m pe tent an d d en ied

the claim

based on

a la ck of su pp ort ingm ed ica l ev ide nc e. He fu rth er
co nte nd s th at the Bo ard

err ed when

it f ail ed to p rov ide anad eq

uate s tat em ent of

rea so ns or b ase s for its deter mination that "'the evidenc e of record does not s upport his as sertions of havi ng had . . . a continuit y of sym

ptomatology.'" Appellant's Brief (Br.) at 7-8 ( quoting R. at 9). In r esp on se, the Se cre tar

y argu es t hat Savage do es n ot s up po rt M r. Barr's cla im be cau se, although a la y person is competent to de scribe obs er va ti on s regardi ng veins, an int erpreta tion of wh eth er t ho se s ym pto m s am ount t o a d iag no sis of varic os e v ein s re qu ire s m ed ica l expe rti se. Se cre tar y' s (S ec' y) B r. at 8- 9. He fu rth er c onten ds that, e ve n a ssum ingMr. Barr i s co m pe tent to dia gn os e v ari co se v ein s, the 27 -ye ar h iat us betw een

Mr. B arr ' s sep aratio n e xam inatio n f rom ser vic e and his first di agnosis of varicos e veins gave t he Board a plausi ble basis t o conclude that"'the evidence of recor d does not suppor t hi s ass ertions of having ha d relate d in[-]service manifestations
or a co nti nu ityof

sym pto m ato log y o r tr eatm ent th ere af ter .' " Id . at 8 ( qu oti ng R. at 9 ). B. Law Establishi ng service co nn ection ge ne ra llyrequires (1) medical evidence of a current disabili ty; (2) medical or , in certa in ci rc umstances , lay evidence of in-service incurrenc e or ag gravatio n o f a

dis eas e o r injury; and (3) m ed ica l ev ide nc e o f a ne xu s b etw een

the cla im ed in-servi ce disease or injury a nd the presentdisabili ty. See Caluza v. Brown , 7 Vet.App. 498, 5065

(1995), aff'd per cur iam , 7 8 F .3 d 6 04 (F ed . C ir. 19 96 ) (t ab le) ; seeals o H ick so n v . We st , 12 Vet.App. 247, 253 (1999); 38 C.F.R. § 3.303. Under § 3.303(b), and of rel evance here, a n alterna tive method of establ ishing the s econd and/or t hird Ca luz a elem ent is through a demonstration of continuit y of symptom atology. See Savage , 10 V et. Ap p. at 4 95 -97 ; seeals o C lyb ur n v . We st , 12 Vet.App. 296, 30 2 (1 999). Continu ityof sym pto m ato log y m aybe est ab lis he d if a cl aim ant can d em on str ate (1 ) t ha t a co nd it io n wa s " no te d" du ri ng se rv ic e; (2) ev id en ce of p os ts er vi ce co nt in ui ty of t he sa me symptom atology; and ( 3) medical or, i n cer tain circumstances, lay e vidence of a nexus between t he pr es en t d is ab il it y a ndth e p os ts ervi ce sy mpt omat ol og y. Savage , 1 0 V et. Ap p. at 4 95 -96 ; seeHi cks on , 12 Ve t.A pp . at 25 3 (lay ev ide nc e of in -se rvi ce inc urr en ce su ff ici ent i n so m e cir cum stances for purposes of es tablishi ng ser vice connection) ; 38 C.F.R. § 3.303(b)

. The Board's determination on
co nti nu ityof

sym pto m ato log y is a finding of f act rev iew ed

bythi s C ourt und er the "cl ear ly erroneous" standard of revi ew. Savage , 10 Vet.App. at 496. Si gn if icant i n o ur c ase lawis th at l aype rso ns are no t co m pe tent to op ine as t o m ed ica l etiology orrender medical opini ons. Se e G ro ver v. Wes t , 1 2 V et. Ap p. 10 9, 11 2 (1 99 9); Es pir itu v. De rw ins ki , 2 Vet.App. 492, 494 (1992). Lay test imony is competent, howev er , to establ ish the pre sen ce o f ob ser

va ble s ym pto m ato log y an d "m ayp rov ide s uf fi cie nt su pp ort fo r a c lai m

of ser vic e
co nn ect ion ." Layno v. Brown , 6 Ve t.A pp . 4 65 , 4 69 (19 94 ); see also Falzone v. Brown , 8 Vet.App. 39 8, 40 5 (1 99 5) ( lay

pe rso n c om

pe tent to tes tif

y to pa in and

vis ibl e flatness of

his fe et) ; Es

pir itu , 2 Vet.App. at 494-95 (la y person may provide eyewitness account of med ic al s ymptom s). The Co urt h as em ph asi zed th at "sym pto m s, no t tr eatm ent, are t he ess en ce o f anyev ide nc e o f c ontin uit y of symp tom ato log y. " Savage , 10 Vet.App. at 496 (cit ing Wil so n v . D erw ins ki , 2 Ve t.A pp . 16, 19 (19 91 )). On ce e vid en ce i s d ete rm ine d to be competent , th e B oard m us t de ter m ine wheth er s uc h evidence is also cre dib le

. See Layno , supra (disti nguishing between c ompetency ("a l egal concept de term in in g w h e th e r t e s ti m o n ym ayb e h e ard an d c o n s id e re d ") an d

c re d ib il it

y(" af a ctu al de ter m inatio n go ingto the pro bativ e v alu e o f t he ev ide nc e to be m ad e af ter the ev ide nc e h as b een admitted")). In Savage , th e C o urt

c o n s id e re d

w h e nan d

h o wac o n d it io nc o u ld

b e "n o te d " i ns e rv ic e. Th ere the ve ter an

ha d p res ented

po sts erv ice test im ony reg ard inganin- ser vic e f all that ha d c au sed him to limp since service. Savage , 10 Vet .App . at 49 6-9 7. The Co urt he ld t hat if the co nd iti on

wa s one "as to which a lay person's observat ion is compete nt ," medical evidence of "noti ng" was not6

necessari ly requir ed. Id . at 49 7. Pr esum ing Mr . S av ag e' s te sti m ony re gardi ng his in- ser vic e f all
cre dib le, the Co urt

he ld s wo rn te sti m ony alo ne su ff ici ent to est ab lis h an in -se rvi ce " no tin g, " an d th at no specific i n- se rv ice medical notati on, let alone diagnosis, was r equired. Id . ( ho ld in g v et er an 's statem en ts, "in

an d o f t he m sel ve s, su ff

ici ent to sh ow

co nti nu ityof

sym pto m ato log y" f

or w ellgro un de dn ess purpo ses ). T he Sa vage Court went on to hold, however , that notwit hstanding the
ve ter an ' s sh ow ingof po sts erv ice sym pto m ato log y, the qu est ion of wh eth er h is arthrit is w as r elated to his in- service fall was a question of eti ology requir ing medical experti se. Id

. at 4 97 -98 ; seeals o Cl yb ur n , 1 2 V et. Ap p. at 3 01 (re co gn izi ng m ed ica l ev ide nc e is no t re qu ire d to de m on str ate rel ati on sh ip be tw een

pres ent dis ab ili ty an d co nti nu ityof sym pto m ato log y if

co nd iti on s ar e su chthat lay person's observat ions are competent, but findi ng Mr. Clyburn "n ot c ompe te nt to test ify to the fa c t th a t w h a t h e e xp e ri e n c e d i ns e rv ic e an d

s in c e s e rv ic e i s th e s a m e c o n d it io nh e i s curre ntl y dia gn os ed

wi th, " w he n c lai m

wa s f or s erv ice conn ect ion

for kne e con dit ion

and Court w as p res ented only with evidenc e of in-servic e knee problems, currentdiagnosis of chondromal aci a patell ae or de ge ne rat ive joi nt d ise ase , and ve ter an ' s lay te sti m ony o f n exus ).

C. An aly sis The type of evidence that will suffice to demonstrate entit lement to service c onnection, and the de ter m inatio n o f whe the r lay e vid en ce m ayb e co m pe tent to sat isf

y anyne ces sar

y e vid entiary hurdles, depends on the type of disabi lity cl aimed. See Falzone , 8 Ve t.A pp . at 40 6. Thus , to ad dre ss the part ies argum ents he re, the C ourt m us t det erm ine wh eth er ( 1) v ari co se v ein s is a co nd iti on that a lay person i s competent to identi fy, and (2) if so, whether the Board erred i n its adjudi cation and
co ns ide rat ion

of th e ev ide nc e in su

pp ort of Mr. Barr' s cl aim . F or t

he fo llo wi ng rea so ns , w e h old that the an sw er t o b oth

of the se q ue sti on s is ye s. 1. La y O bs erv ati on s a nd

Va ric os e V

ein s Th e S ecr eta

ry argu es, an d th e B oard i m pli cit ly h eld , th at the pre sence of varic os e v ein s is a medical determination thatm ust be supported by competent evidence, beyond that which m ay be of fe red bylay tes tim ony. Be cau se o f t he un iqu e natur e of

v ari co se ve ins , we dis ag ree . V ari co se veins are " [e]longated, dilate d, tortuous supe rficial vei ns (usuall y in th e legs) whose val ves have be co m e inc om

pe tent, p erm itt ingrev ers ed fl owin t he de pe nd ent po sit ion ." T HE M ER CK M ANUAL 590 (16th e d. 19 92 ) [ he rei na ft er M ERCK ]; seeals o D ORL AND ' S I LL US TR AT ED M EDI CAL D I CTI ONA RY 2008 (30 th e d. 20 03 ) [ he rei na ft er D ORL AND ' S ] (definin g "v ari co se v ein s" a s v ein s th at are7

"unnaturally and pe rm an entlydis ten de d") ; W EBS TER ' S M EDI CAL D ES K D I CT I ONAR Y 751 (1986) [h ere ina ft er WEB S TER ' S ] ( de fi ni ng "v ar ic os e" as "abn ormal ly swolle n or dilat ed" and "var icose vein" as "an abnormal swelli ng or tortuos ity .

. . of a superficial vei n of the legs"). M ER CK fu rth er s tat es: "T he patie nt u su all y m ak es t he dia gn os is o f v ari co se ve ins , b ut t he ir e xte nt i s u su all y g reater than can be deter mined by sim ple inspect ion and c an be judged accur ately only by pa lpitat ion with the patie nt s tan din g. " M ERCK at 590. As to symptom s, M ER CK states : " Ini tia lly , su pe rf ici al v ein s ar e tens e an d may be pal pitated butare not vis ible. Subsequent ly, they become visibly di lated and tor tuo us ; t he d iag no sis is th eno bv iou s to t he patie nt. " Id . "Varicose ve ins are i ncurable i rrespect ive of the m eth od

of tre atm ent." Id . at 592. Once service connected, varicos e veins are rated purs uant to Diagnostic Code (DC) 7120, which, inter al ia, assigns a noncompe ns ab le rating for "asymptom atic pal pable or vis ible vari cose veins," and a 10% disabi lity ra ting for "in te rmittent ed em a . . . or a ch ingan d f

ati gu e in leg a ft er pro lon ge d stand ingo r w alk ing , w ithsym pto m s re lie ve d by elevati on . . . or compression hosiery." 38 C.F.R. § 4.104, DC 7120 (2006). "A s a ge ne ral m att er, in

ord er f or anytes tim ony to be pro bativ e o f anyfa ct, the wi tne ss m us t be co m petent to t est if y a s to the fa cts un de r co ns ide rat ion ." Layno , 6 Vet.App. at 469 (cit ing Es pir itu , s up ra ). In Falzone , the Court st ated that the ve teran's descri ption of his flat feet was not a determination tha t was "medical in natur e" and, ther efore, lay test imony may "suffice by itsel f" to s how the presence of

su chco nd iti on . 8 Ve t.A pp . at 40 5-0 6; seeLa

yn o, su pra (lay e vid en ce i s
co m pe tent to est ab lis h f

eat ure s o r sym

pto m s o f i nju

ry o r il lness); see also Charles v. Principi , 16 V et. Ap p. 3 70 , 37 4 (20 02 ) ( ap pe llant is co m pe tent t o te sti fy

co nc ern ingsym

pto m s ca pa ble of lay observati on). But see Epps v. Brown , 9 Vet.App. 341, 344 (1996), aff 'd, 12 6 F. 3d

1 46 4 (F ed . C ir. 19 97 ) (r eq

uir ingm ed ica l ev ide nc e to sh ow that s kin co nd iti on

cau sed blo od clo ts that ul tim ate ly resulte d in heart c ondition). Si milarly, the Court has found a vet eran compete nt t o testify as t o a condition within his knowledge and personal observation. Se e B ru ce v . We st , 11 Vet.App. 405, 410- 11 (1 99 8) (finding ve teran competent to des cribe dry, i tchy, scali ng skin). Bu t se e L ay no , s up ra (cautioni ng that lay t estimony that veter an suffered a partic ular il lness (br onchial ast hma) was not
co m pe tent ev ide nc e b eca

us e m att er r eq

uir ed m ed ica l expe rti se)

. W e co nc lud e h ere that a l aype rso n is c ompet ent to ide nti fy ve ins that ar e unn atural ly distended orabnormally swollen and tor tuous. Se e W EBS TER ' S and D ORLAND ' S , both su pra . Although t he symptoms of the initia l st age of vari cose veins ( which M ER CK identifies a s exhibiti ng8

ten se s up erf

isc ial vein s) do not ap pe ar to be cap ab le of lay ob ser vatio n, we co nc lud e th at v ein s th at have be co m e v isi bly

tor tuo us or d ilated

are ob ser va ble an d id entif

iab le b y lay p eo ple . W e f urt he r ho ld t hat be cau se v ari co se v ein s m aybe dia gn os ed by the ir uniq ue an d re ad ilyide nti fi ab le f eat ure s, the pre sen ce of

varic os e v ein s is no t a d ete rm inatio n "m ed ica l in natur e" and

is c ap ab le o f l ay ob ser vatio n. Se e Fal

zo ne , s up ra ; M ER CK at 5 90 ("[ T] he dia gn os is [ of va ric os e v ein s] is the n ob vio us to t

he patie nt. ").

2. Board's Varicose- Veins-Mer its Determinat ion In c on clu din g th at the pre po nd eranc e of the ev ide nc e w as a ga ins t th e cl aim , th e B oard s tat ed that Mr. Bar

r had sub m itt ed

"no co m pe tent evi de nc e" of

in-s erv ice incurre nc e of

his varic os e v ein s. R. at 8- 9. Th e Bo ard

repe ate dly

em ph asi zed that the la ck of m ed ica l evi de nc e and

lac k o f s up po rt
orcon fi rma ti onof Mr . Ba rr 's as se rt io ns was fat al to th e c la im. Id. In l ight of our ho ldi ng that a l ay pe rso n m aybe co m

pe tent to ob ser

ve varic os e v ein s, th e Bo ard ' s rea so nin g fo r d enyin g the cla im is flawed. See Buchanan v. Nicholson , 4 51 F. 3d 1 33 1, 1 33 5 (F ed

. Ci r. 20 06 ) ( statin g "co m pe tent lay evidence can be sufficient in and of itse lf" to obt ain disabi lity benefit s). Mr. Barr t est if

ied rep eat edly dur ing the ad jud icatio n o f h is c lai m

that th e o ns et o f h is
varic os e v ein

co nd iti on occu rre d in se rvi ce an d th at h e h as s uf fe red fr om that co nd iti on

co nti nu ou sly since then. Se e R. at 75, 88-89, 11 5- 30

. T he Board det ermined that Mr. Barrwas not competent to provide suc h evidence. Se e R. at 9 (ve ter an"ha s su bm itt ed no co m pe tent ev ide nc e" o f c ontin uit y of sy m pto m ato log y). Al tho ug h th e B oard w ou ld have be enwi thi n it s p rov inc e to have we igh ed that testimony and to have made a credibi lity det ermination as to whetherthat evide nce supported a fi nd ing of

ser vic e in curre nc e an d c ontin uit y o f s ym pto m ato log y s uf

fi cie nt t o e sta

bli shservi ce connection, t he Board erred i n outright r efusing to considerit as competent. See B uc ha nan , 45 1 F .3 d at 13 37 (" Bo ard , as fa ct f ind er, is o bli gated

to, an d f ull y ju sti fi ed

in, de ter m ini ng wh eth er lay ev ide nc e is cre dib le i n and of its elf , i.e ., b eca us e of p os sib le bia s, c on fl ict ingstatem ents, etc .") ; see also Mc

Lendon v. Nicholson , 2 0 V et.App. 79, 84 (2006) (whe n s ub jec t is on e to wh ich

lay person is " competent" to test ify, such "test imony can be re je ct edo nl y if found to be m istaken or oth erw ise de em ed

no t cr ed ibl e") ; Layno , su pra . In ess entia llydis m iss ing Mr. Barr' s as ser tio ns as
no t co m pe tent, t he Bo ard co mm itted preju dic ial err or i n f ail ingto a de qu ate ly c on sid er m ate ria l evidence favorable to the claim. Se e C alu za , 7 Ve t.A

pp . at 50 6 (B oard m

us t pr ov ide rea so ns fo r it s rej ect ion of any m ate ria l ev ide nc e f

av ora ble to c la im ant); see also Gutie rrez v. Princi pi , 19 Vet.App.9

1, 9 (2 00 4) ( fi nd ingBo ard ' s re aso nin g f law ed wh en it failed

to d isc us s ad eq

uatel y e vid en ce i n support of claim); 38 U.S.C. § 5103A(d)(2) (Secr eta ry must take into consi deration a ll lay or

m ed ica l ev ide nc e o f r eco rd, inc lud ingstatem ents o f c lai m ant); 38 C. F. R. § 3 .3 03 (a)

. Ac co rd in gl y, fo rt h i s r e as onco mbi ne d wi th th e o th ererro rs ad dr es se d b el ow, th e B oa rd 's de cis ion wi ll b e v acated , and

the m att er r em an de d f

or r ead jud icatio n. On

rem an d, the fi nd er o f f

act must consider the cre dibilit y and weight of Mr

. Barr's statements, and any othercompetent lay or medical evidence submitted, to det ermine whether he i s en ti tl edto servic e connection ba sed on continuit y of sym

ptomatology. Se e 38 U. S. C. § 51 03 A( d)( 2); 38 C. F. R. § 3 .3 03 (b) . A s em ph asi zed in Buchanan , th e B oard m ayno t re jec t as not cred ibl e any unc orr ob orated statem ents m ere ly because the c ontemporaneous medical evidence is s ilent as to complaints or tr eatmen t for the relevantcondition orsymptom s. See Buchanan , 4 51 F. 3d at 1 33 6-3 7; see also Mc Lendon , 20 V et. Ap p. at 8 4 (st ati ngth at co m pe tent t est im ony "can be re jec ted o nly if f ound to be m ist ak en
or o the rw ise de em ed

no t cr ed ibl e, a fin din g the Board di d no t m ak e and the Co urt canno t m ak e in the first i nstance")

. III. ADEQUACYOF MEDICAL E XAMINATION Th e S ecretary h as a

duty t o a ssi st c lai m ants and m us t "m ak e re aso na

ble ef fo rts to a ssi st a clai m an t i n ob tai nin g ev ide nc e ne ces sar y to su bs tantiate the c lai m ant' s cla im f or a benefit." 38 U. S. C. § 5 10 3A (a) (1) . A s a p art of his duty to a ssi st c lai m ants, the Secre tar y m us t pr ov ide a
m ed ica l e xam inatio n or ob tai n a m ed ica l o pin ion "whe n su chan ex am inatio n o r op ini on is n ece ssary to m ak e a de cis ion

o n the c lai m ." 3 8 U. S. C. § 5 10 3A (d) (1)

. Am ed ica l o pin ion is a de qu ate wh en it i s b ase d u

po n c on sid eratio n o f t

he ve ter an ' s prior m ed ica l hi sto ry and ex am inatio ns an d a lso de scr ibe s th e d isa

bil ityin s uf

fi cie nt d eta il s o th at the Board' s "' ev alu ati on of th e cla im ed

dis ab ili ty wi ll b e a f

ull y in fo rm ed

on e. ' " Ardison v. Brown , 6 Vet.App. 405, 407 (1994) ( quoting Green v. De rw ins ki , 1 Ve t.A

pp . 1 21 , 1 24 (19 91 )). The record suppor ts Mr. Barr 's argum ent that the Janua ry 1997 VA examination report upon which the Board rel ied was inadequat e because the VAexaminer failed to revi ew Mr. Barr's prior

m ed ica l re co rds and

did no t pro vid e an op ini on as to wh eth er Mr . Barr' s var ico se ve ins we re r elated to servic e. The examiner explicit ly state d that he did nothave the cla ims file to review. R. at 75. It i s w ell est ab lis hed in the Co urt ' s juris pru de nc e th at a tho rou ghm ed ica l ex am inatio n is on e th at10

"take s into a cco unt th e re co rds of pri or m ed ica l tr eatm ent, s o th at t he evalu ati on of the cla im ed disa bil itywi ll b e a f

ull y in fo rm ed

on e. " Green , 1 Ve t.A

pp . at 12 4; seea lso C

oxv. Nicholson , 20 Ve t.A pp . 56 3, 56 8-6 9 (2 00 7); 38 C. F. R. § 4 .1 (20 06 ). F urt he r, w e n ote that th e V A e xam ine r di d not indicat e whether he consi dered Mr. Barr 's assertions of co nti nu ed symptom atology. Cf. Ardison , 6 V et. Ap p. at 4 07 (op ini on is a de qu ate wh enba sed

on co ns ide ration of veteran ' s p rio r m ed ica l history and e xaminations and also desc ribes dis abilit y in sufficient detail s o that Board's evaluat ion will be fully informed). For these r easons, the Board e rred. Further, the Secretary appears to a rgue that a ny inadequacy in the January 1997 e xamination
wa s n on pre jud ici al b eca

us e th e S ecr etary h ad

no duty t o p rov ide the ex am inatio n in the fi rst ins tan ce wh enthe re w as n o m ed ica l ev ide nc e sh ow ingvaric os e v ein s in ser vic e, an d b eca

us e th e B oard reject ed Mr. Barr's clai med history of continuity of symptom atology. For the reasons that follow, this argument is not pe rsuasive. First, the Board never rendered a finding that a medical examination was not warranted and the Secretary's argument that it was not needed is r ejected a s post hoc rat ionaliza tion. Se e Ma rti n v
. Oc cu pa tio na l S

afe ty & He alt

h R evi ew Co mm 'n , 49 9 U. S. 14 4, 15 6 (1 99 1) ( "' Li tig ati ng po sit ion s' are not entit led to defer en ce wh en t hey are merely appell ate counsel 's ' post hoc rat ionaliza tions' for ag en cyact ion , a dv an ced

fo r th e f irs t ti m e in

the rev iew ingco urt .") . Further, once the S ecr etary
un de rtake s th e ef

fo rt t o p rov ide an ex am inatio n wh end ev elo pin g a se rvi ce- co nn ect ion cla im , e ve n if not statut orily obli gated to do so, he must provide a n adequate one or , at a minim um, notify the claimant why one will not or c annot be p ro vided. See Daves v. Nicholson , 21 Vet.App. 46, 52 (2007) ("Due pr ocess requi res the Secr etary to not ify the claimant priorto the adj ud ic at io n of the cla im of his ina bil ityto ob tai n ev ide nc e he h as un de rtake n to ob tai n, s o that t he cla im ant ha s a f

air
an d re aso na

ble o pp ort

un ityto tr y an d s ecu

re i t or pro cure a lte rnativ e ev ide nc e at a ti m e whe n s uc h inf orm ati on w ill b e m os t u sef

ul t o th e ad

jud icator .") ; Sanders v . Principi , 17 Vet.App. 232 (2003) (highlight ing vetera n-friendly nature o f VA adjudication proces s, and stati ng that when heari ng
ex am ine r pr om ise d a

m ed ica l ex am inatio n b ut VA d id n ot pr ov ide on e, Bo ard m us t expla in i n it s de cis ion why it "w ou ld no t or n eed no t pr ov ide the pro m ise d e xam inatio n") ; seeals o Ste ga ll v . We st , 11 Vet.App. 268, 270-71 (1998) (r emanding where VA examination was "inadequat e for evaluati on p urp o s e s") ; Hicks v. Brown , 8 Ve t.A pp . 4 17 , 4 22 (19 95 ) (c on clu din g th at i na de qu ate m ed ica l evaluati on frustrates judicial review). Even ass uming, a rg uendo, tha t a VA m edical exa mination11

wa s n ot r eq

uir ed bylawin t

his cas e, be cau se VA und ert oo k to pro vid e o ne , the Bo ard err ed in failing to ensur e it was adequat e or to otherwise notify Mr. Barras discusse d above.

IV. REMEDY Al tho ug h Mr. Bar

r ar gu es f or r ev ers al, rem an d is the ap pro pri ate rem ed y whe re the Bo ard ha s in co rre ctl y ap pli ed

the law or

fai led to pro vid e an ad eq

uate st ate m ent of

rea so ns or b ase s f

or i ts determinations. Tu cke r v. Wes t , 11 Vet .App . 36 9, 374 (199 8). Th is is not a sit uatio n whe re the on ly permissible view of the evide nce is c on trary t o the Board's decision. See Johnson v. Brown , 9 Vet.App. 7, 10 (1996). Accordingl y, be cause VA m ust make the credibil ity deter minations necessary t o resolve Mr . Barr's s ervice- connection cl aim, rem and, as opposed to r eversal, i s the appropr iate re medy. Se e G uti errez , 1 9 V et. Ap p. at 1 0. Du rin g re m an d, any is su es s urrounding
no tic e an d th e app lic ati on of th e cor rec t lawmay be rais ed . T he ref ore , w e n eed

no t ad dre ss h ere Mr. Barr' s argum ents c on cer nin g th e S ecr etary' s co m pli an ce w ithhis no tif icatio n d

uti es. Mahl v. Princi

pi , 1 5 V et. Ap p. 37 (20 01 ) (C ourt w ill rar ely ad dre ss i ssu es u

nn ece ssary to its de cis ion ). F urt

he r, o n re m an d M r. B arr

m aypre sent ad dit ion al ev ide nc e and arg um ent in

su pp ort of his claim, and the matter i s to be provide d expeditious treatment. Se e 38 U.S.C. §§ 5109B, 7112; Kay v. Principi , 1 6 Vet.App. 529, 534 (2002). In adjudi cating Mr . Barr's claim, VA m ust give considerat ion as to whethercontinuit y of sym ptomatology is to be pres umed based on the unique nature of varic ose veins. Se e M ER CK at 592 ("Vari cose ve ins are i ncurable i rrespect ive of the

m eth od of tre atm ent." )

V. CO NC LU SI ON The Board's February 17, 2004, deci sion i s VACATED, and the matter is REMANDED for further adjudi cation consi stent with t his opinion.