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 . 05-1468 F RA N CES D'A RI ES , A P P EL LA NT ,

V . J A M ES B. P EA KE , M.D., 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 (Argued February 6, 2008 Deci ded April 8, 2008 )

Mic ha el A . L eo na rd, o f W ilm ing ton , N ort h C aro lin a, fo r th e ap pe llant. Lesli e C . R og all , wi thwho m Pa ul J

. H utter , A cti ngGe ne ral Co un sel ; R. Ra nd all Ca mp be ll , Assistant Gener al Counsel; and Jo an E. Mor iar ty , Deputy Assistant General Counsel, were on the bri ef , a ll o f W ash ing ton , D .C ., fo r th e ap pe lle e. Before KASOL D, HAGE L, and LANCE, Ju dges . PER CURIAM. HAGEL, Judge , and LANCE, Judge , f ile d c on curri ngop ini on s. PER CURIAM: Before the Court is Franc es D'Aries's appeal of a May 18, 2005, Board of Ve t e r an s ' Ap pe al s ( Boa rd ) d ec is io n tha t d en ie d s ervi ce co nn ec ti onforth e c au se of h erhu sb an d's death under 38 U.S.C. § 1310. Because the VA medical examination sought under the authorit y of 38 U

. S

. C

. § 7 1 0 9 an d

3 8 C

. F

. R

. § 2 0

. 9 0 1 w a s a d e qu ate f o r r ati n g p urp o s e s , th e B o ard p ro v id ed adequate re asons orbases for reject ing the opinion of the tr eating physi cian, and ther e was no error in the noti ce provided, the Board decisi on will be affirmed.

I. FACTS Mrs. D'Aries's husband, Lawrence D 'Aries, served on active duty in the U.S . Ar my from De ce m b e r 1 9 4 2 t o F e b ru ary

1 9 4 6 d uri n g W o rl d

W ar II

. H is s e rv ic e i n c lu d e d c o m b at duty i n Ge rmany , wh er e h e s uff

er eda h ea d i nj ury i n M ar ch1 94 5 whe n a sh el l la nd edne arhi m. Atth e t ime2

of his de ath

on De cem be r 27 , 1 99 8, Mr. D ' Ar ies wa s re cei vin g VA c om pe ns ati on fo r se ve ral service- connected dis abilit ies, incl uding chronic br ain syndrome associate d with br ain trauma from the 1945 incide nt, with p os t- tr aumatic headaches, rat ed 70% disabl ing, and a loss of bone of the sk ull , rated 30 % di sab lin g. Hi s co m bin ed sch ed ular evaluatio n w as 8 0% d isa bli ng . T he de ath
cer tif icate lis ted

h is cau se of

d eat h a s cardi ore sp irator

y arre st d ue to o r as a co ns eq

ue nc e o f s ep sis , due to or as a c onsequence of pneumonia. Record (R.) at 177. In A pri l 19 99 , Mrs

. D' Ar ies ap pli ed fo r de pe nd en cyan d in de mnit y c om pe ns ati on . W ithhe r cla im , M rs. D' Ar ies sub m itt ed a lette r fr om

Mr. D' Ar ies ' s p riv ate phys ici an , D r. H enry M cC ab e. In that lett er, Dr. McC ab e exp res sed his op ini on

that Mr . D ' Ar ies ' s chron ic b rai n d iso rde r, " alo ngwi th his [d]iabetes, preve nted him from sensing appropr iately t he symptom s which were developi ng lea din g u p to his pn eum on ia and blo od po iso nin g (s ep sis ), and

ult im ate ly, un fo rtunatel y, his untimely demise." R. at 179. In August 1999, VA receivedM r. D'Aries's hospital a dmission records, which i ndicated that he h adb ee n ad mitted to the hospit al on December 27, 1998, with a
co ug h, fe ve r, and

co nf us ion . T he rec ord

no ted that he ha d a

his tor y of "co ng est ive he art

fa ilure, diabe te s mellitus, cerebr ovascular a ccident with right hemiplegia, and c hronic obstructive pu lm on ary

dis eas e. " R

. at 19 4. Later th at s am e d ay , M r. D ' Ar ies wa s f ound in r esp irator

y d istres s an d intub ate d, an d d ied

sh ort ly t he rea ft er. In Augus t 199 9, aft er re vie wi ngthe m ed ica l evi de nc e of reco rd, a VA r eg ion al o ff ice de nie d Mrs. D'Aries's claims for benefits for the cause of herhusband's death and dependency and ind em nit y c om pe ns ati on , f

ind ingth at the re wa s no re lat ion sh ip be tw een M r. D' Ar ies ' s de ath

and his military servi ce. Mrs. D'Aries filed a Notic e of Disagreement with that deci sion. In J anuary 2 00 0, Dr . M cC ab e sub m itt ed an oth er l ett er r eg ard ingMr. D' Ar ies ' s d eat h. In t hat letter , D r. M cC ab e in dic ate d th at h e h ad tre ate d M r. D ' Ar ies "pr im ari ly" fo r di ab ete s m ell itu s, congestive he art failur e, arteriosc leroti c car diovasculardisease, at rial fibri llati on, and hypertensi on. R. at 2 33 . D r. M cC ab e wrot e: Th e co m bin ati on o f [ Mr. D' Ar ies ' s] dis eas es, art eri os cle rot ic c ard iov asc ular di sea se an d hyp ert en sio n a ll c om bin ed to c au se a

chron ic o rganic brai n syn dro m e, wh ich be cam e pro gre s s iv e ly

w o rs e in h is late r y e ars . . . . [ I] t i s myo p in io nth at t h ese pr ob le ms bot h di re ct lyandind ir ec tl y co ntri bu te d to the con di ti onli st edat t he ti me of his de m ise (i. e. [, ] C hro nic Br ain Synd rom e).3

It i s q uit e po ssi ble that

the he ad traum a wh ich

he su sta ine d m any y ear s ag o m ayals o have contri buted to thi s c ondit ion, but in al l likel ihood, the more chronic and pro gre ssi ve natur e of

his othe r con dit ion s wa s re sp on sib le f or t he de ter ior ati on

of his m ental sk ill s later

in l if e. Id. Mrs. D'Aries appealed t o the Board in April 2000. In May 2001, Mrs. D'Aries rec eived notic e pursuant t o the then-r ecently ena cted Vetera ns Cl aim s As sis tan ce A ct of

200 0, Pub . L. No. 106 -47 5, 114 Stat . 20 96 (cod if ied at 38 U .S .C . § 51 03 ). Th at l etter exp lai ne d what in fo rm ati on an d e vid en ce s he wa s re sp on sib le f or o bta ini ngan d what inf orm ati on an d e vid en ce VA w ou ld o bta in. Th e le tte r al so expla ine d th e ev ide nc e n ece ssary t o est ab lis h entit lem ent t o co m pe ns ati on f or ser vic e-c onne cte d co nd iti on s an d advis ed Mrs. D'Arie s of the in fo rm ati on

VAneed ed

fro m her. A Su

pp lem ental Stat em ent of

the C ase was issu ed

in Apri l 2002. T hat d oc um ent a dv ise d Mrs

. D' Ar ies th at he r c lai m h ad b een "c on sid ere d ba sed

o n all the evidence of recor d, including r eview of [the] claim as a result of [the] passag e of [the] Veterans Cl aim s Assistance Act of 20 00 ." R . at 25 4. Al so in t hat do cum ent, t

he reg ion al o ff

ice co nti nu ed to d eny e nti tle m ent to de pe nd en cyan d in de mnit y c om pe ns ati on an d s e rv ic e c o nn e c ti o n

f or t he cau se of Mr. D'Aries's death. In August 2002, the Board re manded Mrs. D'Aries's claims in order to afford her a hear ing be for e the Boa rd . I n Oc to b e r2 00 2, Dr . M cC ab e s ub mit te d ath ir d l et te r r eg ar di ng Mr . D'A ri es 's de ath . In that le tte r, D r. M cC ab e wrot e: To ward s the la tt erpartof h is li fe, Mr

. D' Ar i e s b e gan t o e xp er ie nc e s ympt oms consis tent w ithOr ganic Br ain Synd rom e. Th ese sym

pto m s in clu de d c on fu sion, ha ll uc in at io ns , e up ho ri a, ag it at io n, in so mni a[, ] and[,] subseque nt ly [,] di se qu il ib ri um. In a ll p rob ab ili ty, the cu lm inatio n o f t his e nti ty wa s ini tiated

b y ane pis od e o f s ev ere he ad traum a wh ich

he sus tai ne d m any ye ars ago . Ove r a lon g pe rio d of tim e[ ,] thi s cau sed cer eb ral atr op hy [, ] whic h s ign if icantl y re du ced

an d im pa ire d his m ental cap aci ty and

m oto r sk ill s. De sp ite his oth er m ed ica l il lne sse s[ ,] it w as t he com pli cat ion s of

his Or ganic Br ain Synd rom e an d th eir

s eq ue lae whic h led

to h is m ental and

phys ica l de ter ior ati on

lat er in life[,] and ultimately to his dem ise. It is my m edical opi nion that any r etroact ive review of his government benefits must incorpor ate this issue in i ts evaluat ion due to the causa l effect it had upon his death. R. at 262. Mrs. D'Aries was afforded a Board hearing he ld in February 2003.The C our t not es t hat t he B oar d bi f ur cat ed M r s. D ' A r i es ' s cl ai m s i n Septe m ber 2003 and deni ed he r cl ai m f or 1 depende ncy a nd i ndem ni t y com pens at i on under 38 U

. S. C

. § 1318. T hi s C our t r ever se d t hat dec i si on and r em anded t he m a tter to th e B o a rd fo r re a d ju d ic a tion

. See D '

Ari es v. N i chol

son , N o. 03- 1974, 2006 W L 954009 ( V et
. A pp. Feb. 22, 2 0 0 6 ). T h e S e c re ta ry h a s a p p e a le d th a t d e c isio n , an d th e a p p e a l i s c u rre n tly p e n d in g b e fo re th e U .S . C o u rt o f A p p e a ls fo r th e F e d e ra l C irc u it. 4 In O cto be r 20 04 , th e B oard i nf orm ed Mrs . D' Ar ies that

it had "dec ide d to a sk

on e o r m ore expe rts to p rov ide a m ed ica l opi nion" w ithres pe ct t o h er c lai m fo r be ne fi ts f

or t he cau se o f h er husband's death. R. at 279. The Board sent an engagem ent letter to the Portland, Oregon, VA 1 Medical Cent er, asking the chief of staff of thatfacili ty for a "medical expert opinion." R. a t 281. Sp eci fi cal ly, the Bo ard

req ue ste d th at " anint ern al m ed ici ne spec ial ist

. . . pro vid e a m ed ica l ad

vis ory opinion" on the question of whether Mr . D'Aries's chronic br ain syndrome and/or loss of bone of the skull caused or contri buted to his de ath. Id. The Board direct ed that the medical expert "r eview the cla im s f ile in i ts e nti rety" and

included an explanatio n o f t he cri ter ia f

or d ete rm ini ngwh eth er a co nd iti on wa s a p rin cip al o r co ntr ibutor y c au se o f d eat

h. R. at 2 81 -82 . F ina lly , th e B oard r eq ue ste d that the medical expe rt comm ent on the opini ons offered by Dr. McCabe. R. at 282. Th at s am e m onth, Dr . J os ep h Q uinn, a n eurol ogist with t he Po rtl an d VA m ed ica l ce nte r, provided th e reque sted opinion. Dr. Quinn r ecounted Mr. D'Aries's extensive medical history, be ginnin g w iththe he ad

tra um a he su ff

ere d in 19 45 an d e nd ingwi th t he ill ne sse s th at p rec ed ed his death in 1998. Dr. Quinn note d that ther e was no evidence i n Mr. D'Aries's m edical history that he
su ff ered from m ental im

pa irm ent, r etardatio n, or d if fi cu ltyco nc entratin g a s a r esu lt o f h is h ead tra um a. Dr . Q uinn a lso summ ari zed the op ini on s of

Dr. McC ab e, high lig hti ngtho se p ort ion s q uo ted above. In pert inent part , Dr. Quinn concluded: [T]he record indicate s that [Mr. D'Aries] sustaine d a severe hea d injury in 1945, res ult ingin

c hro nic h ead ach es an d "ne rvo us ne ss" , but w ith out c og nit ive o r othe r ne uro log ic d ef

ici ts. He wa s f

irs t ap pre ciated

to s ho w si gn s of

dem entia in 1 98 7, in concert wit h evidenc e of severe diabet es-rel ated vascul ar diseas e. His cogniti ve de fi cit s w ere sti ll c on sid ere d m ild durin g e va luation o nly

a f ewm onths be fo re h is death in 1998. His death by pneum onia and sepsis is not unusual for unh ealthy eld erl y d iab eti c p ati ents, ev enin t he ab sen ce o f d em entia

. I co nc lud e th at the re is littl e evi de nc e to ind icate that [ Mr. D' Ar ies ' s] he ad inj ury cau sed his dem entia , an d that th ere is l itt le e vid en ce t o in dic ate that th e d em entia wa s sev ere en ou ghto r esu lt i n p ne um on ia and sep sis . I t

he ref ore fu rth er c on clu de that [his] service-conne cted brai n syndrome did not cause or contri bute to his de ath.5

R. at 274-75. On May 18 , 2 00 5, the Bo ard

iss ue d th e d eci sio n o n a

pp eal , d enyin g entit lem ent t o s erv ice
co nn ect ion

for the ca us e of Mr. D ' Ar ies ' s d eat

h. Th e B oard f

irs t de ter m ine d th at VA h ad

sat isf ied its duty t o n oti fy

un de r th e V ete ran s C lai m s A ssi stanc e A ct thro ug h th e May 20 01 lette r. T he Bo ard noted that t he lette r was provided afterthe init ial adjudi cation o f t he c la im in August 1999, but found that any defect was non-pr ejudicia l because there was no indicati on thatthe outcome of the
cas e h ad be enaf fe cte d, an d b eca

us e Mr s. D' Ar ies ha d b een af fo rde d a m ean ing ful opportuni ty t o part ic ip at e i n the pr oc es si ng of h ercl ai m. W ithres pe ct t o th e m eri ts of th e cla im , the Bo ard

att ach ed "si gn if icant p rob ati ve va lue " to the op ini on

of Dr . Q uinn an d "e sse nti all y n o pro bativ e v alu e" t o th e o pin ion of Dr . M cC ab e. R. at 6. The Board found that Dr. Quinn had revi ewed Mr. D' Aries's claims file and provided " a thorough
an d d eta ile d o pin ion

ab out a d iso rde r w ith in h is are a of m ed ica l e xp ert ise " th at w as " co ns ist ent w ith the co m pe tent ev ide nc e o [f

] r eco rd. " Id. In c ontra st, the Bo ard stated that i t coul d not es tab lis h wh eth er D r. M cC ab e h ad

rev iew ed the cla im s f

ile be fo re r en de rin g h is O cto be r 200 2 op ini on , whic h the Bo ard fo un d in clu de d "virtual ly n o ratio na le and

. . . f ail [e d] to a dd

res s h ow[M r. D ' Ar ies ' s] mental deteriora tion resul ted in sepsis and pneum onia." R. at 6-7. The Board also noted factual and medical inconsistencies in D r. McCabe's opini ons, which it found "greatly reduce[d] the probat ive
va lue of h is m os t r ece nt (an d m os t f av ora ble ) o pin ion ." R

. at 7. Th e Bo ard s tat ed th at the fa ct that Dr . M cC ab e w as M r. D ' Ar ies ' s tr eat ingp hy sic ian d id no t, alo ne , inc rea se the pro bativ e v alu e o f h is op inion, espec ial ly g ive n th at D r. M cC ab e d id n ot t reat Mr . D ' Ar ies durin g th e h os pit al s tay that preceded his death. Id. T he Boa rdde te rmi ne d tha t, de sp it e M rs . D'A ri es 's a rg umen t t o the co ntra ry , Dr . Qu in n's
ex ten siv e re co untin g o f M r. D ' Ar ies ' s m ed ica l hi sto ry l ef t "l itt le d ou

bt" that he ha d re vie we d M r. D'Aries's claims file a s in structed. Id. Th e B oa rd a lso rej ect ed

Mrs . D ' Ar ies ' s ar gum ent th at D r. Qu inn did no t g ive h er the b en ef

it of th e do ub t whe n ren de rin g his o pin ion . T he Bo ard stated that the benefit of the doubt doc trine i s a legal s tandard to be em ployed by an adjudi catory body, not by
a m ed ica l pr of

ess ion al. Fin all y, the Bo ard fo un d th at D r. Q uinn' s sp eci alty in ne uro log y c learly "re nd er[ ed ] h im

qu ali fi ed to a dd res s th e ef fe cts o f ano rganic b rai n dis ord er. " R. at 7 -8. Th e B oard
co nc lud ed

that th ere wa s n o c om

pe tent m ed ica l ev ide nc e li nk ingM r. D' Ar ies ' s te rm ina l il lne ss t o hi s mi li ta ryse rv ic e a ndth er efo re de ni edMr s. D'Ar ie s's cl ai m.6

In her bri ef, Mrs. D'Aries m akes three arguments. First, thatthe Board err ed by relying on
a m ed ica l ad

vis ory op ini on that w as i na de qu ate fo r th e fo llo wi ngreas on s: (1 ) th e B oard r eq ue ste d
anop ini on

f rom an "inter na l m ed ici ne s pe cia lis t" but r ece ive d ano pin ion fr om a n eurol og ist ; (2 ) D r. Qu inn wa s d ire cte d bythe B oard to revi ewMr. D ' Ar ies ' s cla im s fi le in its entir ety , b ut h e in dic ate d in his r ep or t only that he ha d received a"chart" on Mr. D'Aries; and (3) " the Board viola ted the principl es of fundam ent al fa irness" by including i n its reque st an explana tion of the cri teria for de ter m ini ngwh eth er a

c on dit ion w as a pri nc ipa l o r c ontri butor y c au se o f d eat

h b ut n ot a dv isi ngthat the benefit of the doubt must be given t o a veteran on any m ateria l issue. Appellant's Br. at 8-10. Se co nd , M rs. D' Ar ies argue s th at the Bo ard err ed byfa ili ngto g ive we ight to the fa ct that D r. McC ab e w as Mr. D ' Ar ies ' s tre ati ngp hy sic ian f or the nin e y ear s p rio r to his de ath . App ell ant' s B r. at 1 1. Fi na lly , M rs. D' Ar ies ass ert s th at the Board er red in fi nd ingthat V A c om

pli ed wi th i ts d uty to notify under the Veterans Clai ms A ssistanc e Act because she was not given adequat e notice pr ior to the ini tial adj udication of her c laim. In th is res pect, she ar gues that the Board erred by r elying
on a p os t-d eci sio na l do cum ent, t he May 20 01 no tic e le tte r, t o f

ind that the duty

to no tif y h ad be en satisfied. Appell ant's Br. at 13-14. Mrs. D'Aries reque sts thatthe Court vacat e the Board's May 18, 20 05 , d eci sio n and

rem an d th e m att er. The Secretary, in his bri ef, argues that t he Board's decision is s upported by the evidence of
rec ord an d is , th ere fo re, no t cl ear ly e rro ne ou s. Sp eci fi cal ly, the Se cre tar y c onten ds that th e B oard did no t er r in acc ep tin g an a dv iso ry m ed ica l o pin ion f rom a n eurol og ist

rat he r th anfr om

anint ern al medicine speci al is t. He ass erts tha t, althou gh the Board reques ted that a n internal medicine speciali st renderthis opinion, the c hief of st aff of the medical cente r t o whom the requestwas sent de te rmi ne d tha t t he ap propr iate medical ex pe rtto ad dr es s the qu es ti onwa s ane ur ol og is t. Se cr et ary's Br . a t 1 6. Th e S ec re ta ryne xtar gu es th atMr s. D'Ar ie s h as ta ke n asi ng le s e n t e n ce inDr . Qu in n's op ini on out of co nte xt i n argu ingthat he did no t rev iewMr. D ' Ar ies ' s cla im s f ile , a s h e w as d ire cte d to d o b y th e B oard' s en ga ge m ent le tte r. S ecr etary' s Br. at 17. In this res pe ct, he argue s th at i t is clear fro m Dr

. Qui nn's "detailed opi nion," which incl udes an "exte nsive and thor ough review" of the m ed ica l ev ide nc e, that he ha d a cce ss t o and rev iew ed

the cla im s f

ile pri or t o mak inghis assessment. Id. As to Mrs. D'Aries argument regarding t he benefit of the doubt doctri ne, the Se cre tar y c onten ds that th e d oc tri ne is a stat uto ry c on str

uc t ap pli cab le o nly

to t ho se who are adjudicat ing a clai m, not to m edical p ro fes si on als render ing opinions. Secr etary's Br. at 18. The7

Secretary next rejects Mrs. D'Aries "treating physician" argum ent, asserting that, not only has she
no t ci ted any a uth ori ty to supporther ar gum ent, b ut a lso sh e h as i gn ore d th is C ourt' s expre ss rej ect ion o f su cha ru le in Va n Sl ac k v. Brown , 5 Vet.App. 499 (1993), and Guerrieri v. Brown , 4 Vet.App. 46 7 (1 99 3). Secreta ry's Br. at 19-20. The Secret ary further ar gues that any r eliance by Mrs. D'Aries on Padgett v. Nichols on , 19 Vet.App. 133 (2005), withdrawn , 19 Ve t.A pp . 3 34 (20 05 ),
rev 'd an d rem an de d, 473 F.3d 1364 (Fed. Cir. 2007) , is misplaced, as that decisi on was withdrawn,
an d, in anyev ent, t

hat po rti on

of the w ith drawn

d eci sio n on

whic h s he rel ies do es n ot s up po rt h er po sit ion . S ecr etary' s B r. at 20-21. Finall y, wi th r eg ard to n oti ce, the Se cre tar

y argu es t hat Mr s. D'Ar ie s's cl ai m was in i t i a l l ya d j ud ic at edin19 99 , p ri orto th e p as sa ge of the Ve te ra ns Cl ai ms Assistance Actin 2000, and there fore timely notice was impossible

. S ecretary's Br. at 21. The Se cre tar y no tes that , fo llo wi ngthe en actm ent of the V ete ran s C lai m s A ssi stanc e A ct, Mrs . D ' Ar ies
rec eiv ed co m pli ant no tic e an d w as i nf orm ed that sh e co uld

su bm it a dd iti on al e vid en ce t o substanti ate her cl aim. Id. The Secre tary asks the Court t o affirm the May 18, 2005, Board deci sion.

II. AN AL YS IS A. Ad eq ua cyof the Med ica l E xam inatio n S ou ght by the Bo ard Th e te x t o f

3 8 U

. S

. C

. § 7 1 0 9 (a ) p ro v id e s : " Wh e n , in th e ju d g m e nt o f

th e B o ard , m e d ica l expert opini on . . . is warrant ed by the medical complexity or contr oversy in an appe al case, t he Board may secure an advisory medical opini on . . . ." The i mplem enting regulati on for sect ion 7109 pro vid es t

hat "[ t] he Bo ard

m ayob tai n a

m ed ica l op ini on

fr om anap propriate heal th c are professional i n t he Veterans Heal th Administration or t he Department of Veterans Affairs on
m ed ica l qu est ion s invo lve d in the co ns ide rat ion

of anap pe al whe n, in i ts j ud gm ent, s uc h m ed ica l expertis e is needed for equi table dis position of an appeal ." 38 C.F.R. § 20.901(a) (2007). When the Board relie s on such an opinion, t hat opinion must be adequate to allow judi cial re view. Se e Gree n v. De rw ins ki , 1 Ve t.A

pp . 1 21 , 1 24 (19 91 ) (h old ingthat re m an d is ap pro pri ate wh ere the Bo ard rel ied
on anina de qu ate m ed ica l ex am inatio n re po rt) ; see also Hicks v. Brown , 8 Vet.App. 417, 422 (1995) (co nc lud ingthat an

ina de qu ate m ed ica l evaluation fr us trates jud ici al r ev iew ). An o pin ion is adequate where i t is based upon c onsiderat ion o f the veteran's priormedical history and examinations and also des cribes t he disabil ityin sufficient deta il so thatthe Board's "evaluat ion of the cla im ed

dis ab ili ty w ill be a f

ull y in fo rm ed

on e. " Ardison v. Brown , 6 Vet.App. 405, 407 (1994)The C our t f i nd s i t n ec es s ar y t o po i nt o ut t ha t t hi s i s s ue was r ai s ed b y co un s el f or t he f i r s t t i me on a pp ea l

. A t or al 2
ar gum ent , couns el f

or M r s. D ' A r i es conc eded t hat he ha d not r ai se d t hi s pr eci se i ss ue t o t he B oar d, al t hough he a ss er t ed t hat i t w as t he B oar d' s f ai l ur e t o pr ovi de D r . Q ui nn' s cur r i cul um vi t ae t hat pr event ed hi m f r om doi ng s o. H ow ever , t he r ecor d r evea l s t hat couns el s ought c l ar i f i cat i on of

D r . Q ui nn' s "qua l i f

i cat i ons" by r eques t i ng hi s cur r i cul um vi t ae f r om t he B oar d i n a D ece m ber 2004 l et t er , as w el l as i n an A pr i l 2005 l et t er . R

. at 284, 292. T he B oar d r es ponded t hat i t had "no i nf or m at i on on D r . Q ui nn" and t her ef or e c oul d not pr ovi de hi s cur r i cul um vi t ae, a n i ss ue t hat c ounse l r ai se d t o t he B o a rd , b u t w h ic h th e B o a rd fo u n d m e ritl e ss . R . at 2 8 8 ; se e R

. at 8. H ow eve r , i n the D ecem ber 20 04 l et t er, cou nsel al so re q u e ste d a c o p y o f th e e n g a g e m e n t le tter th e B o a rd se n t to t h e P o rtlan d V A fac ili ty , a n d he re c e iv e d th a t d o c u m e n t i n ear l y A pr i l 2005. R

. a t 288, 291. I t i s cl ear t hat c ounse l ha d not i ce t hat t he B oar d r eques t ed a m edi cal opi ni on f r om an i nt er nal m edi ci ne s peci al i st , and t hat he ha d a c opy of D r . Q ui nn' s r epor t , w hi ch r evea l ed hi m t o be a m em ber of t he neur ol ogy depa r t m ent of t he Por t l and V A M edi cal C enter
. R

. at 28 8, 291- 92. Fur t her , i n an A pr i l 2005 l et t er t o t he Bo a r d , wh i l e i n p o s s e s s i o n o f b o t h t h e Bo a r d ' s e n g a g e me n t l e t t e r a n d Dr

. Qu i n n ' s o p i n i o n , c o u n s e l o bj e c t e d t o s o me a sp e c ts o f D r. Q u in n ' s o p in io n

– b u t n o t spe ci f i cal l y t o hi s spe ci al i t y–and r eques t ed t hat t he B oar d " ret urn the case t o D r. Q ui nn f or hi s r evi ew of

t he e nt i r e c l ai m s f

i l e a nd a ne w opi ni on w hi ch t akes i nt o c onsi der at i on t he be nef i t
- of

- t he- doubt doct r i ne . " R

. a t 2 92 ( emph as i s a dd ed )

. I f c ou ns el wer e co nc er ne d ab ou t t he p r op r i et y of t he Boa r d r el yi ng o n t he o p in io n o f a n e u ro lo g ist in ste a d o f a n in te rn a l m e d ic in e sp e c ia list, on e is h a rd p re s s e d to u n d e rs ta n d w h y h e w o u ld 8 (quoting Green , 1 V e t. Ap p . at 1 2 4 ). Wh e th e r a m e d ic a l o p in io nis a d e qu ate is af in d in g o f f act , which the Court re views under the " clearly err oneous" standa rd. Se e 38 U. S. C. § 7 26 1(a )(4 ); Gi lbe rt
v. De rw ins ki , 1 Vet.App. 49, 52 (1990). "A factual f inding 'is "clearly erroneous" whe n alt hough there is evidence to s upport it, t he re viewing c ourt on the entire evidence is l eft with the de finite and fi rm c onvic tio n that a

m ist ak e ha s be enc om

m itt ed .' " He rse

y v. De rw ins ki , 2 Vet.App. 91, 94 (1992) (quoting United States v. U.S. Gypsum Co. , 333 U.S. 364, 395 (1948)). In r endering its deci sion, the Board i s require d to provide a wri tten sta tement of the reasons or bases for it s "findings and c on cl us io ns [] on all m ateria l issues of fact and l aw presented on t he
rec ord ." 3 8 U .S .C . § 71 04 (d) (1) . T he statement must b e ad eq uate t o e na

ble a cl aim ant to
un de rst an d th e p rec ise ba sis fo r th e B oard' s d eci sio n, as w ell as t o f aci litat e re viewin t

his Co urt
. Se e G ilb ert , 1 Vet.App. at 57. To comply with this requir ement, the Boardmust analyze the credibil ity and probat ive va lue of the e vidence, account for the evidence that itfinds to be persuas ive or unpersuasi ve, and provide the r easons for its rej ection of any materia l evidence favorable to the claimant. See Caluza v. Brown , 7 Ve t.A pp . 49 8, 5 06 (1 99 5). Th e Bo ard m ayc om m it r em an da

ble error when itfails to provide an adequate st atement of its reasons orbases. Se e G ilb ert , 1 Vet.App. at 57. 1. En tit lem en t to Co mp lia nc e w ith theOc tob er 2 00 4 E ng agem en t L etter Mrs. D'A ri es fi rs t a rg ue s tha t t he medi ca l a dv is ory o pini on was inadequate be cause, although the Board reques ted the opini on of an "internal med ic ine specia list," it rece ived the opini on of a neurologist

. She asserts that thi s is a viol ationof this Court's ruling in Ste ga ll v . We

st , whic h h eld 2req u es t t h at the n eu rolog i st pro v i d e a se co n d , m o re t h o rou g h , o p i n i o n . A s it i s o b v i o u s tha t co u n se l ha d t h e n ec es sa ry

i nf or m at i on t o m ake t hi s ar gum ent i n a t i m el y m anner t o t he B oar d, t he C our t ca n onl y s pecul at e a s t o w hy he di d not do so. Th e C ou r t r em i nd s cou nsel t hat i t has di scr et i on r ega r di ng w hether t o ent ert ai n an ar gu m ent r ai sed for t he fi r st t im e o n a p p e a l ( se e M aggi t tv. West , 2 0 2 F .3 d 1 3 7 0 , 1 3 7 7 -7 8 (2 0 0 0 )), an d th a t t h e C o u rt h a s c h o se n to d o so in th is i n s t a n c e s h o u l d n o t b e i n t e r p r e t e d b y c o u n s e l a s a p p r o v a l o f h i s f a i l u r e t o r a i s e a k n o wn i s s u e b e l o w. 9 that an orde r from this Court or the Board re manding an appeal for further acti on and adjudicat ion
co nf ers up on a cl aim ant th e ri ght to com pli an ce w iththat

orde r. 11 V et. Ap p. 26 8, 27 1 (1 99 8); see also Co lay ong v . We

st , 12 V et. Ap p. 5 24 , 53 3-3 4 (19 99 ) ( ho ldi ngth at rel ian ce byth e Bo ard on a medical report tha t did not comply with the Board's remand order was improper). Th e S ecr etary, in c ontra st, wo uld hav e u s f

ind that Ste ga ll do es n ot a

pp ly because an engagement letter from the Board to a VA medical center r equesting a med ic al opinion or examination under sect ion 710 9 an d § 20.901 is factually dist inct from a remand decision by the Bo ar d , an d

c o n s e qu e ntl yc ann o t b e g iv e nth e s am e auth o ri tati v e w e ig h t. H o w e v e r i ntr igu in g thi s qu est ion , it is on e the C ourt ne ed n ot ad dre ss in o rde r to res olv e th is c ase . T his is s o b eca us e, ev en ass um ingthat Ste

ga ll co ntro ls , o n lysubs ta nt ia l c ompl ia nc e w ith the te rms of the Boa rd 's engagement lett er would be require d, not stri ct compliance. Se e Dy me nt v. Wes t , 13 Vet.App. 141, 14 6-4 7 (19 99 ) ( ho ldi ngth at the re was no Stegall vio lat ion wh enthe ex am ine r m ad e th e u lti m ate de ter m inatio n req

uir ed b y the Bo ard ' s re m an d, be cau se s uc h d ete rm inatio n "m ore than s ub stanti all y co m pli ed wi th t he Bo ard ' s re m an d o rde r")

. App lyi ngth is rul e to the in stant cas e, the Co urt fi nd s, as d id t he Board, that

Dr. Qui nn ' s op ini on

was suf fi cie nt to reso lve the iss ue fo r whic h an a dv iso ry medi ca l o pi ni onwa s r eque st ed . T he re for e, th er e h as be ensubs ta nt ia l c ompl ia nc e wi thth e B oa rd 's engagement letter. Fi rst , the Boar d e xp lic itl y re co gn ize d in its de cis ion

that D r. Q uinn' s "s pe cia lty[i n neurology] alone re nders him qualified t o addre ss the effects of an or ganic brain disorder." R. at 8. Ad dit ion all y, the Board recounte d D r. Q uinn' s re cit ati on of Mr. D' Ar ies ' s "e xte ns ive m ed ica l his tor y, " as we ll as the do cto r' s tho rou ghexplanatio n and rat ion ale in r eac hin g h is c on clu sio n th at Mr. D'Aries's service -conne cted brai n injurie s did not cause or contri bute to his de ath. Id. The Bo ard co nc lud ed

that, b eca us e D r. Q uinn "p rov ide d a tho rou ghan d d eta ile d o p in io n a b o ut a d iso rde r wi thi n h is area

of e xp ert ise , and

[b eca us e] the op ini on

[w as] co ns ist ent w iththe co m pe tent ev ide nc e o[ f] rec ord ," h is o pin ion

wa s o f " sig nif

icant p rob ati ve va lue ." R . at 6. Finally , th e C ourt t ak es ju di ci al no ti ce of th e fa ctth atne ur ol og y i s the medi ca l s pe ci al tyth atde al s w ith the ne rv ou s s ys te m,10

which includes the bra in. D ORL AND ' S I LL US TR AT ED M EDI CAL D I CT I ONAR Y 12 85 (31 st e d. 20 07 );
seea lso S mi th (B ra dy

) v . D erw ins ki , 1 Ve t.A

pp . 23 5, 238 (199 1) (" Co urt s m aytak e ju dic ial no tic e of facts not subject t o reasonable dispute." ( citing F ED . R. E V ID . 2 01 (b) )). Mr. D' Ar ies's ser vic eco nn ect ed

injur ies we re r elated

to t he he ad an d b rai n, an d a

ne uro log ist

is a sp eci ali st who co uld reasonably be expected to pr ovide the appr opriate medical ana lysis and opi nion t o re so lve t he qu est ion po sed bythe Bo ard

in it s en ga ge m ent le tte r: whe the r Mr . D ' Ar ies ' s se rvi ce- co nn ect ed bra in inj uri es c au sed

or c ontri buted to his de ath . In lig ht o f t his dis cu ssi on , th e C ourt f ind s th at D r. Quinn's opinion substanti ally complied with the t erms of the Board 's October 2004 engagement lette r. Con sequently, eve n assuming that Mrs. D'Aries's argument regarding the applicabil ity of S te ga ll to t his factu al s itu ati on is c orr ect , b eca

us e th e B oard r eco gn ize d th e d ev iat ion fr om its req ue st, tho rou gh ly ana lyz ed the m ed ica l op ini on

pro vid ed , an d pro vid ed

s uf fi cie nt rea so ns f

or i ts relianc e the reon, the st andard of compliance require d by that case has been demonstrated her e and there coul d be no error. Se e S teg all , 1 1 V et. Ap p. at 2 71 ; Dyment , 13 Vet.App. at 146-47. 2. Re vie w o

f th e C lai ms Fi le Mrs . D ' Ar ies s tat es that D r. Qu inn in dic ate d on ly that h e "re cei ve d a ch art on " Mr . D ' Ar ies , wh ich sh e conten ds is ins uf

fi cie nt to com

ply with the B oard' s in str

uc tio n th at the ex am ine r "r ev iew the cla im s f

ile in i ts e nti rety. " R . at 27 3, 28 1. Th e B oard f ound that "[t]he extent to whic h [ Dr

. Qu inn ] r ep ort ed

[M r. D ' Ar ies ' s] ex ten siv e m ed ica l hi sto ry . . . leave s li ttl e d ou bt t hat he rev iew ed the cla im s f

old er. " R . at 7. Th e C ourt a gre es w iththe Board. Fo llo wi nghis ini tia l st ate m ent th at he receive d a chart on Mr. D'Aries, Dr. Quinn summ arized Mr . D'Aries's medical history, s panning more than 50 years. He also re ferenced and quoted from numerous medical r ecords, tes t result s, and tre atm ent no tes. R. at 27 3. In h is c on clu sio n, he stated , "T he rec ord ind icates that [ Mr. D' Ar ies ] sustained asevere head i njury . . . resul ting in chr onic headaches and 'n er vo usness ', but without
co gn iti ve or o the r neurol og ic de fi cit s. " R. at 27 4. As no ted ab ov e, a m ed ica l op ini on m us t be ba sed upon considerat ion of t he veteran's priormedical history and exa minations and also descr ibe the disabili ty in enough deta il for the Board t o be able to make a n in formed decision. See Ardison , 6 Ve t.A pp . at 40 7. Dr . Q uinn' s ad vis ory m ed ica l op ini on

m et this stand ard. Failure by a m ed ica l examiner t o us e th e precise terminology "clai ms f ile" when indi cating the records that he or she
rev iew ed wi ll n ot b e f

ata l whe re, as h ere , it can

b e est ab lis he d fr om

th e fa cts th at the cla im s f

ile wa s, in f act , re vie we d. In l ight of Dr . Q uinn' s th oro ug h re vie w o f M r. D' Ar ies ' s m ed ica l hi sto ry, Mrs

.A t t he t i m e G ilbe rt w as dec i ded, t he be nef i t of t he doubt doct r i ne w as codi f i ed a t 38 U

. S. C

. § 3007( b) and pr ovi ded: 3
W hen, af

t er cons i der at i on of

al l t he evi dence and m at er i al of r ecor d i n a cas e bef

or e [ V A ] w i t h r es pect t o bene f i t s under l aw s adm i ni st er ed by [ V A ] , t her e i s an appr oxi m at e bal ance of pos i t i ve a nd nega t i ve evi dence r egar di ng t he mer i t s of an i ss ue mat er i al t o t he de t er m i nat i on of t he m at t er , t he be nef

i t of t he d o u b t i n re so lv in g e a c h su c h iss u e sh a ll b e g iv e n to th e c la im a n t.
T h at pro v i sion w as am en d ed i n M ay 19 9 1 an d red es i g n ated as 3 8 U .S.C

. § 51 0 7 (b). 11 D' Ar ies ha s no t d em on str ate d that t he B oard' s f

act ua l de ter m inatio n th at D r. Q uinn c om pli ed wi th its request to review Mr. D' Aries's claims file was clearl y erroneous. Se e G ilb ert , 1 Vet.App. at 52. 3. Requirement To Advise a M edical Examiner of

the Benefit

of the Doubt Doctri ne Fi na lly , M rs. D' Ar ies co nte nd s th at D r. Q uinn' s ad vis ory m ed ica l opi nio n w as i na de qu ate be cau se t he Bo ard "vi olated the pri nc ipl es o f f

un dam ental fa irn ess " by

no t in clu din g a

req ue st that the m ed ica l expe rt g ive Mr. D' Ar ies the be ne fi t of the do ub t on

mater ial iss ue s. Ap pe llant' s B r. at 10. Contrary to herargument, however, the benefit of the doubt doc trine i s a legal c onstruct t o be ap pli ed b y an a dju dic ato ry b od y whe n th e ev ide nc e is ap pro xim ate ly b alanc ed , n ot b y a m ed ica l professio na l when re ndering an opini on as to the cause of a veteran's death. Se e 38 U.S.C. § 5 10 7(b ). Th e expre ss lan gu ag e of th e statut e m ak es it c lear th at i t ap pli es o nly to t he ad jud icator y process of the Secretary (and by extension, the Board) in the context of weighing inform ation and evidence. Id. ("T he Se cre tar y s ha ll c on sid er a ll i nf

orm ati on an d lay and

m ed ica l ev ide nc e o f r eco rd in a case before t he Secretary . . . . When there i s an approximate balance of positive and negat ive evidence regardi ng any issue material to the determ ination of a m atter, theSe cre tar y shall give the be ne fi t of the do ub t to the cla im ant." (em ph asi s ad de d)) . F urt

he r, t his Co urt ha s exp res sly

held that the benefit of the doubt doc trine " does not app ly during the process of submitting and gathe ring
ev ide nc e. " Gi lbe rt , 1 Ve t.A pp . at 55

. Th e B oard w as t he ref ore un de r no ob lig ati on

to re qu est

that 3 the medical expert gi ve the benefit of the doubtto the ve te ra n, a nd , in fact, could not ha ve ap pro pri ate ly r eq

ue ste d th at h e d o s o b ecause the be ne fi t of the do ub t do ctr ine is n ot a pp lic ab le during the evi dence-gathe ring phase of a case

. See id. T he ref ore , the C ourt fi nd s n o e rro r on thi s point. Fo r th ese rea so ns , the C ourt fi nd s that t he m ed ica l e xam inatio n pro vid ed b y Dr . Q uinn w as adequate for rating purposes, and that the Board's explanati on for f inding thatopinion credi ble and adequate for rat ing purposes i s supported by adequate reasons or bases. Se e G ilb ert , 1 Ve t.A pp . at12

57. Therefore, the Board's reli ance on Dr. Quinn's opinion was not clearl y erroneous. See Ardison , 6 V et. Ap p. at 4 07 ; Gi lbe rt , 1 Vet.App. at 52.

B. W eig ht A ssi gn ed

to t he Op ini on

of Mr. D' Ar ies ' s T reatin g P hy sic ian Th e B oard i s p erm itt ed

to f av or o ne m ed ica l op ini on ov er ano the r pr ov ide d it giv es an adequate st atement of its re asons a nd bases for doing so. Se e S im on v. De rw ins ki , 2 Vet.App. 621, 622 (1992). The Board, of course, must explain its choice in a manner adequate to enable a claimant to u nd ers tan d th e pre cis e bas is f or th e Bo ard ' s d eci sio n, as w ell as t o f aci lit ate rev iewin t

his Co urt
. See G ilb ert , 1 Ve t.A

pp . at 57

. C red ibi lity de ter m inatio ns are fi nd ing s of f act to b e made by the Board. See Layno v. Brown , 6 Vet.App. 465, 469 (1994) (finding that the weight and cre dibilit y of
ev ide nc e "i s a fa ctu al de ter m inatio n go ingto the prob ati ve valu e of the ev ide nc e to be m ad e af ter the ev ide nc e h as b een

adm itt ed "); see also Was hing ton v. Nic holson , 19 Vet.App. 362 (2006) (ho ldi ngthat it

is the Board' s re spo ns ibi lity to de ter m ine the ap pro pri ate we ight to be giv ento evidence). The Boar d's assessment of the credibili ty and weight to be given to evide nce is a finding of fact that the Court r evie ws u nd erthe " clearl y erroneous" standard of revi ew. 38 U.S.C. § 7 26 1(a )(4 ); Woo d v . D erw ins ki , 1 Ve t.A pp . 19 0, 19 3 (1 99 1); Gi lbe rt , 1 Vet.App. at 52. Mr s. D'Ari es arg ue s th atthe Boarderr edby no t gi vi ng add it io na l we ig htto Dr . M c Cab e 's op ini on in l ight of

his rol e as Mr . D' Ar ies ' s per so na l phy sic ian . In do ingso , M rs. D' Ar ies ign ore s this Court's express rejecti on of a "rule that gives the opinions of treati ng physicians great er weight in e va luatin g c lai m s m ad e b y v ete ran s. " Gu err ier i , 4 Ve t.A pp . at 47 3; seeals o V

an Sla ck, 5 V et. Ap p. at 5 02 ; Harder v. Brown , 5 Ve t.A pp . 18 3, 1 88 (1 99 3). Ad dit ion all y, th e Co urt n ote s th at, byD r. McC ab e' s own adm iss ion , he w as no t M r. D' Ar ies ' s tre ati ngp hy sic ian f or t he bra in and

he ad injurie s at issue in this case. R. at 233. Mrs. D'Aries's reliance on this Court's decision i n Pa dgett , 19 Vet.App. 133 (2005), withdrawn , 19 Vet.App. 334 (2005), rev 'd an d rem an de d, 473 F.3d 1364 (Fed. Cir. 2007), is misplaced because she misstate s the holding of tha t case . Pa dgett gave no special wei ght to the medical opinions in that case based on a physi cian's role as treating phys ician. Se e Pad ge tt , 19 Vet.App. at 148. Turning to the ge neral issue of the weight afforded by the Board to Dr. Mc Cabe's opinion, the Court finds no error. In assigning "essenti ally no probat ive va lue" to Dr. Mc Cabe's opinion, the Board engaged in extensive discussion of the conf licti ng m edical evi dence of record. R. at 6- 8. The Bo ard fou nd that it cou ld n ot d ete rm ine wh eth er D r. M cC ab e h ad rev iew ed Mr. D' Ar ies ' s cl aim s f

ile13

bef ore ren de rin g h is O cto be r 20 02 op ini on . R . at 6. Th e B oard a lso fo un d th at t he Oc tob er 2002 opinion co nta ine d "v irt

ua llyno rat ion ale " and

fa ile d to ad dre ss h owMr. D' Ar ies ' s m ental de ter ior ati on

led to th e sep sis and

pne um on ia th at ca

us ed his de ath . R . at 6- 7. Furth er, the Bo ard noted "a le vel of incons is tency, with both t he medical evidence and [Dr. McCabe's] own statem ents, " in

the thr ee o pin ion s p rov ide d byDr . M cC ab e. R. at 7 . S pe cif ica lly , th e B oard n ote d that Dr. McCabe's December 1998 opinion include d diabe tes as a significant cause of death, but l eft that cause of death out of his two subsequentopinions. Id. ; see also R. at 179 , 23 3, 262 . The Bo ard also found that Dr. McCabe's December 2000 opinion, in which he sta ted that acombination of hypertensi on, renal disease, and cardiovascular diseas e caused Mr. D' Aries's mental deteriora tion,
co ntr ad ict ed

his Oc tob er 2 00 2 op ini on , in wh ich he stated that co m pli cat ion s f

rom org an ic b rai n synd rom e led to M r. D' Ar ies ' s d ete rio rat ion an d s ub seq

ue nt d eat h. R. at 7 ; see also R. at 233, 262. Ul tim ate ly, the Bo ard

co nc lud ed

that D r. McC ab e "d em on str ate d a wi lli ng ne ss t o re nd er a

m ed ica l op ini on wi tho ut a clo se and acc urate r ev iew " of

Mr. D' Ar ies ' s m ed ica l hi sto ry, and thu s f ound that his opinions l acked probati ve value. R. at 7. Inco ntra st , the Boardfoun d th atDr . Qu in n's op in io n wa s b as edona r ev ie w of Mr . D'A ri es 's
co m ple te c lai m s f

ile , th at he was fam ili ar w ithMr. D ' Ar ies ' s "ex ten siv e m ed ica l hi sto ry, " an d th at he pro vid ed

"a tho rou ghan d de tai led

opin ion abo ut a di so rde r wit

hin his ar ea o f m ed ica l expe rti se" that w as " co ns ist ent w ithco m pe tent ev ide nc e o f r eco rd. " R

. at 6. In l ight of thi s d isc us sio n, an d in light of the fact that it is t he Board, not the Court, that is r esponsible for asses sing the cr edibili ty and weight to be give n to evidence, the Court cannot say that the Board's assignm ent of more probative value to Dr. Quinn's opinion tha n to Dr. McCabe's was clearl y erroneous. See Owens v. Brown , 7 Ve t.A pp . 4 29 , 4 33 (19 95 ); Layno , 6 Ve t
. Ap p . at46 9 . Furthe r, th e C ourtfi nd s tha t the Boa rd 's decision was supported by adequate reasons or ba ses. Se e G ilb ert , 1 Vet .App . at 57 ; Ca luza , 7 Vet.App. at 506. C. Pr ead jud icator y N oti ce Secti on5 10 3( a) of titl e 38, U.S. Code, requires tha t VA inform the clai mant of (1) the information and evidence not of recor d that is necessa ry to substantiate the claim, (2) which porti on of that information and evidence, i f any, the claimant is expect ed to provide, a nd (3) which port ion of that inf ormation and evidence, if any, VA will seek to obtain. 38 U.S.C. § 5103(a). The duty of affirm ative noti fication under § 5103(a) "i s not sati sfied by various post -decisi onal comm unications14

from which a c la ima nt might have been able to i nfer what evidence [] VA found lacking in the cla im ant' s p res entat ion ." Mayfield v. Nicholson , 4 44 F. 3d 1328, 13 33 (F ed . C ir. 20 06 ). W he the r a cla im ant has rece ive d ad eq uate no tic e un de r the Vet erans Cla im s As sis tan ce A ct i s a " su bs tantia lly factual determination" by the Board. Id. at 133 3. Su cha dete rm inatio n is re vie we d und er a "cl ear ly
erro neous" standa rd of review. See Garrison v. Nichol son , 49 4 F. 3d

1 36 6, 1 37 0 (F ed

. Ci r. 2007) (ho ldi ngthat it

is p rop er f

or t his Co urt to r ev iewa B oa

rd f ind ingthat VA c om

pli ed wi th t he no tic e provisions of 38 U.S.C. § 5103(a) under a"clear ly erroneous " standar d of review). Mrs. D'Aries argues tha t the Board erred i n finding that VA complied with its duty to notify
un de r th e V ete ran s C laim s Assis tan ce A ct. Sh e co nte nd s o nly that, b eca

us e th e May 2 00 1 n oti ce letter w as sent a ft er the in iti al ad jud icatio n o f h er c lai m , s he wa s n ot p rop erl y n oti fi ed an d th e B oard
err on eo us ly rel ied

o n a po std eci sio na l d oc um ent i n rea ch ingits co nc lus ion . T he Co urt dis ag ree s. Mrs . D ' Ar ies ' s argum ent fa ils to add res s the fac t th at the ini tia l ad jud icatio n o f h er c lai m

oc curre d in August 1999, more than one year before the Veterans Clai ms A ssistanc e Act was enacted. At t he tim e o f t he Au gu st 1 99 9 a dju dic ati on of Mrs. D'Aries's cla im , VA h ad no duty t o p rov ide su ch predec is ional notice. This Courthas held thatwhere "notic e was not mandated at the ti me of the ini tia l [ Ag en cyof

Or igi na l Juris dic tio n] de cis ion , th e [ Ag en cyof Or igi na l Ju

ris dic tio n] did

no t er r in no t p rov idi ngs uc h no tic e sp eci fi cal ly co m ply ingw iths ect ion

5 10 3(a )/§ 3 .1 59 (b) (1) b eca us e an ini tia l [ Ag en cyo f Or igi na l J uri sd ict ion ] ad

jud icatio n h ad

alr ead y o ccu rre d. " Pelegrini v . Principi , 18 Ve t. App

. 11 2, 1 20 ( 20 04 ). How ev er , whe re , as h er e, ac la im wa s pe nd in g be for e V A a t the ti me of the pa ssa ge of

the Ve ter an s C lai m s A ssi stanc e A ct, VAwa s re qu ire d to pro vid e co m pli ant no tic e and readjudi cate the c laim. Hupp v. Nicholson , 2 1 V et. Ap p. 34 2, 35 0 (2 00 7); seeals o Pric ket t , 20 Vet.App. at 377 (holding t hat a Vetera ns Claims Assistance Ac t ti ming err or could be cur ed by iss uanc e of

com pli ant not ice and

a subs eq ue nt S tat em ent of

the Ca se) ; May

fie ld, 444 F.3d at 1333- 34 (ho ldi ngthat V A c ancure t im ingde fe cts throu ghc om pli an ce w ithpro pe r re m ed ial m eas ure s). VA did this by issui ng the May 2001 noti ce lett er and the Apri l 2002 Supple mental Statement of the Case. The May 2001 notice let ter advis ed Mrs. D'Aries that she could submit additional information and evidence t o support her c laim, and, other than it s timing, Mrs. D 'Aries does not challe nge the ad eq ua cyof that le tte r. T he Co urt

no tes that Mr s. D' Aries submitted ad dit ion al e vid en ce, an d, in Ap ril 2 00 5, throu ghc ouns el, e xp res sly w aiv ed "anyri ght t o have th e ca se r em an de d to the [r ]e gio na l [o]f fice for review of the new evidence and/or argument priorto a deci sion by the Boar d." R. at 291.15

Be cau se VA c ure d anyerr or wi th res pe ct to the ti m ingo f the n oti ce giv en , and be cau se M rs. D' Ar ies do es n ot c ha lle ng e th e su ff ici en cyof the no tic e th at w as u lti m ate ly pr ovid ed , th e C ourt f ind s th at the Boar d did not err in finding thatVA com plied with i ts duty to not ify. See Garrison , 494 F.3d at 1370.

III . C ON CL US ION On considerati on of the foregoing, the May 18, 2005, Board de cision is AFFIRMED.
HAGEL, Judge , concurring i n the resul t: I concur in the conclusion of the Courtthat the
m ed ica l op ini on

pro vid ed byDr . Qu inn

su bs tantia llyco m

pli ed wi th t he ter m s o f t he Bo ard ' s O cto be r 20 04 en ga ge m ent le tte r, and fo r th e re aso ns set

for th in the pe r curiam

de cis ion . I writ e se parat ely only to express my belief thatther e is , in practic al t erms, no difference between a remand decision bythe Bo ard

dir ect ingthat a m ed ica l ex am inatio n o r op ini on be p erf orm ed or o bta ine d and

an en ga ge m ent le tte r is su ed

bythe Bo ard

req ue sti ng th e sam e, an d th ere fo re Ste ga ll co ntr ols in t

his ins tan ce. In my view, the Board's October 2004 engagement letter was as much a directi ve regardi ng the sp eci alt

y o f t he m ed ica l ex am ine r as wo uld be a rem an d de cis ion : Th e letter was sig ne d b y an ag ent of the Se cre tar

y who ide nti fi ed

he rse lf as an "A cti ngVe ter an s Law Ju dg e" ( R. at 2 82 ); i t posed a pa rticul ar medical question to be answered by the speciali st ( R. at 281); the purpose of the requested medical opi nion was to serve as the basis for an adjudi cation by the Board ( see R. at 2 82 ); the chief of staff of a VA m edical ce nter was requi red to comply with th e request by se lecting a physician t o answer t he question pose d ( see Medic al Review Assistance to Board of Vete rans Ap pe als Ca ses , VHA Directive 2000-049 at 1 (Dec. 13, 2000) [ hereinafterVH A D irecti ve]; 69 Fed. Reg. 19,935, 19,936); the re sulting medical opini on had to be returned t o the Board ( see R. at 282; VH A D ire cti ve 20 00 -04 9 at 2) ; an d th e o pin ion wa s, in f

act , u sed –b y th e sam e act ingBo ard
m em be r who req

ue ste d th e op ini on

–a s the b asi s fo r t

he Bo ard ' s ad

jud icatio n o f M rs. D' Ar ies ' s cl aim (R. at 6, 8). My colleague 's contrary s tatement below notwithst anding, I take no position r egarding the Board's com

pet en ce or aut hority under§ 20.901 to specify thata medical examination or opinion be pe rf orm ed or p rov ide d b y a

m ed ica l pr of

ess ion al w itha p art icu lar specialt y, as t

hat is su e n eedV H A D i rec t i v e 2 0 0 0 -04 9 ha s be en sup erse d ed by dir ec t i v e 2 0 0 6 -01 9 , w h i ch r em ain s su b stan t i v ely t h e s a m e . See 4 M edi calRevi ew Ass i st ance t o Board of Vet er ans Appeals C ase s , V H A D ire c tive 2 0 0 6 -0 1 9 (A p r. 3 , 2 0 0 6 ).

16 not be address ed at this time. As is clear from the brief disc ussion above, I s imply see no basis on wh ich to d ist inguis h an in stru cti on in a rem an d d eci sio n th at a

phys ici anof

a p art icu lar

m ed ica l sp eci alt y p erf orm an ex am inatio n o r re nd er an o pin ion fr om anide nti cal ins tru cti on in an engagement letter. Accor dingly, I would hold t hat an engagement le tt erfr om the Board to a VA
m ed ica l f aci lity re qu est inga m ed ica l ex am inatio n o r op ini on co nf ers on a cl aim ant th e ri ght to compliance with the terms of that reque st. Se e S

teg all , 11 Vet.App. at 271.
LANCE, Judge , concurring i n the resul t: I concu r in the r esult re ached by the Court, but write separ ately si mply to state that my colle ag ue , in his concurring stat ement, assum es that t he Bo ard is v est ed wi th t he autho rity to spec if

y the app rop riate m ed ica l exp ert to ans we r the m ed ica l qu est ion (s) fo rm ingthe ba sis of the § 2 0. 90 1(a ) re qu est . A s a c oro llary, he ne ces sar ilya ssum es t hat the Bo ard is c om pe tent to m ak e th at d ete rm inatio n. I do not b eli ev e th at the autho rit ies pre sented to the Court at t his j uncture provide definitive support for either pr oposition. Co mp are 38 C.F.R. § 20.901(a) (prov idi ngthat th e B oard, in i ts d isc ret ion , m ayob tai n a m ed ica l op ini on

fr om "an appropriat e health ca re profe ssi on in t he Ve ter an s H eal th A dm ini str ati on [( VH A)] or the Department of Veterans Affairs"), wi th Med ica l R evi ew

Assis tan ce to Boa rd

of Vetera ns Ap

pe als Ca ses , VHA Directive 2000-049 1-2 (Dec. 13, 2000) ("[The Board] w ill selectVAm edical cente rs wi th the 4 ap pro pri ate m ed ica l expe rti se i nd icated in the listi ng[pr ov ide d byVH A] . E ach [B oard] req

ue st w ill cle arl y and

co nc ise ly s tat e th e medical questi ons(s) for which a medical advisory opinion is being sought ." ( emphasis added)), and Board of Veterans' Appeals: Rules of Practice–Medic al Opinions from the Veterans Health Administration, 69 Fed. Reg. 19,935, 19,936 (Apr. 15, 2004) (co dif ied at 38 C.F.R. § 20.901(a)) ("[T]he ultimate select ion of the physicia n asked t o rende r the opinion is l eft to t he Of fi ce o f t he Ch ief of Staf f of that fac ili ty. In o the r w ord s, the sel ect ion of the phys ici anis a proc ess t hat i s in fact over seen by VHA managem ent."), and 38 U. S. C. § 7 10 9(b ) (p rov idi ngthat, in the cas e of a n indepe ndent medical opinion, "the actual selecti on of the expert orexperts t o give the advis ory

m ed ica l op ini on

in an in div idu al c ase sh all be m ad e b y an a pp rop riate o ff

ici al o f s uc h ins tit uti on "); seeals o Stefl v. Nic holson , 2 1 V et. Ap p. 1 20 , 1 24 (20 07 ) (h old ingthat th e B oard m us t17

consider whethe r a medical opinion cont ains "such s ufficient information that itdoes not requi re the Bo ard to e xe rci se i nd ep en dent m ed ica l ju dg m ent") ; McLendon v. Nicholson , 20 Vet.App. 79, 85 (20 06 ) (n oti ngthat "the degree of

. . . in jur y and wh eth er anydis ab ili tie s re su lte d th ere fr om are m e d ic a l a s s e s s m e nts th at t h e B o ard is n o t c o m

p e te nt t o re n d e r i nth e f

ir s t i n s tan c e "); Colvin v. De rw ins ki , 1 Vet.App. 171, 175 (1991) (holdi ng that the Boar d may only con si de r independent
m ed ica l ev ide nc e an d m ayno t sub sti tut e its own me dic al op ini on ). Ho we ve r, as Mrs. D' Ar ies ha s failed to pers uasively ar gue that the medical opinion the Board r eceived was ina dequate or that the Bo ard did no t pr ov ide an ade qu ate stat em ent of rea so ns or b ase s su

pp ort ingits de cis ion

to u lti m ate ly rely on thatopinion, we need not addr ess these i ssues at this time.