THI S VERSI ON I CL UDES THE ERRATAS DATED 15SEP00 AND 17OCT00-e
UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

No. 99-347
M ER L E D. S TO NE , A PP EL L ANT ,

V
. H ER SH EL W. G OBER , A C TI NG S EC RE T A RY O F V ET ER A N S A FF A I RS , A PPEL L EE
.

On Ap pe a l f ro m th e B oa

rd of Ve te ra ns ' Ap pe a ls
(De cided Sep 11, 2000)

Jame s J. W all, of Wilmi ng ton , N .C. , w a s o n th e ple a din g s f or the a pp e lla nt. Robert E. Coy , A c tin g Ge ne ra l Co un se l; Ro n G arv in , A ssi sta nt G e ne ra l Co un se l; Carolyn F. W ashington , Deputy

Assistant Gener al Counsel; and Mi c ha e l R . S

ma lls , all of Washington, D.C., wer e on the plea dings f

or the a ppellee.
Be fore FARL EY, I VERS, and GREENE, Judges

. I VERS, Judge : T he a

pp e lla nt, Me rl e D. Sto ne , w ido w o f v e te ra n Pe rc y V. Sto ne , a

pp e a ls a Fe bruar y 4, 1999, decision of the B oard of Veter ans' Appea ls (BV A or B oard) that denied se rvice connect i o n fo r t h e cause of the ve tera n' s death. Rec ord (R.) at 10. Both the Sec reta ry and the

ve te ra n h a ve fi le d b ri e fs . T his a pp e a l is tim e ly , an d the Court ha s juri sd ic tio n p ur su ant t o 3 8 U .S. C. § 7252(a) and 7266(a ). F or the reasons set forth below, the C ourt will vacate t he Board' s Fe bruar y 4, 1999, decision and r emand the matter.

I. F AC TS Th e ve te ra

n, Pe rc y V. Sto ne , s e rv e d o n a c tiv e du ty in t he U. S. Ar

my fr om Oc tob e r 19 43 to J anuar y 1946. R. at 14. The re cord r efle cts that the vete ran se rved w ith the 62nd Signal B attalionin the Hiroshim a area from October 22, 1945, to Dec ember 27, 1945. R. at 3, 14, 97. The ve tera n was fir st diag nosed with ca rcinoma at a private hospital in S ep t em b er 1978. R. at 18-24. The

ve te ra n w a s hosp ita lize d at the loc a l VA me dic a l ce nte r se ve ra l time s, inc lud ingDe c e mbe r 1 97 8 to J anuar y 1979 (R. at 83-90) a

nd in Febr uary , May , J une, and J uly 1979 (R. at 61-70, 75-82, 85) . There is no me n t ion in any

of the ve tera

n' s service medical r ecor ds (SMRs) of exposure to radiation during service

. R. at 61- 70, 75-82, 83-90. The veter an' s SMR s are available (R. at 46-59), but may be incomplete be cause a repor t from the National Personnel Recor ds Center (N PRC ) indicate s that the fi re a t the NPR C build ing in St. L ou is, Mis so ur i in 19 73 c a us e d some of

the ve te ra

n' s r e c or ds to be destroyed or lost. R. at 92. The ve tera n' s available SMRs ref

lect that he did not have any diseases of the liver, c olon, or rec tum and no car cinoma on any part of his body

during service . R. at 46-59. Th e v e te r an d ie d o n Se p te mb e r 1 1 , 1 9 7 9 , w it h th e im me d iate c a

u s e o f d e a th li sted as

car diorespiratory

arr est. R. 101. Carcinoma of the re ctum with metastasis to liver was listed under "ot her s igni fi cant con di ti on s con tr ib ut in g t o deat h bu t no t rel ate d to caus e." Id. The ve tera n was not service connec ted for a ny disability at the time of his death. I n O c to b e r 1 9 8 6 , th e a

p p e ll an t f il e d a c la im f

o r s e r v ic e c o n n e c ti o n f

o r th e cause of the veter an' s death. R. at 37-40. The cl ai m wa s d en ied in an unappe aled Septembe r 1987 rating decision. R . at 111-12. Af ter the de cision, the reg ional office (RO) notified the a ppellant that substantive chang es had be en made to the laws and r egulations gove rning radiatio n cl ai m s
. R

. at 114-16. In J une 1993, in re sponse to the RO' s notice, the a ppellant fil ed a new claim for se rvice

connec tion for the cause of the ve tera n' s death. R. at 118, 120. The RO reque sted an e stimate from the Def ense N uclea

r Ag ency (DNA ) of the possible r adiation dose that the ve tera n might have

rec eived f rom his service in the vi cinity of Hiroshima. R. at 30. DNAdeter mined that the veter an
was e x posed to a maxi mum of .03 rem g amma radiation a nd no neutron ra diation, resulting in a total possible expos ure of

less than 1 re m. R. at 140. I n J une 1996, VA Chief Public Health and Environme ntal Hazards Of fice r, Susan H. Mathe r, M.D., M.P.H., on behalf of the Under

Secre tary for Health, determined that "it is unlikely that the [veteran' s] carcinoma of the rec tum a nd anal a rea can be attributed to exposure to ioniz ing r adiation i ns erv i ce
. " R

. at 1 5 3

. I n J u l y 1 9 9 6 , t h e U n d er S ec re t ary fo r B en ef i t s , af t er re v i ew i n g Dr

. M at h er 's

o p i n i o n , d e t e r

m i n e d , " A s a

r e s u l to f t h i s o p i n i o n , an d

f o l l o w i n g r e v i e w o f

t h e e v i d e n c e i ni t s e n t i r e t y, it is our opinion t hat there is no reasona ble possibilit y

that the veter an' s disability was the r esult ofsu c h e xpos ur e ." R. at 15 5. Th e RO , r e lyingupon Dr. Mathe r' s o pin ion , d e nie d th e c la im i n July

1996. R. at 157-59. The a ppellant appe aled the denial. R. at 183-85. The a ppellant noted in her VA F orm 9: Whil e the theor

y of a thre shold dose of ionizi ng radiation, below which ther e wa s no car cinog enic e ffe ct, was g ener ally acc epted in the pa st, the co n s en s u s today is that any le ve l of ra diatio n to da

y is p ro ba bly ha rm fu l, in the se ns e that e xpos e d in div idu a ls run incre ased risks of developing maligna nt dise ase.
. . . Fur

thermore aft er recent rea dju s t m en t o f the ra diation doses rec eived by atomic bomb survivors in J apan, a g rowingdebate about per

missibl e exposure levels has r ece ntly led to call [sic] many sc ie nti sts fo r t

he sta nd ard se tti nga g e nc ie s to low e r t he pe rm iss ibl e le ve ls.
R

. at 1 8 5

. (C i t i n g Gordy-G ray, Attorney's Textbook of Me dicine. ) I n Fe bruar

y 1998, the B oard r emande d the claim, with the instruction, a mong others, that the claim was to be retur n ed t o Dr . Mather so that she could consider the appe llant's c ontention that

rec ent scientific de velopments wer e pertinent to the question, and addre ss whether there had bee n any interveningscienti fi c d ev el opments that would alter he r finding s or conc lusion. R. at 190. Dr. Mathe r, i n a S eptember 4, 1998 memorandum, responded, "We are not awar e of a ny signific ant scientific de velopments reg arding the re lationship between ionizing ra diation and the deve lopment of re ctal or a

nal ca rcinomas since our pre vious opinion dated J u n e 1 3 , 1 9 9 6

. " R. at 205. Dr. Mathe r' s o ri g ina l op ini on , that it was un lik e ly that th e ve te ra

n' s c arc ino ma

c ou ld b e a ttr ibute d to exposure to ioniz ing r adiation in service , rema ined uncha ng ed. Id. The RO, in compliance with r emand instructions f rom the B oard ( R. at 188-91), re quested that the appe llant submit the autopsy repor t and the vete ran' s medical tre atment re cords f rom his final ho sp i t a l i z a t i o n
. R

. a t1 9 3

. T h e R O i n f o r m e d t h e a p p e l l an tt h a tb e c a

u s e t h e r e qu e s t e d

d o c u m e nts

wer e held by

a private hospital, she would have to acquire the re cords a nd submit t hem. Id. The

rec ord does not indicate that the appe llant has submitted the reque sted rec ords. Th e B oa rd , in the de c isi on

he re on a pp e a l, d e nie d s e rv ic e c onne c tio n f or the ve te ra

n' s c a us e of death. R. at 3.

II. AN AL YSI S A. Adequate Reasons or B asesSe rv ic e c onne c tio n ma y be g ra nte d fo r a ve te ra

n' s c a us e of de a th if

a dis a bil ity c a us ingde a th

occur red dur ing se rvice or if a se rvice -conne cted disabili ty either c aused de ath or c ontributed substantially

and materially

to the cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312 (1999). Se rv i ce co nnection for

canc er w hich is claimed to be attributable to ioniz ing r adiation exposure during service can be establi s h ed i n t hree differ ent way s. Ramey v. Br own , 11 Vet.App. 40, 44 (1 99 6) . F ir st, un de r 38 U. S.C. § 111 2( c ) t he re are 15 ty

pe s o f c anc e r whic h c an b e pr e sumpt ive ly

se rv ic e c onne c te d. Se c on d, 38 C.F .R. § 3 .3 11 (b ) ( 19 99 ) pro vide s a lis t of " ra dio g e nic dis e a se s" wh ic h w ill be se rv ic e c onne c te d if c e rt ain condit ion s sp e c if ie d in the re g ulatio n h a ve be e n me t. Third, direc t service co n n ec tion can be e stablished by "show [i ng ] t hat the disea se or mala dy was incurre d d u ri ng or ag g ravated by service ," a

task that " includes the diff icult burden of tr acing

caus ati on to a con di ti on or ev ent du ri ng ser vi ce." Com be e v . B ro wn , 34 F.3d 1039, 1043 (F ed. Cir. 1994). T h e B o ar d

d e n ie d d ir e c t s e r v ic e c o n n e c ti o nf

o r th e v e te r an ' s c a

u s e o f d e a th , c an c e r

o f the

rec tum. R. a t 6

- 7 , 1 0

. Re c ta l c an c e r is n o t o n e o f

th e 1 5 d is e a s e s s u

b je c t t o p r e s u mp ti v e s e rvice

connec tion under 38 U.S.C. § 1112(c) and i ts impl ementing regulation 38 C.F.R. § 3.309(d). Rec tal

canc er, is howe ver, a

"r adiog en i c d i s ease" listed in 38 C.F.R. § 3.311(b)(2). Sec tion 3.311(b)(1)

c on c e rn ingini tia l r e vie w o f c la ims pr ov ide s: (b)( 1) When it is determined: (i ) Ave te ra

n w a s e xpos e d to ion izin g ra diatio n a s a re su lt o f p art ic ipatio n in the atmospheric testing of nuclea r weapons, t he occupation of Hiroshima or Nag asaki, Japan, from September 1945 until J uly 1946, or other a ctivities as claimed; (ii) The ve tera

n subsequently

develops a

radiog enic disea se; and (i ii) Suc h d ise a se fi rs t be c a me manife st w ith in t he pe ri od sp e c if ie d in para g raph ( b ) ( 5 ) o f th is s e c ti o n ; b e f o r e it s a d ju d ic a ti o n th e c la im w il l be re fe rr e d to the Un de r S e c re tary fo r B e ne fi ts f

or fu rther c on sid e ratio n in ac co rd an ce wi t h p ar agr ap h ( c ) o f t h i s s ec t i o n
. I f a n y o f t h e f o re go i n g 3 require ments has not bee n met, it shall not be determined that a disease ha s resulted f rom exposure to ioniz ing r adiation under such circ umstances. The ve tera

n satisfies all of the re quirements of se ction 3.311(b)( 1): the vete ran se rved a s part of the

oc c up a t i o nf

o r c e a tH i r o s h i m a

d u r i n g t h e r e qu i s i t e t i m e p e r i o d ; an d h e d e v e l o p e d

a r a d i og e nic dis e a se , c anc e r o f t

he re c tum , th a t manif

est ed it self mo re tha

n 5 y e ars a ft e r e xpos ur e purs ua nt t o
se c tio n 3 .3 11 (b )( 5) (i v) . Se c tio n 3 .3 11 (c ) o f t itl e 38 , Co de of F e de ra l Re g ulatio ns pr ov ide s:(1 ) Wh e n a c la im i s f

or wa rd e d f or re vie w p ur su ant t o p aragr a ph(b )( 1) of

thi s section . . . the Under Secre tary for Be nefits shall consider the claim with re fer ence to the fac tors specifie d in para g raph ( e) of this section and may

reque st an advisory medical opinion from the U nder Sec reta ry of He alth. (i) I f after such consideration the Under Secre tary for B enef

its is convinced sound scientific and medical evidence supports the conclusion it is at least a s lik e ly a s n ot t he ve te ra n' s d ise a se re su lte d f

ro m e xpos ure t o ra diatio n in service , the Under

Secre tary for be nefits shall so inform the re g io nal offic e in writing . . . (i i) I f the Un de r S e c re tary fo r B e ne fi ts d e te rm ine s th a t th e re is n o r e a so na ble po ssi bil ity that

the ve te ra

n' s d ise a se re su lte d f

ro m r a diatio n e xpos ur e in service , the Under

Secre tary for Bene fits shall so inform t he reg ional office in writing, se tting for

th the rationale for this conc lusion. (2) I f the Unde r Secr etar

y for B enef

its, after consi deringany

opinion of the Under Secr et ar y for He alth, is unable to conc lude whethe r it is at least as likely or not, or that there is no rea sonable possibili ty , the veter an' s disease resulted from ra d i ati on exposure in service , the Under S ec re tary for B enef

its shall refer

the matter to a

n outside consultant in acc ordanc e with par agraph ( d) of this section.
Th e B oa rd in i ts d e c isi on

state d: When presente d with the facts of this claim, a medica l doctor and r epre sentatives of the VA Unde r Secr etar ies for B enef its an d He al t h deter

mined that based on the v e t e r an ' s l o w l e v e l o f e x p o s u r e t o i o n i z i n g r a d i a t i o nw h i l e i ns e r v i c e i ti s " u n l i k e l y" that his carc inoma of the re ctum was the r esult of such e x posure. When pre sented wi th t he a pp e lla nt' s c ite d s c ie nti fi c e vid e nc e , the VAme dic a l do c tor a g a in f ound it

" un lik e ly " the ve te ra

n' s e xpos ur e to ion izin g ra diatio n duri ngse rv ic e re su lte d in his car cinoma. There fore , service connec tion for the vete ran' s car cinoma of the rec tum is n ot w arr ante d o n a

pr e sumpt ive bas is as a

" ra dio g e nic " dis e a se un de r 3 8 C. F .R. § 3.311(b)( 2).
R. at 9. Section 19.9(a) of title 38, Code of F eder al Regulations p ro v i d es , "I f fur ther e vidence or
c lari fi c a tio n o f t

he e vid e nc e or c or

re c tio n of a

pr oc e dura l de fe c t is e sse nti a l f or a pr op e r a pp e llate decision, [the Boa

rd] shall remand th e ca s e to t he ag ency of orig inal jurisdiction, specifying the act io n t o b e un dert aken

. . . . " See also D ouglas v. Derwinski , 2 Vet.App. 435, 443-44 (1992). On b eh al f o f t h e U n d er

S ec re t ary fo r H e a l t h , Dr

. M at h er

o p i n edt h at i twa s u n l i k el y t h at t h e v et er an 's

canc er w as ca

used by his in-servic e ex posure. R. at 153. The Unde r Secr etar y for B enef

its stated, "We have re ceive d a medica l opinion from the Under Secre tary [for Hea lth] , with which we a g ree ,that a dv ise s it is un lik e ly that th e ve te ra n' s c arc ino ma

of the re c tum

and ana l are a re su lte d f ro m hi s exposure to ioniz ing r adiation in service ." R. at 155. This Court has held that the Under Secre tary for Be nefits is not expli citly require d to refe r to the fac tors listed in section 3.311(e), but should, rather, consul t those fac tors as a point of ref ere nce when making rec ommendations to the VARO. Hi lk e rt v . W est , 12 Vet.App. 145, 149- 50 (1999). In this c ase, while the Unde r Secr etar y for B enef

its was not require d to expl icitly consider

eac h of the fac tors in se ction 3.311(e) , the cur sory explanation provided by

the Under

Secre tary for B e ne fi ts did no t pr ov ide a de qu a te ra tio na le fo r the c on c lus ion that the re wa s n o re a so na ble po ssi bil ity

that th e ve te ra

n' s c anc e r w a s ca

us e d by his in- se rv ic e e xpos ur e a s r e qu ir e d b y 38 C.F .R. § 3.311(c) (ii). R. at 155. The Boa rd err ed in r elying upon that opinion and in failing to remand the claim to the Under

Secre tary for B enef

its to request an a dequate rationale for its dec ision. Purs uant t o 38 U

. S. C. § 7104(d) ( 1) , a f i nal deci si on of the Board mu st i ncl ude "a wri tt en st at ement of

the Board' s f

i ndi ngs and con cl usi ons, and the reason s or base s for thos e f i ndi ngs and

conc l usi ons, on al l m at eri al i ss ues of fa ct and l aw pre sen t ed on t he recor d.

. . . " Th i s Court has hel d "t hat the BV A [ m ust] art i cul at e w i th rea sona bl e cl ari t yi t s ' rea sons or bas es' for deci si ons, and i n o r d e r t o f

a c i l i t a t e e f

f e c t iv e j udi ci al r e v i e w, the Bo a r d mu s t i d e n t i f ytho s e f i n d i n g s i t d e e ms
cruc i al t o i t s dec i si on and a ccount for the evi dence whic h it fi nds t o be pers ua siv e or
un persu asive." Gilb er t v. D er winski , 1 V et.A pp . 4 9 , 5 7 (1 9 9 0 ). W h er e th e B o ar d fa ils to fu lfill th is d u ty, th e C o u r t is p r ec lu d ed fro m ef fe ctiv ely r ev iew ing th e a d ju d ica tion
. Meeks v . Br own , 5 V et.A pp . 2 8 4 , 2 8 8 (1 9 9 3 ); Br owd er v . Br own , 5 V et.A pp . 2 6 8 , 2 7 2 (1 9 9 3 ). Th e Board di d not

adequat elydi sc uss i t s r eas oni ng f or con si deri ng i t

unnece ss ary

t o ret urn the cas e t o the U nder Sec ret ary of Ben ef i t s f or a more compl et e ra t i onal e. Th ere i s no art i cul at i on of t he Board' s rea sons for fi ndi ng t he U nder Sec ret ary

of Ben ef i t s' opi ni on conv i nci ng, but r at her

a mere res t at ement of

D r. M at her' s opi ni on i n conj unct i on wi t h the deni al of p res um pt ive s ervi ce
c on ne c t i on . W i thou t su c h a n e xp l an at i on , the Co ur t hol ds tha t

the B VA di d n ot

pr ov i de ad eq ua t e r ea s on s or ba s es f or de ny i ng the v et er an ' s c l ai m, ba s ed on al l the evi de nc e p r es en t ed

.

B . D uty to A ssi st Th e B oa rd fu rt he r n ote d in

its de c isi on

that: The a ppellant has a lso cited to scientific studies which sug g est a c onnection betwe en even e x tremely

low levels of ra diation and subsequent c arc inomas in humans, but as a tr ie r of fa c t, the B oa

rd do e s no t fi nd the se su ff ic ie nt to ra ise a

re a so na ble do ub t in fa vo r o f t he a pp e lla nt. Th e c ite d sci e nti fi c inf or matio n o nly

ind ic a te s su c h a

lin k ispo ssi ble a s a g e ne ra l matte r. Suc h li te ratur e do e s no t pr ov ide su ff ic ie nt guid anc e in resolving the spec ific question pre sented in this case : What is the likelihood that the c anc e r thi s ve te ra

n inc ur re d in the 19 70 s is the re su lt of his e xpos ur e to r a diatio n in the per iod from October to D ece mber 1945 in the Hiroshima ar ea? I n contra st, the VA me d ic a l e xp e rt' s o p in io n is s p e c if ic to th is c la im an d is ma d e a f te r a revie w of the estimate dosag e leve l and other r eleva nt fac ts. R. at 9. The U.S. Court of Appe als for the Fe dera l Circuit held in Epps that "unde r [38 U.S.C .] § 5 10 7( a ), [VA ] ha s a

du ty to a ssi st on ly

those claimants who have esta blished ' well[-] g rou

n ded' (i.e., pl aus ib le) cla im s. " Epps v. Gobe r , 126 F.3d 1464, 1469 ( Fe d. Cir. 1997), cert. de nied , 524 U.S. 940 (1998) ( emphasis adde d). The F eder al Circuit has re cently held: that once a

veter an has pr operly m ade out a well-g rounded c laim for a c urre nt dis a bil ity a s a re su lt o f a

sp e c if ic in -se rvi ce oc c ur

re nc e or a g g ra vatio n o f a

dis e a se or injury , the ag ency ' s duty to assist . . . attaches to the investig ation of all po ssi ble in-servic e ca

uses of that c urre nt disability , including those unknown t o the veter an. Sc hr oe de r v . W

est , 212 F.3d 1265, 1271 (F ed. Cir. 2000) (empha sis in orig inal). The Boa rd found that th e a pp e lla nt' s c la im f

or se rv ic e c onne cti on for

the c a us e of the ve te ra

n' s d e a th w a s w e ll g rounded. R. at 6. The ref ore, unde r Schroede r , the Secre tary was obligated to a ssist t he appe llant in developing her c laim. I n the September

4, 1 9 9 6 statement by

Dr. Mathe r, on beha lf of the Unde r Secr etar y of Hea lth, she s a id

th a t s h e w a s " n o t a

w ar e o f an y s ig n if ic an t s c ie n ti f

ic d e v e lo p me n ts r e g ar d in g the relationship between ionizing ra diation and the deve lopment of rec tal or ana l car cinomas since our previous opinion dated J une 13, 1996." R. at 205. That mere cursor y dismiss al of the possibility of the e xiste nc e of

e vid e nc e be ne fi c ia l to the a pp ell ant 's c la im d id n ot s a tis fy the Se c re tary ' s d

uty to assist. The Secr etar

y h ad a d u t y

to inform the appe llant that she nee ded to submit the studies she relied upon in support of her claim, to attempt to obtain the studies f or Dr. Mather' s consideration in making her deter

mination, or , at a minimum , provide specific citations to the materia ls so that VA could ac cess them in complianc e with the B oard' s remand i n s t ru ctions. I n failing to do so, VA violated its duty

to assist. The Secre tary

also violated his duty to comply with the B oard' s remand ins tr uc tio n th a t D r. Mathe r c on sid e r wh e the r any re c e nt int e rv e nin g sc ie nti fi c de ve lop me nts wo uld alter he r finding s or co n cl u sions in viol ation of Stegall v. W est, 11 Vet.App. 268, 271 ( 1998) (h oldin g "t hat a remand

by thi s Co ur

t or the B oa rd c on fe rs on

the ve te ra

n o r o the r c la ima

nt, a s a matter of la

w, the rig ht t o compliance with the rema nd order s") . Since the B oard f ound theappellant's c laim to be well g rounded, Schroede r require s that the claim be r emande d for the Secre tary to satisfy the duty to assist as to all theories of the c laim. The Court has c onsidered the additional arguments raised in the a ppellant' s brief and finds the m to be wi tho ut m e ri t.

III . C ON CL USI ON After consideration of the appe llant's brief, the Secre tary ' s brief, a nd a re view of the rec ord, the Cou rt ho lds that th e ve te ra

n h a s d e mon str a te d th a t th e B oa rd c omm itt e d leg a l er

ro r whic h w ou ld

war rant rem an d

. T he Court is also not satisfied that the B oard' s decision fulfills the " rea sons or ba se s" re qu ir e me nt o f 3 8 U .S. C. § 71 04 (d )( 1)

. Th e re fo re , the B oa rd ' s F e br ua ry 4, 19 99 , de c isi on

is VACATED a

nd the matter is REMANDED for a djudication consistent with this opi nion.