UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

N O

. 10-3605

R O B E R T L

. T R A F T E R , A P P E L L A N T ,

V

. E R I C K. S H I N S E K I , S E C R E T A R Y O F V E T E R A N S A F F A I R S , A P P E L L E E

.
On Appea l from the B oard of Veter ans' Appea ls

(Arg ued January

30, 2013 Dec ided April 29, 2013)

Daniel G. Curry , of Ka

nsas City , Missouri, for the appe llant.

Jesse B. Gree nstein , Appellate Attorney , with whom W ill A. Gunn , Gene ral Counsel, R. Randall Campbell , Assistant Gene ral Counsel, and N i s ha C. Hall , Deputy Assistant Gene ral Counsel, were on the brief , all of Washington, D.C., for the appe llee.

Be fore HAGEL , MOORMAN, and SCHOEL EN, Judges

. MOORMAN, Judge , filed the opinion of the Court. HAGEL , Judge , filed a separ ate opinion
concur ring in the result.
MOORMAN, Judge : Veter an Robert L

. Traf ter appea ls, throug h counsel, an October 5, 2010, Boa

rd of Veter ans' Appea ls ( Boa rd) decision that denied entitlement to c ompensation under 38 U.S.C. § 1151 for a mental disorder alleg edly due to trea tment occur ring at a VA fac ility

. See Record ( R.) at 3-17. This panel was convene d to decide , in the context of a 38 U.S.C. § 1151 compensa tion claim, whether th e corr ect leg al standard for deter mining if VA must provide a medical examination or opinion is provided under 38 U.S.C. § 5103A(a ) or 38 U.S.C. § 5 103A(d). The Court holds that VA' s application of section 5103A(d) to section 1151 disability compensa tion claims is in keepingwith the statutory lang uag e, prior case law from this Court and the United States Court of Appe als for the Fe dera l C i rc u i t (" Fe dera l Circuit") , and leg islative history

. Howeve r, beca use the Boa

rd misint erpr eted a section 5013A(d)( 2) fac tor, to the detriment of the appellant, rema nd is require d.

I. BACKG ROUND The appellant prese nted two theories of entitlement to compensa tion under section 1151 to the Boa rd: (1) VA failed to timely diag nose and trea t his brea st canc er, which led to the development

or ag g rava tion of his mental disability ; (2) VA misdiagnose d him as having bipolar disorder, which, in turn, cause d or ag g rava ted his mental disability . R. at 8; see M21-1 MR, pt. I V, Subpart ii, ch. 2, sec. G (34)( b) (" Entitlement to compensation under 38 U.S.C. [§] 1151 may be base d on acts of omission as well as acts of c ommissi on.") . I n its Oc tober 5, 2010, de cision, the Boa rd re cog nized "tha t assistance shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is n ec essary to make a decision on the claim." R. at 6 (citing 38 U.S.C. § 5103A(d) and McLendon v . Nicholson , 20 Vet.App. 79 (2006)). How ever , the B oard found that bec ause the rec ord contained no "c ompetent medical evidenc e that additional disability resulted as a conseque nce of neg lige nce, car eless[ness], or other fault on the part of VA, or an event

n o t reasonably fore seea

ble," and the appellant' s lay testimony did not "sa tisfy the criter ia for obtaining a VA opinion or examination," VA was not require d to provide a medical examination or opinion in thi s case

. Id

. On appea l, the appellant asser ts tha t V A should ha

ve provided him with a medical opinion under section 5103A(d), beca use "both the competent medical evidenc e and [hi s] lay testimony –was sufficie nt to ' indic a

te ' that an additional disability (depr ession) resulted from VA medical trea tment." Appellant' s (App.) Br ief (B r.) at 6. I n the alterna tive, and in response to the Court's re q u es t fo r additional briefing , the appellant arg ues that section 5103A(a ) should have been applied to his claim beca use a section 1151 claim does not seek "disa bility compensa

tion," as require d for the application of section 5103A(d). He asser ts tha t, a ccor ding to section 5103A(a ), VA must provide him with a medical o p i n i o n beca

use it is nece ssary to decide his claim and has a rea sonable possibili ty of substantiating his claim. The appellant also contends that the Boa rd improperly substitut ed its own

2medical judgme nt in lieu of obtaining a medical opinion, provided an inadequa te statement of

rea sons or bases f

or its determination, and f ailed to obtain re levant priva te medica l rec ords. T h e Secre tary arg

ues that the application of section 5103A(d) to a claim for disabi l i t y

com p en s at i o n u nder section 1151 is rea sonable in the absenc e of clea r Congr essional intent as to which part of section 5103A s h o u l d ap p ly

. He also arg ues that VA is not require d to provide a medical opinion beca

use "the rec ord is absent sufficie nt evidenc e to establish fault on the part of VA,
or sugg est an association betwee n any VA medical car e [ t h e] [ a] ppellant receive d and his alleg ed

curr ent mental condition," and that VA has no duty to obtain irrele vant private canc er trea tment

rec ords that the appe llant failed to identify . Secre tary ' s (Sec.) Br . at 15, 22. Be cause deter

mining which part of se ction 5103A applies to a section 1151 compensa tion claim is c ritical in resolving the key issues raised in this appea l, the Court be g ins by revie wing the
statutes involved de novo. See 38 U.S.C. § 7261; Bradley v. Peak e , 22 Vet.App. 280, 290 (2008).

II. ST ATUTORY ANALYSIS When this Court revie ws statutes that VA administers, we are initially confr o n t ed wi th whether Congr ess has direc tly spoken to the prec ise question at issue. See Chevron v. Nat' l Res. Def. Council, Inc

. , 467 U.S. 837, 842 (1984). The matter of statutory construction is at an end if the intent of C ong ress is unambig uously expressed. Id

. at 842-43. Howeve r, i f t he st atutes are si lent

or ambig uous with respe ct to th e s pecif ic issue, the second question become s whether VA' s interp re t ati on is based on a permissible construction of the statutes. See id. at 843. Wit hin the complex veter ans benef

its scheme , if VA' s interpre tation of the statutes is rea sonable, the courts are prec luded from subst i t u t i n g t heir judgme nt for that of VA, unless the Secre tary has exceede d his authority ; the Secre tary ' s action wa s clea rly wrong ; or the Secr etar

y ' s interpre tation is unfavora ble
to veter ans, such that it conflicts with the benef icenc e underpinning VA' s veter ans benef its scheme , and a more liberal construction is available that aff ords a harmonious interplay betwee n provisions. See Brown v. Gardner , 513 U.S. 115, 117-18 (1994); Train v. Nat' l Res. Def. Council, Inc. , 421 U.S. 60, 87 (1975); U.S. v. Shimer , 367 U.S. 374, 382 (1961); Fishgold v. S u l l i va n Dr

ydock & Repair Corp. , 328 U.S. 275, 285 (1946).

3A. 38 U.S.C. § 1151

To decide the corr ect application of section 5013A to section 1151, we start by revie wing the lang uag e of 38 U .S.C. § 1151(a) to deter mine the ty

pe of be nefit at issue. Sec tion 1151(a) state s: Compensat io n u

n d e r th is c h a

p te r a n d d epende ncy and indemnity compensa tion under chapte r 13 of this title shall be aw ar ded for a qualify ing additional disability or a qualify ing d ea t h o f a veter an in the s ame manner as if such additi onal di sability or death wer e service -conne cted. For purposes of this section, a disability or death is a qualify ing additional disability or qualify ing death if the disability or death was not the result of the veter an' s willful misconduct and [setti ng forth other require ments]. 38 U.S.C. § 1151(a); see U .S. v. Turkette , 452 U.S. 576, 580 (1981) ( "I n deter mining the sc ope of

a statute, we look first to its lang uag e." ). The plain lang uag e of section 1151(a) unequivoca lly lists
two possible ty

pes of benef

its available under the provision: (1) co m pensation for an additional qualify ing disability or (2) depende ncy and indemnity compensa tion (DI C) for the qualify ing death of a ve tera

n. See 38 U.S.C. § 101(13) (" The term ' compensa tion' mea ns a monthly

pay ment made by the Secr etar

y to a veter an bec ause of

service -conne cted disability , . . .")

. Although the lang uag e of section 1151 does not expli citly state that the compensa tion

awa rded "unde r this ch ap ter" is disability compensa tion, a common sense rea ding dictates that
compensa tion for an additional qualify ing disabil i t y under a statutory section titled "B enef its for
persons disabled by trea tment or vocational reh ab i l i t at ion," which is under a chapte r titled "Compensa tion for Service -Connecte d Disability or Dea th," is proper ly considere d to be disability
compensa tion, as opposed to a hitherto unidentified compensa tion ty pe. See 38 U.S.C. § 1151; Food & Drug Admin. v. Brown & W illiamson Tobacco Corp. , 529 U.S. 120, 132 (2000 ) (" I t i s 'a fundame ntal canon of statutory construction that the words of a statute must be rea d in their context and with a view to thei r p l ace i n the overall statutory scheme .' " (quoting Gustafson v. All oyd C o. , 513 U.S. 561, 569 (1995)) ). I ndeed, such a rea ding is harmonious with 38 U.S.C. § 5110(c) , which explains that "[t]he eff

ective date of an awa

rd of disabili ty compe nsation by rea son of section 1151 of this title shall be the date such injury or agg rava tion was suffe red if an application there for is

rec eived within one y ear from such date" (empha sis added)

. See id. ; Fishgold , s u p r a ; Ga s t on v. Shinseki , 605 F.3d 979, 983 n.2 (F ed. Cir. 2010) (noting that 38 U. S.C. § 5110(c) specifie s the "e ffe ctive date of

disabili ty compe nsation under 38 U .S.C. § 1151"(empha sis added))

.

4Fur ther, such a straig htforwa rd read i n g i s i n keeping with the well-e stablished purpose of section 1151. Although the languag e of section 1151 has been modified over the y ear s, its underly ing purpose of providing compensa tion to veter ans disabled as a result of train ing or trea tment for their injuries, has not signific antly chang ed. See Kilpat rick v. Principi , 327 F.3d 1375, 1379 (F ed

. C i r. 2003); Bartlett v. Shinseki , 24 Vet.App. 328, 330-331 (2011); see also Gardner, 513 U.S. at 116, n.1 (" Section 1151 is invoked ty pically to provi d e b en efits to veter ans for nonservice rela ted disabiliti es, althoug h it is not so limit ed by its terms." ); Mansfield v. Peak e , 525 F.3d 1312, 1 3 1 4 (F ed. C ir. 2008) ("I n g ener al t erms, section 1151 provides that veter ans di sabled

as a result of neg lige nt trea tment at VA medical fac iliti es shall be compensa ted as if their disabiliti es

are service -conne cted." ); Alleman v. Principi , 349 F.3d 1368, 1370 (F ed. Cir. 2003) (" Section 1151 does not acc ord service-c onnecte d status to a vete ran' s disability or dea th, but rather provides t hat in cer tain instances a veter an' s disability or death will be trea ted ' as if' it wer e service -conne cted for

cer tain purposes." ). Henc e, thi s Court has routinely ref err ed to section 1151 compensa tion claims as di sabi lity
compensa tion claims. See Bartlett, 24 Vet.App. at 329 (summarizing the Boa rd decision as one that "de nied his claim for disability compensa tion pursuant to 38 U.S.C. § 1151") ; Ingram v. Nicholson , 21 Vet.App. 232, 247-48 (2007) (explaining that in reg ard to a 1151 claim "the re was nothing in the Aug ust 1986 RO [(reg ional office )] decision or cover letter that informed Mr. I ng ram of any thing that might rela te to a disability compensa tion claim" ); Kilpat rick v. Principi , 16 Vet.App. 1, 4 (2002) (" Although section 1151(a) provides for the pay ment of comp en s at i on (disability compensa tion under chapter 11 or depende ncy and indemnity compensa tion under chapte r 13) to the class of benef iciarie s to which the appellant belong s, the parties seem to have forg otten that the appellant is seeking benef

its . . . ." ), aff'

d 327 F.3d 1375 (F ed. Cir. 2003); Cottl e v. P rincipi , 14 Vet.App. 329, 334 (2001) (" Section 1151 states that a veter an who was injured as the resu l t o f 't h e p u rsui t of a

course of vocat i o n al reha bilitation,' shall be awa

rded disability compensa tion."); Jones v. W est , 12 Vet.App. 460, 461 (1999) (explaining that the Boa rd denied a claim as not well g rounded "inter alia, a claim for [VA] disability compensa tion pursuant to 38 U.S.C. § 1151 for r esiduals of a fall
at a VA hospital."); see also Cogburn v. Shinseki , 24 Vet.A p p

. 205, 212-13 (2010) (quoting the finding in Ingram , 21 Vet.App. at 247-48, t h at "' he had no rea son to know how a disability

5compensa tion claim based on section 1151 might have been decide d by the reg ional office ' ") ; Gree n

v. Brown , 10 Vet.App. 111, 118 ( 1997) (summarizing the Fe dera l Circuit's de cision in Gardner v. Brown , 5 F.3d 1456, 1458 (F ed. Cir. 1993) as "V A could not by reg ulation add to an entitlement to disability compensa tion established under 38 U.S.C. § 1151

. . . . ") ; cf. Loril lard v. Pons , 434 U.S. 575, 581 (1978) (" Congr ess is presumed to be awa re of an administrative or judicial interpre tation of a s t at u t e

. . . . [W ]here

. . . Congr ess adopts a new law incorporating sections of a prior law, Congr ess normally ca n b e presumed to have had knowledg e of the interpre tation g iven to the incorpora ted law . . . " ) (c itations omi tted). The Fe dera l Circuit has simil arly ref err ed to compensa tion under section 1151 as "disa bility
compensa tion." See Gaston , supra ; Seym our v. Principi , 245 F.3d 137 7 , 1 3 8 0 (F ed. Cir. 2001) (" Congr ess has specific ally provided that disability compensa tion under section 1151 is ' awa rded in the same manner as if such disability

. . . wer e service connec ted.' " ); see also Adams v. Shinseki , 568 F.3d 956, 962 (F ed. Cir. 2009) (explaining that in Ingram "the reg ional office ' s explanation of its reje ction of Mr. I ng ram' s non-ser vice- con n ec t i on claim for pension benef its did not g ive Mr. I ng ram rea sonable notice that it was also reje cting his claim for disability compensa tion under section 1151" ). Although scant, the available leg islative history sup p o r ts th e Co u r ts ' in te r p r e ta tion of the term "disa bility compensa tion" as including section 1151 compensa tion claims. See S.Rep. 103-280 (June 7, 1994) (" Section 1151 of title 38, United States Code, g o v er n s cl ai m s for disability
compensa tion or depende ncy and indemnity compensa tion

. . . .") ; S.Rep. 87-2042 (Sept. 13, 1962) (" I t is possible today for an injured veter an to secur e a judgme nt under the Fe dera l Tort Claims Act and there afte r be awa

rded disability compensa tion f rom the Veter ans' Administration for the same injury .")

. Ho we v er , the appellant arg ues that a section 1151 claim is not a disability compensa ti o n claim under the definition provided in W ood v. Pe ake , 520 F.3d 1345, 1349 n. 3 ( Fe d. Cir. 2008)

. I n W ood, the Fe dera l Circuit explained that the g overnme nt had conce ded that a DI C claim was not a disability

compensa tion claim, and noted: The VA defi n es "disa

bility compensa tion" as "a monthly pay ment made by the Depa rtment of Veter ans Affa irs to a veter an beca use of service -conne cted disability

. . . . if the veter an is disabled as the result of a persona l injury or disease (including

6aggra vation of a condition exis ting prior to service ) while in active service if th e injury or disease was incurre d or ag g rava ted in line of duty ." 38 C.F.R. § 3.4(a) , (b)( 1). Thus, as the g overnme nt conced ed , p aym ents to a widow or widower of a veter an ar e not " disability compensa

tion."

W ood , 520 F.3d at 1349, n. 3; see DeLaRosa v. P eake , 515 F.3d 1319, 1321-22 (F ed. Cir. 2008) (explaining that § 5103A(a ) applies to any "be nefit under a law administered by the Secre tary " and thus encompa ss es DIC cl ai ms, but that § 5103A(d) only applies to "c laim[ s] for disability
compensa tion," which doe s not include DI C claims.) The Fe dera l Circuit's dictum in W ood occur red in the context of a Chapter 13 DI C case wher e any ref ere nce to section 1 1 5 1 w o u ld h a ve been unnece ssary and the resulting lang uag e was obviously
not intended to apply outside of t h e n ar row contex t of DI C claims. See W ood , supra ; DeLaRosa , 515 F.3d a t 1322 n.1. I n both W ood and DeLaRosa , the Fe dera l Circuit was discussing only DI C, which is listed separ ately from compensa tion within section 1151. 38 U.S.C. § 1151(a) (" Compensation under this chapte r and depende ncy and indemnity compensa tion under chapte r 13 of this titl e shall be a

war ded .

. . ")

. Additionally , the definition provided by the Fe dera l Circuit is
const ructe d from two separ ate parts of 38 C.F.R. § 3.4—(a) and (b)( 1). See 38 C.F.R. § 3

. 4 (a ), (b)( 1) (2012). Section 3.4(a) define s the term "c ompensation," while § 3.4 (b)( 1) explains that "ba sic entitlement" to disability compensa tion exis ts when a v et eran has a persona l injury or disease incurre d while in active service

. Compare 38 U.S.C. § 1110 (B asic entitlement) with 3 8 U.S.C. § 1151 (B enef

its for persons disabled by trea tment or vocational reha bilitation). Thus, althoug h not expli citly stated, t h e Fe dera l Circuit was, at most, defining "ba sic entitlement to disability
compensa tion" only

. I ndeed, subsequent to W ood and DeLaRosa , the Fe dera l Circuit took no issue with the lang uag e of 38 C.F .R. § 3.154, which, since 2004, ha s stated: "V A may acc ept as a c laim for benef its under 38 U.S.C. § 1151 and § 3.361 any communication in writing indicating an intent
to file a claim for disabili ty compe nsation or depende ncy and indemn i t y co mpensation under the law s go v er n i n g enti tlement to veter ans' benef its for disability or death

. . . ." (empha sis added)

. 3 8 C.F.R. § 3.154 (2012); see Mansfield , 525 F.3d at 1318. Thus, the Feder al C ircuit' s definit i o n

7of basic entitlement to disability compensa tion in the context of a DI C claim should not be construed as imply ing tha

t section 1151 compensa tion is not "disa bility compensa tion." 1
I n sum, even if the lang uag e of section 1151 does not ex p licitly define what ty pe of
compensa tion is aw arde d for an additional qualify ing disability , the Secre tary ' s construction that a section 1151 compensa tion claim, as opposed to a section 1151 DI C claim, is considere d a claim for disability compensa tion within the veter ans benef its schema is not only rea sonable, but also the only rational int erpr etation t hat allows for harmony betwee n separ ate provisions of t i t l e 3 8 , chapte r 11 of the United States Code. See Turket t e , s u p r a
. There fore , the Court holds that a section 1151
compensa tion claim is considere d a disability compensa tion claim for the purposes of deter mining what par t of section 5103A a

pplies. B. 38 U .S.C. § 5103A Under section 5103A(d), titled "Me dical examinations for c ompensation claims," part (d)( 1) clar ifies that "[i] n the case of a claim for disabili ty compe nsation , the assistance provided by the Secre tary under subsection (a) shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is nece ssary to make a decision on the claim." 38 U. S

. C

. § 5103A(d)( 1) (emphasis added)

. Thus, section 5103A(d)(1) applies to a section 1151 disability compensa tion c laim. See 38 U.S.C. §§ 1151, 5103A(d)( 1), 5110(c ); see also Traynor v. Turnage , 485 U.S. 535, 545–46 (1988) (assuming that Congr ess was awa re of VA interpre tation of "w illful misconduct" when it enac ted new law using that term "a nd that Congr ess intended that the
term rec eive the same meaning for purposes of that statute as it had re ceive d for pur poses of other
veter ans' benef

its statutes"). Howeve r, the application of section 5103A(d)( 2) to a section 1151 compensa tion claim is not

so easily addre ssed. For instance, s ec t i o n 5 103A(d)( 2)(B ) require s evidenc e of rec ord that 2

R e g a r d i n g t h e a p p e l l a n t 's c o n t e n t i o n t h a t " t h e b a s i c h o l d i n g o f W o o d i s c l e a r , a n d b i n d i n g : A s u s e d i n [ s ] e c t i o n 1 5 1 0 3 A ( d ) , 'd i s a b i l i t y c o m p e n s a t i o n ' o n l y r e f e r s t o c l a i m s f

o r s e r v i c e - c o n n e c t i o n " ( A p p

. R e s p

. a t 6 ) , t h e d i c t u m i n W o o d d o e s n o t s u g g e s t t h a t t h e F e d e r a l C i r c u i t f o u n d t h a t s e c t i o n 1 1 5 1 c o m p e n s a t i o n i s n o t t o b e c o n s i d e r e d " a s i f " i t w e r e s e r v i c e - c o n n e c t e d f

o r p u r p o s e s o f a p p l y i n g t h e t e r m " d i s a b i l i t y c o m p e n s a t i o n

. " S e e 3 8 U

. S

. C

. § 1 1 5 1 ( a ) ; W o o d , s u p r a
.

3 8 U

. S

. C

. § 5 1 0 3 A ( d ) ( 2 ) s t a t e s i n f u l l : 2

T h e S e c r e t a r y s h a l l t r e a t a n e x a m i n a t i o n o r o p i n i o n a s b e i n g n e c e s s a r y t o m a k e a d e c i s i o n o n a c l a i m 8"indica tes" a disability or sy mptoms may be associate d with "a ctive milit ary , naval, or air service ," but, in a section 1151 compensa tion claim, as in this case , th e d i s ab i l i t y or sy mptoms are not

nece ssarily associate d with active duty service

. S e e 3 8 U

. S. C. § § 1 1 5 1 ( a ), 5103A(d)( 2)(B ); Gardner , 513 U.S. at 117 n.1. Although section 1151 compensa tion is to be awa rded in the same manner "a s if" an additional qualify ing d i sability wer e service connec ted, neither section 1151 nor 5103A specifie s how the fa ctors under section 5103A(d) (2) should apply to a sec tion 1151 compensation claim in which the disability or sy mptoms are not dir ec t l y re l at ed to the claimant' s active duty service

. See 38 U.S.C. §§ 1151, 5103A; Alleman , supra
. The appellant arg ues that, beca use the lang uag e of section 5103A(d)( 2) "is silent reg arding what other kinds of evidenc e might make a medical opinion nece ssary in other kinds of claims, like Section 1151 claims," that "[s]ection 5103A(a )' s descr iption of w h e n th e d u ty to a s s is t e ng ag es–whe n the evidenc e is ' nece ssary to substantiate the claimant' s claim' and when a 're asonable possibili ty exis ts' that such help would aid the claimant–must fill that void." App. Response to the Court's J uly 18, 2012 , Or d er (R es p .) at 6. The Secre tary counter s that, althoug h the lang uag e of section 5103A(d)( 2)(B ) applies specific ally to basic entitlement to service -conne ction claims, that it is VA' s

rea sonable poli cy to look to the factors under section 5 1 0 3 A( d )(2) as guidanc e when deter mining whether an examination is nece ssary in a s ec t i on 1151 disability compensa tion claim. See Sec. Resp. at 3, 6, 9. To the ex t ent that the appellant sug g ests that section 5103A(d)( 1) could be applied in isola t i o n , the plain lang uag e of section 5103A(d)( 2) disproves such an interpre tation, stating that "[t]he Secre tary shall trea t an examination or opinion as being nece ssary to make a decision on a claim for purposes of para g raph (1) if the evidenc e of rec ord

. . . " befor e listi ng fac tors that must be

f o r p u r p o s e s o f p a r a g r a p h ( 1 ) i f t h e e v i d e n c e o f r e c o r d b e f o r e t h e S e c r e t a r y , t a k i n g i n t o c o n s i d e r a t i o n a l l i n f o r m a t i o n a n d l a y o r m e d i c a l e v i d e n c e ( i n c l u d i n g s t a t e m e n t s o f t h e c l a i m a n t )

- - ( A ) c o n t a i n s c o m p e t e n t e v i d e n c e t h a t t h e c l a i m a n t h a s a c u r r e n t d i s a b i l i t y , o r p e r s i s t e n t o r r e c u r r e n t s y m p t o m s o f d i s a b i l i t y ; a n d ( B ) i n d i c a t e s t h a t t h e d i s a b i l i t y o r s y m p t o m s m a y b e a s s o c i a t e d w i t h t h e c l a i m a n t 's
a c t i v e m i l i t a r y , n a v a l , o r a i r s e r v i c e ; b u t ( C ) d o e s n o t c o n t a i n s u f f i c i e n t m e d i c a l e v i d e n c e f o r t h e S e c r e t a r y t o m a k e a d e c i s i o n o n t h e c l a i m

.

9met befor e a medical examination or opinion is require d in a disability compensa tion claim.

38 U.S.C. § 5103A(d); see W ells v. Principi , 326 F.3d 1381, 1384 (F ed. Cir. 2003) (explaining that

no basis was prese nted to support the appellant' s contention at oral arg ument that section 5103A(d) trig g ers an obliga tion for the Secre tary to provide a medical ex am i n at i on or opi nion reg ardle ss of the s pecif ic provisi ons under 5103A(d), which limit the S ecr etar y ' s obliga tion). Additionally , the appellant' s sug g estion that the Court interpre t section 5103A(d)( 1) as having the same require ments

as those under section 5103A(a ) in a section 1151 compensa tion claim, wo u l d m ak e section 5103A(d)( 1) redunda

nt and section 5103A(d)( 2) superf luous. Such an interpre tation violates the well-e stablished interpre tive canon that a "' statute should be construed so that eff ect is g iven to a ll its provisions, so that no part will be inoperative or superf luous, void or i nsignific ant.' " Corley v. U.S. , 556 U.S. 303, 314 (2 0 0 9 ) (q uoting Hibbs v. W inn , 542 U.S. 88, 101 (2004)) ; see Hornick v. Shinseki , 24 Vet.App. 5 0 , 52, 55 (2010) (explaining that "the plain meaning of any statutory provision must be deter

mined in ligh t of the statutory scheme as a whole" and the Court should interpre t statutory provisions in the same subchapte r of title 38 as producing a harmonious whole); Cottl e , 14 Vet.App. at 334 (ea ch section or part of a statute should be construed with ever y other part of section to produce a harmonious whole (citing Mee ks v. W es t , 1 2 Vet.App. 352, 354 (1999)) ). Thus, section 5103A(d) (1) must be re ad in conjunction with 5103A(d) (2). Be cause section 5103 A( d )(1) applies to a section 1151 compensa tion claim and section 5103A(d)( 1) cannot be rea d in isolation, the Court ag ree s with the Secre tary that it is useful and consistent with the trea tment of other disability claims to interpre t the fac tors under 5103A(d)( 2) b ro ad l y to deter

mine when a medical examination or opinion must be provided in a section 115 1
compensa tion claim. Cf. Zenith Radio Corp. v. United S t a t es , 437 U.S. 443, 450 (1978) (" Moreove r, an admi n i s t ra t ive ' prac tice has peculiar weig ht when it involves a contempora neous construction of a statute by the [persons] char g ed with the responsibility of setting its machiner y in

m o t i o n , o f making the parts work eff iciently and smoothly while they are y et untried and new

. " (quoting Norwegian Nitrogen Products Co. v. United States , 288 U.S. 294, 315 (1933)) ). Thus, the question become s: I n a section 1151 compensa tion c laim, what interpre tations of the fac tors under 5103A(d)( 2) are permissible? See Chevron , 4 6 7 U. S

. at 843; see Brown & W illiamson Tobacco

10Corp. , 529 U.S. at 132 (" [I ]f Congr ess has not specific ally addre ssed the question, a revie wing court

must respec t the ag ency ' s construction of a statute so long a s it is permissi ble." ). C. I nterpre ting the F actor s Under Sec tion 5103A(d)(2) T h e Secre tary conce des that "38 C.F.R. § 3.159(c) (4) is the implementing reg ulation for 38 U.S.C. § 5103A(d), but notes that in reg ard to the applicability of the standards set-for th in both to[ sic] a Veter an' s claim for disability b e n e f it s u n d er section 1151, [§] 3.159(c) (4) is simil arly silent." Sec. R esp. at 6, n.1 (citing to Sharp v. Shinseki , 23 Vet.App. 267, 275 ( 2009), for the proposit ion that "[d]efere nce to the reg ulation that offe rs no additional clar ity to the interpre tive issue would be inappropria te." ). Although the Secre tary has not presc ribed a reg ulation perta ining to the application of sectio n 5 1 0 3 A(d) to section 1151 compensa tion claims, the Court will revie w his curr ent interpre tations and provide g uidance on interpre ting the section 5103A(d)( 2) fac tors to eff ectua te a purposef ul rema nd. See 38 U.S.C. § 5103A(e ); Zenith Radio Corp. , 437 U.S. at 450 (" longsta nding and consistent administrative interpre tation is entitled to considera ble weig ht.") ; Quirin v. Shinseki , 22 Vet.App. 390, 396 (2009) (noting t h at additional arg uments may be addre ssed to provide
g uidance to a lower

tribunal). i. Fac tor 5103A(d) (2)( A) a nd Fa ctor 5103A( d)(2) (C) Acc ording to the first fac tor und er s ec t i o n 5103A(d)( 2) (factor A), a medical ex amination

or opinion is nece ssary to mak e a d ec ision on a claim if the evidenc e of rec ord, along with the require ments under the other fac tors, "c ontains competent evidenc e that the claimant has a curr ent disability , or persistent or rec urre nt sy mptoms of disability

. . . " 38 U.S.C. § 5103A(d)( 2)(A)

. The Secre tary asser

ts that in the context of a s ec t i o n 1 1 5 1 compensa tion claim, fac tor A should be interpre ted i n t h e s am e m anner as i t is in a non-section 1151 disability compensa tion claim. Sec. Resp. at 12-13. The Court discerns no difficulty or i rra tionality with the application of f

actor A to a section 1151 disability

compensa tion claim in a manner simil ar to that used i n basic entitl ement
t o d i s ability compensa tion claims—if there is no competent evidenc e of a curr ent disability o r persistent or rec urre nt sy mptoms of a disability , then a medical examination or opinion is not mandated by statute. See 38 U.S.C. § 5103A(d)( 2)(A)

. Such a straig htforwa rd application of fac tor A is also most f

avora ble to ve tera

ns, as it does not require the weig hing of competing fac ts,

11but rathe r the assessment of the exis tence of such evidenc e in the rec ord and whether such evidenc e

is competent. See G ardner , 513 U.S. at 117-18; McLendon , 20 Vet.App. a t 81-82. 3 As to fac tor 5103A(d)( 2)(C) (fa ctor C), taking i n t o account the require ments of the other fac tors, it manda

tes that a medical examination or opinion be provided when the rec ord befor e the Secre tary "doe s not contain sufficie nt medical evidenc e for the Secre tary to make a decision on the claim." 38 U.S.C. § 5103A(d)( 2)(C). The Court ag ree s that there is no need to interpre t fac tor C any differ ently for a section 1151 compensa tion cl ai m t han for a basic entitlement disability
compensa tion claim, beca use the plain l an gu age applies eff ortlessly to both. See id .; McLendon , 20 Vet.App. a t 84-85; Sec. Resp. at 12- 13. ii. Fac tor 5103A(d) (2)( B) Fa ctor 5103A(d)( 2)(B ) (fa ctor B) states that a medical examination or opinion is mandated, in conjunction with the require ments of fac tors A and C, if the evidenc e of rec o rd b ef o re the Secre tary "indicates that t h e d i s ability or sy mptoms may be associate d with the claimant' s active milit ary , naval, or air service ;

. . . ." 38 U.S.C. § 5103A(d)( 2)(B ). As explained above, the lang uag e of fac tor B must be interpre ted broadly beca use a section 1151 compensa tion claim does not require that there be an association betwee n the disability or sy mptoms and the claimant' s "a ctive milit ary , naval, or air ser vice." See 38 U.S.C. § 1151(a); Gardner , supra
. The Secre tary contends that VA "r easona bly inquires

. . . whether there i s evidenc e supporting the materia l components of a section 1151 claim" when as s es s i n g whether a medical opinion is necessar

y . Sec. Resp. at 12. Specifica lly , the S ecr etar y asser ts that, when adjudicating

a section 1151 compensa tion c laim, it is rea sonable to interpre t fac tor B as meaning "a n indication that said disability

or sy mptoms [ may ] be associate d with car elessness, neg lige nce, lack of proper skill, err or in judgme nt, or simil ar instance of fault on the part of VA, or an event not re as o n ab ly foreseea ble, in the trea tment VA provided a claimant." Id

. at 13. Acc ording to the S ec re t ar y 's

A l t h o u g h t h e e x i s t e n c e o f a n a d d i t i o n a l q u a l i f

y i n g d i s a b i l i t y m u s t b e a s c e r t a i n e d f o r d i s a b i l i t y c o m p e n s a t i o n 3 b e n e f i t s t o b e a w a r d e d u n d e r s e c t i o n 1 1 5 1 , s u c h a d e t e r m i n a t i o n i s s e p a r a t e f r o m t h e a p p l i c a t i o n o f t h e d u t y t o a s s i s t f a c t o r s u n d e r s e c t i o n 5 1 0 3 A ( d ) ( 2 ) , w h i c h s h o u l d g e n e r a l l y b e r e v i e w e d p r i o r t o a n y d e t e r m i n a t i o n r e g a r d i n g t h e g r a n t i n g o f b e n e f i t s

. C o m p a r e 3 8 C

. F

. R

. § 3

. 3 6 1 ( b ) ( 2 0 1 2 ) w i t h 3 8 C

. F

. R

. § 3

. 1 5 9 ( c ) ( 4 ) ( 2 0 1 2 ) ; s e e a l s o V e t e r a n s B e n e

f i t s A d m i n i s t r a t i o n A d

j u d i c a t i o n P r o c e d u r e s M a n u a l M 2 1

- 1 M R ( M 2 1

- 1 M R ) , p t

. I V , S u b p a r t i i , c h

. 2 , s e c

. G ( 3 3 ) ( c ) ( 2 0 1 1 ) ( U n d e r t h e " G e n e r a l I n f o r m a t i o n o n E n t i t l e m e n t t o B e n e f i t s U n d e r 3 8 U

. S

. C

. 1 1 5 1 , " a d i s c u s s i o n a b o u t " D e t e r m i n i n g W h e t h e r A d d i t i o n a l D i s a b i l i t y E x i s t s " )

. 12interpre tation, the lang uag e" may be associate d" includes an element of causa tion. I n eff ect, not only does the evidenc e have to indicate that there wa s VA t re atm ent, but that the trea tment may have

cause d the disability or sy mptoms. See id .; cf. 38 C.F.R. § 3.159 (c) (4)( i)(B ),(C). As the Fe dera l Circuit e x plained in W

ells , supra , having a disability without a ny causa l c onnection is insuff icient
to obliga te t he S ecr etar

y to provide a medical opinion or ex amination. See also Chotta v. Peake , 2 2 Ve t.App. 80, 85 (2008) (interpr eting McLendon to mean that the duty to provide a medi ca l examination applies "only once the evidenc e has met the minimal threshold of indic at i n g t he exis tence of a medical question" beca use the duty to a ssist does not r equire a fishing expedition to substantiate a completely unsupported claim (quoting Gobber v. Derwinski , 2 Vet.App. 470, 472 (1992) an d ci t i n g to 38 U.S.C. § 5103A(a )(2) )). Thus, the Secre tary ' s interpre tation appea rs

rea sonable in that it proper ly eff ectua tes the intent of section 5103A(d)( 2) and complies with leg al
prec edent. T h e C o u rt holds that the lang uag e "ma y be associate d" require s that the evidenc e of

rec ord indicate a causa l connec tion betwee n the curr ent disability and the VA trea tment befor e VA is require d to provide a medical examination or opinion. 38 U.S.C. § 5103A(d)( 2). Howeve r, in l i gh t of the purpose of section 5103A and our analy sis in McLendon , the nature of a ca u s al

connec tion in thi s interpre tation nece ssitates further discussion. C o n gre s s perc eived signific ant barr iers to veter ans who neede d assistance in obtainin g information and evidenc e to rec eive benef its from VA, and eliminated the we l l -gr o unded-c laim require ment by enac ting the Veter ans Claims Assistance Act of 2000 (VCAA ), which was later codified, in part, as 38 U.S.C. § 5103A. Duenas v. P rincipi , 18 Vet.App. 512, 516 (2004) (per curia m). Prior to the enac tment of t h e VC AA and the filing of the appellant' s claim, this Court explained in Jones v. W

est , 12 Vet.App. 460, 464 (1999), that the require ments of a well-g rounded section 1151 compe nsation claim wer e: para lleling those [requirements] set forth in Caluza [ v. Brown , 7 Vet.App. 498, 506 (1995), aff'

d per curiam , 78 F.3d 604 (F ed. Cir. 1996) (table) ] g ener ally as follows: (1) Medica l evidenc e of a curr ent disability ; (2) medical evidenc e, or i n ce rt ain circ umstances lay evidenc e, of incurre nce or ag g rava tion of an injury as the result of hospitaliz ation, medical or surg ical trea tment, or the pursuit of a course of vocational reha bilitation u nder chapte r 31 of title 38, United States Code; and (3) medical evidenc e of a nexus betwee n that asser ted injury or disease and the curr ent disability

.

13Today , a section 1151 compensa tion claim does not need to meet the require ments of being

well-g rounded for VA to have a duty to assist. See 38 U.S.C. § 5 1 0 3 A. I ndeed, this Court has explained that, in a basic entitlement disability compensa tion claim, fac tor B only require s that the evidenc e meet a low threshold, such that the evidenc e "indic at es " that there "ma y " be a nexus betwee n the disability (o r p er s i s tent or rec urre nt sy mptoms of a disability ) and milit ary service

. McLendon , 20 Vet.App. at 83; see Alleman , supra ; cf. Jones , 12 Vet.App. at 463 (treating the
veter an' s claim for an additional disability under section 1151 as it would a claim for service

connec tion). There fore , in keeping with this Court's deter minations in McLendon , in a section 1151 disability compensa tion claim, the threshold under fac tor B must be e qually low. Thus, when apply ing fac tor 5103A(d)( 2)(B ) to a section 1151 compens at i o n claim, the S ec re t ary may not require that the evidenc e of rec ord be sufficie nt to prove a nexus betwe en t h e

asser ted injury or event and the curr ent disability

. See McLendon , 20 Vet.App. at 84 (" I ndeed, in this instance, althoug h the medical evidenc e was deeme d insufficient to establish a nexus, that evidenc e, toge ther with other evidenc e of rec ord, may never theless be sufficie nt for the Boa rd to conclude that i t 'i n d i ca t es ' t hat M r. McL endon' s curr ent di sability ' may be associated' with

. . . . ")

. Nor may th e Secre tary require that the rec ord provide competent medical evidenc e that an "a dditional disability resulted as a conseque nce of neg lige nce, car eless[ness], or other fault on the part of VA, or an event
not rea sonably fore seea

ble," prior to deter

mining whether a medical opinion must be provided. R. at 6 (standar d used by the Boa rd). Mandating that the rec ord include competent medical evidenc e of fault, befor e rec eiving a medical opinion as to whether VA failed to exercise the deg ree of car e that would be expected of a rea sonable health car e provider, would potentially defe at the purpose of not h av i n g t o prese nt a well-g rounded section 1151 compensa tion claim. Compare 38 U.S

. C

. § 5103A(d)( 2) with Jones , 12 Vet.App. at 464; see also 38 C.F.R. § 3.361(d)( i); M21-1 MR, pt. I I I , Subpart i v , ch. 3, sec. A(9)( f) (2011) (whe n reque sting a medical opinion in a 1151 claim, the provider should be asked, in pertinent part, to "sta te whether i t is as l east as lik el y as n o t t h at –the cl ai m ed d i s ability was cause d by or beca me worse as a result of the VA trea tment at issue

. . . – failure on the par

t of VA to timely

diag nose and/or proper ly trea t the claimed disease or disability allowed the dise ase or

disability to continue to prog ress" ); Jandreau v . Nicholson , 492 F.3d 1372, 1376-77 (F ed. Ci r

. 2 0 0 9 ) ( competent medical evidenc e may not be require d if the deter minative issue

14involves medical etiology or medical diag nosis and there is competent lay evidenc e sufficie nt to

establish a diag nosis). There fore , when adjudicating a section 1151 compensa tion claim, the Boa rd m ust analy

ze the evidenc e of rec ord t o d et er m i ne whether it indicates that the disability or sy mptoms may be associate d with the hospital ca re , m ed ical or surg ical trea tment, or examination furnished the claimant under any law administered by th e Secre tary , either by a Depa rtment employ ee or in a Depa rtment fac ility as defined i n 38 U.S.C. § 1701(3)( A), or as part of an approve d reha bilitation
prog ram under chapte r 31 of title 38, or a prog ram (know as a "c ompensated work thera py prog ram" ) under 38 U.S.C

. § 1 7 1 8. See 38 U.S.C. §§ 1151(a) (1),( a)( 2), 5103A(d)(2)( B) ; McLendon , supra ; M21-1 MR (M21-1MR), pt. I V, Subpart ii, ch. 2, sec. G(35)( d) (When prepa ring a rating decision, VA advises: "D o not make uncorr oborate d conclusions in the rating decision that a rela tionship betwee n the trea

tment, surg ery , or medication provided and the claimed disability does not exis t.")

III. REVIEW OF THE OCTO BER 5, 2010, BO ARD DECISION

A. The D uty

to Provide a Medica l Opinion I n reg ard to both of th e appellant's theories for entitlement to section 1151
compensa tion—that VA failed to timely diag nose his rec urre nt brea st canc er and misdiagnose d his mental condition—the Boa rd rec og nized "tha t assistance shall include providing a m ed i ca l examination or obt aining a medical opinion when such an ex aminat i o n o r opinion is nece ssary to make a decision on the claim." R

. at 6 (citing to section 5103A( d) and McLendon ). Howe ver, the Boa rd there afte r not only failed to discuss the section 5103A(d)( 2) fac tors with any specific ity , but implied that a medical opinion did not need t o b e p ro v i d ed beca use "the rec ord is absent for competent medical ev i d en ce that additional disability resulted as a conseque nce of neg lige nce,

car eless[ness], or o t h er fa u l t o n the part of VA, or an event not rea sonable fore seea ble." Id

. As discussed above, the finding that a medical opinion is not war rante d beca

use the evidenc e of rec ord does not include competent medical evidenc e of fault on the part of VA is leg ally untenable, beca use under fac tor 5103A(d)( 2)(B ), the evidenc e must only "indicate" that there "ma y " be an association betwee n a current disabili ty and VA trea tment. See 38 U.S

. C

. § 5103A(d)( 2)(B ); see also M21-1 MR, pt. I V, Subpart ii, ch. 2, sec . G(34)( b).

15I n addition to the Board' s g ener al m isinterpreta tion of section 5103A(d), for the following

rea sons the claim on appea l will be rema nded. See Mayfield v. N

i ch o l s o n , 19 Vet.App. 103, 116 (2005) (stating t h at the key to deter mining whether an err or i s prejudicia l is the effec t of t he error

on the essential fairne ss of the adjudication), rev'd on other grounds , 444 F.3d 1328 (F ed. Cir. 2006). 1. Fa ilure to Timely

Diag nose. I n reg ard to the appellant' s first theory of injury under section 1151—that VA failed to timely diag nose his rec urring brea st canc er such that his mental d is a b il it y o ccur red or worsene d— the Boa rd initially stated t hat a medical opinion was not war rante d beca

use there was no c ompetent m edica l evidenc e of causa tion and the appellant was n o t co mpetent to provide lay testimony as to the complex medica l que stion of causa tion. See R. a t 6, 8. There afte r, the Boa rd ag ain explained that the appellant "a s a lay

person, is not competent to comment on the timeliness of a diag nosis of canc er, such as in this case ." R. at 15 (citing broadly to Jandreau for the propos i t i o n t h at "a v eter an is competent to provide a diag nosis of a simple condition such as a br oken leg , but not competent to provide evidenc e as to more complex medical questions")

. Howeve r, this finding did not deter the Boa rd from itself deter

mining that "[t]here is nothing in the medical rec ords from VA to sug g est that the diag nosis of brea st canc er was not made in a timely fashion." R. at 15. Although this latter d et er m i n ation appea

rs wit hin the Board' s analy sis of t he merits of t he section 1151 compensa tio n claim, it indicates that the Boa rd failed to appre ciate that it is restric ted from making unsubstantiated medical deter

minations a

nd considering the absenc e of evidenc e as substantive neg ative evidenc e, including when deciding whether it has complied with the duty to assist provisions. Compare R. at 6 with R. a t 15; see Buczynsk i v. Shinseki , 24 Vet.App. 221, 224 (2011) (" When a ssessing a claim, the Boa rd may not consider the a bsence of evide nce a s substantive neg ative evide nce." ); Duenas , 18 Vet.App. at 516 (explaining that whether a claimant p re vails on the merits of a 1151
compensa tion c laim r emains a separ ate matter from whe ther VA has a duty to a ssist under section 5103A(d)) ; Santiago v. Brown , 5 Vet.App. 288, 292 (1993) (citing Colvin v. Derwinski , 1 Vet.App. 171, 175 (1991), overruled on other grounds by Hodge v. W est , 155 F.3d 1356, 1360 (F ed. Cir. 1998)). Thus, the Boa

rd not only misint erpr eted fac tor B as requiring competent medical evidenc e of VA fault, but also provided inadequa te rea sons or bases for its deter mination that a m ed i cal opinion was not war

rante d in reg ard to whether VA failed to timely diag nose the appellant' s brea st

16canc er. See 38 U.S.C. § 7104(d)( 1); Allday v. Brown , 7 Vet.App. 517, 527 (1995); Caluza , supra ;

Simon v. Derwinski , 2 Vet.App. 621, 622 (1992); Gilbert v. Derwinski , 1 Vet.App. 49, 57 (1990). Howeve r, the Boa

rd did make cer

tain finding s of fac t that rema in undisputed by the parties: (1) "I n Fe bruar y 2005 the Ve t eran prese nted at the Kansa s City VA Medica l Center (VAMC) to establish car e" (R. at 9); (2) "A t this time, he expressed that he desire d to use the VAMC to che ck up on possible brea st canc er" (R. at 9); (3) the appe llant missed his S eptember 2005 appointment, and in November 2005, he aga in reque sted a breast can ce r ch eck- up (R. at 725); (4) the appellant was seen for s ever al ps y chiatric evalua tions at t he VAMC there afte r (R. at 7-9); (5) in September 2006, "[t]he Veter an also talked about rec ently fin d i n g an o t h er brea st lump" (R. at 11), and he underw ent a biopsy later that month ( R. a t 12) ; ( 6) the appellant stated that he "w ent into a serious
state of depre ssion as [he] fe l t t h at [he] was not proper ly trea ted" (R. at 13); the appellant was subsequently diag nosed with dy sthimi c disorder and depre ssion (R. at 14). See App. Br

. at 1-4; Sec. Br . at 2, 9-10. These undisputed finding s, taken as a whole, unequivoca lly "indica te" that there "ma

y be an

as sociation" betwee n the appellant' s curr ent mental disability and his VAMC trea tment, which included an approximately 11-month g ap betwe en a r epeated re quest for a brea st canc er chec k-up and a diag nosis of rec urre nt brea st canc er. See 38 U.S.C. § 5103A(d)( 2)(A) ,(B ); see also Cantu v. 4 Principi , 18 Vet.App. 92, 99-100 (2004) (apply ing the plain meaning of 38 U. S

. C

. § 1 7 10 to the undisputed fac ts of the case to conclude that the appellant met the elig ibilit y criter ia for VA hospital

car e). I t is also clea

r from the Boa

rd' s statements that the rec ord does not contain "suf ficient medical evidenc e for the Secre tary to make a decision on the claim." 38 U.S.C. § 5103A(d)( 2)(C). There fore , the Board clear ly err ed in finding that VA had substan t i al l y co m p lied with "a ssistance require ments." R. at 6 ; s ee Gilbert , 1 Vet.App. at 52. On rema nd, the Boa

rd must provide the

T o t h e e x t e n t t h a t t h e a p p e l l a n t s u g g e s t e d , d u r i n g o r a l a r g u m e n t , t h a t h e m i g h t h a v e a l s o s u f f e r e d a p h y s i c a l 4 i n j u r y , s e p a r a t e f

r o m a m e n t a l d i s a b i l i t y , d u e t o t h e a l l e g e d d e l a y i n b r e a s t c a n c e r t r e a t m e n t , s u c h a c l a i m w a s n o t p r e s e n t e d t o t h e B o a r d

. T h u s , t h e C o u r t d o e s n o t h a v e j u r i s d i c t i o n o v e r i t

. S e e S e r i v

. N i c h o l s o n , 2 1 V e t

. A p p

. 4 4 1 , 4 4 3 ( 2 0 0 7 ) ; T

u b i a n o s a v

. D e r w i n s k i , 3 V e t

. A p p

. 1 8 1 , 1 8 4 ( 1 9 9 2 ) ( a p a r t y b e f o r e t h e C o u r t s h o u l d d e v e l o p a n d p r e s e n t a l l

o f i t s a r g u m e n t s i n i t s i n i t i a l p l e a d i n g )

. 17appellant with a medical opinion pursuant to 38 U.S.C. § 5103A(d). Cf. M21-1MR, pt. I I I , Subpart

iv, ch. 3, sec . A(9)( f) ( "I

nstructions for Providing Medica l Opinions–1151 Cl aims")

. 5

2. Misdiagnosis As to the appellant' s second theory of injury under section 1151—that VA misdiagnose d him with b ip o la

r disorder, which, in turn, cause d or ag g rava ted his mental disability —the Boa rd provided the same err oneous analy sis as it had for the appellant' s first theory

. See R. at 6, 8. Howeve r, unlike the appellant' s first theory , sever al pertinent fac ts are disputed as to this theory , such that the Court
cannot conclude that there is unequivo c a ll y a n in d ic ation that the appellant' s curr ent mental disability
may be assoc iated with VA tre atment. See 38 U.S.C. § 5103A(d)(2) (B ); R. at 9, 16. Be cause the Boa

rd failed to discuss whether the evidenc e of rec ord indicated that there may be an association betwee n the appellant' s curr ent disability and VA trea tment, it provided inadequa te

rea sons or bases for its de termination that the duty to assist was met. See 38 U.S.C. § 7104(d)(1); Allday and Gilbert , both supra
. On rema nd, the Boa

rd must provide a det ai l ed analy sis of its application of section 5103A(d)( 2) to the pertinent fac ts surrounding the appellant' s curr ent mental disability and diag noses.

B. The Duty

to Assist i n Obtaining Medica l Records I n addition, the Boa

rd found that "[a]ll known and available rec ords rele vant to the issues on appea l have been obtained." R. at 5. The appel l an t arg ues t hat t he Board failed to obtain rec ords of his Uni v er s i t y of Kansa s Medica l Center (KUMC) canc er trea tment, which was provided

concur rently with some of his VAMC canc er trea tment by a phy sician who also worke d at the VAMC. R. at 624, 683; App. B r. at 25-26. I t appea rs t hat s ome porti on of t he appellant' s private

canc er tre atment re cords we re f axed from the KUMC to the VAMC. R. at 618. Any KU M C re co rd s in the pos session of VA prior to the Board' s decision on appea l wer e also constructively befor e the Boa rd. See Bell v. Derwinski , 2 Vet.App. 611, 613 (1992 ). I t is unclea r from the rec ord befor e the Court a nd from the parties' arg uments exactly what rec ords VA

I n r e q u i r i n g t h e S e c r e t a r y t o o r d e r a m e d i c a l o p i n i o n b a s e d o n t h e u n d i s p u t e d f a c t s o f t h i s c a s e , t h e C o u r t i s 5

n o t s u g g e s t i n g t h e s e f

a c t s n e c e s s a r i l y p r o v e t h a t t h e r e w a s f a u l t o n t h e p a r t o f V A , o r t h a t t h e a p p e l l a n t 's c l a i m e d d i s a b i l i t y w a s c a u s e d b y o r b e c a m e w o r s e a s a r e s u l t o f V A m e d i c a l c o n d u c t , o r t h a t a n y o f t h e l a t t e r d i a g n o s e s c o n s t i t u t e a n a d d i t i o n a l q u a l i f

y i n g d i s a b i l i t y
. S e e 3 8 U

. S

. C

. § 1 1 5 1

. W h i l e s u c h q u e s t i o n s a r e i n t e g r a l t o a n a n a l y s i s o f t h e m e r i t s o f a s e c t i o n 1 1 5 1 c o m p e n s a t i o n c l a i m , t h e y a r e n o t p e r t i n e n t i n q u i r i e s w h e n d e t e r m i n i n g t h e S e c r e t a r y 's d u t y t o a s s i s t
u n d e r t h e l o w t h r e s h o l d r e q u i r e m e n t s o f f a c t o r 5 1 0 3 A ( d ) ( 2 ) ( B )

. S e e D u e n a s , s u p r a
. 18may or may not have in its possession, but it appea rs that such rec ords may be rele vant to the claim

on appea l. See R. at 9, 11, 618. On rema nd, beca use there appea

rs to be some conce rn that a prior rele ase of information authorization (ROI ) is no longe r viable, the appellant must provide an updated ROI for VA . There afte r, VA is require d to a ttempt to obtain all of the appellant' s KUMC medical

rec ords pertaining to his mental di sability and cance r t rea tmen t

. S ee 38 U.S.C. § 5103A(b); Golz

v. Shinseki , 590 F.3d 1317, 1320-21 (F ed. C i r. 2 0 10). Upon rec eipt of any additional medical

rec ords, an d b ef

o re any additional medical opinions are underta ken, VA is require d to add such

rec ords to the appe llant's c laims file.

IV. CONCLUSION Ba sed on the for eg oing, the October 5, 2010, decision of the Boa rd is VACATED and this matter is REMANDED f

or adjudica tion consistent with thi s opinion.

HAGEL , Judge , concur

ring in the result: I fully concur in the result in this case , but I write

s ep ar ately to express my conce rn over the majority ' s resolution of the centr al issue. A panel wa s

convene d to decide , in the context of a claim for benef its under 38 U.S.C. § 1151, whether 38 U.S.C. § 5103A(a ) or 38 U.S.C. § 5103A(d) controls the deter mination of whether VA must pro v i d e a medical examination or opinion. Ba s ed o n a p lain rea ding of the applicable statutes, and the
prec edential decisions of this court and the U.S. Court of Appea ls for the Fe dera l Circuit, I conclude that the pr o p e r s ta

ndard for deter

mining whether a medical examination or opinion should be order ed in a claim for benef

its under section 1151 is provided under 38 U.S.C § 5103A(a ). Howeve r, beca use analy sis under section 5103A(a ) y ields the same result as did the majority using section 5103A(d), I concur in the result. A. Plain Meaning For emost, a plain rea ding of the rele vant statutes require s t h i s co n clus ion. A fundame ntal

canon of statutory construction is that the words of a statute are g iven "the ir ' ordinary , contempora ry ,
common meaning , ' ab s ent an indication Congr ess intended them to bear some differ ent import." W illiams v. Taylor , 529 U.S. 420, 431 (2000) (quoting W alters v. Metropolitan Ed. Enterprises, Inc. , 519 U.S. 202, 207 (1997); see Smith v. United States , 508 U.S. 223 (1993) (citing Perrin v. United

19States , 444 U.S. 37, 42, (1979) (stating that "[U]nless otherwise define d, words [i n a statute] will be

interpre ted as taking their ordi n ary , contempora ry , common meaning ") ). Section 5103A(d)( 1) expli citly conce rns "a claim for disability compensa tion," while section 5103A(a ) does not. Thus,

we must deter

mine whether a claim made under 38 U.S.C. § 1151 is proper ly construed as "a claim for disability compensa tion." The plain meaning of "disa bility compensa tion" dictates that it is not. First, 38 C.F.R. § 3.4(b)( 1) states that "[b]asic entitlement [for disability compensa tion] for

a veter an exis ts if the veter an is disabled as the result o f a persona l injury or disease (including
ag g rava tion of a c ondition ex isting prior to service ) whil e in active service if the i njury or di sease

was incurre d or ag g rava ted in the line of duty ." 38 C.F.R. § 3.4(b)( 1)(2012)

. The focus of this
reg ulation is that the injury or disease was "inc urre d or ag g rava ted in the line of duty ." Id. (empha sis added)

. "I n the line of duty " is define d as "a n injury or disease incurre d or ag g rava ted during a period of active milit ary , naval, or air ser vice unless suc h injury

or disease was the result of the veteran' s own willful misconduct . . . ." 38 C.F .R. § 3.1(m)(2012). Her e, Mr. Traf

ter sought compensation under section 1151 based on two theorie s : (1) that VA m ed i ca l p er sonnel failed to timely diag nose and trea t his brea st canc er, which led to the development or ag g rava tion of his mental disability ; and (2) that VA misdiagnose d him with bipolar disorder, which, in turn, cause d or ag g rava ted his mental disability

. R. at 8. Section 1151 provides that compensa

tion shall be awarde d for an additional disability or dea th "in the sa me manner as i f such additional disability or death wer e service -conne cted," if the additional disability or death was not the result of the ve tera n' s willful mis conduct a

nd: (1) the disability or death was cause d by hospital car e, medical or surg ical trea tment, or examination furnished the veter an under any law administered by the Secre tary

. . . and the pr ox imate ca

use of the disa

bility or dea th was– (A) car elessness, neg lige nce, lack of proper skill, err or i n judgme nt, or simil ar instance of fault on the part o f t h e De p artment in furnishing the hospital care , medical or

surg ical tre atment, or e x amination; or (B ) an e vent not rea sonably fore seea ble.
38 U.S.C. § 1151(a).

20The premise behind compensa tion under section 1151 is that the veter an suffe red an

additional disability or death as t he result of t raining , hospital car e, medical or surgica l trea tment,
compensa ted work thera

py , or an examination furnishe d b y VA , not by injury or di sease incurre d

or ag g rava ted while in active service

. 38 U.S.C. § 1151; 38 C.F.R. § 3.361 (201 2 ). T h u s , Mr. Traf ter' s theories of entitlement to compensa tion are premised on neg lige nce on the part of VA, not that his depre ssion was i n cu rr ed or ag g rava ted i n the l ine of duty

. The factual premise underly ing section 1151 claims, by the very lang uag e of the statute, does not include a disability that took place in service but is, in fact, linked to trea tment after service

. Second, section 5103A(d)( 2)(B ) expli citly provides that, when the Secre tary is deter mining whether a medical examination or opinion is "ne cessa ry to make a decision on a claim," the evidenc e of rec ord must "indicate[] that the disability or sy mptoms may be associate d with the clai m ant' s active military , naval, or

air ser vice." The ter

m "a ctive military , naval, or air ser vice" includes: (A) a ctive duty ; (B ) any period of a ctive duty

for tra ining dur ing w hich the individual conce rned was disabled or

died from a

disease or

injury incurre d or ag g rava ted in line of duty ; and (C) any period of ina ctive duty

training during which the individual conc erne d was disabled or

died– (i) fr om an injury

incurre d or ag g rava ted in line of duty ; or (ii) from a

n acute my ocar dial infarc tion, a car diac a rre st, or a cer ebrova scular a ccide nt occur ring during such training

.

38 U.S.C. § 101(24). Ag ain, the crux of a claim made pursuant to section 1151 is neg lige nce on the part of VA, specific ally that the claimant' s disability was the result of VA car e or medical trea tment,
not as a result of his active milit ary , naval, or air service

. Thus, the plain meaning of the t erm "disa bility compensa tion" nece ssitates that the disability for which the claimant is seeking benef its is incurre d in or agg rava ted by active military

service . Entitlement to benefits under se ction 1151 is g rounded in post-service fault of VA, not on the in-servic e i n cu rre nce or ag g rava tion of a disability , benef

its that are a

uthorized under 38 U.S.C § 1110.

21B. Prior Case law of This Court

Second, our own prior case law also supports the conclusion that section 1151 claims are not "disa bility compensa tion" cla ims. Contrary to the majority ' s finding , this Co u r t h a s p r e v iously held that, althoug h compensa tion

awa rded to an 1151 claimant is paid in the same manner as if such additional disability wer e service

connec ted, they

are , in fac t, two distinct claims. See Anderson v. Principi , 18 Vet.App. 371, 377 (2004) (" There is a leg al distinction betwee n filing a cla im for service connec tion for a disability pursuant to 38 U.S.C. § 1110 a nd a cla im for compensa tion derived fr om a g rant of c ompensation pursuant to 38 U.S.C. § 1151.")

. Fur ther, this Court has noted that "[s]ection 1151 does not confe r 6
upon its benef

iciarie s the status of service connection; rathe r, section 11 5 1 a w a rds compe nsation as if the claimant were service connec ted

. I n other words, section 1151 nowhe re pr ovides that the disabili ty is

. . . to be trea ted g ener ally as if it wer e service connec ted." K i l p a t r i ck v. Principi , 16 Vet.App. 1, 5 (2002), aff' d , 327 F.3d 1375 ( Fe d. Cir. 2003). A sec tion 1151 claim "c onstitut es

a separ ate and distinct claim for VA benef its." Anderson , 18 Vet.App.a t 377. Thus, this Court's case law has consistently distinguished claims made pursuant to section 1151 and claims for d i s ability
compensa tion pursuant to section 1110. C. The United States Court of Appe als for the Fe dera l Circuit (Fe dera l Circuit) Prece dent The Fe dera l Circuit has also draw n a distinction betwee n "disa bility com p e n s a tion" and other benef its administ ere d by

the Secr etar

y . Section 5103A(a ) provides tha t: (1) The Secre tary shall make rea sonabl e ef fo rt s to assist a claimant in obtaining evidenc e nece ssary to substantiate the claimant' s claim for a benefit under a law administered by the Secre tary

. (2) The Secre tary is not require d to provide assistance to a claimant under this section if no rea sonable possibili ty exis ts that such assistance would aid in substantiating the c laim.

38 U.S.C. 5103A(a )(1, 2) (empha sis added)

. This g ener al lang uag e contra sts starkly with the more specific "disa

bility compensa tion" lang uag e used a s the predic ate f or apply ing se ction 5103A(d). I n W ood v. Peak

e , 520 F.3d. 1345 (F ed. Cir. 2008), the Fe dera l Circuit deter mined that the "g ener al d u t y to assist provision" applies when deter mining whether depende ncy and indemnity

T h i s C o u r t , i n a n a t t e m p t t o s p e a k m o r e s p e c i f i c a l l y , h a s e s c h e w e d t h e u s e o f t h e t e r m " c l a i m f o r s e r v i c e 6

c o n n e c t i o n

. " S e e H i l l

y a r d v

. S h i n s e k i , 2 4 V e t

. A p p

. 3 4 3 , 3 5 5 ( 2 0 1 1 )

. 22compensa tion claimants are entitled to a medical examination or opinion in the development of their

claims. The Fe dera l Circuit conclude d that, "[w]hile [section] 5103A(a ) applies to any ' benef it under

a law administered by the Secre tary ' and thus encompa sses [dependenc y and i n d em nity
compensa tion] claims, § 5103A(d) only applies to ' claim[s] for disability compensa tion,' which does
not include [dependenc y and indemnity compensa tion] claims." W ood , 520 F.3d. at 1349; see also Delarosa v. Peak

e , 515 F.3d. 1319, 1322 (F ed. Cir. 2008) (noting t h at "[s]ection 5103A(d)( 1) expli citly limit s its a

pplicability to claims for disability compensa tion"). Fur ther, in a footnote the Fe dera l Circuit noted, an d the Secre tary conce ded, that depende ncy and indemnity compensa tion
pay ments are not "disa

bility compensa tion." W

ood , 5 20 F.3d. at 1349 n.3. Thus, it is a logic al extension that, if depende ncy and indemnity compensa tion benef

its are not "disa

bility
compensa tion,"1151 claims also fall outside the purview o f "d i s ability compensa tion." Although these Fe dera l Circuit case s wer e decide d in the context of depende ncy and indemnity compensa tion claims, section 1151 claimants also seek compensa tion for injuries that are not connec ted to active service as define d by 38 C.F.R. § 3.4. Thus, by analog y , section 1151 claims fall into the cate g ory of " any other be nefit" administered by the Secre tary , and sec tion 5103A(a) is ther efor e the c orre ct standard to use to determine w hether VA must provide a me dical examination or opinion. I n addition, in Alleman v. Principi , 349 F.3d. 1368 (F ed. Cir. 2003), the Fe dera l Circuit decide d that veter ans rec eiving benef i t s u n der section 1151 wer e not entitled to Service Disabled Veter ans' I nsuranc e under 38 U.S.C. § 1922. The Fe dera l Circuit deter mined that section 1151 "doe s not accord service -conne cted status to a veter an' s disability or death, but rathe r provides that in

cer tain instances a veter an' s disability or death will be trea ted ' as if' it wer e service connec ted." Id. at 1370. Fur

ther, t h e Fe dera l Circuit reiter ated that, "f or a disability to be 'ser

vice- connec ted,' the disability must have been incurre d or ag g rava ted ' in the line of duty in the active milit ary , naval, or air ser vice.' " Id. (quoting 38 U.S.C. § 101(16)). Finally , althoug h section 1151 appea rs in the chapte r titled "C o m p en s ati on for Service

Connected Disability or De ath," and in the sub-c hapter "G ener al compensation provisions" thi s is
not inconsistent wi t h the above analy sis. The logic al interpre tation of this location is that the
compensa tion awa

rded pursuant to section 1151 is paid in the same manner as if the disability was service connec ted, even though section 1151 benef its are not " claim[s] for disabili ty compe nsation ."

23I n light of the above discussion, I strong ly believe that 38 U.S.C. § 5103A(a ) provides the

corr ect standard for when a VA medical examinati o n o r o p i n i o n is require d in claims under section 1151. D. Comparing 5103A(a ) and 5103A (d) Sections 5103A(a ) and 5103A(d) "a pply wholly differ ent and unrela ted require ments," and

are "dr amatica lly differ ent [i n] scope." W ood , 520 F.3d. at 1349. Section 5103A(a ) "r equire s [] VA
to provide a claimant with a fre e medical opinion whene ver such an opinion is (1) ' nece ssary to substantiate [t he] c laim,' unless (2) ' no rea sonable possibility exis ts that such assistance would aid in substantiating [t he] claim.' " W ood , 520 F.3d.a t 1 3 4 9 (q u o t i ng 38 U.S.C. § 5103A(a )). On the other hand, section 5103A(d) require s that "the claimant [] demonstrate that the rec ord evidenc e (1) 'co n t ai n s competent evidenc e that the claimant has a curr ent disability , or persistent or rec urr en t
sy mptoms of disability ; (2) ' indicates th at t h e d isability or sy mptoms may be associate d with the claimant' s active milit ary , naval, or air service ;' and (3) ' does not contain sufficie nt medical evidenc e for the Sec reta

ry to make a de cision on the claim.' " Id. at 1349-50 (quoting 5103A(d)( 2)). 7 E. Application of L aw To This Case S ec t i o n 5103A(a ) require s that VA "a ssist a claimant in obtaining a medical opin i o n o r examination whene ver such an opinion is ' nece ssary to substantiate the claimant' s claim,' " and "only

S e c t i o n 5 1 0 3 A ( d ) p r o v i d e s i n f u l l : 7
( 1 ) I n t h e c a s e o f a c l a i m f o r d i s a b i l i t y c o m p e n s a t i o n , t h e a s s i s t a n c e p r o v i d e d b y t h e S e c r e t a r y u n d e r s u b s e c t i o n ( a ) s h a l l i n c l u d e p r o v i d i n g a m e d i c a l e x a m i n a t i o n o r o b t a i n i n g a m e d i c a l o p i n i o n w h e n s u c h a n e x a m i n a t i o n o r o p i n i o n i s n e c e s s a r y t o m a k e a d e c i s i o n o n t h e c l a i m

. ( 2 ) T h e S e c r e t a r y s h a l l t r e a t a n e x a m i n a t i o n o r o p i n i o n a s b e i n g n e c e s s a r y t o m a k e a d e c i s i o n o n a c l a i m f o r p u r p o s e s o f p a r a g r a p h ( 1 ) i f t h e e v i d e n c e o f r e c o r d b e f o r e t h e S e c r e t a r y , t a k i n g i n t o c o n s i d e r a t i o n a l l i n f

o r m a t i o n a n d l a y o r m e d i c a l e v i d e n c e ( i n c l u d i n g s t a t e m e n t s o f t h e c l a i m a n t )

- - ( A ) c o n t a i n s c o m p e t e n t e v i d e n c e t h a t t h e c l a i m a n t h a s a c u r r e n t d i s a b i l i t y , o r p e r s i s t e n t o r r e c u r r e n t s y m p t o m s o f d i s a b i l i t y ; a n d
( B ) i n d i c a t e s t h a t t h e d i s a b i l i t y o r s y m p t o m s m a y b e a s s o c i a t e d w i t h t h e c l a i m a n t 's
a c t i v e m i l i t a r y , n a v a l , o r a i r s e r v i c e ; b u t ( C ) d o e s n o t c o n t a i n s u f f i c i e n t m e d i c a l e v i d e n c e f o r t h e S e c r e t a r y t o m a k e a d e c i s i o n o n t h e c l a i m

.

24excuses [] VA from making rea sonable eff orts

. . . when ' no rea sonable possibility exis ts tha

t suc h assistance would aid in substantiating the claim.' " W ood , 520 F.3d.at 1348 (quoting 38 U.S.C. § 5103A(a )). Mr. Traf ter soug ht VA disability benef its under section 1151, advanc ing two theories of VA
neg lige nce: (1) that VA medical personne l failed to timely diag nose and trea t his b re as t cancer , which led to the development or ag g rava tion of his mental disability ; and (2) that VA misdiagnose d him with bipol ar disorde r, which, in turn, c aused or ag g rava ted his mental disability . R. at 8. Her e, the Boa

rd cited section 5103A(d) and summarily deter mined that (1) Mr. Traf

ter is not competent to opine as to whether the timeliness of his brea st canc er diag nosis or misdiagnosis of his mental condition demonstrates neg lige nce; and (2) no other competent ev idence of rec ord exis ts demonstrating fault on the part of VA. R. at 6, 15-16. The Boa rd then considere d the merits of Mr. Traf ter' s section 1151 claim without ever discussing w hether

a medica l opinion was "ne cessa ry to substantiate" his claim or explaining why "no rea sonable possibili ty exis ts that [a medical opinion] would aid in substantiating [hi s] claim." 38 U.S.C. § 5103A(a )(1, 2). Although "[t]he duty to assist is not boundless in its scope," without competent evidenc e of rec ord or a medical opinion discussing the t heorie s on which Mr. Tr afte r' s section 1151 claim i s based, it is unclea r how the Board could

rea ch the conclusion that Mr. Traf ter' s mental disability is not the result of VA neg lige nce. R. at 4;

see Golz v. Shinseki , 590 F.3d. 1317, 1320 (F ed. Cir. 2010) (holding that VA' s "duty to assist is not boundless in scope "). The Boa rd' s trea tment of this issue is conclusory , and a more thoroug h discussion is neede d for Mr. Traf ter to understand the Boa

rd' s rea soning and for the Court to conduct

a proper revie w. See G ilbert v. Derwinski , 1 Vet.App. 49, 52 (1990) (holding that the Boa rd must provide a n adequate statement of rea sons or bases for its conc lusions that permits the claimant to understand why the Boa

rd made the deter

mination it did and to allow eff ective judicial revie w of that decision).

25