Another Federal Court Case Concerning Lay Evidence

[free_spirit_etc]

Here is another Federal Court Decision (2007) that says they can't just blow off lay evidence - even of medical conditions. The vet STILL can't diagnose himself. BUT - the VA can't ignore lay statements merely because the medical records didn't document the same thing.

This probably won't result in the VA NOT ignoring lay evidence - They will probably just get more skilled in how the WORD why they are ignoring the evidence.

Can hardly wait until the Federal Courts make a decision on "Internet print-outs"

http://www.cafc.uscourts.gov/opinions/07-7029.pdf

United States Court of Appeals for the Federal Circuit

2007-7029

ALVA JANDREAU,

Claimant-Appellant,

v.

R. JAMES NICHOLSON, Secretary of Veterans Affairs,

Respondent-Appellee.

Ronald L. Smith, Disabled American Veterans, of Washington, DC, argued for claimant-appellant. With him on brief was Zachary M. Stolz.

Leslie Cayer Ohta, Trial Attorney, Commercial Litigation Branch, Civil Division, United States Department of Justice, of Washington, DC, argued for respondent-appellee. With her on the brief were Peter D. Keisler, Assistant Attorney General; Jeanne E. Davidson, Director; and Mark A. Melnick, Assistant Director. Of counsel on the brief were Michael J. Timinski, Deputy Assistant General Counsel; and Y. Ken Lee, Attorney, United States Department of Veterans Affairs, of Washington, DC.

Appealed from: United States Court of Appeals for Veterans Claims

Chief Judge William P. Greene, Jr.

United States Court of Appeals for the Federal Circuit

2007-7029

ALVA JANDREAU,

Claimant-Appellant,

v.

R. JAMES NICHOLSON, Secretary of Veterans Affairs,

Respondent-Appellee.

___________________________

DECIDED: July 3, 2007

___________________________

Before MICHEL, Chief Judge, and BRYSON and DYK, Circuit Judges.

DYK, Circuit Judge.

Alva Jandreau (“Jandreau”) appeals the judgment of the United States Court of Appeals for Veterans Claims (“Veterans’ Court”). That court affirmed an earlier decision of the Board of Veterans’ Appeals (“Board”) that denied service connection for residuals of a right-shoulder dislocation. We reject appellant’s argument that the evidentiary standard should be relaxed, but hold that the Veterans’ Court improperly held that lay evidence cannot be used to establish a medical diagnosis. We remand for further proceedings consistent with this opinion.

BACKGROUND

Jandreau served honorably in the U.S. Army from May 1957 to May 1959. In

May 1997, Jandreau filed a claim with the Veterans Administration (“VA”) for residuals of a right shoulder injury. He asserted that the injury to his shoulder had occurred during basic training at Fort Dix, when he had dislocated his shoulder and had been treated for his injury on the base. The VA attempted to obtain Jandreau’s service medical records, but was unable to do so because those records had been destroyed in a 1973 fire at the National Personnel Records Center in St. Louis.

In an effort to provide the necessary evidence as support for his claim of service connection despite the destruction of the records, Jandreau submitted a number of documents to the VA. He submitted a statement from a fellow serviceman, Frederick Burnham, averring: “I remember Alva [Jandreau] being in great pain after dislocating his shoulder while in training.”1 J.A. at 35. Jandreau also submitted multiple medical reports, detailing medical examinations conducted in 2000. Those reports stated that Jandreau suffered pain, arthritis and rotator cuff impingement in his right shoulder. In particular, one report by Dr. Timothy Snell, M.D., assesses Jandreau’s condition as “[r]ight shoulder pain, most likely sequelae of his dislocation of the shoulder.” Id. at 7. Jandreau also submitted a radiology report indicating a history of right-shoulder dislocation and pain and documents indicating treatment for that condition.

The VA denied service connection because “no medical evidence was received showing continuity of treatment for the right shoulder since discharge from military service.” J.A. at 78. Jandreau appealed to the Board, which issued its decision on May

1 The VA specifically allows veterans to introduce into evidence statements of fellow service members when records were destroyed in the 1973 fire. See Veterans Benefits Administration Adjudication Procedures Manual M21-1MR, part III, subpart iii, ch. 2, § E.27.b (2005), available at http://www.warms.vba.va.gov/admin21/ m21_1/mr/part3/subptiii/ch02/ch02_sece.doc, page 2-E-5.

2007-7029 2

27, 2004. The Board denied service connection for Jandreau’s injury, reasoning that Dr. Snell’s report merely recorded Jandreau’s assertion that he had suffered a dislocation but did not diagnose a dislocation when it occurred. The Board stated that “the Board is not required to accept evidence that is simply information recorded by a medical examiner, unenhanced by medical opinion.” J.A. at 13. It further concluded that “[m]edical diagnosis and causation involve questions that are beyond the range of common experience and common knowledge, and require the special knowledge and experience of a trained physician.” Id. The Board rejected the testimony of both Jandreau and his fellow serviceman, because “[w]hile the veteran and his buddy are arguably competent to present evidence concerning the occurrence of an injury, they are not competent to present evidence to establish the etiology of a current disability.” Id. The Board thus found that “there is no competent evidence on file linking the veteran’s current right shoulder disabilities to service or to any incident therein.” Id.

Jandreau appealed to the Veterans’ Court, which affirmed the Board’s decision. The court concluded that the Board did not err in rejecting lay evidence that Jandreau suffered a dislocation during service and “did not err in discounting Dr. Snell’s medical opinion because it was premised on a fact that Mr. Jandreau was not competent to establish—that he had dislocated his shoulder during service.” Jandreau v. Nicholson, No. 04-1254, slip op. at *3 (Vet. App. Aug. 24, 2006). The court held that “[w]here the determinative issue involves either medical etiology or a medical diagnosis, competent medical evidence is required; however, lay assertions of symptomatology or injury may suffice where the determinative issue is not medical in nature.” Id. Thus the court held that “whether [Jandreau] experienced a dislocation of his shoulder requires a medical

2007-7029 3

diagnosis.” Id.

Jandreau timely appealed the decision of the Veterans’ Court to this court. We have jurisdiction pursuant to 38 U.S.C. § 7292(a). Cromer v. Nicholson, 455 F.3d 1346, 134-49 (Fed. Cir. 2006).

DISCUSSION

I

On appeal Jandreau first argues that the destruction of records while in the government’s custody should result in a relaxed evidentiary standard for veterans. We reject this argument.

The statute provides that “a claimant has the responsibility to present and support a claim for [VA] benefits.” 38 U.S.C. § 5107(a). In our decision in Cromer, 455 F.3d 1346, we considered and rejected the argument that service connection should be presumed when a veteran’s medical records are destroyed while in the government’s custody. 455 F.3d at 1350-51. In Cromer, the medical records were destroyed in the same 1973 fire at the National Personnel Records Center that resulted in the presumed destruction of Jandreau’s records. See id. at 1347. We reasoned that the veteran has the evidentiary burden of establishing his claim in veterans’ benefits cases and that Congress and the VA have specifically shifted that burden in particular cases, but have not done so here. Id. at 1350-51. We further noted that the VA has eased the evidentiary burden on veterans whose records were lost in the 1973 fire, but has not provided for an adverse presumption of service connection. Id. at 1351. 2

2 See Veterans Benefits Administration Adjudication Procedures Manual M21-1MR, part III, subpart iii, ch. 2, § E.27.b (2005), available at http://www.warms.vba.va.gov/admin21/m21_1/...2/ch02_sece.doc,

2007-7029 4

Jandreau on appeal does not deny that our decision in Cromer is controlling on the issue of burden shifting, but asserts that his claim is different because he asserts only that his burden of proof should be “somewhat relaxed.” Reply Br. at 1. To the extent Jandreau seeks a modification of his burden of proof, we see no material difference between his argument and the argument we rejected in Cromer. To the extent that Jandreau seeks to invoke traditional evidentiary adverse inference rules, we find those rules to be inapplicable, even if we were to agree that they apply in the context of VA proceedings. The general rules of evidence law create an adverse inference when evidence has been destroyed and “(1) . . . the party having control over the evidence had an obligation to preserve it at the time it was destroyed; (2) . . . the records were destroyed with a culpable state of mind; and (3) . . . the destroyed evidence was relevant to the party's claim or defense such that a reasonable trier of fact could find that it would support that claim or defense.” Residential Funding Corp. v. DeGeorge Fin. Corp., 306 F.3d 99, 107 (2d Cir. 2002) (internal citation and quotation marks omitted); see also 31A C.J.S. Evidence § 168 (2007); 2 Kenneth S. Brown, McCormick On Evidence § 264 (6th ed. 2006). The burden is on the party seeking to use the evidence to show the existence of each criterion. Residential Funding, 306 F.3d at 107. There is no claim here that the records were willfully or recklessly destroyed. While some circuits have held that a showing that a party was negligent in

page 2-E-5 (listing alternate documents, such as statements from service medical personnel, statements of fellow service members, letters, photographs or prescription records, state or local accident and police reports, that the veteran can provide to substitute for documents destroyed in the 1973 fire).

2007-7029 5

the destruction of records creates an adverse inference,3 we need not decide whether that is the correct rule because Jandreau conceded at oral argument that there was no evidence of government negligence leading to the destruction of the records.

II

Jandreau’s second argument on appeal is that the Veterans’ Court erred in holding that that lay evidence is insufficient “where the determinative issue involves either medical etiology or a medical diagnosis,” and that accordingly, “whether [Jandreau] experienced a dislocation of his shoulder requires a medical diagnosis.” Jandreau, No. 04-1254, slip op. at *3. We agree. The holding of the Veterans’ Court is inconsistent with our decision in Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), which was decided shortly before the decision of the Veterans’ Court in this case.

Buchanan involved a situation where the veteran claimed service connection resulting from schizophrenia that allegedly began during his service. The veteran sought to establish service connection by submitting affidavits of relatives and his commanding officer testifying that his symptoms of paranoid schizophrenia first manifested themselves during service, as well as a medical opinion from 2001, almost twenty years after the conclusion of his service, that stated that his symptoms first

3 See Residential Funding, 306 F.3d at 108; Rogers v. T.J. Samson Cmty. Hosp., 276 F.3d 228, 232 (6th Cir. 2002). Other circuits have held mere negligence insufficient to apply an adverse presumption. See, e.g., Aramburu v. The Boeing Co., 112 F.3d 1398, 1407 (10th Cir. 1997); Bashir v. Amtrak, 119 F.3d 929, 931 (11th Cir. 1997); Brewer v. Quaker State Oil Ref. Corp., 72 F.3d 326, 334 (3d Cir. 1995); Vick v. Texas Employment Comm'n, 514 F.2d 734, 737 (5th Cir. 1975); see also Med. Lab. Mgmt. Consultants v. Am. Broad. Co., 306 F.3d 806, 824 (9th Cir. 2002); Jackson v. Harvard University, 900 F.2d 464, 469 (1st Cir. 1990).

2007-7029 6

appeared during service. Id. at 1333. The Board determined that lay evidence without confirmatory documentary evidence cannot be credible, and the Veterans’ Court affirmed. Id. at 1337. We reversed, holding that numerous veterans’ statutes and regulations require consideration of lay evidence. Id. at 1334-35; see also 38 U.S.C. §§ 1154(a), 5107(; 38 C.F.R. §§ 3.303(a), 3.307(. In other words we found that the statute makes clear that, in the veterans’ context, traditional requirements for admissibility have been relaxed. See 38 U.S.C. § 5107(B) (“The Secretary shall consider all . . . lay and medical evidence of record in a case . . . with respect to benefits.”). We concluded that “lay evidence is one type of evidence that must be considered” and that “competent lay evidence can be sufficient in and of itself.” Buchanan, 451 F.3d at 1335. We noted that the Board retains discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. Id. at 1336-37. The rule announced in Buchanan is particularly important when veterans’ service medical records have been destroyed. Unless lay evidence were allowed, it would be virtually impossible for a veteran to establish his claim to service connection in light of the destruction of the service medical records.

Under Buchanan the conclusion of the Veterans’ Court that “competent medical evidence is required . . . [when] the determinative issue involves either medical etiology or a medical diagnosis” is too broad. Jandreau, No. 04-1254, slip op. at *3. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition,4 (2) the layperson is

4 Sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer.

2007-7029 7

2007-7029 8

reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Contrary to the Veterans’ Court, the relevance of lay evidence is not limited to the third situation, but extends to the first two as well. Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans’ Court. We do not reach the question whether in the present case the lay evidence is competent and sufficient to establish shoulder dislocation, a matter beyond our jurisdiction. We remand to the Veterans’ Court so that it may remand to the Board for further consideration under the correct legal standard.

CONCLUSION

For the foregoing reasons, the decision below is

REVERSED AND REMANDED

COSTS

No costs.

[Berta]

Yes- GOOD case!

Often a vet needs lay testimony to show continuity of symptoms-

When I won my FTCA it was not only due to the clinical medical record but I gave lay testimony.

I considered my lay testimony far more medically sound and competent (with full medical rationale that I sent in support of it) -than anything the VA doctors had come up

with and I won-

You are right about the internet print outs- often BVA accepts them-

but it deoends on many factors-

I just loved it when the VA stated I had sent "internet" printouts for my CUE claims-as evidence but never considered them in the narrative-

heck this was established VA case law, from M21-1, 4 BVA decisions and 2 General Counsel Pres ops-

I sure told the GC what they said-

that is good- we send them their very own regs and they try to blow us off-a crock

[free_spirit_etc]

I was surprised when the RO called the info we sent "treatises." I am HOPING that as they have acknowledged them as such - they will have to treat them as such in decision making.

It might be because we used mostly government sites and very reputable sources for the information.

It could also be because we were actually reporting what is considered COMMON KNOWLEDGE in the medical field.

In this - the treatisy evidence SHOULD be considered.

It is not a case of SOME people with ___ get ___. Or ___ CAN cause ____. Or ___ OFTEN leads to ____.

It is case of it is COMMON KNOWLEDGE that pulmonary adenocarcinoma not only MIGHT be slow growing. It is COMMON KNOWLEDGE that it IS slow growing!

And it is also COMMON KNOWLEDGE that the STANDARD doubling time for this cancer is 180 days. And we have very reputable sources that state this, as well as a statement from a doctor.

And it is COMMON KNOWLEDGE that cancer has to double a certain number of times to reach a certain size. The STANDARD used for a 3.1 cm tumor is 35 doublings.

We even submitted a research article that specifically studied FAST growing tumors. In that study, only 28% of the pulmonary carcinoma were considered fast growing (less than one hundred days doubling time)

- and of those - the FASTEST doubling time was 72 days (so it would still take over SIX YEARS for it to grow to 3 cm).

Now that is one of the "stretches" - as it doesn't apply directly to my husband's personal case. But it was submitted to help counter any opinion THEY might get stating that ALL cancer doesn't grow at the standard rate - an allude that his might have grown extremely rapidly.

Okay.. yeah.. but what are the chances that his grew THREE times FASTER than the "fast growing" tumors that have been studied? NOT more likely than not by any means.

We have SO MUCH treatisy evidence in the file SUPPORTING that the ONLY way to say it is more likely than not that his tumor grew to 3.1 cm within 2 years of discharge would require a doctor to Step WAY outside the realm of ACCEPTED standards - and even WAY beyond the realm of "well it is "possible."

Right now I THINK they are still playing around with the "His symptoms in service were not caused by his cancer." That is what the denial said - but I need to get the doctor's report to see what he actually said. They are SUPPOSED to be sending it to me. But I am also still waiting for the C-file I requested last summer too.

The last IRIS said they would send the doctor letter FIRST - and as his C-file is "large" - they will send that LATER.

Ahem..it is ALREADY later, thank you...

Anyway - I think we have enough supporting medical info about cancer in the files - that when I get the IMO that connects all the dots - it will be hard for a VA doctor to defeat it - which is why they have been avoiding talking about inception in the first place. They can't find any medical evidence to support a theory that the cancer started AFTER service. So they just ignore that part - and blab on about how his symptoms weren't caused by cancer.

The VA IGNORED the claim my husband presented over and over again - "My cancer STARTED when I was in active service."

Now that they have FINALLY acknowledged that IS his claim - it looks like their doctor ignored it - and only talked about symptoms.

I think a real key to claims is what they IGNORE.

Right now, I am so busy keeping up with my life and fighting all the other governmental agencies - that I don't have near enough time to put into getting the VA claim all the way together.

But once I get the C-file and Doctor Report - I think getting the IMO ought to do it.

The BVA has awarded LOTS of claims on the doubling time. They have pretty SHORT discussions on it. I think when they see the IMOs or treating doctor statements that CLEARLY STATE the nature of the cancer makes it so it is VERY UNLIKEY that it would have grown as fast as neccessary to have started AFTER service - they grant it pretty quickly. They don't ususally get into long drawn out discussions of the evidence.

At the BVA - Most of the cases where SC is denied are ones where the claimant JUST relied on lay and treatisy evidence - and the VA doctor who gave the opinion either states it is imposiible to determine EXACTLY when cancer STARTS without speculating - OR they give an opinion that the medical community considers that cancer's ONSET is when it is diagnosed.

The opinion on cancer ONSET can be easily defeated - Why do we push toward EARLY detection if cancer doesn't start until it is diagnosed.

The speculation can also be defeated in MANY cases. If my husband's cancer was a type that grew fast enough that it would have NORMALLY reached that size in four or five years - then it would be harder to determine how likley it would be that it COULD have grown to that size in two years. But his cancer is the time that would NORMALLY take 15 - 17 years to reach 3.1 cm. How much SPECULATION would it really take for a more likely than not opinion?

BUT - IF the claimant has NO medical opinion - AND the VA doc gives one of those flimsy ones - the BVA HAS on occasion, but RARELY will - over-rule the doctor's opinion based on the treatisy evidence.

The best a vet can hope for in that situation is a REMAND - for further development.

But sometimes - they go ahead and deny.

I am not sure what the RO does -

The RO is probably not sure what it does either.

Free

Yes- GOOD case!

Often a vet needs lay testimony to show continuity of symptoms-

When I won my FTCA it was not only due to the clinical medical record but I gave lay testimony.

I considered my lay testimony far more medically sound and competent (with full medical rationale that I sent in support of it) -than anything the VA doctors had come up

with and I won-

You are right about the internet print outs- often BVA accepts them-

but it deoends on many factors-

I just loved it when the VA stated I had sent "internet" printouts for my CUE claims-as evidence but never considered them in the narrative-

heck this was established VA case law, from M21-1, 4 BVA decisions and 2 General Counsel Pres ops-

I sure told the GC what they said-

that is good- we send them their very own regs and they try to blow us off-a crock

[free_spirit_etc]

Thanks Patti! That is very nice of you. I actually think we wrote quite a bit of rationale. We already sent that.

Right now it looks like you have your hands full fighting your own battles - so I am flattered that you offered to help with mine - especially since even I don't have enough time to fight my own battle with this yet.

So if you have some time when I get around to pulling it all together - it would be nice to have another brilliant mind give some input!

Free

i believe if the veteran were to write the rationale for adding germaine journal data, i may strengthen the point. i would be happy to help anybody with this should they care to discuss the case with me by phone and provide the journal articles.

patti

[Jayg]

For right now, there are ways to improve receptivity of some internet info. Though in my case, internet source material were noted in deciding an increase.

But many times you can find medical journal articals on-line. Call your library and have them get you a copy from the printed document. Unfortunately, these days many journals are getting away from printed matter altogether and the internet is becoming the only source for some such.

You might contact a firm, such as a phys therapy office, who's web page has appropriate info. Ask them to mail you, offering to send a self addressed/stamped envelope, the information. Sometimes they will.

Another thought I've had, but not followed up on yet, is to see if I can get access to a medical library and dig through their books. Wouldn't think it'd hurt to be able to quote 'chapter & verse,' so to speak.

[tssnave]

Free,

Is there a case winding its way through the system on internet printouts?

Thanks,

TS Snave

[free_spirit_etc]

TS - Not that I know of. I sure hope one does though - because it seems to be a way for the VA to act like you got your evidence from a cereal box or something.

There is NOTHING wrong with using Internet sources for reputable evidence.

Unfortunately, as anyone can put anything on the internet - just because something is printed, doesn't mean it is true.

However, information from reputable sources does NOT lose it's reputable status just because it is available on the Internet.

My husband and I got MANY of our articles off the internet - but they are STILL peer reviewed journal articles, government traning manuals, military standards, etc. They would also be available in print - we just happened to get them from the Internet.

We used Google Scholar a lot - because that leads you to more actual peer reviewed journal articles. Websites we used were FDA, National Cancer Institute, some of the top medical schools, etc.

With my husband's first appeal - he just typed in a search and printed whatever he could find - but nothing from what I would considered entirely reputable sources.

Look for sources they can't just dismiss.

As long as they are actual Journal articles - you don't actually have to state that you found the journal on the Internet - Just list the journal -- If the journal or author has something that makes it VERY credible - list that too.

Here is a PORTION of some of the Sources we used - and How we cited them in his argument:

Information from U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, published in the Columbia University Medical Center’s Guide to Clinical Preventive Services, Second Edition, Neoplastic Diseases Screening for Lung Cancer states____

An article ZD1839 (IressaTM) in Non-Small Cell Lung Cancer (The Oncologist, Vol. 7, Suppl 4, 9-15, August 15, 2002) reports___

The article A Systematic Review and Lessons Learned From Early Lung Cancer Detection Trials Using Low-Dose Computed Tomography of the Chest, (Cancer Control 10(4):306-314, 2003), H. Lee Moffitt Cancer Center and Research Institute, Inc., Bepler, et. al.) states

Excerpts from the AMERICAN CANCER SOCIETY FACT SHEETS (http://www.cancer.org/docroot/home/index.asp) include:

Excerpt from Case Western Reserve University School of Medicine’s Electronic Curriculum - Pathology of Lung Cancer (http://mediswww.meds.cwru.edu/

ecSample/yeartwo/pulmonary/carcinoma.html):

The article On the Growth Rates of Human Malignant Tumors: Implications for Medical Decision Making (Journal of Surgical Oncology,1997;65:284–297,Friberg & Mattson) states:

In the article Reducing Lung Cancer Risk* : Early Detection (Chest – The Cardiopulmonary and Critical Care Journal for Pulmonologists, Cardiologists, Cardiothoractic Surgeons, Critical Care Physicians, and Related Specialists - 1999;116;493-496) the author states:

Screening, Early Detection, and Early Intervention Strategies for Lung Cancer

(Cancer Control: Journal of the Moffitt Cancer Center, Vol 2, No. 6, November/December 1995) reports:

The article Management of solitary pulmonary nodules: How to decide when resection is required (POSTGRADUATE MEDICINE, VOL 101 / NO 3 / MARCH 1997, Glen A. Lillington, MD) reports,

The article Volumetric Growth Rate of Stage I Lung Cancer prior to Treatment: Serial CT Scanning (Radiology 2002;223:798-805 Winer-Muram, et al., from the Department of Radiology, Indiana University School of Medicine, Indianapolis; and the Department of Radiology, Richard L. Roudebush, Veterans Administration Medical Center, Indianapolis, IN) reports:

The following excerpts from the FDA (Food and Drug Administration) Briefing Document for NDA 21-399 (Documents reviewed EDR Submissions) substantiates that adenocarcinoma has the slowest doubling time of all lung cancers.

The article Innovative molecular and imaging approaches for the detection of lung cancer and its precursor lesions (Oncogene 7 October 2002, Volume 21, Number 45, Pages 6949-6959 Annette McWilliams, et. al.) reports:

ADENOCARCINOMA - DOUBLING TIME 180 DAYS

From the National Cancer Institute SEERS site: (http://www.seer.cancer.gov/)

“The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) is an authoritative source of information on cancer incidence and survival in the United States…The SEER Program is considered the standard for quality among cancer registries around the world. Quality control has been an integral part of SEER since its inception. Every year, studies are conducted in SEER areas to evaluate the quality and completeness of the data being reported.”

The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program Web Based Training Modules (http://www.training.seer.cancer.gov/) reports:

These medically established standards are also taught as sound medical principles in Universities, as evidenced by:

From the Electronic Curriculum of Salisbury University:

Cancer of the Lung

Robert L. Joyner, Jr., PhD, RRT

Associate Professor and Chair

Department of Health Sciences

Director, Respiratory Therapy Program

Salisbury University

---

Maybe that is why they CALLED our info Treatises - rather than "Internet printouts" - I don't know.

Notice how we didn't just list the SEERS site - we included the part that is ON the site that tells how it is THE authoritive source for cancer statistics.

There ARE quite a bit of rulings that discuss how treatises can be used to SUPPORT a medical opinion.

So if you have an opinion from a doctor - and the doctor didn't back it solid with reasons - you CAN use the journal articles to SUPPORT HIS opinion - at least the BVA acknowleges it -

(My doctor said ____. This is supported by ___, and ___.

Free

Free,

Is there a case winding its way through the system on internet printouts?

Thanks,

TS Snave