Viegas v. Shinseki

United States Court of Appeals

for the Federal Circuit

______________________

JOHN L. VIEGAS,

Claimant-Appellant,

v.

ERIC K. SHINSEKI, SECRETARY OF VETERANS

AFFAIRS,

Respondent-Appellee.

______________________

2012-7075

______________________

Appeal from the United States Court of Appeals for

Veterans Claims in No. 10-0568, Judge Alan G. Lance, Sr.

______________________

Decided: January 31, 2013

______________________

LINDA E. BLAUHUT, Paralyzed Veterans of America, of

Washington, DC, argued for claimant-appellant. With

her on the brief was JENNIFER A. ZAJAC.

SCOTT D. AUSTIN, Assistant Director, Commercial

Litigation Branch, Civil Division, United States Depart-

ment of Justice, of Washington, DC, argued for respon-

dent-appellee. On the brief were STUART F. DELERY,

Acting Assistant Attorney General, JEANNE E. DAVIDSON,

Director, TODD M. HUGHES, Deputy Director, and

ELIZABETH M. HOSFORD, Senior Trial Counsel. Of counsel

2 VIEGAS v. SHINSEKI

on the brief were MICHAEL J. TIMINSKI, Deputy Assistant

General Counsel, and CHRISTA A. SHRIBER, Attorney,

United States Department of Veterans Affairs, of Wash-

ington, DC.

______________________

Before RADER, Chief Judge, NEWMAN and MAYER, Circuit

Judges.

MAYER, Circuit Judge.

John L. Viegas appeals the final judgment of the

United States Court of Appeals for Veterans Claims

(“Veterans Court”) affirming a decision of the Board of

Veterans’ Appeals (“board”) that denied his claim for

disability compensation under 38 U.S.C. § 1151. See

Viegas v. Shinseki, No. 10-568, 2011 U.S. App. Vet.

Claims LEXIS 2554 (Nov. 23, 2011) (“Veterans Court

Decision”). Because we conclude that the Veterans Court

misinterpreted the causation requirement set forth in

section 1151(a)(1), we reverse and remand.

I. BACKGROUND

The relevant facts are not in dispute. Viegas served

in the United States Army from November 1965 to No-

vember 1967. After he left the service, he was injured in

a diving accident. As a result, Viegas now suffers from

“incomplete” quadriplegia.

In May 2004, Viegas participated in a prescribed

aquatic therapy session at a Department of Veterans

Affairs (“VA”) medical center in Palo Alto, California.

Afterward, he stopped to use a restroom located in the VA

facility. While he was in the restroom, the grab bar he

was using to lift himself into his wheelchair came loose

from the wall and he fell to the ground. As a result of the

fall, Viegas sustained injuries to both his upper and lower

extremities. Viegas’ medical condition deteriorated after

VIEGAS v. SHINSEKI 3

his fall. Prior to his fall, Viegas could sometimes walk

with a walker, but since the accident he can only stand

with assistance.

In July 2004, Viegas filed a claim for section 1151

benefits. He asserted that as a result of the fall in the VA

restroom he had “incurred severe injury to his shoulder

and neck resulting in loss of use of his lower extremities

and impairment of his upper extremities.” A VA regional

office denied Viegas’ claim, concluding that he was not

entitled to benefits under section 1151 because he was

“not in direct VA care at the time of [his] fall.” On appeal,

the board affirmed, stating that benefits are available

under section 1151 only if a veteran’s “additional disabil-

ity [is] the result of injury that was part of the natural

sequence of cause and effect flowing directly from the

actual provision of hospital care, medical or surgical

treatment, or examination furnished by [the] VA and . . .

such additional disability was directly caused by that VA

activity.”

Viegas then appealed to the Veterans Court. The

court held that although Viegas’ injury occurred in a VA

facility, it was not caused directly by “hospital care,

medical or surgical treatment, or examination furnished

by [the] VA.” Veterans Court Decision, 2011 U.S. App.

Vet. Claims LEXIS 2554, at *2 (citations and internal

quotation marks omitted). In the court’s view, while

Viegas might potentially be able to seek compensation for

his injuries under the Federal Tort Claims Act, 28 U.S.C.

§ 1346(b), the additional disability incurred as a result of

his fall was “simply not covered by section 1151.” Veter-

ans Court Decision, 2011 U.S. App. Vet. Claims LEXIS

2554, at *3. Viegas then filed a timely notice of appeal

with this court.

4 VIEGAS v. SHINSEKI

II. DISCUSSION

We have jurisdiction over appeals from the Veter-

ans Court under 38 U.S.C. § 7292. Questions of statutory

interpretation are questions of law, subject to de novo

review. Chandler v. Shinseki, 676 F.3d 1045, 1047 (Fed.

Cir. 2012); Boggs v. Peake, 520 F.3d 1330, 1334 (Fed. Cir.

2008).

Pursuant to section 1151, a veteran who sustains a

“qualifying additional disability” as a result of VA medical

treatment or hospital care is entitled to benefits “in the

same manner as if such additional disability . . . were

service-connected.” 38 U.S.C. § 1151(a); see Roberson v.

Shinseki, 607 F.3d 809, 813 (Fed. Cir. 2010). In relevant

part, section 1151 provides:

(a) Compensation under this chapter and

dependency and indemnity compensation under

chapter 13 of this title shall be awarded for a

qualifying additional disability or a qualifying

death of a veteran in the same manner as if such

additional disability or death were service-

connected. For purposes of this section, a disabil-

ity or death is a qualifying additional disability or

qualifying death if the disability or death was not

the result of the veteran’s willful misconduct

and—

(1) the disability or death was caused by

hospital care, medical or surgical treatment, or ex-

amination furnished the veteran under any law

administered by the Secretary, either by a De-

partment employee or in a Department facility as

defined in section 1701(3)(A) of this title, and the

proximate cause of the disability or death was—

(A) carelessness, negligence, lack of proper

skill, error in judgment, or similar instance of

VIEGAS v. SHINSEKI 5

fault on the part of the Department in furnishing

the hospital care, medical or surgical treatment,

or examination; or

(B) an event not reasonably foreseeable[.]

38 U.S.C. § 1151 (emphasis added).

Section 1151 delineates three prerequisites for obtain-

ing disability compensation. First, a putative claimant

must incur a “qualifying additional disability” that was

not the result of his own “willful misconduct.” Id.

§ 1151(a).1 Second, that disability must have been

“caused by hospital care, medical or surgical treatment, or

examination furnished the veteran” by the VA or in a VA

facility. Id. § 1151(a)(1). Finally, the “proximate cause” of

the veteran’s disability must be “carelessness, negligence,

lack of proper skill, error in judgment, or similar instance

of fault on the part of the [VA],” or “an event not reasona-

bly foreseeable.” Id. §§ 1151(a)(1)(A), 1151(a)(1)(B).

Section 1151 thus contains two causation elements—a

veteran’s disability must not only be “caused by” the

hospital care or medical treatment he received from the

VA, but also must be “proximate[ly] cause[d]” by the VA’s

“fault” or an unforeseen “event.” Id. § 1151(a). There is

no question that Viegas’ injury meets section 1151’s

second causation element since it was proximately caused

by the VA’s failure to properly install and maintain the

grab bar in a restroom at its Palo Alto Medical Center.

The sole issue presented on appeal is whether his injury

1 In determining whether a veteran has incurred a

“qualifying additional disability,” the VA compares the

veteran’s physical condition immediately prior to the

beginning of the hospital care or medical treatment in

which the claimed injury was sustained with his condition

at the conclusion of such care or treatment. See 38 C.F.R.

§ 3.361(b).

6 VIEGAS v. SHINSEKI

was “caused by” the medical treatment or hospital care he

received from the VA.

The government argues that Viegas’ injury falls

outside the ambit of section 1151 because the statute

encompasses only those injuries that are “directly caused

by the provision of medical care.” In the government’s

view, section 1151 applies “to disabilities that are caused

by actual care or treatment, rather than injuries that

coincidentally occur in VA facilities.” Viegas disagrees.

He asserts that his injury was “caused by” the hospital

care he received at the VA’s Palo Alto Medical Center

because it occurred while he “was receiving care and

treatment” at the facility. According to Viegas, section

1151’s causation requirement is satisfied whenever a

veteran comes to a VA facility for medical treatment and,

as a result of the VA’s negligence, sustains an injury

while on VA premises.

We do not find either the government’s or Viegas’

interpretation of the phrase “caused by” in section

1151(a)(1) wholly satisfactory. Contrary to the govern-

ment’s assertions, nothing in the statutory text requires

that a veteran’s injury must be “directly” caused by the

“actual” medical care provided by VA personnel. On the

other hand, however, section 1151 does not extend to the

“remote consequences” of VA medical treatment, Brown v.

Gardner, 513 U.S. 115, 119 (1994) (“Gardner”), and a

veteran is not entitled to obtain section 1151 disability

benefits simply because he was in a VA medical facility at

the time he sustained an injury.

A. THE STATUTORY TEXT

“As is true in every case involving the construction

of a statute, our starting point must be the language

employed by Congress.” Reiter v. Sonotone Corp., 442

U.S. 330, 337 (1979). Nothing in the plain language of

section 1151 requires that a veteran’s injury must be

VIEGAS v. SHINSEKI 7

“directly” caused by the “actual” provision of medical care

by VA personnel. To the contrary, the statute is framed

disjunctively, stating that a disability must be “caused by”

hospital care or medical treatment that is provided to a

veteran “either by a [VA] employee or in a [VA] facility.”

38 U.S.C. § 1151(a)(1) (emphases added). In other words,

the causation element is satisfied not only when an injury

is directly caused by the actions of VA employees, but also

when that injury occurs “in a [VA] facility” as a result of

the VA’s negligence. By use of the disjunctive, Congress

intended to encompass not simply the actual care pro-

vided by VA medical personnel, but also treatment-

related incidents that occur in the physical premises

controlled and maintained by the VA. See Reiter, 442

U.S. at 338 (eschewing a “strained construction” of a

statute that “would . . . ignore the disjunctive ‘or’” con-

tained in the statutory text); Fed. Commc’n Comm’n v.

Pacifica Found., 438 U.S. 726, 739-40 (1978) (explaining

that where terms “are written in the disjunctive, [it]

impl[ies] that each has a separate meaning”).

Here, Viegas came to the VA’s Palo Alto Medical

Center to participate in a recently-prescribed aquatic

therapy session that was designed to help him manage his

incomplete quadriplegia. He was injured because the VA

failed to properly install and maintain the equipment

necessary to provide him with medical treatment. The

VA cannot reasonably furnish hospital care2 or medical

2 The VA does not care for most veterans in tradi-

tional “hospitals,” but instead provides hospital services

through a large network of medical centers, such as the

Palo Alto Medical Center where Viegas received his

prescribed therapy. See U.S. Dep’t of Veterans Affairs,

Veterans Health Administration, Health Care,

http://www.va.gov/health/aboutVHA.asp. (last visited Dec.

12, 2012) (explaining that VA medical centers “provide a

8 VIEGAS v. SHINSEKI

treatment to disabled veterans without also providing

access to handicapped-accessible restrooms. Restroom

grab bars, and other equipment specifically designed to

assist the disabled, are a necessary component of the

health care services the VA provides because without

such equipment many veterans would be unable to avail

themselves of VA medical care. See, e.g., Galloway v.

Baton Rouge Gen. Hosp., 602 So. 2d 1003, 1008 (La. 1992)

(A hospital has a “duty to protect a patient from dangers

that may result from the patient’s physical and mental

incapacities as well as from external circumstances pecu-

wide range of services including traditional hospital-based

services such as surgery, critical care, mental health,

orthopedics, pharmacy, radiology and physical therapy”).

Here, Viegas was arguably receiving “hospital care” at the

time of his injury since it occurred while he was at a VA

medical center for prescribed physical therapy. See

Jackson v. Nicholson, 433 F.3d 822, 826 (Fed. Cir. 2005)

(“The term ‘hospital care’ implies the provision of care by

the hospital specifically, as opposed to the broader, more

general experience of a patient during the course of hospi-

talization.”). Even if Viegas was not receiving “hospital

care” at the time of his injury, however, the physical

therapy prescribed to help him manage his quadriplegia

would fall under the umbrella of “medical treatment.” See

Bartlett v. Shinseki, 24 Vet. App. 328, 334 n.7 (2011)

(explaining that “treatment” is defined as “medical care

given to a patient for an illness or injury” (citations and

internal quotation marks omitted)); see also Franks v.

Shinseki, No. 11-2477, 2012 U.S. App. Vet. Claims LEXIS

2339, at *19-25 (Nov. 26, 2012) (concluding that the board

erred in rejecting the claim of a veteran seeking section

1151 benefits based upon the VA’s failure to provide him

with required physical therapy).

VIEGAS v. SHINSEKI 9

liarly within the hospital’s control.” (citations and inter-

nal quotation marks omitted)); Johnson v. Grant Hosp.,

291 N.E.2d 440, 446 (Ohio 1972) (“A hospital owes a duty

to its patients to exercise such reasonable care for their

safety as their known mental and physical condition may

require.”). Viegas’ injury was not, as the government

asserts, merely “coincident” with his prescribed physical

therapy, but was instead caused by the VA’s failure to

properly maintain and install the equipment required so

that that treatment could take place. See Bartlett, 24 Vet.

App. at 334-36 (concluding that section 1151 covered an

injury incurred as the result of the VA’s failure to prop-

erly supervise patients hospitalized in a VA psychiatric

facility); see also Sweitzer v. Brown, 5 Vet. App. 503, 507

(1993) (Mankin, J., dissenting) (emphasizing that when a

veteran goes to a VA medical center for examination he

remains under the VA’s “control and authority while on

VA premises” and the VA bears responsibility “for taking

all reasonable precautionary measures to assure” his

safety).

In Gardner, the Supreme Court unanimously re-

jected the government’s efforts to impose limitations on

the scope of section 1151 beyond those specifically dic-

tated by Congress. 513 U.S. at 117-20. The previous

version of section 11513 provided that a veteran was

3 Prior to a 1996 amendment, section 1151 pro-

vided:

Where any veteran shall have suffered an injury, or an

aggravation of an injury, as the result of hospitalization,

medical or surgical treatment, or the pursuit of a course of

vocational rehabilitation . . . or as a result of having

submitted to an examination . . . , and not the result of . . .

willful misconduct, . . . disability or death compensation

10 VIEGAS v. SHINSEKI

entitled to disability benefits for an injury that occurred

“as the result of hospitalization, medical or surgical

treatment, or the pursuit of a course of vocational reha-

bilitation.” The VA had interpreted this provision to

require that a veteran demonstrate that his additional

disability was incurred as the result of “fault” on the part

of the VA. Gardner, 513 U.S. at 117. The Supreme Court

rejected this approach, however, noting that the statutory

language contained not “so much as a word about fault.”

Id. (footnote omitted). Instead, the language of section

1151 is most “naturally read simply to impose the re-

quirement of a causal connection between the ‘injury’ or

‘aggravation of an injury’ and ‘hospitalization, medical or

surgical treatment, or the pursuit of a course of vocational

rehabilitation.’” Id. at 119.

A similar analysis applies here. Although the gov-

ernment asserts that a veteran’s disability must be “di-

rectly” caused by the provision of hospital care or medical

. . . shall be awarded in the same manner as if such dis-

ability, aggravation, or death were service-connected.

Pub. L. No. 85-857, 72 Stat. 1105, 1124 (1958). As will be

discussed more fully in section IIC, Congress amended

section 1151 in 1996, adding a requirement that the

“proximate cause” of a veteran’s additional disability must

be “carelessness, negligence, lack of proper skill, error in

judgment, or similar instance of fault on the part of the

[VA], in furnishing the hospital care [or] medical or surgi-

cal treatment” or “an event not reasonably foreseeable.”

See Departments of Veterans Affairs and Housing and

Urban Development and Independent Agencies Appro-

priations Act, Pub. L. No. 104-204, 110 Stat. 2874, 2926-

27 (1996).

VIEGAS v. SHINSEKI 11

treatment, section 1151 contains not “so much as a word

about” direct causation. There is simply nothing in the

plain language of the statute which requires that an

injury be “directly” caused by the medical care provided

by VA personnel. Instead, the statute requires only a

“causal connection,” Gardner, 513 U.S. at 119, between

the injuries sustained by the veteran and the hospital

care or medical treatment provided by the VA.

Gardner makes clear that if there is any ambiguity

regarding the prerequisites for compensation under

section 1151, “interpretive doubt [must be] resolved in the

veteran’s favor.” Id. at 118. By its plain terms, section

1151 imposes no requirement that a veteran’s additional

disability must be “directly” caused by the “actual” provi-

sion of hospital or medical care by VA employees. Even if

it were a close case, however, we would be constrained to

construe the statute in Viegas’ favor. See, e.g., Fishgold v.

Sullivan Drydock & Repair Corp., 328 U.S. 275, 285

(1946) (“This legislation is to be liberally construed for the

benefit of those who left private life to serve their country

in its hour of great need.”).

B. JACKSON

In Jackson, we interpreted section 1151’s causation

requirement expansively, noting that “[t]he statute uses

broad language and allows for compensation any time

there has been an injury that results from ‘hospitaliza-

tion.’” 433 F.3d at 826.4 There, a veteran, who was

4 Jackson construed the previous version of section

1151 which, as noted previously, provided for compensa-

tion for an injury that was “the result of hospitalization

[or] medical or surgical treatment.” As will be discussed

more fully in section IIC, the 1996 amendment to the

statute substituted the phrase “hospital care” for the word

“hospitalization.”

12 VIEGAS v. SHINSEKI

hospitalized at a VA medical center for physical therapy

and treatment of chronic pain, was injured when she was

assaulted by another patient. Id. at 823. The govern-

ment argued that the veteran was not entitled to benefits

under section 1151 because her injury was caused by

another patient rather than actions of the VA. Id. at 824.

We rejected this argument, however, explaining “that the

fact that a causal connection is required for compensation

does not mean that the cause must be VA personnel.” Id.

at 825. Because the veteran would not have been injured

had she not been hospitalized, her injury was the “result

of [her] hospitalization.” Id. at 826.

The government points to language in Jackson

which states that “[w]hereas medical and surgical treat-

ment involve direct involvement with VA staff, hospitali-

zation need not be related to any treatment, but rather is

related to the circumstance of being hospitalized.” Id. at

825. Relying on this language, the government contends

that because medical treatment requires direct involve-

ment with VA staff, Viegas’ injury, which occurred as a

result of an improperly installed restroom grab bar, was

not “caused by” his medical treatment. We disagree.

There is no dispute that the medical treatment provided

by the VA normally “involve[s] direct involvement with

VA staff.” Id. Viegas’ physical therapy, for example,

presumably involved direct interaction with VA person-

nel. The fact that VA medical treatment normally in-

volves interaction with VA personnel, however, does not

mean that such treatment only encompasses the actions

of VA employees. If, for example, a veteran who was

suffering from an infection visited a VA medical facility

and obtained an antibiotic, his “medical treatment” would

presumably include not only the actions of the VA physi-

cian who prescribed the antibiotic but also the drug itself.

Thus, while the medical treatment provided by the VA

typically includes “direct involvement with VA staff,” id.,

VIEGAS v. SHINSEKI 13

this does not mean that it does not also include the medi-

cations and equipment necessary to provide such treat-

ment.

C. THE LEGISLATIVE HISTORY

Section 1151 has a long history, but contains nothing

to indicate that Congress intended to preclude compensa-

tion for injuries stemming from the VA’s failure to prop-

erly install and maintain the equipment necessary to

provide health care services. See Gardner v. Brown, 5

F.3d 1456, 1460 (Fed. Cir. 1993), aff’d, 513 U.S. at 115

(“The Secretary must make an extraordinarily strong

showing of clear legislative intent in order to convince us

that Congress meant other than what it ultimately

said.”). Prior to 1924, veterans were not eligible for

benefits for injuries caused by VA medical care because

such injuries were not deemed to be service-connected.

Id. Pursuant to the World War Veterans’ Act of 1924,

Pub. L. No. 68-242, § 213, 43 Stat. 607, 623 (the “1924

Act”), however, compensation was provided to those

veterans injured “as the result of training, hospitalization,

or medical or surgical treatment.” Congress repealed the

1924 Act in 1933, but in 1934 replaced it with a similar

statute that was designed to apply to all veterans, not

simply those who had served in World War I. See Act of

Mar. 28, 1934, Pub. L. No. 73-141, § 31, 48 Stat. 509, 526

(the “1934 Act”); see also Hornick v. Shinseki, 24 Vet. App.

50, 55 (2010). The 1934 Act was amended several times,

eventually resulting in the version of section 1151 con-

strued by the Supreme Court in Gardner. That iteration

of the statute, as noted previously, provided compensation

for disabilities which occurred “as the result of hospitali-

zation [or] medical or surgical treatment” provided by the

VA. Although the 1924 Act, the 1934 Act and the previ-

ous version of section 1151 all required that a veteran’s

injury occur as a “result” of specified health care services,

none contained any indication that the equipment neces-

14 VIEGAS v. SHINSEKI

sary to provide medical care was not encompassed within

the scope of the health care services the VA provides.

In 1996, in the wake of Gardner, Congress

amended section 1151, adding a provision that requires

that the “proximate cause” of a veteran’s additional

disability must be “carelessness, negligence, lack of

proper skill, error in judgment, or similar instance of fault

on the part of the [VA],” or “an event not reasonably

foreseeable.” 38 U.S.C. § 1151(a)(1). The stated purpose

of the amendment was “[t]o provide benefits for certain

children of Vietnam veterans who [had been] born with

spina bifida, and to offset the cost of such benefits by

requiring that there be an element of fault as a precondi-

tion for entitlement to compensation for a disability or

death resulting from health care or certain other services

furnished by the Department of Veterans Affairs.” 142

Cong. Rec. S9932 (daily ed. Sept. 5, 1996).

Although the 1996 amendment to section 1151

clearly served to restrict the statute’s reach to situations

in which a veteran’s injury resulted from “fault” on the

part of the VA or an unforeseeable “event,” there is noth-

ing to suggest that it was intended to impose additional

limitations on the statute’s original requirement that a

veteran’s injury must be the result of medical care pro-

vided by the VA.5 In other words, although Congress

5 The 1996 amendment substituted the phrase

“caused by” for the phrase “as the result of,” but this does

not appear to have been a substantive change. See Gard-

ner, 513 U.S. at 119 (explaining that the phrase “as the

result of” simply “impose[d] the requirement of a causal

connection”). Nor is there any indication in the legislative

history that substitution of the phrase “hospital care” for

the word “hospitalization” was intended to change the

statute’s scope.

VIEGAS v. SHINSEKI 15

added a second causation requirement to section 1151,

requiring a showing of fault on the part of the VA, there is

no indication that it intended to impose any additional

restrictions on the statute’s original causation element.

Significantly, the amended version of section 1151 speci-

fies that the “cause[]” of a veteran’s injury must be VA

hospital care or medical or surgical treatment, but that

the “proximate cause” of that injury must be the VA’s

negligence. 38 U.S.C. § 1151(a)(1) (emphasis added); see

K Mart Corp. v. Cartier, Inc., 486 U.S. 281, 291 (1988) (“In

ascertaining the plain meaning of the statute, the court

must look to the particular statutory language at issue, as

well as the language and design of the statute as a

whole.”). Congress plainly knew how to deploy adjectives

when it wished to modify the meaning of the word

“cause.” If it had wanted to impose a requirement that

the “direct” cause of a veteran’s injury must be the “ac-

tual” medical treatment provided by VA personnel, Con-

gress could readily have inserted such a requirement into

the statutory text. See Russello v. United States, 464 U.S.

16, 23 (1983) (When “Congress includes particular lan-

guage in one section of a statute but omits it in another

Pursuant to 38 U.S.C. § 1701, which provides defini-

tions of terms for purposes of chapter 17 of Title 38, “[t]he

term ‘hospital care’ includes . . . medical services rendered

in the course of the hospitalization of any veteran.” 38

U.S.C. § 1701(5)(A)(i) (emphasis added). The term “hos-

pital care” also includes benefits such as travel expense

reimbursement and services, such as family counseling,

for members of the veteran’s family. Id. § 1705(B). The

statute does not limit the term “hospital care” to the care

provided by medical professionals. Nor does the statute

specifically exclude the care provided to a veteran who

receives treatment at a VA medical center, but who is not

actually hospitalized as a patient at the facility.

16 VIEGAS v. SHINSEKI

section of the same Act, it is generally presumed that

Congress acts intentionally and purposely in the dispa-

rate inclusion or exclusion.” (citations and internal quota-

tion marks omitted)).

D. REMOTE CONSEQUENCES

Section 1151 recognizes that a veteran should be

compensated when “[t]he Government having undertaken

to bestow a benefit, has, in fact, inflicted a loss.” Hearings

on H.R. 7320 Before the H. Comm. on World War Veter-

ans’ Legislation, 68th Cong., 1st Sess. 113 (1924). This

does not mean, however, that the statute covers every

injury sustained by a veteran in a VA medical facility.

Gardner makes clear that the statute does not extend to

the “remote consequences” of the hospital care or medical

treatment provided by the VA. 513 U.S. at 119; see also

Roberson, 607 F.3d at 815-16 (emphasizing that the VA

has no responsibility “to insur[e] for every possible condi-

tion that a veteran has, even if unrelated to service or VA

treatment”). If, for example, a veteran reported to a VA

medical center for an examination, and hours later was

injured while engaged in recreational activities at the

facility, his injury might well be deemed only a “remote

consequence” of his earlier examination. Here, however,

Viegas’ injury was not a “remote consequence” of the

treatment he received at the VA’s Palo Alto Medical

Center, but instead occurred because the VA failed to

properly install and maintain the equipment necessary

for the provision of his medical care.

III. CONCLUSION

Accordingly, the judgment of the United States Court

of Appeals for Veterans Claims is reversed and the case is

remanded for further proceedings consistent with this

opinion.

REVERSED AND REMANDED