## Facts

- John L. Viegas, an “incomplete” quadriplegic veteran, attended a VA medical center for a prescribed aquatic therapy session.
- After the session, he went to a restroom within the VA facility.
- While transferring into his wheelchair, he used a wall-mounted grab bar intended to assist disabled users.
- The grab bar came loose, causing him to fall and injure his upper and lower extremities.
- After the fall, Viegas experienced a deterioration in mobility, including losing the ability to walk with a walker.
- He filed for disability compensation under 38 U.S.C. § 1151, alleging additional disability from the fall.
- The VA adjudicatory system and the Veterans Court denied relief on the view that the injury was not caused by “hospital care” because he was not receiving direct, active treatment when he fell.

## Issues

1. Whether 38 U.S.C. § 1151(a)(1) requires that an injury be caused by hands-on medical treatment by VA personnel, or whether an injury caused by unsafe conditions in a VA facility can be “caused by hospital care.”
2. Whether injuries from a defective restroom grab bar at a VA medical center, used immediately after prescribed therapy, can satisfy § 1151’s causation requirement.

## Decision

- The Federal Circuit reversed the Veterans Court and remanded.
- The court held that § 1151 does not impose a “direct VA care” or “hands-on treatment” requirement.
- The court concluded that “hospital care” includes the hospital environment and physical apparatus provided in connection with furnishing care.
- The court determined that an injury resulting from the VA’s failure to maintain facility equipment (such as a grab bar installed for disabled veterans) may satisfy § 1151’s causation requirement, so long as the statutory requirements (including proximate cause) are met.
- The court directed further proceedings to apply the correct legal standard, including any necessary findings on fault or foreseeability and on additional disability.

## Legal Principles

- Under 38 U.S.C. § 1151(a)(1), a qualifying additional disability may be compensable if it was caused by VA-furnished “hospital care, medical or surgical treatment, or examination,” and the proximate cause was VA fault or an event not reasonably foreseeable.
- “Hospital care” is not limited to the moment of clinical treatment; it can include the conditions, equipment, and premises maintenance necessary to provide care within a VA facility.
- A compensable claim requires a meaningful causal connection between the veteran’s additional disability and VA-provided hospital care; the statute does not cover injuries that are merely remote or attenuated from that care.
- When a denial rests on an overly narrow view of § 1151 causation, the proper remedy is reversal and remand for application of the correct standard to the facts.

## Conclusion

The Federal Circuit held that § 1151 can encompass injuries caused by unsafe conditions or defective equipment within a VA medical facility because “hospital care” includes the hospital environment, and it remanded for consideration of proximate cause requirements such as VA fault or unforeseeability and the extent of any additional disability.


Viegas v. Shinseki, 705 F.3d 1374 (Fed. Cir. 2013)