Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca13-15-07094/USCOURTS-ca13-15-07094-0/pdf.json

Parties Involved:
Freddie H. Mathis
Appellant
Robert A. McDonald
Appellee

Document Text:

NOTE: This disposition is nonprecedential. 

United States Court of Appeals 

for the Federal Circuit ______________________ 

FREDDIE H. MATHIS,

Claimant-Appellant

v.

ROBERT A. MCDONALD, SECRETARY OF 

VETERANS AFFAIRS,

Respondent-Appellee

______________________ 

2015-7094

______________________ 

Appeal from the United States Court of Appeals for 

Veterans Claims in No. 13-3410, Judge Alan G. Lance, Sr.

______________________ 

Decided: April 1, 2016

______________________ 

MARK RYAN LIPPMAN, The Veterans Law Group, La 

Jolla, CA, argued for claimant-appellant.

WILLIAM JAMES GRIMALDI, Commercial Litigation 

Branch, Civil Division, United States Department of 

Justice, Washington, DC, argued for respondent-appellee. 

Also represented by BENJAMIN C. MIZER, ROBERT E.

KIRSCHMAN, JR., MARTIN F. HOCKEY, JR.; Y. KEN LEE,

SAMANTHA ANN SYVERSON, Office of General Counsel, 

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2 MATHIS v. MCDONALD

United States Department of Veterans Affairs, Washington, DC. 

______________________ 

Before O’MALLEY, REYNA, and CHEN, Circuit Judges.

Opinion for the court filed by Circuit Judge O’MALLEY. 

Concurring opinion filed by Circuit Judge REYNA. 

O’MALLEY, Circuit Judge.

Appellant Freddie H. Mathis (“Mathis”) appeals from 

a decision of the United States Court of Appeals for 

Veterans Claims (“Veterans Court”) affirming a Board of 

Veterans’ Appeals (“Board”) decision denying service 

connection for sarcoidosis, a pulmonary condition. Mathis 

v. McDonald, No. 13-3410, 2015 U.S. App. Vet. Claims 

LEXIS 654 (Vet. App. May 21, 2015). Because we are 

bound by this court’s controlling precedent establishing a 

presumption of competency for VA medical examiners, we 

affirm. 

BACKGROUND

Mathis served on active duty in the U.S. Air Force 

from August 1980 to August 2002. According to private 

treatment records, Mathis was diagnosed with sarcoidosis 

in September 2009.1 He filed a claim for service connection the following month. After a VA regional office 

(“RO”) denied his claim in March 2010, Mathis appealed 

his case to the Board. 

The RO had determined that certain of Mathis’s service treatment records (“STRs”) had become unavailable. 

 

1 Sarcoidosis is “a chronic, progressive, systemic 

granulomatous reticulosis of unknown etiology, characterized by hard tubercles.” DORLAND’S ILLUSTRATED MEDICAL 

DICTIONARY 1668 (32d ed. 2012).

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MATHIS v. MCDONALD 3

In March 2011, in order to compensate for his missing 

STRs, Mathis and his ex-wife testified at a Decision 

Review Officer (DRO) hearing. During the hearing, 

Mathis testified that his sarcoidosis began during the late 

1990s (i.e., the last few years of his active duty) and that, 

during his active military service, he experienced weakness, fatigue, and shortness of breath. He stated that he 

was treated for these symptoms while in active service. 

He also testified that his sarcoidosis may be the result of 

environmental exposures while he was stationed in Italy. 

Mathis’s ex-wife testified that his health declined during 

their marriage while he was on active duty. Finally, 

Mathis submitted two statements from veterans who 

were in the Air Force with him and described his shortness of breath during his active service and since that 

time. 

Based on these lay assertions, the VA obtained the 

medical opinion of VA medical examiner John K. Dudek 

in February 2012. Dr. Dudek reviewed Mathis’s claims 

file, including the hearing transcript and lay statements, 

but did not examine Mathis or perform any tests. Dr. 

Dudek concluded that Mathis’s sarcoidosis was less likely 

than not incurred in or caused by Mathis’s service. The 

examiner found that there was no evidence to support the 

conclusion that Mathis’s pulmonary symptoms while in 

service were related to sarcoidosis. The examiner stated 

that while he was “not doubting the validity” of the lay 

statements, the sarcoidosis was diagnosed seven years 

after service and nothing indicated the sarcoidosis existed 

within one year of service. Joint Appendix (“J.A.”) 47. 

Moreover, he suggested that, if Mathis had significant 

breathing issues post service, “one can assume he would 

have sought medical care.” Id. 

In June 2013, the Board issued a decision on Mathis’s 

claim. The Board made factual findings that Mathis’s 

sarcoidosis “was not manifested during his military 

service, is not shown to be causally or etiologically related 

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4 MATHIS v. MCDONALD

to his active military service, and is not shown to have 

manifested to a degree of 10 percent or more within one 

year from the date of separation from the military.” J.A. 

51. The Board recognized that the VA has a duty to 

assist, which includes providing a medical examination or 

obtaining a medical opinion when necessary to make a 

decision on a claim. Here, the Board noted that only a VA 

medical opinion, rather than a medical examination, had 

been afforded to Mathis, but, nevertheless, found that the 

VA had met its duty by making all reasonable efforts to 

obtain evidence necessary to substantiate Mathis’s claim. 

The Board then stated that entitlement to service 

connection for a particular disorder requires (1) evidence 

of the existence of a current disorder, and (2) evidence 

that the disorder resulted from a disease or injury incurred in or aggravated during service. 38 U.S.C. 

§§ 1110, 1131. The Board found that, although Mathis 

satisfied the first element, he failed to establish that the 

second was met. Although the Board acknowledged that 

Mathis and his friends and family were competent and 

credible to report that he experienced fatigue and shortness of breath during and since his military service, it 

held that these laypersons were not competent to assert a 

causal link between these symptoms and the sarcoidosis. 

The Board then found that all of the other evidence in the 

claims file supported the VA’s denial of service connection. The only medical opinion contained in the claims 

file, that of VA examiner Dr. Dudek, found no nexus 

between Mathis’s service and sarcoidosis. And Mathis 

testified at the DRO hearing that he did not seek treatment and did not receive a diagnosis of sarcoidosis until

2009, seven years after his active service ended. The 

Board, therefore, denied Mathis’s claim for service connection. 

Mathis then appealed to the Veterans Court. Mathis 

argued to the court that: (1) the Board erred in relying on 

an inadequate VA examiner opinion; and (2) the VA failed 

Case: 15-7094 Document: 34-2 Page: 4 Filed: 04/01/2016
MATHIS v. MCDONALD 5

to establish that the examiner was competent to provide 

an opinion in this case. The Veterans Court dispensed 

with Mathis’s first argument, holding that the Board’s 

finding that the VA examiner’s opinion was adequate was 

not clearly erroneous. It further agreed with the Board 

that Mathis and his fellow service members were not 

competent to draw a conclusion as to the cause of his 

sarcoidosis. 

As for Mathis’s second argument, the Veterans Court 

noted that Mathis recognized legal authority that placed 

the burden on the claimant to challenge the competency of 

VA medical examiners. Nevertheless, Mathis argued that 

the VA failed to establish that Dr. Dudek, who specialized 

in family practice, was qualified to offer an expert opinion 

in the field of pulmonology. The court held that though 

the presumption of competency is rebuttable, objecting to 

the examiner’s competence was the first step to overcoming the presumption. Mathis conceded he had not objected before the Board, but stated that he “wishes to 

preserve for Federal Circuit appeal a challenge to the 

correctness of” the case law on this issue. Mathis, 2015 

U.S. App. Vet. Claims LEXIS 654, at *9. The Veterans 

Court held that the mere fact that the VA examiner was 

not a pulmonologist did not, by itself, render the opinion 

inadequate. Therefore, it affirmed. 

Mathis timely appealed. This court has jurisdiction 

under 38 U.S.C. § 7292. 

DISCUSSION

In an appeal from the Veterans Court, we review all 

questions of law de novo. 38 U.S.C. § 7292(d)(1); see

Beraud v. McDonald, 766 F.3d 1402, 1405 (Fed. Cir. 2014) 

(citing Rodriguez v. Peake, 511 F.3d 1147, 1152 (Fed. Cir. 

2008)). Absent a constitutional issue, however, we lack 

jurisdiction to review factual determinations or the application of law to the particular facts of an appeal from the 

Veterans Court. 38 U.S.C. § 7292(d)(2); see Guillory v. 

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6 MATHIS v. MCDONALD

Shinseki, 603 F.3d 981, 986 (Fed. Cir. 2010); Moody v. 

Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004). 

The only issue on appeal is a legal one: whether this 

court should disavow the presumption of competency as it 

applies to VA medical examiners. Recently, and over only 

a short span of time, this court has developed a line of 

authority applying the presumption of competency to VA 

medical examiners and their medical opinions in veteran’s

benefits cases. 

Rizzo was the first case. There, a veteran appealed a 

denial of service-connection for an eye disability that he 

alleged resulted from his exposure to ionizing radiation 

during his service in the Air Force. The testimony of a 

Ph.D. in radiation physics offered by the veteran and that 

of a VA department expert were in conflict. Rizzo v. 

Shinseki, 580 F.3d 1288, 1290 (Fed. Cir. 2009). The 

veteran argued that the Veterans Court incorrectly held 

that the Board could assume the qualifications of the VA 

expert. We adopted the reasoning of the Veterans Court 

in Cox v. Nicholson, 20 Vet. App. 563, 568 (2007), which 

held that “the Board is entitled to assume the competence 

of a VA examiner” based on the presumption of regularity. 

Rizzo, 580 F.3d at 1290. Thus, we held that, “where as 

here, the veteran does not challenge a VA medical expert’s competence or qualifications before the Board, this 

court holds that VA need not affirmatively establish that 

expert's competency.” Id. 

A year later, we expanded on Rizzo in Bastien v. 

Shinseki, 599 F.3d 1301, 1306 (Fed. Cir. 2010), finding 

that case “controlling” on the issue of whether the Board 

improperly relied on the department’s medical witness 

without establishing his qualifications. We further clarified that, in order to challenge a VA medical examiner’s 

qualifications, a veteran must do more than merely request them. This is because “[a] request for information 

about an expert’s qualifications . . . is not the same as a 

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MATHIS v. MCDONALD 7

challenge to those qualifications. Indeed, one may assume that litigants who are told an expert witness’ qualifications frequently may conclude that there is no 

reasonable basis for challenging those qualifications.” Id.

at 1306. We stated, moreover, that, in order to give the 

trier of fact the ability to determine the validity of a 

challenge to the expertise of a VA expert, a challenge

“must set forth the specific reasons why the litigant 

concludes that the expert is not qualified to give an opinion.” Id. at 1307. 

These variations on a theme continued the following 

year when we issued Sickels v. Shinseki, 643 F.3d 1362 

(Fed. Cir. 2011). 38 U.S.C. § 7104(d)(1) requires the 

Board’s decisions to include a written statement of the 

reasons or bases for its findings and conclusions. In 

Sickels, the veteran argued that the Board violated 

§ 7104(d)(1) by not providing a written explanation for its

implicit conclusion that a VA medical opinion was sufficiently informed. We held that, “[w]hile we did not explicitly state so in Rizzo, it should be clear from our logic that 

the Board is similarly not mandated by section 7104(d) to 

give reasons and bases for concluding that a medical 

examiner is competent unless the issue is raised by the 

veteran. To hold otherwise would fault the Board for 

failing to explain its reasoning on unraised issues.” 

Sickels, 643 F.3d at 1366. 

Finally, and most recently, we applied the presumption of competency in Parks v. Shinseki, 716 F.3d 581, 584 

(Fed. Cir. 2013). There, the VA selected an advanced 

registered nurse practitioner (ARNP) to determine 

whether there was a relationship between a veteran’s 

service and several health conditions, including diabetes. 

We found that the VA was required to rely only on “competent medical evidence,” which is defined by VA regulations as “evidence provided by a person who is qualified 

through education, training, or experience to offer medical 

diagnoses, statements, or opinions.” 38 C.F.R. 

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8 MATHIS v. MCDONALD

§ 3.159(a)(1). We then stated, however, that, “[i]n the 

case of competent medical evidence, the VA benefits from 

a presumption that it has properly chosen a person who is 

qualified to provide a medical opinion in a particular 

case.” Parks, 716 F.3d at 585 (citing Sickels, 643 F.3d at 

1366). We explained that the presumption furthered the 

policy of preventing “[r]epeated unnecessary remands for 

additional evidence [that may] complicate many cases and 

lead to system-wide backlogs and delays.” Id. We addressed, moreover, the veteran’s argument that under

Comer v. Peake, 552 F.3d 1362, 1363, 1369 (Fed. Cir. 

2009), the record must be construed sympathetically in 

favor of pro se veterans. We held that, because the veteran failed to raise an objection before the Board that 

anything was improper with the VA’s selection of an 

ARNP or the particular ARNP on his case, Comer did not 

apply. Thus, we held that the Board was not required to 

read into the record an argument that was never made. 

Turning to the case at bar, Mathis recognizes that we 

have endorsed the presumption of competency, but, 

nevertheless, “asks th[is court] to disapprove Rizzo v. 

Shinseki, 580 F.3d 1288 (Fed. Cir. 2009) and its progeny.” 

Appellant Br. 6 (citing Fed. Cir. R. 35(a)(1)). He says that 

Rizzo came as a blow to pro se claimants and that applying the presumption “shift[s] the VA disability benefits 

program towards an adversarial adjudicatory model and . 

. . degrade[s] the disability evaluation process [by] 

hav[ing] unqualified medical personnel provide expert 

medical opinions.” Appellant Br. 3. 

Mathis raises several arguments against the application of the presumption of competency. He argues that 

the presumption of regularity, which underlies the presumption of competency, should only apply to routine, 

non-discretionary, and ministerial procedures. As such, 

he maintains, it is improper to apply the presumption to 

VA medical examiners where the procedures for their 

selection and assignment are discretionary and have not 

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MATHIS v. MCDONALD 9

been shown to bear indicia of reliability. He contends 

that the presumption of competency lies in contradiction 

to Congress’s articulated desire to create a nonadversarial 

adjudicatory system for veterans. See Vanerson v. West, 

12 Vet. App. 254, 260 (1999) (“[T]he legislative history of 

the Veterans’ Judicial Review Act, Pub. L. No. 100-687, 

102 Stat. 4105 (1988), indicates that adversarial concepts 

of adjudication were not to be adopted into the VA adjudication system.”). According to Mathis, the presumption of 

competency also unfairly puts the burden on the veteran—an unsophisticated party who cannot readily access 

the relevant information—to raise a specific objection to 

an expert’s testimony. Finally, he argues that it would 

not be unduly burdensome for the government to establish the qualifications of its examiners affirmatively.

Mathis’s presumption of regularity argument in particular presents some legitimate concerns. Rizzo invoked 

three cases in support of its holding: Cox, 20 Vet. App. at

568, Miley v. Principi, 366 F.3d 1343, 1347 (Fed. Cir. 

2004), and Butler v. Principi, 244 F.3d 1337, 1338 (Fed. 

Cir. 2001). None of these cases, however, provides a solid 

foundation for the broad application of the presumption of 

regularity to medical examiners. Cox relied on Hilkert v. 

West, 12 Vet. App. 145, 151 (Vet. App. 1999), a Veterans 

Court case that merely briefly noted that the Board in 

that case implicitly accepted the VA physician’s competency and the claimant had failed to show that such 

reliance was in error. 

Miley was concerned with whether the VA RO timely 

mailed the veteran a notice of its decision, thus triggering 

the veteran’s time to file an appeal. We stated that the 

presumption of regularity could be employed, “in the 

absence of evidence to the contrary, [to establish] that 

certain ministerial steps were taken in accordance with 

the requirements of law.” Miley, 366 F.3d at 1347 (emphasis added). We held that the presumption of regularity applies where “the Board finds that [a] decision notice 

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10 MATHIS v. MCDONALD

was designated to be mailed along with other documents 

that were in fact [timely] mailed. . . . In that setting, the 

presumption of regularity may properly be invoked . . . .” 

Id. at 1347 (emphasis added). Thus, the holding of that 

case was limited to certain ministerial steps, and there 

was no discussion of whether it would be appropriate to 

apply the presumption to VA medical examiners. 

Finally, Butler stated that, the “‘presumption of regularity’ supports official acts of public officers” and holds 

that, “[i]n the absence of clear evidence to the contrary, 

the doctrine presumes that public officers have properly 

discharged their official duties.” 244 F.3d at 1340. It, too, 

however, pertained only to the presumption of regularity 

as it applied to the VA’s mailing of notices to veterans 

under 38 U.S.C. § 5104. 

The presumption of regularity, like the hearsay exception for business records in the Federal Rules of Evidence, 

has “at [its] root a showing that the [result] was the 

product of a consistent, reliable procedure.” Posey v. 

Shinseki, 23 Vet. App. 406, 410 (2010). Thus, the presumption should be predicated on evidence that gives us 

confidence that a particular procedure is carried out 

properly and yields reliable results in the ordinary course. 

As the Third Circuit has recognized, “[m]ost presumptions 

have come into existence primarily because judges have 

believed that proof of fact B renders the inference of the

existence of fact A so probable that it is sensible and 

timesaving to assume the truth of fact A until the adversary disproves it.” Malack v. BDO Seidman, LLP, 617 

F.3d 743, 749 (3d Cir. 2010) (quoting McCormick on 

Evidence § 343 (John W. Strong ed. 5th ed. 1999)). 

It is no wonder, therefore, that the presumption of 

regularity has been applied repeatedly to the government’s mailing of certain types of notices. See e.g., Crain 

v. Principi, 17 Vet. App. 182, 186 (2003) (“the law presumes the regularity of the administrative process”); 

Case: 15-7094 Document: 34-2 Page: 10 Filed: 04/01/2016
MATHIS v. MCDONALD 11

Davis v. Principi, 17 Vet. App. 29, 37 (2003) (applying a 

“presumption of regularity of mailing”); Schoolman v. 

West, 12 Vet. App. 307, 310 (1999) (“‘clear evidence to the 

contrary’ is required to rebut the presumption of regularity, i.e., the presumption that notice was sent in the regular course of government action”). In such cases, the acts 

at issue are typically ministerial, routine, and nondiscretionary.2 

The Veterans Court has displayed caution and hesitance towards expanding the presumption of regularity to 

new contexts. In Kyhn v. Shinseki, 26 Vet. App. 371, 374 

(2013), for example, the Veterans Court remanded a case 

to the Board for it to assess, in the first instance, whether 

(1) the VA’s duty to notify a veteran of his upcoming

medical examination was actually fulfilled, or (2) the VA 

is entitled to a presumption of regularity in its mailing of 

notices of scheduled VA examinations. Id. Thus, though

Rizzo already had established the presumption of competency and the presumption of regularity had long been 

applied to certain VA mailing procedures, the court still 

saw a need for a separate evaluation of whether the 

presumption was proper with respect to the mailing of

notices to veterans regarding their VA examinations. 

Nowhere in the Rizzo line of cases, however, did either the 

Veterans Court or this court perform an analysis to verify 

that the procedures attending the selection and assign-

 

2 See Latif v. Obama, 677 F.3d 1175, 1207 (D.C. Cir. 

2012) (Tatel, J., dissenting) (finding that “every case 

applying the presumption of regularity” has “in common: 

actions taken or documents produced within a process 

that is generally reliable because it is, for example, transparent, accessible, and often familiar. As a result, courts 

have no reason to question the output of such processes in 

any given case absent specific evidence of error.”). 

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12 MATHIS v. MCDONALD

ment of VA examiners are, in fact, regular, reliable, and 

consistent. 

In fact, Mathis argues that the VA’s procedure for selecting qualified examiners is inherently unreliable

because the VA broadly recommends assigning generalists except in unusual, ill-defined cases. The VA Adjudication Procedures (M21-Manual) states that examinations 

routinely performed by specialists include hearing, vision, 

dental, and psychiatric examinations, but otherwise 

instructs its staff to “[r]equest a specialist examination 

only if it is considered essential for rating purposes,” for 

example “if an issue is unusually complex[, ] if there are 

conflicting opinions or diagnoses that must be reconciled, 

or [ ] based on a BVA remand.” VA Adjudication Procedures Manual, M21-1MR, Part III, Subpart iv, ch. 3, 

§ A(6) (change date July 30, 2015). Furthermore, a VA 

fast letter directed to “All VA Regional Offices and Centers,” states: “[p]lease note that a specialist is only required in limited situations . . . . For all other types of 

examinations, a generalist clinician may perform the

examination. For example, an office may order a cardiac 

examination, but it should not generally request that a 

cardiologist (a specialist) conduct it.” Veterans Benefits 

Administration Fast Letter 10-32 (September 1, 2010). 

Mathis argues that this guidance fails to ensure to a high 

degree of certainty that the VA examiner assigned to a 

given case is able to provide a “competent medical opinion” in accordance with 38 C.F.R. § 3.159(a)(1). In his 

view, a generalist is not competent to provide an expert 

opinion on a condition like sarcoidosis absent a showing of 

education, training, or experience relevant to such a 

condition.

The government attempts to reassure us that the veteran may obtain a specialist’s opinion where the government determines that such an opinion is “necessary to 

make a decision on the claim,” 38 U.S.C. § 5103A(d). But 

the process by which the VA appoints examiners for a 

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MATHIS v. MCDONALD 13

particular case remains unclear. Without this information, we cannot tell whether the procedures in question

are, in fact, regular, reliable, and consistent. 

We need not—and cannot—resolve this debate. We 

lack jurisdiction to make factual findings on appeal regarding the competency of the particular examiner employed by the VA in this case and are bound by clear 

precedent to presume that Dr. Dudek was competent to 

render the opinion he did. We note, however, that, 

though there may be a fair basis to criticize the Rizzo line 

of cases, there exists a practical need for an administrable 

rule, given the volume of claims the VA is charged with 

processing. Replacing the presumption established by 

Rizzo would require a concrete, clear standard for determining the sufficiency of an examiner’s qualifications to 

conduct an examination or provide a medical opinion. 

CONCLUSION

The Veterans Court did not err in its interpretation of 

our precedent. We, therefore, affirm.

AFFIRMED

Case: 15-7094 Document: 34-2 Page: 13 Filed: 04/01/2016
 

NOTE: This disposition is nonprecedential. 

 

United States Court of Appeals 

for the Federal Circuit ______________________ 

FREDDIE H. MATHIS,

Claimant-Appellant

v.

ROBERT A. MCDONALD, SECRETARY OF 

VETERANS AFFAIRS,

Respondent-Appellee

______________________ 

2015-7094

______________________ 

Appeal from the United States Court of Appeals for 

Veterans Claims in No. 13-3410, Judge Alan G. Lance, Sr.

______________________ 

REYNA, Circuit Judge, concurring. 

I write separately to state my view that experience 

has shown that presuming the competence of individuals 

who write medical opinions in veterans cases has produced results inconsistent with the statute. My conclusion is that the entire court should review the case law 

concerning the presumption of competence with the 

objective of eliminating it. 

The presumption of competence has delegitimized the 

process of adjudicating veterans’ entitlement to disability

benefits. Under the presumption, no Board or judicial 

review of a VA examiner’s qualifications occurs unless the 

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2 MATHIS v. MCDONALD

veteran makes a specific objection to the examiner’s 

qualifications while the case is before the Board. The 

veteran is hobbled in making a specific objection because 

the VA does not by default disclose any information about 

the examiner’s qualifications other than his or her credentials, such as “MD.” If a veteran asks for an examiner’s

qualifications, the VA will not provide them unless it is 

ordered to do so. The Board has at times refused to order 

the VA to do so because the veteran has not raised a 

specific objection to the examiner’s competence. This 

creates a catch-22 situation in which the veteran must 

have grounds to object to an examiner’s competence before 

the veteran can learn the examiner’s qualifications.

The presumption of competence was created based on

the presumption of regularity, and it was unprecedented 

to apply the presumption of regularity to a process such 

as determining whether a nurse is qualified to provide an 

opinion on a particular issue. This court has held that the 

Veterans Court lacks jurisdiction to create such presumptions, and so this court should not have upheld the Veterans Court’s creation of a presumption in Rizzo. Applying

the presumption of regularity requires evidence that a 

process is regular, and such evidence has not been presented. Even if the VA’s process for selecting examiners 

was “regular” when the presumption was established in 

Rizzo, the process has continued to evolve, and the VA 

does not always successfully follow its own guidelines for 

selecting examiners. The circumstances when this court 

established the presumption suggest that these negative

consequences were unanticipated. 

Eliminating the presumption will require the VA to 

provide the Board with evidence that an examiner “is 

qualified through education, training, or experience to 

offer medical diagnoses, statements, or opinions” on the 

issue that the examiner is testifying about. The VA could 

meet this requirement by attaching an examiner’s curricCase: 15-7094 Document: 34-2 Page: 15 Filed: 04/01/2016
MATHIS v. MCDONALD 3

ulum vitae (CV) to her report, and, if necessary, having 

her state in her report why she is qualified.

The Panel Opinion implies that in order to overturn 

Rizzo, there must first be established a clear standard for 

determining whether an examiner is competent. Op. at 

13. It is not clear that this is the case. Assuming that 

such a standard would be necessary, its development 

would be the responsibility of the Board or the Veterans 

Court, and not this court.

DISCUSSION

The VA’s adjudicatory process for disability benefits 

“is designed to function throughout with a high degree of 

informality and solicitude for the claimant.” Henderson v. 

Shinseki, 562 U.S. 428, 431 (2011) (citation omitted). The 

“system is constructed as the antithesis of an adversarial, 

formalistic dispute resolving apparatus.” Forshey v. 

Principi, 284 F.3d 1335, 1360 (Fed. Cir. 2002) (Mayer, 

C.J., dissenting) (majority overruled by statute). “The 

purpose is to ensure that the veteran receives whatever 

benefits he is entitled to, not to litigate as though it were 

a tort case.” Id.

The VA must assist veterans in obtaining evidence 

needed to support disability benefits claims. 38 U.S.C. 

§ 5103A(a)(1). At times this includes providing a medical 

examination or obtaining a medical opinion. Id. at

§ 5103A(d).

The presumption of competence applies both to VA 

examiners who conduct an examination of a veteran 

before preparing a report and to VA examiners who only 

examine medical records or other evidence before preparing a report.1 The presumption also applies to the reports 

 

1 See, e.g., Rizzo v. Shinseki, 580 F.3d 1288, 1292 

(Fed. Cir. 2009) (examiners who prepared opinions withCase: 15-7094 Document: 34-2 Page: 16 Filed: 04/01/2016
4 MATHIS v. MCDONALD

themselves. Sickels, 643 F.3d at 1366 (“The argument 

that a VA medical examiner’s opinion is inadequate is 

sufficiently close to the argument raised in Rizzo that it 

should be treated the same.”)2

Under the presumption, a veteran must set forth specific reasons why the veteran believes an examiner is not 

qualified before the VA has to provide any evidence 

regarding the examiner’s qualifications. Bastien v. 

Shinseki, 599 F.3d 1301, 1307 (Fed. Cir. 2010). If a 

veteran fails specifically object to an examiner’s compe-

 

out examining veteran were presumed competent); Parks 

v. Shinseki, 716 F.3d 581, 583 (Fed. Cir. 2013) (same); 

Sickels v. Shinseki, 643 F.3d 1362, 1366 (Fed. Cir. 2011) 

(same); Johnson v. Shinseki, 440 F. App’x 919, 922 (Fed. 

Cir. 2011) (examiner who examined veteran was presumed competent). 

2 Exactly how the presumption of competence applies to examiners’ reports has not been fully established. 

See, e.g., Whitehead v. Shinseki, No. 10-4166, 2012 WL 

2054875, at *5 (Vet. App. June 8, 2012) (“Sickels does not, 

as the Secretary argues, ‘entitle[ ] [the Board] to presume 

the adequacy of the VA medical examiner’s opinion.’ 

Secretary’s Br. at 17–18. The Board is decidedly not

entitled to presume the adequacy of a VA examination—

that is a question of fact to be determined in each case 

where a VA medical examination was provided.”); but see, 

e.g., Woods-Calhoun v. McDonald, No. 13-3507, 2015 WL 

5449888, at *5 (Vet. App. Sept. 17, 2015) (applying the 

presumption of competence in analysis determining 

whether a report is adequate); Brown v. McDonald, No. 

14-0464, 2015 WL 691200, at *5 (Vet. App. Feb. 19, 2015) 

(same); Felix v. Gibson, No. 13-2977, 2014 WL 3609630, at 

*1 (Vet. App. July 23, 2014) (same); Irish v. Shinseki, No. 

11-1426, 2012 WL 1739712, at *2 (Vet. App. May 17, 

2012) (same).

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MATHIS v. MCDONALD 5

tence while his case is before the Board, any such challenge is waived. Parks, 716 F.3d at 586; see also, e.g., 

Nohr v. McDonald, 27 Vet. App. 124, 132 (2014). 

The VA Generally Presents No Evidence Regarding an 

Examiner’s Qualifications

As the VA is not obligated to provide evidence regarding an examiner’s qualifications, it does not do so. Under 

the Adjudication Manual of the Veterans Benefits Administration, M21-1MR (“M21-1MR” or “VA Manual”), an 

examiner who prepares a report includes only her name, 

address, credentials (e.g., MD, PA, NP, MA, LCPG, or 

LCSW), and her phone, fax, and medical license numbers. 

M21-1MR § III.iv.3.D.2.b.3 Her specialty is provided “if a 

specialist examination is required or requested.”4 Id.

If a veteran seeks information about an examiner’s 

qualifications, the VA will not provide such information 

unless it is ordered to do so. In Nohr v. McDonald, 27 

Vet. App. 124, 128 (2014), a veteran requested an examiner’s CV. The Board denied the request, and the Secretary’s counsel argued before the Veterans Court that the

request was “a fishing expedition.” Id. at 132.5

 

3 M21–1MR is available at Department of Veterans 

Affairs, KnowVA Knowledge Base (last visited Mar. 28, 

2016), http://www.knowva.ebenefits.va.gov. 4 This guideline is not always followed. See, e.g., 

No. 1320853, 2013 WL 4450861, at *2 (Bd. Vet. App. June 

27, 2013) (Board requested specialist but it was unclear 

whether examiner had a specialty). Under 38 C.F.R. 

§ 20.1301, Board decisions such as this one are issued 

without titles, as personal identifiers are redacted.

5 See also, e.g., No. 1543733, 2015 WL 7875614, at 

*2 (Bd. Vet. App. Oct. 13, 2015); No. 1501503, 2015 WL 

1194124, at *7–8 (Bd. Vet. App. Jan. 13, 2015); No. 

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6 MATHIS v. MCDONALD

The Veterans Court found that the Board erred in 

denying the veteran’s request because the veteran had 

identified an ambiguous statement in the examiner’s 

report that suggested “there may have been some irregularity in the process” of selecting the examiner. Id. at 

132. The Veterans Court explained that, under those 

circumstances, the Board could not deny the veteran’s 

request for a CV. Id. at 133. 

In one case, the Board interpreted Nohr as meaning 

that a veteran must rebut the presumption of competence

before the veteran is entitled to receive information about

an examiner’s qualifications. No. 1452787, 2014 WL 

7740599 at *8 (Bd. Vet. App. Dec. 1, 2014). Distinguishing Nohr, the Board rejected a veteran’s request for an 

examiner’s CV because it was made before the examiner 

provided her opinion, so there was no evidence “sufficient

. . . to rebut the presumption of administrative regularity.” Id. at *8–9. Since Nohr, it appears that the Board 

has ordered the VA to provide a veteran with an examiner’s CV in five cases.6

 

1452787, 2014 WL 7740599, at *9 (Bd. Vet. App. Dec. 1, 

2014).

This court in Bastien stated that the VA provided an 

examiner’s qualifications when a veteran’s wife requested 

them. 599 F.3d at 1306. This seems to be a mistake, as 

both of the veteran’s appeal briefs state that, despite 

requests, the VA did not provide the qualifications. Brief 

for Claimant-Appellant at 11, 2009 WL 2610099 and 

Reply Brief at 3, 10–11, 2009 WL 4829105. The VA’s brief 

does not deny this, and it cites the same “public profile” 

the veteran’s wife found for an examiner’s qualifications. 

Brief of Respondent-Appellee at 6 n.7 & 12–13, 2009 WL 

4248807.

6 See No. 1552016, 2015 WL 10004845 at *12 (Bd. 

Vet. App. Dec. 11, 2015); No. 1543733, 2015 WL 7875614 

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MATHIS v. MCDONALD 7

The VA Manual provides regional offices with guidelines for responding to veteran “requests for information 

about the examiner’s qualifications.” M21–1MR

§ III.iv.3.D.2.m. The Manual does not suggest that a 

regional office should respond to such a request by actually providing an examiner’s qualifications. Id. If a veteran 

submits interrogatories to a regional office, it is instructed 

“do not complete and return the document” and “do not 

refer it to the examiner.” Id.7

The Presumption Makes the Competence of VA Examiners Effectively Unreviewable

Since the presumption was created, Board or judicial 

review of examiner qualifications rarely occurs. Veterans 

regularly make “general” objections to an examiner’s 

competence, but not “specific” objections, so the Board 

does not review the examiner’s competence.8 Veterans 

likely fail to make “specific” objections because they have 

no information regarding an examiner’s qualifications. 

 

at *2 (Bd. Vet. App. Oct. 13, 2015); No. 1538484, 2015 WL 

6939522 at *1–2 (Bd. Vet. App. Sept. 9, 2015); No. 

1531027, 2015 WL 5212552 at *1 (Bd. Vet. App. July 21, 

2015); No. 1501503, 2015 WL 1194124 at *7–8 (Bd. Vet. 

App. Jan. 13, 2015).

7 Because of the presumption, the VA does not have

records regarding examiners’ qualifications. Appellee Br. 

at 17. 

8 E.g., No. 1539156, 2015 WL 6940254 at *4 (Bd. 

Vet. App. Sept. 14, 2015); No. 1526395, 2015 WL 4690503, 

at *6–7 (Bd. Vet. App. June 22, 2015); No. 1451247, 2014 

WL 7502140, at *5–6 (Bd. Vet. App. Nov. 19, 2014); No. 

1446634, 2014 WL 6876771, at *5–6 (Bd. Vet. App. Oct. 

21, 2014); No. 1444538, 2014 WL 6874328, at *4–5 (Bd. 

Vet. App. Oct. 7, 2014); No. 1428938, 2014 WL 3961243, 

at *3–4 (Bd. Vet. App. June 26, 2014).

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8 MATHIS v. MCDONALD

Even if a veteran sufficiently challenges an examiner’s qualifications, the Board has often failed to consider 

whether the examiner was qualified.9

If a veteran does not sufficiently object, the Board only needs to consider an examiner’s competence when the 

examiner unambiguously states in her report that she is

not competent. This occurred in Wise v. Shinseki, 26 Vet. 

App. 517 (2014). In Wise, a veteran’s wife sought to show 

that the veteran’s service-connected post-traumatic stress 

disorder (“PTSD”) had contributed to his heart disease. 

Id. at 521. Opposing the claim, the VA submitted the 

report of a cardiologist who stated in her report that she 

had no training in psychiatry other than a month-long 

rotation while in medical school over 25 years earlier, that 

she had little experience treating veterans, and that the 

majority of the documents she had received for review 

were psychiatry-related. Id. at 522. She called herself “a 

relative lay person” with regard to psychiatry, but she

opined that the veteran’s PTSD symptoms were not very 

severe and were unlikely to have caused his heart disease. 

Id. at 522–23.

 

9 See, e.g., Temples v. McDonald, No. 14-1604, 2015 

WL 4169190, at *3 (Vet. App. July 10, 2015) (finding that 

a veteran had sufficiently challenged an examiner’s 

qualifications to the Board and remanding for the Board 

to analyze the examiner’s competence); Learman v. 

McDonald, No. 14-0148, 2015 WL 1622162, at *3–5 (Vet. 

App. Apr. 13, 2015) (same); Acosta v. Shinseki, No. 12-

3433, 2014 WL 1577773, at *6 (Vet. App. Apr. 22, 2014)

(same); Kanuch v. Shinseki, No. 11-3711, 2013 WL 

1200607, at *4–5 (Vet. App. Mar. 26, 2013) (same). In 

these cases, although specific objections were raised, the 

VA argued before the Veterans Court that the veteran did 

not specifically object before the Board and had waived 

the issue. Id.

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MATHIS v. MCDONALD 9

At the Veterans Court, the veteran challenged the 

Board’s decision to rely on the cardiologist’s opinion. Id.

at 524. The Veterans Court found that the presumption 

of competence did not attach when “evidence of record 

creat[ed] the appearance of irregularity.” Id. at 526–28. 

In contrast, a merely ambiguous disclaimer of competence will not prevent challenges to an examiner’s competence from being waived when they are not raised before 

the Board. Johnson v. McDonald, No. 14-1587, 2015 WL 

4075155, *7 (Vet. App. July 6, 2015).

Under the Presumption, the Board Cannot Fairly Weigh 

the Probative Value of an Examiner’s Report

That an examiner is qualified to provide a report 

should be a “threshold consideration” before her report is 

considered by the Board. Nieves-Rodriguez v. Peake, 22 

Vet. App. 295, 304 (2008). While “most of the probative 

value of a medical opinion comes from its reasoning,” id., 

an examiner’s qualifications should not be disregarded. 

The weight accorded to an examiner’s report should 

depend in part on the examiner’s knowledge and experience, including whether the examiner has “specific expertise in the relevant specialty.” Itliong v. Shinseki, No. 09-

0886, 2011 WL 4485886, at *2 (Vet. App. Sept. 29, 2011); 

see also, e.g., Black v. Brown, 10 Vet. App. 279, 284 

(1997); No. 1452787, 2014 WL 7740599, at *12 (Bd. Vet. 

App. Dec. 1, 2014).

When private examiners provide opinions on behalf of 

veterans, the Board is “unable to assess [their] experience 

or qualifications to render an opinion” when they do not 

include information regarding their specialty or a CV. 

No. 1512074, 2015 WL 2161715, at *16 (Bd. Vet. App. 

Mar. 20, 2015). See also, e.g., No. 9919708, 1999 WL 

33869596, at *1 (Bd. Vet. App. July 19, 1999) (noting that, 

without a CV or other evidence showing a veteran’s 

physician’s qualifications, “the Board is unable to deterCase: 15-7094 Document: 34-2 Page: 22 Filed: 04/01/2016
10 MATHIS v. MCDONALD

mine the degree of weight or probative value that may be 

attached to [her] opinion.”).

VA guidelines for responding to complaints that an

examiner was unqualified state that “where an examiner 

is basically competent, matters like specialty, Board 

certification, experience and other related considerations 

will merely be considerations in determining probative 

value of the examination or opinion.” M21-1MR 

§ III.iv.3.D.2.m. In reality, these factors will almost never

be considered in determining the probative value of a VA 

examiner’s opinion. 

Determining whether an opinion is adequate and 

weighing its probative value solely on its analysis without 

knowledge of its author’s qualifications can lead to absurd 

results. Because the analysis turns on an author’s skill in 

opinion-writing rather than her skill in medicine, a 

skilled opinion-writer could write persuasive opinions 

about issues she is entirely unqualified to opine about.

Veterans have no opportunity to confront VA examiners, such as through cross-examination, so “in many cases 

the most effective way of countering a questionable opinion [is] to offer a contrary opinion with more support in 

the medical literature or from other medical experts.” 

Gambill v. Shinseki, 576 F.3d 1307, 1318–19 (Fed. Cir. 

2009) (Bryson, J., concurring). A veteran’s ability to 

advance a contrary opinion is fettered when the experience, educational background, and training of the examiner are unknown. Even if a veteran finds the preeminent 

expert on her specific disability to provide an opinion 

supporting her claim, because the record is silent as to the 

VA examiner’s qualifications, the Board or any court 

rarely has the ability to weigh their relative qualifications 

in evaluating their competing opinions.

For example, in D’Auria v. McDonald, a veteran argued that the Board erred in according more weight to a 

VA examiner’s opinion than the veteran’s physician’s 

Case: 15-7094 Document: 34-2 Page: 23 Filed: 04/01/2016
MATHIS v. MCDONALD 11

opinion. No. 14-3224, 2015 WL 5307462, at *2 (Vet. App. 

Sept. 11, 2015). At the Veterans Court, the pro se veteran’s appeal brief said “[the veteran’s physician’s] credentials are impeccable. What credentials and specialty does 

your VA examiner hold?” Id. The Court explained that 

VA examiners are presumed competent, the veteran had 

not challenged the examiner’s qualifications at the Board, 

and so the Board did not have to evaluate his or her

qualifications before relying on his or her report. Id.

Occasionally, the Board still weighs the probative 

value of competing reports on the basis of credentials. In 

one recent case, the Board afforded more probative value 

to the veteran’s physician’s opinion, explaining that “a 

relevant difference in the level of expertise and professional credentials of the two examiners [existed], as the 

VA examiner was a nurse practitioner and the private 

examiner was a licensed physician with an extensive CV

showing years of experience in occupational and environmental medicine, [including] the types of workplace 

injuries from which the Veteran alleged his in-service 

right knee trauma originated.” No. 1504782, 2015 WL 

1600923, at *5 (Bd. Vet. App. Feb. 2, 2015). But the 

presumption of competence discourages the Board from 

finding a VA examiner anything less than perfectly competent. Parks, 716 F.3d at 585 (the presumption applies 

to nurse practitioners); see also, e.g., No. 1549456, 2015 

WL 9698285 at *1 (Bd. Vet. App. Nov. 23, 2015). 

The Board eschews wrongly awarding benefits by assigning undue weight to favorable medical opinions. No. 

1452787, 2014 WL 7740599, at *5 (Bd. Vet. App. Dec. 1, 

2014). It should not assign undue weight to unfavorable 

opinions either. It cannot fairly weigh an opinion while

knowing almost nothing about its author’s qualifications.

The Presumption Creates a Due Process Problem

The VA’s duty to assist veterans includes providing an 

examination or report by a competent examiner, when 

Case: 15-7094 Document: 34-2 Page: 24 Filed: 04/01/2016
12 MATHIS v. MCDONALD

needed. 38 U.S.C. § 5103A. As a result of the presumption of competence, the burden to object to an examiner’s 

competence is placed on the veteran, but the veteran is 

hindered in doing so. 

A veteran’s interest in disability benefits is protected 

by the Due Process Clause. Cushman v. Shinseki, 576 

F.3d 1290, 1298 (Fed. Cir. 2009). The presumption of 

competence increases the risk of an erroneous deprivation 

of that interest. See Mathews v. Eldridge, 424 U.S. 319, 

335 (1976). Removing the presumption would help safeguard a veteran’s right to an opinion or examination 

prepared or performed by a qualified examiner, and 

create only a minimal burden on the VA to provide evidence regarding the qualifications of its examiners. 

“In the veterans’ uniquely claimant friendly system of 

awarding compensation, breaches of the duty to assist are 

at the heart of due process analysis.” Cook v. Principi, 

318 F.3d 1334, 1354 (Fed. Cir. 2002) (Dyk, J., concurring). 

“If the Constitution provides no protection against the 

occurrence of such breaches, then the paternalistic interest in protecting the veteran is an illusory and meaningless assurance.” Id.

The Interests the Presumption Serves Do Not Outweigh 

Its Disadvantages

The presumption serves to eliminate the VA’s burden 

to produce evidence and reduce remands. Parks, 716 F.3d 

at 585. Without a presumption, the VA would need to 

provide the Board with evidence that an examiner satisfies the 38 C.F.R. § 3.159 requirement of being “qualified 

through education, training, or experience to offer medical 

diagnoses, statements, or opinions.” Yet, simply attaching an examiner’s CV to his report would reveal the 

examiner’s education, training, and experience. Attaching a CV to his report is a task an examiner can easily 

handle.

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MATHIS v. MCDONALD 13

Because the VA usually selects generalist examiners, 

an examiner’s CV usually will not show that the examiner 

has any expertise in the subject of her report.10 If a CV

reveals that an examiner lacks such expertise, she can

also explain in her report why she is qualified. Including 

such a statement would not be difficult for examiners. If 

an examiner prepares a statement describing why she is 

qualified to opine on cardiac issues, for example, she can 

likely reuse it the next time she opines on cardiac issues.

It appears that this court’s Rizzo decision led the VA 

to change a practice of usually attaching an examiner’s 

CV to his report. Before Rizzo, which issued in September 

2009, it appears that Board orders remanding cases for 

medical examinations had instructed an examiner to 

append a CV to his report only about four times.11 But 

after Rizzo, between March 2010 and September 2011,

the Board included such an instruction in over two hun-

 

10 At argument, the Secretary’s attorney stated “[i]n 

this case, [the VA examiner] was a general practitioner. 

Providing a CV would demonstrate that. . . . What Mr. 

Mathis [seeks] is something tailored to every single case, 

saying [the examiner’s] exact experience with lung conditions, for instance, or heart conditions, or whatever it is. 

A CV is not going to cut the muster in this situation.” 

Recording at 22:16, available at http://www.cafc.uscourts.

gov/oral-argument-recordings/search/audio.html. 

For discussion on the VA’s use of generalist examiners, see infra at page 17. 

11 No 0802829, 2008 WL 4320116, at *2 (Bd. Vet. 

App. Jan. 25, 2008); No. 0432514, 2004 WL 3311593, at *1

(Bd. Vet. App. Dec. 8, 2004); No. 0108160, 2001 WL 

34585997, at *6 (Bd. Vet. App. Mar. 20, 2001); No. 

0105152, 2001 WL 34582992, at *3 (Bd. Vet. App. Feb. 20, 

2001).

Case: 15-7094 Document: 34-2 Page: 26 Filed: 04/01/2016
14 MATHIS v. MCDONALD

dred decisions.12 This significant increase suggests both 

that a change had occurred in the frequency with which 

the VA attached CVs to examiners’ reports and that the 

Board preferred having examiners’ CVs. A requirement 

that examiners attach their CVs to their reports would 

not create an undue administrative burden, particularly if 

examiners typically attached CVs to their reports before 

the presumption was created. 

Since September 8, 2011, it appears that the Board 

has requested in a remand order that an examiner include her CV only once, in No. 1222819, 2012 WL 

3271702, at *3 (Bd. Vet. App. June 29, 2012). It appears 

that the Board stopped trying to order the VA to provide 

examiners’ CVs because doing so was futile. Numerous 

Board decisions state that no CV was attached to an 

examination report, even though the Board had requested 

one.13

 

12 E.g., No. 1133177, 2011 WL 5316250, at *5 (Bd. 

Vet. App. Sept. 8, 2011); No. 1132969, 2011 WL 5316041, 

at *12 (Bd. Vet. App. Sept. 7, 2011); No. 1101423, 2011 

WL 751267, at *4 (Bd. Vet. App. Jan. 12, 2011); No. 

1107166, 2011 WL 1355701, at *5 (Bd. Vet. App. Feb. 23, 

2011); No. 1037779, 2010 WL 5378203, at *2 (Bd. Vet. 

App. Oct. 6, 2010); No. 1014091, 2010 WL 2478922, at *7

(Bd. Vet. App. Apr. 14, 2010); No. 1017678, 2010 WL 

2807490, at *7 (Bd. Vet. App. May 12, 2010); No. 1009397, 

2010 WL 1941350, at *9 (Bd. Vet. App. Mar. 12, 2010). 13 E.g., No. 1443791, 2014 WL 6873578, at *9 (Bd. 

Vet. App. Oct. 1, 2014); No. 1336907, 2013 WL 6991931, 

at *2 (Bd. Vet. App. Nov. 13, 2013); No. 1320853, 2013 WL 

4450861, at *2 (Bd. Vet. App. June 27, 2013); No. 

1243635, 2012 WL 7016213, at *6 (Bd. Vet. App. Dec. 20, 

2012); No. 1217374, 2012 WL 2881745, at *2 (Bd. Vet. 

App. May 15, 2012); No. 1137554, 2011 WL 6043315, at *2

(Bd. Vet. App. Oct. 5, 2011); No. 1137348, 2011 WL 

Case: 15-7094 Document: 34-2 Page: 27 Filed: 04/01/2016
MATHIS v. MCDONALD 15

Removing the presumption of competence will assist 

veterans in challenging the competence of examiners and 

reduce the risk of unqualified examiners providing opinions. Unqualified examiners are less likely to provide 

accurate opinions. Veterans are harmed when their 

claims are improperly rejected, and the public fisc is 

harmed when veterans’ claims are improperly granted.

Establishing Competency Is Not a Ministerial Act

This court in Rizzo should not have applied the presumption of regularity to the VA’s process of selecting 

examiners. The presumption of regularity is usually 

applied to ministerial acts such as mailing notices. Miley 

v. Principi, 366 F.3d 1343, 1347 (Fed. Cir. 2004). Mailing 

a notice is very different from selecting an examiner: 

mailing is administrative but determining whether a 

specific nurse is qualified to provide an opinion on a 

particular issue is not. As the Panel Opinion states, 

“Mathis’s presumption of regularity argument in particular presents some legitimate concerns.” Op. at 9. No case

Rizzo cited when applying the presumption of regularity 

to medical examiners provides “a solid foundation” for 

Rizzo’s holding. Id. 

Before a presumption of regularity was applied to the 

VA’s process for selecting examiners, there should have 

been “a showing, by affidavit or otherwise,” that the VA’s 

 

5325231, at *2 (Bd. Vet. App. Sept. 30, 2011); No. 

1134614, 2011 WL 5322294, at *3 (Bd. Vet. App. Sept. 15, 

2011); No. 1134415, 2011 WL 5322094, at *2 (Bd. Vet. 

App. Sept. 14, 2011); No. 1129400, 2011 WL 4890482, at 

*2 (Bd. Vet. App. Aug. 9, 2011); No. 1122079, 2011 WL 

3507772, at *1 (Bd. Vet. App. June 7, 2011). But see No. 

1300336, 2013 WL 1093814, at *2 (Bd. Vet. App. Jan. 4, 

2013) (noting that a CV was added to a report to comply 

with remand instructions).

Case: 15-7094 Document: 34-2 Page: 28 Filed: 04/01/2016
16 MATHIS v. MCDONALD

process for selecting examiners was “regular.” Kyhn v. 

Shinseki, 716 F.3d 572, 579 (Fed. Cir. 2013) (Lourie, J., 

dissenting); see also, e.g., Echevarria-North v. Shinseki, 

437 F. App’x 941, 946 (Fed. Cir. 2011). In Rizzo, neither 

this court’s decision nor the Veterans Court’s decision 

cited evidence about the VA’s process. 580 F.3d 1288 at 

1292; Rizzo v. Peake, No. 07-0123, 2008 WL 4140421, at 

*2 (Vet. App. Aug. 26, 2008).

Further, it appears that creating a presumption of 

competence for VA examiners was outside the Veterans 

Courts’ jurisdiction, and so this court should not have 

upheld the Veterans Court’s creation of one in Rizzo. In 

Kyhn, this court held that the Veterans Court lacked 

jurisdiction to create a presumption of regularity for 

certain notices, as this required factfinding outside the 

record to determine that a process was regular. 716 F.3d 

at 578. Here, the presumption was apparently established based on an implicit factfinding of regularity. 

The Process by Which the VA Chooses Examiners is 

Largely Unknown

Apparently only the VA and its outside contractors 

know how they select examiners. The VA Manual says

very little about how examiners are chosen to provide 

examinations or deemed qualified. One section states 

that “[t]he choice of examiners is up to the VA medical 

facility conducting the examination,” unless it is necessary that a specialist be used. M21-1MR § III.iv.3.A.6.d.

A section on “Ensuring Examiners Are Qualified”

states that “VA medical facilities (or the medical examination contractor) are responsible for ensuring that 

examiners are adequately qualified.” Id. at 

§ III.iv.3.D.2.b. It states that “Veterans Service Center 

(VSC) employees are not expected to routinely review the 

credentials of clinical personnel to determine the acceptability of their reports, unless there is contradictory evidence of record.” Id. (Emphasis original). It appears 

Case: 15-7094 Document: 34-2 Page: 29 Filed: 04/01/2016
MATHIS v. MCDONALD 17

that, currently and when the Rizzo decision issued, the 

choice of examiners and review of their qualifications is 

often performed by outside contractors, such as QTC 

Medical Services.14 To the extent aspects of the VA’s 

process for selecting examiners are known, those aspects 

do not suggest that it is a regular process.

Since the Presumption was Created, the VA Has Emphasized the Use of Non-Specialist Examiners

VA usually selects non-specialist examiners to perform examinations. M21-1MR §§ III.iv.3.A.1.g, h. Except

for vision, hearing, dental, and psychiatric examinations, 

specialists perform medical exams only in “in unusual 

cases, or as requested by a Board of Veterans’ Appeals 

(BVA) remand.” Id. Also, an initial diagnosis of traumatic brain injury must be made by one of the following

specialists: physiatrists, psychiatrists, neurosurgeons, or 

neurologists. Id. at § III.iv.3.D.2.h.

While certain actors in the disability claim adjudication process may request a specialist examiner, the choice

of examiners is “up to the VA medical facility conducting

the examination,” unless a remand from the Board specifically states that the examiner must be a “Board-certified

specialist in . . . ” or a “specialist who is Board qualified.” 

Id. at § III.iv.3.A(6)(d). “In the absence of a [Board]

 

14 Department of Veterans Affairs Audit of VA’s Efforts to Provide Timely Compensation and Pension Medical Examinations, VA Office of Inspector General (Mar. 

17, 2010), http://www.va.gov/oig/52/reports/2010/VAOIG09-02135-107.pdf; Wesley Brown, Local veteran says VA 

contractor examinations not thorough enough, Augusta Chron., 

(Aug. 17, 2014), http://chronicle.augusta.com/latestnews/2014-08-17/local-veteran-says-va-contractorexaminations-not-thorough-enough.

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18 MATHIS v. MCDONALD

remand, [regional offices] may not designate qualification 

requirements for a specialist examination.” Id.15

As the Panel Opinion notes, in September 2010, one 

year after Rizzo, the VA issued a Fast Letter emphasizing 

the distinction between “specialist” and “specialty” examinations.16 Op. at 12. The letter explained that, while a 

regional office could request a “specialty examination” it 

should generally not even request a “specialist examination.”

The VA’s emphasis on using generalist examiners is 

concerning. While a generalist healthcare provider may 

have experience treating patients with a wide variety of 

ailments, and may be similarly qualified to treat patients 

as a specialist is, the opinions examiners are asked to 

provide are often more complicated than mere diagnosis 

or treatment. For example, the questions the examiner 

needed to answer in this case included whether Mr. 

Mathis’s sarcoidosis occurred as a result of his military 

 

15 The VA has different guidelines for requesting 

opinions to be prepared without examining the veteran. 

M21-1MR § III.iv.3.A.7.a.

16 A specialty examination focuses on the disabilities 

that are specifically at issue in a veteran’s claim, as 

compared to a general medical examination which involves screening all body systems. A specialist examination is any examination that is conducted by a clinician

who specializes in a particular field. M21-1MR

§§ III.iv.3.A.1.f, g, h.

The VA Manual does not indicate that someone can

ever request that an opinion be prepared by a specialist, 

when the opinion is prepared without an examination of 

the veteran. The VA Manual distinguishes between 

examinations and opinions, and there is no discussion of 

requesting specialist medical opinions.

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MATHIS v. MCDONALD 19

service, if it began while he was in service, or if symptoms 

of it had occurred within one year of his service.17

Particularly when an examiner is presented with issues such as what caused a disease or when it began, the 

examiner’s opinions are necessarily somewhat speculative, even when the examiner is an expert on that disease. 

Specialist doctors exist because the body of medical 

knowledge is larger than any individual doctor can learn, 

and it continues to grow as new research is conducted. No 

doctor can read every journal in every specialty. 

In some circumstances, specialist examiners are preferable. A specialist doctor has years of additional training in her specialty beyond that of a generalist doctor, and

will often also have more experience in her specialty. The 

Board sometimes requests examiners with specific expertise, although the VA considers itself free to disregard 

 

17 See also, e.g., Rizzo, 580 F.3d at 1289 (whether a 

veteran’s radiation exposure during military service

caused his eye conditions); Parks, 716 F.3d at 583 (whether a veteran’s exposure to three chemical warfare agents 

as part of a classified project were related to his diseases); 

Bastien, 599 F.3d at 1303–04 (whether a veteran’s participation in military experiments involving radiation 

caused his diseases); D’Auria, 2015 WL 5307462 at *1 

(whether a veteran’s exposure to asbestos and smoke as 

an Air Force fire inspector caused his diseases); Temples, 

2015 WL 4169190, at *3 (whether a veteran’s exposure to 

Agent Orange caused his diseases); Johnson, 2015 WL 

4075155, at *2–3 (whether a veteran’s service-connected 

hip disabilities made him unable to find gainful employment).

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20 MATHIS v. MCDONALD

such requests unless they specifically require a boardcertified or “board qualified” examiner.18

Medicine is like law. While a generalist lawyer may 

be qualified to take on a wide variety of cases, if someone 

has a narrow question about a certain area of the law and 

it is important that she receives a good answer, it may be

preferable for her to ask a lawyer specialized in that area 

with at least a few years of experience. No lawyer can be 

an expert in every area of the law.

In the first cases establishing the presumption of 

competence, this court appears to have found it important 

that the examiners had expertise in the area they testified about. In Rizzo, this court observed that the VA 

examiner, who had been asked to opine on radiation, was 

“a medical doctor[,] serves as VA’s Chief Officer of Public 

Health and Environmental Hazards[, and] represented 

VA’s Under Secretary for Health, whose opinion the 

Board must consider in claims based on exposure to 

ionizing radiation” under a regulation. 580 F.3d at 1291. 

In Bastien, where the issue was whether radiation exposure caused blood cancer and lymphoma, the VA submitted reports from “Dr. Mather, [the VA’s] Chief Public 

Health and Environmental Hazards Officer,” and “Dr. 

Pasquale, a hematologist, who was also an associate 

professor of medicine at Albany Medical College.” 599 

F.3d at 1304. It seems that the presumption as applied in 

those cases was a presumption that a doctor with exper-

 

18 See supra, p. 17. Examples of cases where the 

Board requested a specialist but the request was apparently disregarded by the VA include Kanuch v. Shinseki, 

No. 11-3711, 2013 WL 1200607, at *2 (Vet. App. Mar. 26, 

2013); No. 1336907, 2013 WL 6991931, at *2 (Bd. Vet. 

App. Nov. 13, 2013); and No. 1320853, 2013 WL 4450861 

at *2 (Bd. Vet. App. June 27, 2013). 

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MATHIS v. MCDONALD 21

tise in a certain topic was qualified to opine on that topic. 

This court has stated that “one part of the presumption of 

regularity is that the person selected by the VA is qualified by training, education, or experience in the particular 

field.” Parks, 716 F.3d at 585 (emphasis added).

As the presumption has been interpreted and applied, 

however, it has come to mean that any healthcare professional is competent to opine on any disease or condition, 

unless it is a vision, hearing, dental, or psychiatric problem, or is an initial examination for traumatic brain 

injury. As VA examiners usually do not have expertise in 

the field they opine about, a presumption of competence 

should not apply.

Since the Presumption was Created, the VA Removed Its 

Requirement that All Reports Needed to be Signed by a 

Doctor 

When the presumption was created, the VA Manual 

stated that “[a]ll original examination reports must be 

signed by a physician, unless the examination was performed by a clinical or counseling psychologist, dentist, 

audiologist, or optometrist.” M21-1MR § III.iv.3.D.19.a 

(2007). Reports of examinations conducted by “qualified

medical examiners other than physicians” were only

acceptable if they were signed by a physician. Id. 

Now, the corresponding provision states that “[a]ll examination reports must be signed by the examining 

health care provider.” M21-1MR § III.iv.3.D.2.a. No 

doctor’s signature is required. It appears that the only

time that a doctor’s co-signature is required for examinations performed by non-doctors is when, for initial mental

disorder examinations, certain specified examiners perform an examination under the supervision of a boardcertified or board-eligible psychiatrist or licensed doctorate-level psychologist. Id. at § III.iv.3.D.2.f. This change

was announced in September 2010 in Fast Letter 10-32.

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22 MATHIS v. MCDONALD

Doctors undergo significantly more education, training, and experience before they are licensed to practice

than most other healthcare professionals. As a result,

this change represents a significant decrease in the minimum qualifications needed for the examiner who ultimately approves an examination report after Rizzo. 

A Recent Incident Demonstrates that the VA’s Process for 

Selecting Examiners is Not Regular

The VA’s process for determining which examiners 

conduct examinations does not always result in a competent examiner being selected.19 Initial examinations for 

traumatic brain injury are treated differently than most 

other diseases, and must be performed by only certain 

types of doctors. M21-1MR § III.iv.3.D.2.h. The Minneapolis VA admitted in the fall of 2015, however, that since 

2010 many examinations for traumatic brain injury had 

been conducted by unqualified examiners.20 The VA has 

denied Freedom of Information Act requests seeking the

 

19 See, e.g., Minnesota lawmaker calls for inquiry into VA brain exam, Wash. Times (Sept. 10, 2015), http://

www.washingtontimes.com/news/2015/sep/10/minnesotalawmaker-calls-for-inquiry-into-va-brain/; A.J. Lagoe & 

Steve Eckert, VA fighting release of names tied to brain 

injury exams, KARE 11 (Minn.), (Sept. 8, 2015), http://

legacy.kare11.com/story/news/investigations/2015/09/08/ 

va-fighting-release--names-tied--brain-injury-exams/

71900484/; Steve Eckert and A.J. Lagoe, Unqualified 

doctors performed brain injury exams at Mpls VA Medical 

Center, Kare 11 (Minn.), http://legacy.kare11.com/story/

news/investigations/2015/08/05/unqualified-medicalpersonnel-performing-exams-mpls-va-medical-centertraumatic-brain-injury/31168581/.

20 Id. 

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MATHIS v. MCDONALD 23

qualifications of examiners who performed traumatic 

brain injury exams.21

To receive disability benefits, a veteran generally 

must show that he has been diagnosed with a current 

disability, that he suffered an in-service incurrence or 

aggravation of a disease or injury, and that there is a 

causal link, or nexus, between his present disability and 

the disease or injury incurred or aggravated during 

military service. Leonhardt v. Shinseki, 463 F. App’x 942, 

945 (Fed. Cir. 2012). VA examiners perform examinations that may be directed to any or all of these factors.

The cited news articles describe veterans who suffered 

head injuries during service. The VA examiners were 

tasked with determining whether a diagnosis of traumatic 

brain injury was appropriate. As noted, the VA Manual 

requires certain specialized doctors to have performed 

these diagnosis examinations, but such doctors were not 

used. The VA failed to ensure that the examinations were 

performed by qualified doctors starting in 2010, after 

Rizzo issued in 2009. This suggests that requiring the VA 

to present the qualifications of its examiners for Board 

review is appropriate, to ensure that the VA is selecting 

qualified examiners for all examinations.

CONCLUSION

Reversing precedent requires justification beyond a 

belief that the precedent was wrongly decided. Kimble v. 

Marvel Entm’t, LLC, 135 S. Ct. 2401, 2409 (2015). A 

court may overrule its own decisions “when they are 

‘unworkable or are badly reasoned,’ when ‘the theoretical 

underpinnings of those decisions are called into serious 

question,’ when the decisions have become ‘irreconcilable’ 

with intervening developments in ‘competing legal doctrines or policies,’ or when they are otherwise ‘a positive 

 

21 Id.

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24 MATHIS v. MCDONALD

detriment to coherence and consistency in the law.’” 

Halliburton Co. v. Erica P. John Fund, Inc., 134 S. Ct. 

2398, 2425 (2014) (Thomas, J., concurring) (citations 

omitted). 

Overruling precedent is “particularly appropriate” 

when “the precedent consists of a judge-made rule that 

was recently adopted to improve the operation of the 

courts, and experience has pointed up the precedent’s 

shortcomings,” and where “subsequent legal developments have unmoored the case from its doctrinal anchors.” In re One2One Commc’ns, LLC, 805 F.3d 428, 449 

(3d Cir. 2015) (citations omitted).

These circumstances are met in this case. Having 

taken full advantage of the presumption, the VA no longer 

provides any information about its examiners’ qualifications. A veteran must convince the Board or the Veterans 

Court to order the VA to produce such information. 

Before the Board will consider whether an examiner was 

qualified, the veteran must sufficiently object to the 

examiner’s qualifications. But a veteran has difficulty 

objecting without knowledge of an examiner’s qualifications. 

This outcome is absurd. “The government’s interest 

in veterans cases is not that it shall win, but rather that 

justice shall be done.” Barrett v. Nicholson, 466 F.3d 

1038, 1044 (Fed. Cir. 2006). The presumption makes the 

choice of examiners and their qualifications effectively 

unreviewable, and bars consideration of an examiner’s 

qualifications in weighing the persuasive value of her

testimony. The burden on the VA would be minimal if we 

restore the status quo before the presumption of competence was established. A veteran’s need for a CV certainly outweighs the burden of routinely attaching it. 

A presumption based on no evidence is an assumption. Assuming that every examiner is competent stacks 

the deck against a veteran seeking to challenge an adCase: 15-7094 Document: 34-2 Page: 37 Filed: 04/01/2016
MATHIS v. MCDONALD 25

verse medical opinion. We should overturn the “assumption of competence.” The VA should provide evidence 

regarding the qualifications of the examiners on whose 

opinions it relies when denying veterans benefits.

Case: 15-7094 Document: 34-2 Page: 38 Filed: 04/01/2016