Mathis v. McDonald
2016 U.S. App. LEXIS 15232
Fed. Cir.2016Background
- Freddie Mathis applied for VA disability benefits for pulmonary sarcoidosis; VA denied benefits after relying on a VA examiner’s opinion that service connection was "less likely than not."
- The examiner was identified only as a "staff physician;" Mathis did not request the examiner’s CV or challenge competence before the Board, and first raised competence on appeal.
- The Veterans Court and this court applied a rebuttable presumption that VA-selected examiners are competent when their qualifications are not challenged at the agency level.
- Mathis sought rehearing en banc of this court’s decision affirming the presumption; the petition for rehearing en banc was denied.
- Concurrences (by Judges Dyk and Hughes) accept a limited, rebuttable presumption but emphasize VA’s duty to assist and that veterans can request examiner qualifications; dissenters (Reyna, Stoll) argue the presumption lacks evidentiary basis and violates due process.
Issues
| Issue | Plaintiff's Argument (Mathis) | Defendant's Argument (VA) | Held |
|---|---|---|---|
| Presumption that VA-selected medical examiners are competent | Presumption is unsupported by evidence of VA selection procedures and should not apply; it deprives veterans of ability to challenge examiner competence | The presumption is practical and reasonable given VA’s large exam volume and permits efficient adjudication | Court (panel; en banc denied) permits a limited, rebuttable presumption of competence but confines it; concurrence stresses it is rebuttable and subject to VA’s duty to assist |
| Access to examiner qualifications (CVs) / VA duty to assist | Veterans need routine access to examiner qualifications to mount challenges; VA’s refusal or failure to disclose impairs non‑adversarial system and due process | Releasing CVs routinely would be administratively burdensome; VA already has procedures and will provide info when appropriate | Concurrences: VA should provide qualifications when duty to assist requires it; veterans may request CVs and Board/Veterans Court can order disclosure where needed; the scope/timing not decided here |
| Distinction between examiner competence and adequacy of exam/opinion | Presumption of competence should not foreclose review of report adequacy; but plaintiffs argue competence presumption impedes meaningful review | VA: competence presumption does not mean the report is correct; adequacy remains separately reviewable | Held: Court emphasizes separate inquiries — competence (presumed but rebuttable) vs. adequacy (report must still be adequate for review) |
| Due process / ability to confront examiners | Mathis: Presumption plus limited disclosure denies veterans due process (no cross‑examination, voir dire, or access to qualifications); analogous protections in other contexts support scrutiny | VA: Administrative burden and existing regulations justify practical presumptions; Perales and other precedents support admission of written exams without cross‑examination | Dissenters: Presumption risks denying due process; majority/concurrences declined to overturn presumption and focused on remedial duties (duty to assist, remands) |
Key Cases Cited
- Rizzo v. Shinseki, 580 F.3d 1288 (Fed. Cir. 2009) (applied presumption of regularity to VA selection of examiners)
- Sickels v. Shinseki, 643 F.3d 1362 (Fed. Cir. 2011) (discussed presumption that examiner was sufficiently informed; held challenge not raised below)
- Parks v. Shinseki, 716 F.3d 581 (Fed. Cir. 2013) (noted competency requires nexus between qualifications and opinion; court declined to resolve some qualification questions)
- Nohr v. McDonald, 27 Vet.App. 124 (Vet. App. 2014) (Veterans Court: VA duty to assist may require obtaining examiner CVs when competency is in issue)
- Richardson v. Perales, 402 U.S. 389 (U.S. 1971) (upheld admission of written medical reports without cross‑examination under certain reliability safeguards)
- Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579 (U.S. 1993) (gatekeeping role for courts to assess expert reliability and qualifications)
- Cushman v. Shinseki, 576 F.3d 1290 (Fed. Cir. 2009) (recognized veterans’ disability benefits as a property interest entitled to due process)