## Facts

- Richard Gambill, a U.S. Army veteran (1969–1971), suffered an in-service head injury when a trash barrel fell on his head, causing a small scalp laceration and a forehead abrasion; his separation examination was normal.
- In 1994–1995, Gambill was treated for bilateral cataracts and was told head trauma can possibly cause cataracts.
- Gambill sought VA service-connected disability benefits, alleging his cataracts were caused by the in-service head injury.
- After an initial VA consultation, a Regional Office denied service connection.
- On appeal, the Board of Veterans’ Appeals determined the initial opinion did not adequately address etiology and obtained an expert opinion from a Veterans Health Administration ophthalmologist under 38 C.F.R. § 20.901.
- The VHA ophthalmologist did not examine Gambill but reviewed the record, identified cataract risk factors, and stated medical literature did not support head trauma (absent ocular trauma) as a cause; the report noted Gambill denied direct eye trauma.
- The Board provided Gambill the written VHA opinion and 60 days to submit additional evidence or argument; Gambill had waived a Board hearing.
- The Board denied service connection, relying substantially on the VHA opinion; the Court of Appeals for Veterans Claims affirmed.
- Gambill appealed to the Federal Circuit raising constitutional due process challenges.

## Issues

1. Whether due process requires VA to provide an in-person medical examination, rather than a records-based expert opinion, when adjudicating a service-connection claim.
2. Whether due process entitles a claimant to cross-examine a VHA medical expert whose written opinion is considered by the Board.
3. What constitutional framework governs procedural due process challenges in veterans’ benefits adjudication.

## Decision

- The Federal Circuit affirmed the decision upholding the Board’s denial of service connection.
- Due process does not categorically require an in-person medical examination in VA benefits adjudications; a records-review VHA opinion may be constitutionally sufficient.
- Due process does not require cross-examination of a VHA expert in these circumstances.
- The court applied the Mathews v. Eldridge balancing test and found existing procedures (notice of the opinion, opportunity to submit evidence/argument, and availability of a hearing) adequate.

## Legal Principles

- Procedural due process in veterans’ benefits adjudication is evaluated under Mathews v. Eldridge: (1) the private interest, (2) risk of erroneous deprivation and value of added safeguards, and (3) governmental burdens.
- Even assuming a protected interest in disability benefits, due process is flexible; it does not mandate trial-type procedures in the VA’s nonadversarial system.
- A records-based medical opinion, coupled with disclosure to the claimant and a meaningful opportunity to respond (including the option of a hearing), can satisfy due process.
- Cross-examination is not a constitutional requirement where written rebuttal and optional hearing procedures provide an adequate opportunity to contest an expert opinion.

## Conclusion

The Federal Circuit held that, under Mathews v. Eldridge, VA’s use of a disclosed records-review VHA medical opinion with an opportunity to submit rebuttal evidence and argument (and an available hearing) satisfies due process; neither an in-person examination nor cross-examination of the medical expert is constitutionally required in this setting.


Gambill v. Shinseki, 576 F.3d 1307 (Fed. Cir. 2009)