Glossary

MDE - Medical Disability Examination (company)

Medical Disability Examination companies - The Veterans Benefits Administration (VBA), a component of the U.S. Department of Veterans Affairs (VA) contracts with companies to provide compensation and pension examinations (C&P exams) to veterans filing claims for compensation and other benefits due to service-connected disabilities. 

These companies in turn contract with physicians, audiologists, psychologists, and other clinicians to conduct the exams. 

As of early 2021, the companies with MDE contracts are:

• Logistics Health Inc. (LHI) [owned by OPTUM]; 
• QTC Medical Services Inc. (QTC) [owned by Leidos]; 
• Veterans Evaluation Services (VES); and 
• VetFed Resources Inc. (VetFed).
  

Negative reinforcement - From learning theory, in particular operant conditioning theory, "reinforcement" is an event that occurs shortly after a behavior and which increases the frequency of that behavior.

Most people are familiar with positive reinforcement, such as a teacher rewarding good behavior by placing a gold star next to a student's name. The gold star, which represents approval and positive attention, reinforces the student's good behavior thereby increasing the probability that the student will either continue to exhibit good conduct or improve even more. 

Negative reinforcement is a bit harder to understand, mainly due to the way we process (interpret) the word "negative". The best way to remember what negative reinforcement means is to recall that reinforcement increases the frequency of a behavior.

Both positive and negative reinforcement increase the frequency of a behavior.

When a behavior is followed by the removal of an unpleasant experience, that behavior is likely to increase in frequency. This effect is negative reinforcement. 

For example, posttraumatic stress disorder (PTSD) causes many patients to experience chronic tension and dysphoric mood. If a person suffering PTSD-induced chronic apprehension and unhappiness drinks several beers and then no longer feels tense and unhappy, negative reinforcement has occurred.

Drinking beer removed the unpleasant experience (tension and dysphoria). The removal of the unpleasant experience (apprehension and unhappiness) reinforces drinking beer.

Consequently, the behavior (drinking beer) will likely increase in frequency because it has been reinforced.

Presumption of competence for VA compensation and pension examiners - The Department of Veterans Affairs (VA) does not need to demonstrate a C&P examiner's qualifications or competence for a claim being heard by the Board of Veterans Appeals, unless the veteran questions the examiner's competence.

• Rizzo v. Shinseki, 580 F.3d 1288, 1291 (Fed. Cir. 2009) ("Absent some challenge to the expertise of a VA expert, this court perceives no statutory or other requirement that VA must present affirmative evidence of a physician’s qualifications in every case as a precondition for the Board’s reliance upon that physician’s opinion. Indeed, 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.").
  
  
• See also Bastien v. Shinseki, 599 F.3d 1301, 1306–1307 (Fed. Cir. 2010) (The veteran must specifically challenge the examiner's competence, and the veteran "... must set forth the specific reasons why the litigant concludes that the expert is not qualified to give an opinion.").
  
  
• Cf. Francway v. Wilkie here on PTSDexams.net ("Veterans who appeal a VBA claim decision to the Board of Veterans Appeals will increasingly raise the question of examiner competence and request information about the examiner's education, training, and experience. At a minimum, an appellant-veteran or their attorney will request the examiner's curriculum vitae (CV) or résumé.")
  
  
• Contra Mathis v. McDonald, 834 F.3d 1347, 1353 (Fed. Cir. 2016) (Reyna, J., dissenting from denial of rehearing en banc) ("... the court leaves in place a judicially created evidentiary presumption that in application denies due process to veterans seeking disability benefits. The presumption, that the Veterans Administration ordinarily and routinely selects competent medical examiners as a matter of due course, was created void of any evidentiary basis. Its application has resulted in a process that is inconsistent with the Congressional imperative that the veterans’ disability process be non-adversarial, and that the VA bears an affirmative duty to assist the veteran.").
  
  
• See also Mathis v. Shulkin, 137 S.Ct. 1994, 1995 (2017) (Gorsuch, J., dissenting) ("Lower courts often presume that Department of Veterans Affairs medical examiners are competent to render expert opinions against veterans seeking compensation for disabilities they have suffered during military service. The VA appears to apply the same presumption in its own administrative proceedings. ¶ But where does this presumption come from? It enjoys no apparent provenance in the relevant statutes. There Congress imposed on the VA an affirmative duty to assist — not impair — veterans seeking evidence for their disability claims. See 38 U.S.C. § 5103A(a)(1). And consider how the presumption works in practice. The VA usually refuses to supply information that might allow a veteran to challenge the presumption without an order from the Board of Veterans' Appeals. And that Board often won't issue an order unless the veteran can first supply a specific reason for thinking the examiner incompetent. No doubt this arrangement makes the VA's job easier. But how is it that an administrative agency may manufacture for itself or win from the courts a regime that has no basis in the relevant statutes and does nothing to assist, and much to impair, the interests of those the law says the agency is supposed to serve?").

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