Homer Sickels sought service connection for a right knee disability and argued that VA failed to obtain an adequate medical opinion because the examiner did not perform additional diagnostic testing, including an MRI. The Board had previously remanded for a nexus opinion, and VA obtained file-review opinions stating that the current knee disability was less likely than not related to service. The Board found the remand instructions complied with and denied the claim. On appeal, Sickels argued that the Board’s reasons-or-bases statement was inadequate because it did not explain why the medical opinions were thorough and informed. The Federal Circuit held that the Board was not required to address adequacy or competence sua sponte where Sickels had not raised those concerns before the Board. Relying on Rizzo, the court emphasized that VA may presume examiner competence and that the Board need not justify that presumption unless the claimant first challenges it. The court also rejected the argument that the nonadversarial nature of the system eliminated the need to preserve the issue.

When a claimant does not challenge a VA examiner’s competence or the adequacy of the examination/opinion before the Board, the Board is not required under 38 U.S.C. § 7104(d)(1) to provide separate reasons and bases proving the opinion was competent or sufficiently informed.

To preserve an adequacy or competency attack on a VA medical opinion, the objection must be raised at the Board. Otherwise, the Board may rely on the presumption of regularity and competence without a detailed explanation.

Sickels is a preservation case for challenges to VA medical opinions. It gives the Secretary a strong defense against late-raised arguments that an examiner was not adequately informed or should have performed more testing, and it reinforces that reasons-or-bases review has limits when the issue was never presented below.

Failure to challenge the competence or adequacy of a VA medical opinion at the Board stage before seeking judicial review.

A veteran argues at the Court that a VA examiner failed to order an MRI, but the Board record never included an objection to the examiner’s competence or the scope of the examination. Under Sickels, the Court is unlikely to require the Board to have separately explained why the opinion was adequate.

Use Sickels defensively when the claimant did not preserve an opinion-adequacy objection, or offensively to distinguish cases where the veteran did preserve the challenge. It is also useful for arguing that the presumption of competence and regularity applies absent a specific Board-level contest.

Rizzo v. Shinseki, Comer v. Peake, Miley v. Principi, Butler v. Principi