Citation Nr: 19128331 Decision Date: 04/11/19 Archive Date: 04/11/19 DOCKET NO. 19-06 910 DATE: April 11, 2019 REMANDED Whether the change in the Veteran’s means test eligibility category from exempt to copay required in the VA healthcare system for income year 2016 was proper is remanded. REASONS FOR REMAND The Veteran had active service from October 1961 to January 1965. Income Verification Match (IVM) is a secure procedure by which VA may obtain income information from the Social Security Administration and the Internal Revenue Service (IRS), in order to verify income amounts that are reported to VA. The adjudication of this matter involves information provided by SSA and the IRS for 2016. However, to avoid disclosure of sensitive information, the Board’s decision does not directly cite dollar amounts included in any IVM report that has not been verified by the Veteran. Therefore, the text of this decision is not subject to the additional protections required under the IVM procedures. Whether the change in the Veteran’s means test eligibility category from exempt to copay required in the VA healthcare system for income year 2016 was proper is remanded. VA shall furnish hospital care and medical services to any veteran who is unable to defray the expenses of necessary care. 38 U.S.C. §§ 1710(a)(2)(G). For the purposes of 38 U.S.C. § 1710(a)(2)(G), a veteran shall be considered to be unable to defray the expenses of necessary care if his attributable income is not greater than a specified income threshold, which is updated annually. 38 U.S.C. § 1722 (a)-(c). If a veteran does not qualify under 38 U.S.C. § 1710(a)(2)(G), he or she will be responsible for a copayment for VA healthcare services that relate to nonservice-connected disabilities. The Veteran’s copay means test eligibility category was changed from exempt to copay required for income year 2016 due to excessive income. The Veteran wrote in November 2018 that he only receives income from Social Security. The IVM report from the IRS showed additional income for 2016. In February 2019 the Veteran wrote that he was submitted evidence showing $26,378.00 in expenses and $47,330.90 in dental expenses for 2016. This evidence of not of record. The list of evidence from the January 2019 statement of the case includes the following: Received September 12, 2018: • HEC Form 200-1A (Option 3) form signed and dated August 18, 2018 • Dental receipts totalling $1,794 • Bank statements • Insurance statements or documentation • Spouse’s death certificate showing date of death of May 16, 2016 Received October 31, 2018: • 2017 SSA-1099 form • Marriage license • Income verification division letter Received December 13, 2018: • Response checklist letter • SSA-1099 form • 2016 tax return • Expenses related to deceased mother • Three letters from the Veteran • Bank statements with account history listing ATM fees and household expenses Received December 18, 2018: • HEC Form 200-1A (Option 2) signed and dated November 30, 2018 • Documents relating to funeral expenses paid in 2007 and 2009 The list of evidence from the February 2019 supplemental statement of the case includes the following that was received on February 20, 2019: • HEC Form 200-1A (Option 2) signed and dated November 30, 2018 • Proof of $50,383.90 in out of pocket medical expenses • Correspondence from Wells Fargo regarding a non-medical payment • Bank statements with markings • Payment history from Century Link • Paper work from Grainger about a “water well” • 2015 SSA-1099 form • Receipt related to a payment to VA by the Veteran’s mother • Dental ledger These documents are not in the claims file. The documents that the Veteran has submitted for this claim, including the above-named documents, must be associated with the claims file before the claim is decided on the merits. The matter is REMANDED for the following action: 1. Associate the documents received on or around September 12, 2018, October 31, 2018, December 13, 2018, December 18, 2018, and February 20, 2019, with the claims file. These include: • HEC Form 200-1A (Option 3) form signed and dated August 18, 2018 • Dental receipts totalling $1,794 • Bank statements • Insurance statements or documentation • The Veteran’s spouse’s death certificate, showing date of her death of May 16, 2016 • 2015 SSA-1099 form • 2017 SSA-1099 form • SSA-1099 form (year unknown) • Marriage license • Income verification division letter • Response checklist letter • 2016 tax return • Expenses related to deceased mother • Three letters from the Veteran • Bank statements with account history listing ATM fees and household expenses • HEC Form 200-1A (Option 2) signed and dated November 30, 2018 • Documents relating to funeral expenses paid in 2007 and 2009 • Proof of $50,383.90 in out of pocket medical expenses • Correspondence from Wells Fargo regarding a non-medical payment • Payment history from Century Link • Paper work from Grainger about a “water well” • Receipt related to a payment to VA by the Veteran’s mother • Dental ledger 2. If any of these documents are determined to be unavailable, the Veteran should be so notified of such unavailability and given the opportunity to provide any copies of such requested documents. In addition, the Veteran should be notified that he may submit additional documents or reports regarding his 2016 income and expenses. 3. If any of these documents cannot be obtained and associated with the claims file, and further attempts to obtain these records would be futile, the Health Eligibility Center must note such unavailability in a Memorandum of Unavailability and associate it with the claims file. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Scott Shoreman, Counsel