Citation Nr: 20005124 Decision Date: 01/23/20 Archive Date: 01/22/20 DOCKET NO. 19-22 309 DATE: January 23, 2020 ORDER The change in the Veteran's means test category from copay exempt to copay required for income year 2016 was improper, and the appeal is granted. FINDING OF FACT 1. The Veteran’s attributable household income for 2016 exceeded the VA National Means Test threshold of $40,098. 2. The Veteran’s household income for 2017 was substantially less than the VA National Means Test threshold. CONCLUSION OF LAW The criteria for treatment in the VA healthcare system without a copayment requirement for income year 2016 have been met. 38 U.S.C. §§ 1710, 1722; 38 C.F.R. §§ 3.271, 3.272, 17.47. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from October 1985 to October 1989. Income Verification Match (IVM) is a secure procedure by which VA may obtain income information from the Social Security Administration (SSA) 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 category from copay exempt to copay required for income year 2016 was proper 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 Means Test income threshold is updated annually and published in the Federal Register. See 38 C.F.R. § 3.29. For the year 2016, that threshold was $38,489 for a veteran with one dependent. The Veteran was enrolled in the VA healthcare system and had one dependent, her husband. The record shows that she has since gotten divorced. Determinations with respect to attributable income shall be made in the same manner, including the same sources of income and exclusions from income, as determinations with respect to income that are made for assessing eligibility for pension under 38 C.F.R. §§ 3.271 and 3.272. Payments from any source shall be counted as income during the 12-month annualization period in which received unless specifically excluded under 38 C.F.R. § 3.372. See 38 C.F.R. § 3.371. The exclusions do not include retirement benefits under any circumstances. The term “attributable income” means income for the calendar year preceding application for care, determined in the same manner in which an income determination is made for pension purposes under 38 U.S.C. § 1521. 38 U.S.C. § 1722(f)(1), (3); 38 C.F.R. § 17.47(d)(4). The IVM report shows that the Veteran’s income in 2016 was approximately $1,500 over the National Means Test threshold. Approximately half of her income was from gambling winnings. The Veteran wrote in July 2019 that she had a severe stroke in November 2017. Her income is less than the cost of the medical care that she requires, and her parents helped her “make up the difference.” She also wrote that she and her ex-husband had a gambling problem and lost all of their money. An exception to the threshold income requirement exists to avoid hardship. VA may determine that a veteran is eligible for care without a copayment requirement notwithstanding income in excess of the means threshold requirements if current projections of the veteran’s income for the year following application for care are substantially below the means threshold income threshold requirement. See 38 U.S.C. § 1722(e); 38 C.F.R. § 17.47(d)(6). The Veteran’s gambling winnings for 2016 cannot be expected to recur, especially in light of that she wrote that she and her ex-husband lost all of their money gambling. Therefore, the record shows that for 2017 her income was substantially below the National Means Test threshold. Consequently, to avoid hardship, the Board finds that the Veteran must not be assigned a copayment in conjunction with her VA healthcare for income year 2016, and the Veteran’s claim on appeal should therefore be granted. 38 U.S.C. § 1722(e); 38 C.F.R. § 17.47(d)(6). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Scott Shoreman, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.