Citation Nr: 21061334 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 19-18 646 DATE: October 1, 2021 ORDER The change in the Veteran's means test eligibility category from copay exempt to copay required for income year 2015 was proper, and the appeal is denied. FINDING OF FACT The Veteran's attributable household income for income year 2015 exceeded the VA National Means Test threshold of $38,374 for a veteran with one dependent. CONCLUSION OF LAW The criteria for treatment without a copay in the VA healthcare system for income year 2015 have not been met. 38 U.S.C. §§ 1710, 1722; 38 C.F.R. §§ 3.271, 3.272, 17.36, 17.47. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the Army from January 1993 to January 1996. The claim was remanded by the Board of Veterans' Appeals (Board) in December 2019 for additional development which has been substantially completed. 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 2015. 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 copay exempt to copay required for income year 2015 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 2015, the National Means Test Threshold was $38,374 for a veteran with one dependent. 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. § 3.272. See 38 C.F.R. § 3.271. 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. The Veteran is enrolled in the VA healthcare system. The IVM report shows that the Veteran's income for 2015 was more than $10,000 greater than the National Means Test for a veteran with one dependent. Specifically, the Veteran confirmed that he received $21,515 from SSA and a one-time settlement from Prudential Insurance of $16,585. In determining annual income, all payments of any kind or from any source (including salary, retirement or annuity payments, one-time lump sum payments or similar income, even if waived) shall be included during the 12-month annualization period in which received, except for income specifically excluded. 38 U.S.C. § 1503(a); 38 C.F.R. §§ 3.271(a), 3.272. The amount of nonrecurring income (e.g., a settlement) received by a beneficiary shall be added to the beneficiary's annual rate of income for a 12-month annualization period commencing on the effective date on which the nonrecurring income is countable. 38 C.F.R. § 3.273(c). Therefore, the one-time settlement received by the Veteran is included when determining annual income. The Veteran also reported paying $334 per month for child support. However, child support payments may not be deducted from income for VA purposes. See 38 C.F.R. § 3.272. Finally, the Veteran submitted receipts for unreimbursed out-of-pocket medical expenses and his 1099 showed deductions for Medicare Part B premium. Medical expenses in excess of five percent of the applicable maximum annual pension rate (MAPR) can be excluded from countable income. 38 C.F.R. § 3.272(g). The MAPR in 2015 for a veteran with one dependent was $16,851. Therefore, the five percent deductible was $842.55. Here, the Veteran submitted evidence showing that he paid $796.63 in out-of-pocket medical expenses and his 1099 for 2015 shows he paid $209.80 for Medicare Part B. Therefore, in total, the Veteran paid $1,006.43 for medical expenses in 2015. After the five percent deductible is applied, the Veteran had $163.88 that is eligible as deduction from countable income. The Veteran's spouse's income was not included in his 1099. The IVM report shows that she did not have any earned income on file for 2015. The income submitted by the Veteran's spouse in the December 2016 income verification response (HEC Form 200-1) is confirmed by her 1099 for 2016, which is ineligible for consideration for a claim regarding 2015. Regardless, the Veteran's income, alone and with the $163.88 deduction for medical expenses, is above the National Means Test. Therefore, the Board does not find it necessary to obtain income information for the Veteran's spouse for 2015 and the Veteran is not copay exempt for income year 2015. See 38 U.S.C. §§ 1710, 1722; 38 C.F.R. §§ 3.271, 3.272, 17.36, 17.47. Because the evidence preponderates against the claim that the Veteran's Means Test eligibility category should be copay exempt, the benefit of the doubt doctrine is inapplicable, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee 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.