Citation Nr: 21061429 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 19-22 594 DATE: October 4, 2021 ORDER The change in the Veteran's Means Test eligibility category from copay exempt to Geographic Means Test copay required in the VA healthcare system was proper for income year 2016, and the claim is denied. FINDING OF FACT The Veteran's attributable household income for the year 2016 exceeded the VA National Means test threshold of $34,461 for a veteran with zero dependents. CONCLUSION OF LAW The criteria for treatment without a copay in the VA healthcare system for income year 2016 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 October 1960 to September 1962. This claim was previously before the Board of Veterans' Appeals (Board) in July 2021, at which time the Board remanded it for additional development. The requested development has been completed, and the claim is properly before the Board for appellate consideration. 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 eligibility category from copay exempt to Geographic Means Test copay required in the VA healthcare system 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 her 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, the National Means Test threshold was $34,461 for a veteran with zero dependents. 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. See 38 U.S.C. § 1722(f)(1), (3); 38 C.F.R. § 17.47(d)(4). The Veteran is enrolled in the VA healthcare system. The IVM reports show that the Veteran's income for 2016 was greater than the National Means Test for a veteran with zero dependents, and below the Geographic Means Test of $36,650 for his location. In February 2018, the Veteran indicated on a signed income verification response form that he agreed with income information provided by the IRS and SSA showing income greater than $34,461. The Veteran submitted a notice of disagreement (NOD) in April 2018 where he explained that he had two dependents. The summary of the evidence in the December 2018 statement of the case (SOC) includes a timeline of the appeal and reveals that on July 13, 2018, the Veteran was called by VA regarding his NOD. VA explained that his two claimed dependents were both over the age of 18 years old. The Veteran agreed with his income for 2016 and stated that he would like to update the information on his dependents as one was disabled. Subsequently, the Veteran submitted a January 2019 substantive appeal where he wrote that his 34 year old son was disabled and a dependent. In July 2021, the Veteran was sent a letter from VA asking for supporting documentation from income year 2016. Specifically, he was instructed to submit a letter from his dependent-son's doctor stating that the dependent-son was diagnosed as being disabled before the age of 18. The Veteran has not submitted information regarding his dependent-son nor any other supporting documentation for income year 2016. The duty to assist is not a one-way street. If a Veteran wants help in developing his claim, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Furthermore, the Veteran has not submitted information regarding expenses that could be deducted from his income under 38 C.F.R. § 3.272. Unfortunately, the Veteran's income for 2016 was over the National Means Test, and he is not exempt from copays in the VA healthcare system for the income year of 2016. See 38 U.S.C. § 1722(f)(1); 38 C.F.R. § 17.47(d)(4). Because the evidence preponderates against the claim, 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.