Citation Nr: 21065200 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 19-18 936 DATE: October 25, 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 for income year 2016 was improper, and the appeal is granted. FINDING OF FACT The Veteran's attributable household in 2016 did not exceed the VA National Means Test threshold of $40,694 for a veteran with two dependents. 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, 17.36, 17.47. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from January 1976 to October 1978. This claim was previously before the Board in December 2019, 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 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 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 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 $38,489 for a veteran with one dependent and $40,694 for a veteran with two 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. In the September 2018 decision on appeal, the Veteran's copay exempt status was changed from copay exempt to Geographic Means Test copay required for income year 2016 based on the income of him and his spouse being above the National Means Test. An August 2015 letter from a state child services department shows that the Veteran's spouse was the caregiver for H. (referred to as G., her former name), a child born in January 2015 who was a ward of the state and had been placed with the Veteran's spouse. A copy of his 2016 tax return submitted by the Veteran shows that he and his spouse claimed H. as a dependent. An adoption decree shows that the Veteran and his spouse adopted H. in May 2017. H. was not included as a dependent in the September 2018 decision on appeal. The term "child" is defined, for purposes of VA benefits, as an unmarried person who is a legitimate child, a child legally adopted before the age of 18 years, a stepchild who acquired that status before the age of 18 years and who is a member of the veteran's household or was a member of his household at the time of the veteran's death, or an illegitimate child; and who is (i) under the age of 18 years; (ii) before the age of 18 years became permanently incapable of self-support; or (iii) after reaching the age of 18 years and until completion of education or training (but not after reaching the age of 23 years) is pursuing a course of instruction at an approved educational institution. 38 U.S.C. § 101(4)(A); 38 C.F.R. § 3.57. Under VA regulations, an adopted child means a child adopted pursuant to a final decree of adoption, a child adopted pursuant to an unrestricted interlocutory decree of adoption while remaining in the custody of the adopting parent (or parents) during the interlocutory period, and a child who has been placed for adoption under an agreement entered into by the adopting parent (or parents) with any agency authorized under law to so act, unless and until such agreement is terminated, while the child remains in the custody of the adopting parent (or parents) during the period of placement for adoption under such agreement. 38 C.F.R. § 3.57(c). The record shows that the Veteran and his spouse adopted H. within a year of her being placed in their home. The Veteran wrote in May 2019 that they had raised H. since she was four months old. H. was in the custody of the Veteran and his spouse during the period of adoption, which includes income year 2016. The Board therefore finds that H. qualified as an adopted child for income year 2016. See 38 C.F.R. § 3.57(c). Therefore, the Veteran had two dependents in 2016 for the purposes of this claim. See 38 U.S.C. § 101(4)(A); 38 C.F.R. § 3.57. The IVM reports show income for 2016 that was just below the National Means Test for a veteran with two dependents. See 38 C.F.R. § 3.29. See 38 C.F.R. § 3.29. Accordingly, the Board finds that 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 improper, and the appeal is granted. TRACIE N. WESNER Acting 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.