Citation Nr: A21019727 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 200425-83215 DATE: December 10, 2021 ORDER Entitlement to beneficiary travel payment for expenses incurred for ambulance transport on January 9, 2020, is denied. FINDINGS OF FACT 1. On January 9, 2020, the appellant was transported by ambulance to a private hospital after experiencing chest pain. 2. At the time the emergency transportation was provided, the appellant was not service-connected for any disabilities. 3. At the time the transportation was provided, the appellant's reported annual income of $32,322.10 for the year immediately preceding his March 2020 application for beneficiary travel exceeded the applicable maximum annual pension rate (MAPR) for pension benefits for a veteran without a dependent ($13,535); there is no indication in the record that this would change in the following year due to loss of employment or incurrence of disability. CONCLUSION OF LAW The requirements are not met for payment or reimbursement of beneficiary travel expenses incurred for ambulance transport on January 9, 2020. 38 U.S.C. § 111; 38 C.F.R. §§ 70.4, 70.10. REASONS AND BASES FOR FINDINGS AND CONCLUSION In the April 2020 VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the appellant with, or within 90 days from receipt of the VA Form 10182. 38 C.F.R. § 20.303. In the decision on appeal, the AOJ, that is, the Department of Veterans' Affairs (VA) Rosenberg Healthcare System denied beneficiary travel payment for expenses incurred for ambulance transport on January 9, 2020. The AOJ favorably found that the appellant's application was received and that he received emergent medical care. However, the AOJ denied the appellant's claim on the basis that his income exceeded the maximum allowable rate of VA pension or was not of record. The appellant disagrees with the AOJ's decision: arguing that payment or reimbursement for the beneficiary travel in question is warranted. With his Notice of Disagreement, he attached a Social Security Administration (SSA) benefit statement, which shows that he received SSA benefits in the amount of $15,606.00 in 2019, and a 2019 tax form, which shows that he received retirement benefits in the amount of $15,716.10 in 2019. These documents show that in 2019, the appellant's combined income was $32,322.10. The VA regulation that is the focus of the present Board decision, 38 C.F.R. § 70.10 (a) provides that the following persons are eligible for travel payments under this part: (1) A veteran who travels to or from a VA facility or VA-authorized health care facility in connection with treatment for a service-connected disability (regardless of percent of disability). (2) A veteran with a service-connected disability rated at 30 percent or more who travels to or from a VA facility or VA-authorized health care facility for examination, treatment or care for any condition. (3) A veteran who travels to a VA facility or VA-authorized health care facility for scheduled compensation and pension examination. (4) A veteran receiving pension under 38 U.S.C. § 1521 who travels to or from a VA facility or VA-authorized health care facility for examination, treatment, or care. (5) A veteran whose annual income (as determined by 38 U.S.C. § 1503) does not exceed the maximum annual rate of pension that the veteran would receive under 38 U.S.C. § 1521 (as adjusted under 38 U.S.C. § 5312), if the veteran was eligible for pension and travels to or from a VA facility or VA-authorized health care facility for examination, treatment or care. (6) A veteran who travels to or from a VA facility or VA-authorized health care facility for examination, treatment, or care, and who is unable to defray the expenses of the travel (as defined further below). (7) A member of the veteran's immediate family, a veteran's legal guardian, or a person in whose household the veteran certifies an intention to live, if such a person is traveling for consultation, professional counseling, training or mental health services concerning a veteran who is receiving care for a service-connected disability, or a member of a veteran's immediate family if such person is traveling for bereavement counseling relating to the death of such veteran in the line of duty and under circumstances not due to the veteran's own misconduct. (8) An attendant other than a VA employee who is accompanying and assisting a beneficiary eligible for beneficiary travel payments under this section, when such beneficiary is medically determined to require the presence of the attendant because of a physical or mental condition. (9) Beneficiaries of other Federal agencies, incident to medical services rendered upon requests of those agencies, subject to reimbursement agreements by those agencies. (10) Allied beneficiaries as defined by 38 U.S.C. § 109 subject to reimbursement by the government concerned. Under 38 C.F.R. § 70.10 (b), for purposes of this section the term "examination, treatment or care" means the care or services provided under the Medical Benefits Package in 38 C.F.R. § 17.38. Under 38 C.F.R. § 70.10 (c), a beneficiary shall be considered "unable to defray the expenses of travel," if the beneficiary: (1) Has an income for the year (as defined under 38 U.S.C. § 1503) immediately preceding the application for beneficiary travel that does not exceed the maximum annual rate of pension that the beneficiary would receive under 38 U.S.C. § 1521 (as adjusted under 38 U.S.C. § 5312) if the beneficiary were eligible for pension that year; or, (2) Is able to demonstrate that due to circumstances such as loss of employment, or incurrence of a disability, his or her income in the year of travel will not exceed the maximum annual rate of pension that the beneficiary would receive under 38 U.S.C. § 1521 (as adjusted under 38 U.S.C. § 5312) if the beneficiary were eligible for pension; or, (3) Has a service-connected disability rated at least 30 percent; or (4) Is traveling in connection with treatment of a service-connected disability. Upon review of the record, entitlement to beneficiary travel payment for expenses incurred for ambulance transport on January 9, 2020, is not warranted. See 38 U.S.C. § 111; 38 C.F.R. §§ 70.4, 70.10. The appellant does not meet any of the enumerated requirements for eligibility for such benefit under 38 C.F.R. § 70.10: (1 & 2) the appellant does not have a service-connected disability; (3) the travel was not for a scheduled compensation and pension examination; (4) the appellant was not receiving pension under 38 U.S.C. § 1521; (5) the medical services were not rendered upon request by another Federal agency subject to a reimbursement agreement; (6) the appellant's annual income exceeded the MAPR that he would have received under 38 U.S.C. § 1521 and he is not otherwise unable to defray the expenses of that travel as defined by the regulation; and (7) the appellant's circumstances do not fit under any of the other eligibility criteria. With regard to his annual income level and the ability to defray expenses of the travel, the appellant's annual income is found to be have been too high for the year in question for eligibility. As noted above, in April 2020, the appellant submitted evidence indicating that in the previous year, he had a gross annual income from retirement and SSA benefits which totaled $32,322.10. Indeed, the AOJ denied the appellant's claim for reimbursement of the ambulance expense on the basis that his too excessive to qualify for beneficiary travel benefits. As of December 1, 2019, the MAPR for a veteran without a spouse or child was $13,535. See 38 C.F.R. § 3.23(a)(1); https://www.va.gov/pension/veterans-pension-rates/past-rates-2019/. It follows that the appellant's annual income of $32,322.10 for the year immediately preceding the March 2020 application for beneficiary travel exceeds the MAPR for pension benefits for a veteran with no dependent; and the appellant would not be legally entitled to VA pension benefits due to excessive income for the date in question. See 38 C.F.R. § 3.3 (a)(3). According to the pertinent VA regulation, the appellant would be found able to defray the expenses of his travel, as his annual income exceeded the MAPR and there is no indication in the record that this would change in the following year due to loss of employment or the incurrence of a disability. Indeed, neither of the above-discussed income sourcesSSA and a teachers retirement fundwould have decreased based on loss of employment or incurrence of disability. While the appellant believes his 2019 income should not prevent him from qualifying for beneficiary travel reimbursement for the ambulance transportation, this belief does not confer entitlement to the benefit claimed, as the income level for eligibility is set by law and is binding on the Board. For these reasons, entitlement to beneficiary travel payment for expenses incurred for ambulance transport on January 9, 2020, is not warranted. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joshua R. Castillo, 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.