Citation Nr: 21042297
Decision Date: 07/12/21	Archive Date: 07/12/21

DOCKET NO. 17-30 277
DATE: July 12, 2021

REMANDED

Whether the change in the Veteran's Means Test eligibility category from copay exempt to copay required in the VA healthcare system for 2015 was proper is remanded.

REASONS FOR REMAND

The Veteran had active service from October 1986 to October 1989 and from January 1990 to May 1990.

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 the IRS and Social Security Administration (SSA) 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 in the VA healthcare system for 2015 was proper is remanded.

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 summary of evidence in the December 2018 statement of the case (SOC) includes that on February 17, 2017 a signed HEC Form 200-1A, HEC Form 200-1, and a 2015 SSA-1099 form were received, along with a typed letter.  A letter dated January 31, 2017, which is the notice of disagreement, is of record.  However, other documents noted above are not of record and must be associated with the claims file before the claim is decided on the merits.

The matters are REMANDED for the following action:

1. Notify the Veteran that he may submit additional documents or reports regarding his 2015 income and expenses, including tax forms and medical expenses.

2. Associate with the claims file the HEC Form 200-1A, HEC Form 200-1, and 2015 SSA-1099 forms, submitted by the Veteran.

3. If the HEC Form 200-1A, HEC Form 200-1, and 2015 SSA-1099 forms submitted by the Veteran are not available, and further attempts to obtain these records would be futile, the Health Eligibility Center must note such unavailability in a Memorandum of Unavailability and associate it with the claims file.

4. If the benefits sought on appeal are not granted, the Veteran should be furnished with an SSOC and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration.

 

 

H.M. WALKER

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.