Citation Nr: 22014063
Decision Date: 03/11/22	Archive Date: 03/11/22

DOCKET NO. 19-22 064
DATE: March 11, 2022

REMANDED

Whether the change in the Veteran's means test eligibility category from copay exempt to copay required in the VA healthcare system for income year 2016 was proper is remanded.

REASONS FOR REMAND

The Veteran had active service from August 1959 to August 1962.  

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 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 copay required in the VA healthcare system for income year 2016 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 the evidence in the July 2019 statement of the case (SOC) includes that on September 20, 2018, HEC Form 200-1A and HEC Forms 220-1 and 220-2, all signed and dated June 26, 2018, were received.  On October 4, 2018, documentation regarding medical expenses was received, and on October 16, 2018, two pages of the 2016 tax return and a related letter were received.  These documents 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. Associate with the claims file the HEC Form 200-1A, HEC Form 220-1, and HEC Form 220-2 signed on June 26, 2018, the documentation regarding medical expenses received on October 4, 2018, and the pages of the tax return and related letter received on October 16, 2018.

2. If the June 26, 2018 signed HEC Form 200-1A, HEC Form 220-1, and HEC Form 220-2, the documentation regarding medical expenses received on October 4, 2018, and the pages of the tax return and related letter received on October 16, 2018 cannot be obtained, 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.

3. 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.