Citation Nr: A25035245
Decision Date: 04/16/25	Archive Date: 04/16/25

DOCKET NO. 220127-215347
DATE: April 16, 2025

REMANDED

Entitlement to eligibility for benefits under the Program of Comprehensive Assistance for Family Caregivers (PCAFC) is remanded.

REASONS FOR REMAND

The Veteran served on active duty from October 2011 to October 2012. 

This appeal is before the Board of Veterans' Appeals (Board) from a January 2021 decision of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA), which denied eligibility for PCAFC.  The Veteran filed a VA Form 10182, Decision Review Request: Board Appeal, in January 2022.

The PCAFC requires VA to notify individuals who apply for the program of decisions affecting the furnishing of assistance with notice as described in 38 U.S.C. § 5104. 38 U.S.C. § 1720G(a)(12).  Generally, notice under 38 U.S.C.        § 5104 must include the following: 1) identification of the issues adjudicated; 2) a summary of the evidence considered by the Secretary; 3) a summary of the applicable laws and regulations; 4) identification of findings favorable to the claimant; 5) in the case of a denial, identification of elements not satisfied leading to the denial; 6) an explanation of how to obtain or access evidence used in making the decision; and 7) if applicable, identification of the criteria that must be satisfied to grant service connection or the next higher level of compensation. 38 U.S.C. § 5104b).  Notice must also set forth the right to a hearing, the right of representation, and the right, as well as the necessary procedures and time limits to initiate a higher-level review, supplemental claim, or appeal to the Board of Veterans' Appeals.  38 C.F.R. § 3.102(b)(1).  Claimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief.  38 C.F.R. § 3.103(b)(1).  Notification will be in writing.  See 38 C.F.R. § 3.103(f).

The notification of the January 2021 decision does not meet the criteria outlined in 38 U.S.C. § 5104(b) and as directed in 38 U.S.C. § 1720G (a)(12).  The notice explained that the Veteran did not meet the PCAFC eligibility criteria as he did not require personal care services for a minimum of 6 continuous months based on an inability to perform an activity of daily living and/or a need for supervision, protection, or instruction and that participation in the program was not in the Veteran's best interest.  However, it did not provide a summary of the evidence, the applicable laws and regulations, any favorable findings or other elements that were not satisfied leading to the denial, or an explanation of how to obtain or access the evidence used in making the decision.  Moreover, the January 2021 denial letter was not sent to the Caregiver-Applicant or to the Veteran's representative.  Thus, notice is insufficient in this case.

As correction of this error by the AOJ in satisfying its regulatory and statutory duties would have at least a reasonable possibility of aiding in substantiating the claim on appeal, the appeal must be remanded for the AOJ to provide the Veteran with complete notice of the decision as required by 38 U.S.C. § 5104.  See 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

1. Issue the Veteran, Family Caregiver applicant, and the Veteran's representative notice of the decision on entitlement to eligibility for designation and approval for a Family Caregiver under the PCAFC that complies with 38?U.S.C. §?5104.

 

 

M. HYLAND

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Casadei, 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.