Stabb v. McDonald, Opinion Number 14-0957, decided April
8, 2016 involves a case where a veteran was treated for a heart attack and
stroke at a non-VA hospital and then sought for the VA to pay for such care.
The Board denied the request stating the veteran was
ineligible for reimbursement under 38 USC Section 1725 because he was covered
by Medicare and that a claim must be denied as a matter of law. The Board stated that while the veteran only
sought the portion of expenses not covered by Medicare, the fact not all medical
expenses for his treatment were covered is not relevant.
The Court noted that Section 1725(b)(3)(B) states the
veteran is personally liable if they have “no entitlement to care or services
under a health care plan contract. “Thus,
subection 1725(b)(3)(B) appears to contemplate a situation when coverage under
a health-plan contract would wholly extinguish a veteran’s financial liability.” ID. at *5.
“Therefore, it is clear from the plain language of the statute that
Congress intended VA to reimburse a veteran for that portion of expenses not
covered by a health-plan contract.” Id.
at *6.
The Court then note that the VA’s regulation is at odds with
the amended statute and thus the statute rules.
As a result, the Court found expenses not covered by Medicare should be
reimbursed by the VA.
While this case might not apply to most VA attorney’s daily
practice, it offers a view into winning a statutory interpretation case and offers significant benefit to veterans. When they need emergency treatment and
receive it at a non-VA hospital, the VA should reimburse them for any expenses
not paid by Medicare. The cases logic
should also cover deductibles and co-payments required by private insurance.
Opinion by Judge Greenberg, joined in by Judges Lance and Pietsch.
