Burnham v. STATE, DSHS

63 P.3d 816
CourtCourt of Appeals of Washington
DecidedFebruary 7, 2003
Docket28292-5-II
StatusPublished
Cited by25 cases

This text of 63 P.3d 816 (Burnham v. STATE, DSHS) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Burnham v. STATE, DSHS, 63 P.3d 816 (Wash. Ct. App. 2003).

Opinion

63 P.3d 816 (2003)
115 Wash.App. 435

Wilma BURNHAM, Appellant,
v.
STATE OF WASHINGTON, DEPARTMENT OF SOCIAL AND HEALTH SERVICES, Respondent.

No. 28292-5-II.

Court of Appeals of Washington, Division 2.

February 7, 2003.

*817 Lisa Ellen Brodoff, Seattle University Peterson Law Clinic, Seattle, WA, for Appellant.

William Thomas Stephens, Attorney Generals Office, Adrienne Elizabeth Smith, Olympia, WA, for Respondent.

BRIDGEWATER, J.

Wilma Burnham applied for Medicaid coverage of costs associated with her service animal. The Department of Social and Health Services (DSHS) denied coverage because Burnham's service animal is not "durable medical equipment" or a "prosthetic device." The superior court affirmed DSHS' final order. We affirm, holding that other relevant sections of the Washington Administrative Code describing durable medical equipment support DSHS' determination that service animals are not equipment; and the animal does not qualify as a prosthetic device because it does not remedy a deficient body part. Additionally, other statutes and WAC regulations define "service animals" and do not classify them as equipment or prosthetic devices.

Wilma Burnham is 27 years old and suffers several mental disorders including generalized anxiety disorder, agoraphobia, and post-traumatic stress disorder. Burnham's symptoms include social isolation, extreme discomfort in public settings, excessive worry and fear, restlessness, difficulty concentrating, and panic attacks. Burnham has received therapy at Vashon Youth and Family Services since 1999. Burnham is a DSHS client, and she receives public assistance in the form of Social Security Disability, Supplemental Security Income, food stamps and Medicaid.

In 1998, Burnham was united with her service animal Shelby. Shelby is a German Shepherd-Golden Retriever mix dog that is trained to respond to outward symptoms of a panic attack. The service animal provides the focus and companionship necessary for Burnham to feel secure and to function in public. Upon the service animal's arrival, Burnham noted a lessening of her anxiety.

As with any domesticated animal, Burnham's service animal incurs various costs and *818 expenses. At the time of DSHS' initial decision, the service animal was under veterinary care "for an undetermined malady." Administrative Record (AR) at 63. In addition to vet bills for this malady, the service animal incurs other care, training, health, and grooming costs. DSHS pays $33.66 monthly for the service animal's food, which lessens the burden somewhat. But, since June 1999, Burnham has incurred approximately $2,300 in costs above and beyond the monthly food payment. Burnham could not afford to pay these costs on her public assistance income, so a friend loaned her the required amount.

In June 2000, Burnham applied for assistance to cover the costs that she had incurred for her service animal. DSHS denied the application, treating Burnham's request as an application for additional emergency assistance. Burnham appealed DSHS' denial to the Office of Administrative Hearings. At the subsequent hearing, the administrative law judge denied Burnham's requested assistance, ruling that Burnham's service animal is not durable medical equipment (DME) or a prosthetic device under WAC XXX-XXX-XXXX. The DSHS Board of Appeals and Thurston County Superior Court both affirmed.

Analysis

The Administrative Procedure Act, RCW 34.05, governs review of agency decisions. "We apply the standards of RCW 34.05 directly to the record before the agency, sitting in the same position as the superior court." City of Redmond v. Cent. Puget Sound Growth Mgmt. Hearings Bd., 136 Wash.2d 38, 45, 959 P.2d 1091 (1998). We review agency orders in adjudicative proceedings for an erroneous interpretation or application of the law. RCW 34.05.570(3)(d). "On issues of law, we apply the error of law standard of review, permitting us to substitute our judgment for that of the administrative body; however, we accord substantial weight to the agency's view of the law it administers." Valentine v. Dep't of Licensing, 77 Wash.App. 838, 844, 894 P.2d 1352, review denied, 127 Wash.2d 1020, 904 P.2d 300 (1995).

While the parties agree that de novo review applies, they dispute whether DSHS' interpretation should be given weight. As it represents, DSHS administers the state Medicaid program. RCW 74.09.500. Part of DSHS' duty in administering Medicaid is to determine whether a particular item is DME or a prosthetic device under WAC XXX-XXX-XXXX. As DSHS administers the specific provision at issue, and because the terms are technical Medicaid terms, DSHS' interpretation should be given weight. But we analyze the issues first without giving weight to DSHS's interpretation.

The principal issue raised by Burnham's single assignment of error asks whether a medically necessary service animal is DME or a prosthetic device. Burnham argues that her service animal is both DME and a prosthetic device. Therefore, Burnham argues, the animal's care costs (veterinary and grooming) are compensable labor and repair costs under WAC XXX-XXX-XXXX(1). DSHS claims that the service animal is neither DME nor a prosthetic device, and therefore DSHS' denial was appropriate.

DSHS covers "DME ... prosthetics ... repairs and labor charges" when "[m]edically necessary." WAC XXX-XXX-XXXX. DSHS found that Burnham's service dog is "medically necessary." AR at 67. DSHS does not challenge that finding. Therefore, the issue left for review is whether a service animal is DME or a prosthetic device.

I. Durable Medical Equipment

"`Durable medical equipment (DME)' means equipment that: (1) Can withstand repeated use; (2) Is primarily and customarily used to serve a medical purpose; (3) Generally is not useful to a person in the absence of illness or injury; and (4) Is appropriate for use in the client's place of residence." WAC XXX-XXX-XXXX. DSHS disputes whether service dogs can be "equipment" and whether they satisfy definitional elements (1)-(3).

That the subject item be equipment is the threshold inquiry. The WAC does not define "equipment." Our obligation is thus to determine whether service animals are includable as "equipment." We turn to other sections *819 of the WAC and to relevant statutes to see if "equipment" includes service animals:

A. WAC XXX-XXX-XXXX:[1] This regulation, in part, sets forth an extensive list of medical assistance items that do not require prior authorization for Medicaid coverage. The list includes items expressly considered DME or prosthetics. Service animals and maintenance expenses associated with their care are not included items. And, no listed item is akin in its physical composition to service animals. Subsection (11), which sets forth covered prosthetics and orthotics, is illustrative. It includes:

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Bluebook (online)
63 P.3d 816, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burnham-v-state-dshs-washctapp-2003.