Daniel W. Beverly v. R. James Nicholson

19 Vet. App. 394, 2005 U.S. Vet. App. LEXIS 836, 2005 WL 3543823
CourtUnited States Court of Appeals for Veterans Claims
DecidedDecember 29, 2005
Docket04-0086
StatusPublished
Cited by31 cases

This text of 19 Vet. App. 394 (Daniel W. Beverly v. R. James Nicholson) is published on Counsel Stack Legal Research, covering United States Court of Appeals for Veterans Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Daniel W. Beverly v. R. James Nicholson, 19 Vet. App. 394, 2005 U.S. Vet. App. LEXIS 836, 2005 WL 3543823 (Cal. 2005).

Opinion

LANCE, Judge:

The appellant, Daniel W. Beverly, seeks review of a December 9, 2003, Board of Veterans’ Appeals (Board or BVA) decision that denied reimbursement for costs incurred at a community residential care (CRC) facility, beginning in March 2001. Record (R.) at 1-7. This appeal is timely, and the Court has jurisdiction over the case pursuant to 38 U.S.C. §§ 7252(a) and 7266. For the reasons that follow, the Board’s decision denying reimbursement for costs incurred at a CRC facility will be affirmed, and the matter of whether an informal claim to reopen a previously denied claim for special monthly compensation (SMC) for aid and attendance had been presented will be remanded for further proceedings consistent with this opinion.

I. FACTS

The appellant served on active duty in the U.S. Army from March 1967 to January 1969. R. at 11. In a March 1969 decision, the Los Angeles, California, VA regional office (RO) granted him service connection for schizophrenic reaction and assigned a 10% disability rating. R. at 93. In November 1973, the RO increased the appellant’s disability rating to 100% for his service-connected schizophrenia. R. at 95-96. In a January 16, 1998, RO decision, VA determined that he was not competent to handle the disbursement of funds and denied an inferred claim for SMC under 38 U.S.C. § 1114(l), (s) because he was not “so helpless as to be permanently bedridden or in need of regular aid and attendance,” or permanently housebound by reason of his service-connected disability. R. at 101-03. In reaching that determination, VA received and reviewed recent letters of conservatorship issued by the Superior Court of California as well as a statement by Dr. James E. Rosenberg, chief of psychiatric intensive care at a VA medical center, who determined that the appellant lacked capacity to make informed choices about his finances. Id. The appellant did not appeal that decision and it became final.

In March 1999, Guy C. Lamunyon, R.N., the appellant’s case manager in VA’s Intensive Psychiatric Community Care (IPCC) Program, sent a letter to the Superior Court of California that noted that the appellant was a participant in the IPCC Program. R. at 105. Mr. Lamunyon indicated that the IPCC Program would continue to follow the appellant with weekly *397 contacts and frequent home visits for the duration of his benefits. Id.

In an April 21, 2003, letter, Dr. Stephen Marder,- the ÍPCC medical director, verified that the appellant had'been referred to the Salvation Army Haven/Exodus Lodge (Exodus Lodge), a licensed facility for’ the mentally disordered, on March 5, 2001, and again on August 3, 2001, as a result of chronic medication noncompliance. R. at 165. A March 6, 2001,- psychiatric’ progress note also confirms that the appellant had been discharged to Exodus Lodge, a CRC facility. Supplemental (Suppl.) R. at i. In a July 19, 2001, IPCC progress note, Mr. Lamunyon, reported the following:

Escorted vetjeran] to Court 95 and back to unit. Vet[eran] withdrew his objections to the renewal of the ... conserva-torship with the agreement that he can have [his] drivers license restored after six months if stable and medication- compliant living in a ’ board and care. Vet[eran] understands he is to remain an additional six months in a board and care prior to returning to the community. Vet[eran] also understands that medication noncompliance resulting in readmission within this time frame will result in locked placement. Vet[eran’]s wife/eonservator is in agreement with these terms.

R. at 171. An August 3, 2001, progress note recorded:

[C]lient [was] escorted to [E]xodus [Lodge,] paperwork and med[ieation]s given to staff. [C]lient expressed belief that he did not “need to be in a board and care” but would agree to stay there for at least 6 months and take medications for “5 years” because he promised Guy Lamunyon and Dr. Marder that he would.

Suppl. R. at 3.

On December 15,- 2002, the appellant appeared at the Los Angeles, California, VA office and requested reimbursement for his rent at the CRC facility. R. at 112. In a December 16, 2002, letter, VA informed him that his request for reimbursement was denied on the basis that VA regulations require that the cost of care be financed by the veteran’s own resources. R. at 107. In January 2003, he filed a Notice of Disagreement (NOD) and VA issued a Statement' of the Case. R. at 137-39, 109-13. The appellant filed a timely Substantive Appeal requesting retroactive payment for his rent at the CRC facility beginning in March 2001. R. at 115. '

On May 12, 2003, the appellant was provided a BVA hearing where he contended that VA should reimburse him for the costs of the CRC facility because he is 100% service connected for schizophrenia, and the costs incurred were a direct result of his service-connected disability. R. at 175-78. He also Maintained that he was referred to CRC by a VA doctor who “coerced” him into going to the CRC facility. R. at 175-78. He stated that as a result of his mental condition, he was given “two ultimatums”: (1) A locked facility, or (2) a CRC facility. R. at 178. Last, because he was required to stay at the CRC facility to regulate his medications, he contended that this should be considered “medical treatment” subject to reimbursement under 38 C.F.R. § 17.120 (2003). Id.

At the May 2003 hearing, the Board Chairman informed the appellant that there “may be a deficiency in the record” with regard to VA’s responsibilities under the Veterans Claims Assistance Act (VCAA) of 2000, but that it is a deficiency that may be waived. R. at 179. The Chairman further noted that “if it becomes necessary to cure that [deficiency], that would ... have to be done.” Id. The appellant declined to waive his right to further VCAA development. R. at 180.

*398 By correspondence dated July 30, 2003, and September 25, 2003, the appellant requested that the Board advance his case on the docket based upon the severity of his service-connected mental condition. R. at 190, 192. Attached to his July 2003 request was an examination report by Dr. Steven Marder, on VA Form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. R. at 195-96. Dr. Marder noted the appellant’s complaint that board and care placement was causing a financial hardship for him and his family. R. at 195. Dr. Marder also noted: “[Veteran’s] chronic medication noncompliance has resulted in one or more hospital admission[s] per year over the past 30 years. Medication monitoring in a board and care environment has maintained the veteran for two years without readmission, but is causing a financial strain on the family.” R. at 196. Dr. Marder certified that the appellant required the daily personal health care services of a skilled provider without which he would require hospital, nursing home, or other institutionalized care. Id.

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Bluebook (online)
19 Vet. App. 394, 2005 U.S. Vet. App. LEXIS 836, 2005 WL 3543823, Counsel Stack Legal Research, https://law.counselstack.com/opinion/daniel-w-beverly-v-r-james-nicholson-cavc-2005.