Florence Petite v. Denis McDonough

CourtUnited States Court of Appeals for Veterans Claims
DecidedDecember 16, 2021
Docket19-5815
StatusPublished

This text of Florence Petite v. Denis McDonough (Florence Petite v. Denis McDonough) 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
Florence Petite v. Denis McDonough, (Cal. 2021).

Opinion

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

NO. 19-5815

FLORENCE PETITE, APPELLANT,

V.

DENIS MCDONOUGH, SECRETARY OF VETERANS AFFAIRS, APPELLEE.

On Appeal from the Board of Veterans' Appeals

(Argued October 1, 2021 Decided December 16, 2021)

Kenneth M. Carpenter, of Topeka, Kansas, for the appellant.

James R. Drysdale, with whom Richard A. Sauber, General Counsel; Mary Ann Flynn, Chief Counsel; and Anna Whited, Deputy Chief Counsel, were on the brief, all of Washington, D.C., for the appellee.

Before BARTLEY, Chief Judge, and PIETSCH and ALLEN, Judges.

BARTLEY, Chief Judge: Florence Petite appeals through counsel an August 15, 2019, Board of Veterans' Appeals (Board) decision denying entitlement to continued benefits under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). 1 Record (R.) at 3-6.2 This appeal, over which the Court has jurisdiction pursuant to 38 U.S.C. §§ 7252(a) and 7266(a), was referred to a panel of the Court, with oral argument, 3 to address who qualifies as a "child" for CHAMPVA purposes. Although the parties' briefing and argument

1 CHAMPVA is a federal health insurance program for spouses, surviving spouses, children, and certain caregivers of qualifying veterans. Under the program, VA pays a share of the cost (usually 25% after reaching a deductible) of covered medical services and supplies. CHAMPVA does not have a network of medical providers; instead, beneficiaries can seek care at private or government medical facilities, including VA medical centers and clinics, that accept assignment of CHAMPVA benefits. See U.S. DEP 'T VETERANS AFF ., CHAMPVA GUIDE (2021), available at https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/champva_guide.pdf, see also Braan v. McDonald, 28 Vet.App. 232, 235 (2016). 2 Ms. Petite was originally self-represented. However, after the appeal was submitted for panel consideration, her current counsel entered an appearance, the parties filed substitute briefs, and the Secretary filed an amended record of proceedings. All citations to the record are to the amended record of proceedings. 3 Oral argument was held at the National Organization of Veterans' Advocates (NOVA) Fall 2021 Conference in Washington, D.C. See Petite v. McDonough, No. 19-5815, Oral Argument [hereinafter "Oral Argument"], available at https://www.youtube.com/watch?v=TprIbn1Ijsw. We would like to thank NOVA for inviting the Court to hold oral argument at the Conference. covered a wide range of topics, including whether the Patient Protectio n and Affordable Care Act's (ACA) mandate that certain health insurers who provide dependent care coverage must make that coverage available to adult children up to age 26 4 and whether corresponding changes to the Department of Defense's Civilian Health and Medical Program of the Uniformed Services 5 (CHAMPUS or TRICARE) apply to CHAMPVA, the issue we decide today is considerably narrower. Specifically, we hold that, to qualify as a "child" eligible to receive CHAMPVA benefits between ages 18 and 23, the course of instruction that an individual is pursuing at a VA-approved educational institution need not be full-time. Accordingly, and for the reasons that follow, the Court will reverse the Board's finding that Ms. Petite was ineligible to continue to receive CHAMPVA benefits because she was not pursuing a full-time course of instruction, set aside the remainder of the Board decision, and remand the matter for further development, if necessary, and readjudication consistent with this decision.

I. FACTS The appellant's father, veteran Darren J. Petite, served on active duty in the U.S. Army from October 1993 to October 1999. R. at 1334. Ms. Petite was born on August 2, 1999. R. at 1335. In May 2008, VA determined that the veteran was permanently and totally disabled due to service-connected disabilities. R. at 97-104, 108-10. Ms. Petite applied for CHAMPVA benefits later that month, R. at 1731, which were granted in July 2008, R. at 1713. She was 8 years old at the time. Nine years later, in May 2017, VA informed Ms. Petite that, to remain eligible for CHAMPVA benefits after she turned 18 in August 2017, she needed to submit evidence that she was pursuing a full-time course of instruction at a VA-approved educational institution. R. at 1710-12. VA sent another letter to that effect in June 2017. R. at 1707 -09. Ms. Petite did not respond to those letters so, on August 3, 2017, the day after her 18th birthday, VA notified her that she was no longer eligible to receive CHAMPVA benefits. R. at 1700-06.

4 Pub. L. No. 111-148, § 2714, 124 Stat. 119 (2010) (codified at 42 U.S.C. § 300gg-14). 5 Ike Skelton National Defense Authorization Act of FY2011, Pub. L. No. 111 -383 § 702, 124 Stat. 4137 (2011) (amending 10 U.S.C. § 1110b(b)).

2 Ms. Petite filed a Notice of Disagreement later that month, arguing that it was unfair that she was "'kicked off' the CHAMPVA health plan at age 18, when other insurance carriers allow dependents to remain covered on their parents' plans until age 26." R. at 1699. In response, the VA Office of Community Care (OCC), the agency of original jurisdiction for CHAMPVA claims, issued a decision in December 2017 finding that she did not qualify for CHAMPVA benefits. R. at 1766-69. Ms. Petite promptly disagreed with that decision, R. at 1765, and the OCC issued a Statement of the Case in June 2018 continuing to deny CHAMPVA eligibility, R. at 1665 -83. Ms. Petite perfected an appeal to the Board in September 2018, R. at 1636, and submitted a statement in June 2019 asserting that she was a part-time student, R. at 11. In August 2019, the Board issued the decision currently on appeal. R. at 1 -6. Citing "controlling regulations," the Board found that Ms. Petite was not eligible for continued CHAMPVA benefits because she was over age 18 and had not demonstrated that she was permanently incapable of self-support or was pursuing a full-time course of instruction at a VA- approved educational institution. R. at 6; see R. at 3. This appeal followed.

II. THE PARTIES' ARGUMENTS & RELEVANT STATUTES The central issue in this case is whether the Board correctly interpreted controlling statutes when determining that Ms. Petite's CHAMPVA eligibility ended when she turned 18. 6 The problem is that the parties disagree as to which statutes actually control. There are three statutes at issue here. The first is the CHAMPVA statute, 38 U.S.C. § 1781, which authorizes the Secretary to "provide medical care, in accordance with provisions of subsection (b) of this section," to certain individuals "who are not otherwise eligible for medical care under [TRICARE]." 38 U.S.C. § 1781(a). As relevant here, those individuals include "the spouse or child of a veteran who has a total disability, permanent in nature, resulting from a service-connected disability." 38 U.S.C. § 1781(a)(1); see Holle v. McDonald, 28 Vet.App. 112, 116 (2016). Section 1781 does not expressly define "child" for CHAMPVA purposes. That's where the other statutes potentially come into play. According to Ms.

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Florence Petite v. Denis McDonough, Counsel Stack Legal Research, https://law.counselstack.com/opinion/florence-petite-v-denis-mcdonough-cavc-2021.