Larry S. Helmick v. Denis McDonough

CourtUnited States Court of Appeals for Veterans Claims
DecidedMay 25, 2021
Docket19-5290
StatusPublished

This text of Larry S. Helmick v. Denis McDonough (Larry S. Helmick 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
Larry S. Helmick v. Denis McDonough, (Cal. 2021).

Opinion

UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

No. 19-5290

LARRY S. HELMICK, APPELLANT,

V.

DENIS MCDONOUGH, SECRETARY OF VETERANS AFFAIRS, APPELLEE.

On Appeal from the Board of Veterans' Appeals

(Argued April 14, 2021 Decided May 25, 2021)

Andrew Cho, of Bethesda, Maryland, with whom Glenn R. Bergmann, of Bethesda, Maryland, was on the brief for the appellant.

Ryan D. Harrison, of Washington, D.C., with whom William A. Hudson, Jr., Principal Deputy General Counsel; Mary Ann Flynn, Chief Counsel; and James B. Cowden, Deputy Chief Counsel, all of Washington, D.C., were on the brief for the appellee.

Before ALLEN, TOTH, and LAURER, Judges.

ALLEN, Judge: Appellant Larry Helmick is the adult child of veteran Karl Helmick and the veteran's spouse, Lois Helmick. Karl and Lois Helmick are now deceased, though Karl Helmick predeceased Lois Helmick. In this appeal, which is timely and over which the Court has jurisdiction,1 Larry Helmick appeals an April 9, 2019, Board of Veterans' Appeals decision that denied him additional accrued benefits based on special monthly pension with aid and attendance benefits due and unpaid to his mother at the time of her death.2 Congress has provided in 38 U.S.C. § 5121 that certain persons may receive accrued benefits following the death of someone entitled to receive periodic monetary benefits from VA at the time of his or her death. No matter how we approach this appeal, whether the Board erred comes down to the meaning of the phrase "bore the expense" in section 5121(a)(6), a provision describing one category of persons entitled to such accrued benefits. That statutory section provides that "only so much of the accrued benefits may be paid as may be necessary to reimburse

1 See 38 U.S.C. §§ 7252(a), 7266(a). 2 Record (R.) at 5-11. the person who bore the expense of last sickness and burial."3 If "bore" means "paid," as the Board assumed, then the Board did not err in denying appellant additional accrued benefits. That is so because it is undisputed that appellant did not pay his mother's medical expenses. Rather, he has always maintained, and as the Board acknowledged, he loaned her $15,000 so that she herself could use the money to pay her medical expenses. She did, but she died before she could repay the loan. But if, on the other hand, "bore" means something broader than "paid," then the Board erred. The Board would have applied the incorrect legal standard to the facts. We hold that, for purposes of section 5121(a)(6) and 38 C.F.R. § 3.1000(a)(5), "bore the expense" means something broader than "paid." That phrase includes, at a minimum, a loan under the circumstances we have here. The Board erred by employing too narrow an understanding of what entitles a person to accrued benefits under the law. Although we are troubled that this matter has been pending for far too long before VA—nearly a decade in fact—we are unable to bring appellant's saga to an end today. The Board here did not make the factual findings necessary for us to find that appellant "bore the expense." And although we had previously remanded appellant's claim to the Board to make the factual determination whether the expenses appellant allegedly bore were related to his mother's "last sickness," the Board did not do so. In other words, the Board failed to make all the predicate factual findings necessary for us to review the ultimate issue of appellant's entitlement to accrued benefits. So, we will set aside the Board's decision and remand this matter for further proceedings consistent with this decision.

I. FACTS AND PROCEDURAL HISTORY The material facts are undisputed here. The veteran died in May 2007. His spouse, appellant's mother, subsequently applied for and in an August 2009 rating decision was awarded a death pension, with aid and attendance, effective May 1, 2007.4 In February 2011, the spouse submitted a report asserting that she had paid $39,842.69 in her own unreimbursed medical expenses in 2010 and expected to pay $51,260.50 for her medical expenses in 2011.5 The medical expense report for 2010 included $28,061.13 for assisted living

3 38 U.S.C. § 5121(a)(6); see also 38 C.F.R. § 3.1000(a)(5) (2020) (employing the statute's same language, except using an "or" in place of an "and"). 4 R. at 208. 5 R. at 175.

2 expenses. 6 The form instructed her to "[r]eport the actual amount of unreimbursed medical expenses you paid for yourself . . . . Do not report any expenses you did not pay or expenses for which you were or will be reimbursed."7 She estimated that her assisted living expenses for 2011 would be $45,600.8 But she died in April 2011.9 Appellant then applied for some of his mother's accrued benefits, stating that he had paid $1,496.89 in burial expenses, and identifying a "[l]oan for assisted care in 2010, 2011" of $15,000 as an additional debt he had incurred on behalf of his mother. 10 In March 2012, VA granted $1,496.89 in accrued benefits for the burial expenses.11 In August 2012, appellant disagreed with the decision because it did not address the $15,000 loan.12 In a March 2015 Statement of the Case, VA continued to deny $15,000 in accrued benefits because appellant had not stated that he paid for his mother's last sickness.13 "In addition," VA said, "as caregiver fees were considered as medical expenses in determining the amount of pension she was entitled to they would not be allowable expenses for accrued purposes"; VA cited no law to support this assertion.14 From now on, we'll refer to this reasoning as the "double counting" or "can't have your cake and eat it too" basis for denial. In April 2015, appellant filed a Substantive Appeal to the Board.15 He stated that "[w]e loaned [my mother] money for her to pay the increased cost of care" following her stroke in 2011.16 "That cost," he continued, "was reported as paid 2010 and partial 2011 medical expenses. This generated the accrued amount. It was her intent to use the adjustment for her reported medical expenses to repay us."17 He further reported that his mother did not receive those adjusted funds

6 R. at 176, 178. 7 R. at 176. 8 R. at 179. 9 R. at 162. 10 R. at 168. 11 R. at 147. 12 R. at 145. 13 R. at 129. 14 Id. 15 R. at 109. 16 Id. 17 Id.

3 because she died during a delay in processing her medical expense report.18 Along with a February 2016 statement, appellant submitted bank statements demonstrating that between September 2010 and April 2011, three checks, each in the amount of $5,000, had been issued to his mother, and that she had deposited them into her Fifth Third Bank account.19 The evidence submitted indicated that the three $5,000 checks originated from a "Helmick Living Trust" account; appellant stated that this Discover Bank Money Market account was his.

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Larry S. Helmick v. Denis McDonough, Counsel Stack Legal Research, https://law.counselstack.com/opinion/larry-s-helmick-v-denis-mcdonough-cavc-2021.