Lee v. West

13 Vet. App. 388, 2000 U.S. Vet. App. LEXIS 231, 2000 WL 287806
CourtUnited States Court of Appeals for Veterans Claims
DecidedMarch 14, 2000
Docket98-726
StatusPublished
Cited by29 cases

This text of 13 Vet. App. 388 (Lee v. West) 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
Lee v. West, 13 Vet. App. 388, 2000 U.S. Vet. App. LEXIS 231, 2000 WL 287806 (Cal. 2000).

Opinion

STEINBERG, Judge:

The pro se appellant, veteran Raymond Lee, appeals a March 18, 1998, decision of the Board of Veterans’ Appeals (Board or BVA) that determined that an effective date earlier than September 20, 1994, for the payment of monthly disability benefits under the total disability insurance provision (TDIP) of the appellant’s National Service Life Insurance (NSLI) policy was not warranted. Record (R.) at 10. The appellant has filed a brief. The Secretary has filed a motion for summary affirmance, and the appellant has filed a response in opposition to that motion. For the reasons that follow, the Court will deny the Secretary’s motion, reverse the Board decision, and remand the matter.

I. Facts and Procedural History

The following facts are undisputed. The veteran had active service in the U.S. Army from June 1948 until May 1952. R. at 12. He filed with the Department of Veterans Affairs (VA) an application for NSLI coverage, which became effective on July 7, 1948. R. at 14-15. In May 1953, he filed an application for renewal of his NSLI policy on the five-year-level-premium term plan. R. at 20. In March 1960, he filed an application for a TDIP to be added to his NSLI policy, and the addition of that TDIP to his policy was approved in April 1960. R. at 25-28. The TDIP in effect for the veteran’s policy included the following terms:

If the Insured becomes totally disabled before his/her 65th birthday, and remains so disabled for at least 6 consecutive months, there will be paid to the Insured, for as long as the total disability continues, a monthly income of $10.00 for each $1,000 of face amount of this policy, and the payment of the premiums for this provision (as well as for this policy) will be waived, subject to the following clauses (A) to (L):
(A) Total disability is defined as any one of the following:
(1) Any impairment of mind or body which continuously renders it impossible for the. Insured to follow any substantially gainful occupation,
(2) The permanent loss of the use of both feet, or of both hands, or of both eyes, or of one foot and one hand, or of one foot and one eye, or of one hand and one eye,
(3) The total loss of hearing of both ears, or
(4) The organic loss of speech.
(D) The disability income payments will be paid from the first day of the seventh consecutive month of continuous total disability, except that if the total disability is not due to one of the specific causes listed in (A)(2), (A)(3), and (A)(4) above, the disability income payments will not relate back to a date more than 6 months prior to receipt at [VA] of the required proof....

Nov. 1, 1999, Response (Resp.), Appendix (App.) D and E. But see R. at 87-88, 113— 14 (text of paragraph (para.) (D) that was in veteran’s possession referred to para. (A)(4) only).

On May 1, 1979, the veteran requested a waiver of his NSLI premiums on the ground that at the end of 1977 he had had major surgery and that he was “now” disabled. R. at 30. Although there is a notation on the veteran’s letter that his request was answered (R. at 30), there is no indication in the record on appeal as to the content of that answer. In November 1993, the veteran notified VA that he was then totally disabled due to a heart condition and requested information on how to apply for a monthly payment under the TDIP. R. at 32. In December 1993, VA notified the veteran as follows:

To file a claim for disability insurance benefits, you should complete and return the enclosed claim form.
*391 If you have been found to be totally disabled by the Social Security Administration [(SSA),] it will not be necessary for you to have the medical portion of the claim completed.
It is important that you return your claim as soon as possible because the beginning date of benefits is determined by when we receive proof of your total disability.

R. at 34.

In March 1995, the veteran filed that application, accompanied by an SSA decision that he was totally disabled as of November 8, 1992. R. at 37-43. In April 1995, the VA Insurance Center (VAIC) notified the veteran that he had been found to be totally disabled for insurance purposes and noted that his NSLI policy provided that “payments will begin six months prior to the date proof of your total disability was received” and that he was entitled to monthly payments of $150.00 beginning on September 20, 1994. R. at 45. The VAIC requested additional information from the SSA as to the veteran’s claim that he had been found to be totally disabled as of November 1992. R. at 47-48. The veteran filed a Notice of Disagreement as to the determination “that September 20, 1994, is the commencement date for [his] eligibility [for] benefit payments.” R. at 50-51. He filed part II (report of attending physician) of the TDIP application. R. at 56. Several days later, the VAIC, citing para. (D) of the TDIP, confirmed its determination as to the effective date of TDIP payments and sent under separate cover a copy of the TDIP. R. at 53, 87-89. The veteran requested information on the TDIP and the VAIC’s adjudication process and requested a hearing. R. at 58-59. The VAIC replied with a brief explanation of TDIP para. (D) and a notification that a hearing would be scheduled. R. at 62-63.

At a September 1995 hearing before the Honolulu, Hawaii, VA Regional Office (RO), the veteran testified under oath that, although he had been disabled since 1977, he had continued to work part time until November 8, 1992 (his 62nd birthday), when he applied to SSA for total disability benefits. R. at 74. He argued that his TDIP payments should begin as of November 8, 1992, because that is the date that the SSA had determined that he had become totally disabled. R. at 75. In December 1995, the VAIC issued a Statement of the Case (SOC) that restated the language of TDIP para. (D). R. at 80-85. The veteran filed a Substantive Appeal to the Board (R. at 92-100) and requested a hearing before the Board (R. at 102).

In an April 28, 1997, BVA decision, the Board remanded the claim in order to provide the veteran with the BVA hearing that he had requested and still desired. R. at 126-28. At a May 1997 hearing before the Board sitting in Honolulu, the veteran testified under oath and argued that it was not proper to make his TDIP payments effective only as of September 1994 but that the payments should have begun as of November 8, 1992, the date on which he was found to have been totally disabled by the SSA. R. at 130, 132. In an August 19, 1997, BVA decision, the Board remanded the claim for a determination as to what legal criteria governed the claim because VA regulation 38 C.F.R. § 8.99a had been “deleted as obsolete, effective June 10, 1996”, and for readjudication giving consideration to any VA legal opinion issued and to Karnas v. Derwinski, 1 Vet.App. 308 (1991). R. at 136; see also 61 Fed.Reg. 29,289, 29,289-90 (1996).

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Bluebook (online)
13 Vet. App. 388, 2000 U.S. Vet. App. LEXIS 231, 2000 WL 287806, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lee-v-west-cavc-2000.