Vipers Vietnam Veteran Message Board: Veterans denied VA violation of 1722a claim

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Veterans denied VA violation of 1722a claim

Posted by haik on 3/18/2007, 1:29 pm
172.145.125.223

Lets assume you are at the VA picking up your prescription. You and the veteran in line in front of you are prescribed the exact same identical prescription of 30 pills. Both supplies carry a copay of $8. Right? But, your prescription requires that you split your supply. You now have a two month supply (15 pills 1/2 pill per day). This $8 supply now increases in copay cost to $16, for the exact pill medication and supply that costs $8. But let's assume that veteran in front of you, having still the same prescription, his supply for a 30-day supply is instead 90 pills. Copay remains at $8 for this 30-day 90 pill supply.
Hope this explains, how the veteran is overcharged by the VA, and just got screwed again by the BVA.
What all veterans have known as fact, is that veterans continue to lose benefits. This is just another example.
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Criteria & Analysis by the Board of Veterans Appeals.
To briefly understand my claim, “. ...The appellant contends that the standard copayment is excessive in light of the pill splitting.” No where in my claim did I mention the word ‘standard.’ To determine what then is the standard 30 day supply one must compare 2 supplies. The VA apparently has two(2) standard supplies. A 30 day supply of 30-60-90 pills. Copayment cost $8. Then a second standard 30 day supply of 15 pills, $8 copay. Two distinct standards. A standard in cost, but no.... standard in supply.
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The BVA cites my argument, 38 U.S.C.A. Sec. 1722a “Copayment for medications. Paragraph (2) The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication as described in paragraph (1).”
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“(a)(1) Subject to paragraph (2), The Secretary shall require a veteran to pay the United States $8 for each 30-day supply of medication furnished such veteran under this chapter on an outpatient treatment of a non-service connected disability or condition. If the amount supplied is less than a 30-day supply, the amount of the charge may not be reduced. “
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"In addition, the board notes that the references to the cost of medication contained in USCA 1722a clearly pertains to VA's cost in dispensing the medication, not the cost to the appellant." 1722a, Copayment For Medication, clearly, makes no mention the VA's cost of dispensing medication. It mentions only the veterans' copayment obligation. The "cost in dispensing the medication" is not the argument. It is the cost in overcharges to the veteran.
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To me it is quite simple. “The Secretary may not require a veteran to pay amount in excess of the cost to the Secretary for medication as described in paragraph (1).” If one supply can be a standard 60, or 90 pill 30 day supply with a copay of $8, how can a 30 day supply of 15 pills at a copay of $8 be standard supply? Therefore, an "excess of the cost" does indeed exist.
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If given to an eight grade grammar school class this arithmetic problem of the two supplies to find the excess of the cost, what would be their answer? They too, would find that an excess of the cost does exist, “..for medication as described in paragraph (1)”
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“(b) The Secretary, pursuant to regulations which the Secretary shall prescribe may-...(1) increase the copayment amount in effect under subsection (a);..” "Pursuant to regulations" means according to law, which the Secretary shall follow accordingly, and prescribe. What is being said, judging by the ruling, tscrew the veteran. These are the VA standards, screw the veteran!
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Citing..“Under 38 C.F.R. Sec. 17.110 Copayments for medications.
(b) Copayments. (1) Unless exempted under paragraph (c) of this section, a veteran is obligated to pay VA a copayment for each 30-day or less supply of medication provided by the VA on an outpatient basis (other than medication administered during treatment).” If ‘administered during treatment’ meant hospitalization, that’s not what it says, or should have been worded. But it did not. It is not ambiguous in the context in which it is presented. Citing, ‘on an outpatient basis, other than medication administered during treatment’ The meaning is quite clear. A patient receiving 60, or 90 day outpatient supply is clearly a treatment of a condition, such as a heart condition, diabetes, etc.
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BVA mentions, “Thus, it is clear that the VA’s cost of filling the appellant’s 30-day prescription exceeds the $8 copayment under 38 C.F.R. Sec. 17.110.” Again the argument clearly is not the VA cost as noted in the Federal Register 12/6/2001. When determining the medication copay cost, VA factored in everything, except the cost of the medication.
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BVA denial in part, "...adherence in the face of overwhelming evidence in support of the result in a particular case: such adherence would result in unnecessarily imposing additional burdens on the VA with no benefit flowing to the claimant." Never mind the burden of overcharges to well over 1.1 million veterans whose prescriptions call for pill splitting.
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It is clear, that with the national budget concerns, of how the BVA came up with this denial. But we can't help that. There are many things in life we do not like, but ignoring a veterans' cause, or the law is not an option. Who lost? Having sat in the lobby of my VA hospital and observed those that passed by, it's not hard to see, there are many who could use any help they can get, as well over 1.1 million other veterans.