Perez v. Wilkie, 18-0301

Decision Date12 March 2019
Docket Number18-0301
PartiesJames Perez, Appellant, v. Robert L. Wilkie, Secretary of Veterans Affairs, Appellee.
CourtUnited States Court of Appeals For Veterans Claims

Pursuant to U.S. Vet. App. R. 30(a), this action may not be cited as precedent.

James Perez General Counsel.

Before DAVIS, Chief Judge.

MEMORANDUM DECISION

DAVIS CHIEF JUDGE.

U.S Air Force veteran James Perez served on active duty from February 1953 to February 1956. In November 2013, Mr. Perez sought emergency treatment for head pain at Holmes Regional Medical Center (HRMC), a non-VA hospital. Mr. Perez subsequently sought entitlement to payment or reimbursement for the medical expenses incurred for treatment at HRMC. On November 7, 2017, the Board found that the criteria for reimbursement of private medical expenses for services rendered at HRMC on November 19, 2013, had been met.[1] However, the Board explained that Mr. Perez was enrolled in Medicare Part A and it was "not entirely clear from the record" whether Mr. Perez owed a copayment or deductible, or whether he also owed an amount not covered by Medicare Part A.[2] Nevertheless, the Board granted his claim "to the extent that he owes an amount to HRMC that is not a copayment or deductible," because "VA cannot reimburse a claimant for any deductible, copayment or similar payment that the Veteran owes a third party (e.g.[, ] a Medicare copayment))."[3]

In an informal brief, Mr. Perez argues that all expenses, including any deductible and copayment obligation, should be paid or reimbursed. He also argues that Medicare Part A was applied inappropriately. The Secretary urges the Court to affirm the Board's decision as Mr. Perez is not entitled to reimbursement for a copayment or deductible as a matter of law.

To the extent that the Board's general finding, that Mr. Perez is eligible for payment or reimbursement for the medical expenses incurred as a result of his treatment at HRMC on November 19, 2013, is favorable to the veteran, the Court will not disturb it.[4]

Regarding whether Mr. Perez is entitled to payment or reimbursement for medical expenses incurred from a copayment or deductible or similar payment obligation, this issue is not ripe for review.[5] As the Board stated, it is not clear from the record whether Mr. Perez owed a copayment or deductible or some other amount that was not covered by Medicare Part A. Further, the Board explained that the VA medical center (VAMC) must determine the proper amount of payment or reimbursement. Thus, unless and until the VAMC denies reimbursement for any part of Mr. Perez's expenses because they are a copayment, deductible, or similar payment that VA will not cover, there is no final adverse decision for Mr. Perez to challenge.[6] Once the VAMC determines the amount of payment or reimbursement to which he is entitled Mr. Perez will have the opportunity to contest that decision if he so chooses. But absent a final, adverse decision in this case, the Court must dismiss the appeal.

On consideration of the...

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT