If VA denies your beneficiary travel request, they must do it in writing!

[Vync]

After the VAMC travel office denied me a travel voucher request, I did my homework because it did not pass the smell test. I wanted to verify qualifications for my travel and explore any potential exclusions. I also learned that if the VA denies travel, they must do it in writing so you can appeal the decision.

 

My primary care doctor asked me to return early the following week to have fasting blood labs performed. I completed this the next business day and visited the travel office to get a voucher. This is where it gets interesting. The employee refused to issue a voucher because I "did not have an appointment in the system" for that day. I visited the Patient Advocate, who has always been very helpful, but they told him the same thing. I later placed a call to the White House VA Hotline. Meanwhile, I researched 38 CFR 70 - VHA BENEFICIARY TRAVEL UNDER 38 U.S.C. 111 to arm myself with knowledge of the actual law. 

 

 

Quote

 

§ 70.4 Criteria for approval  

(a) VA will approve payment for beneficiary travel under this part if: 
(1) The travel was made to obtain care or services for a person who is eligible for beneficiary travel payments under §70.10, 
(2) The travel was in connection with care or services for which such person was eligible under the laws administered by VA,

...

(c) When a claimant requests payment for beneficiary travel for care or services that were not scheduled with VHA prior to arrival at the facility and were not emergency treatment and the travel did not include a special mode of transportation, VA will not approve round-trip payment under this part but will approve payment for the return trip if VHA actually provided care or services. 

 

I qualified under the first few lines. However, paragraph (c) is in direct contrast with what I was told.

 

Quote

 

§ 70.10 Eligible persons
(b) For purposes of this section, the term ‘‘examination, treatment, or care’’ means the care or services provided under the Medical Benefits Package in §17.38 of this chapter.

 

§ 17.38 Medical benefits package.

(a)(1) Basic care.

(i) Outpatient medical, surgical, and mental healthcare, including care for substance abuse.

 

Double-checked to confirm having blood drawn at the lab qualifies.

 

Quote

§ 70.40 Administrative procedures.
Upon denial of an initial claim for beneficiary travel, VA will provide the claimant written notice of the decision and advise the claimant of reconsideration and appeal rights. A claimant who disagrees with the initial decision denying the claim for beneficiary travel, in whole or in part, may obtain reconsideration under §17.133 of this chapter and may file an appeal to the Board of Veterans’ Appeals under parts 19 and 20 of this chapter. An appeal may be made directly to the Board of Veterans’ Appeals without requesting reconsideration.

 

This was a surprising find. Looking at the facts, the VA travel employee denied me an initial claim for beneficiary travel. However, they failed to provide me with a written notice of their decision. I was unable to formally appeal, which might be constituted as a violation of my rights to due process. It is also a good way for the VA to hide any paper trail.

 

 

Fast forward to yesterday. I get a call from a VA employee who issued a verbal apology for the mix up and said I would be paid for one-way travel, which is partially vindicating. However, a lingering concern about how § 70.4 (c) defines how "for care or services that were not scheduled with VHA" should be applied remains. The VA does not make appointments to have blood drawn. It is impossible to simply walk in and get labs performed without a consult from a doctor. The word "appointment" is found only once in this entire law, but it applies only to a special aspect of reimbursement for food an lodging. Therefore, in my opinion, the primary care doctor's consult constitutes scheduling of follow up care at the patient's convenience without being scheduled for a dedicated appointment. The VA employee said they would look into it.

 

In conclusion, learning that beneficiary travel denials must be issued in writing was a significant find. However, the VA loosely defining "scheduled" as meaning "appointment" is intriguingly disturbing. Could this be a simple incorrect reading of the law or is it an intentional effort to deny beneficiary travel payments to veterans under certain scenarios? Why doesn't the VA make appointments for labs, having glasses fitted, or picking up equipment for prosthetics? A veteran must travel to the VA facility to have them done much like visiting radiology to have imaging performed. If this happened to me, I can only assume it is happening all over VA-land.