On a Friday afternoon in late February, the US Department of Veterans Affairs filed a motion with the Court of Appeals for Veterans Claims. In this motion, the VA asked the court to stay (lawyer-speak for “pause”) the effect of the court’s decision in a case called Staab v. Shulkin. The Staab case addresses the question of when the VA must reimburse veterans who receive emergency health care outside of the VA system.  In what can only be described as blinding speed (at least as far as the legal system is concerned), the court denied the VA’s motion the following Tuesday.

The court’s decision in Staab and its subsequent denial of the VA’s motion to stay appear to have placed the VA into a bit of a difficult position, if not an economic panic. On the one hand, the VA is charged with the responsibility of caring for the nation’s veterans. On the other, in its argument to the court the VA predicted that the Staab decision may come with a price tag of more than $6 billion – which are funds that it simply doesn’t have available. Newly confirmed VA Secretary David Shulkin acknowledges his responsibility to provide care for veterans, but at least certain members of Congress appear to indicate the government is not interested in providing the additional funds.

The Staab Decision

Richard Staab was an Air Force veteran living in Minnesota who qualified to participate in the VA health care system. In 2015, Staab suffered a heart attack and stroke.  He was rushed to a nearby, non-VA hospital and received treatment. A portion of the care was covered by Medicare, but Staab ultimately paid about $48,000 in out-of-pocket medical expenses. He submitted a claim to the VA for reimbursement of these expenses. The VA denied claim on the basis of a 2009 regulation found at 17 C.F.R. § 17.1002(f). Under this regulation, the VA will only reimburse a veteran if the “veteran has no coverage under a health-plan contract for payment or reimbursement, in whole or in part, for the emergency treatment.” So, because some of Staab’s expenses were partially covered by Medicare, the VA denied his claim for reimbursement of the remaining amount.

Staab appealed the VA’s decision to the Court of Appeals for Veterans Claims. He pointed out that the VA’s regulation conflicted with a change in the law made by Congress in 2010. That change modified the language of 38 U.S.C. § 1725, which is the statute upon which the VA’s regulation is based.  As noted by the court, the purpose of this amendment was to “allow the VA to reimburse veterans for treatment in a non-VA facility if they have a third-party insurer that would pay a portion of the emergency care.”

H.R. 1377 would modify current law so that a veteran who has outside insurance would be eligible for reimbursement in the event that the outside insurance does not cover the full amount of the emergency care. VA would be authorized to cover the difference between the amount the veteran’s insurance will pay and the total cost of care. In essence, VA would become the payer of last resort in such cases. This would keep the veteran from being burdened by medical fees with no insurance with which to pay them.

155 Cong. Rec. S13468 (Dec. 18, 2009) (Remarks from Sen. D. Akaka, Chairman of the Committee on Veterans’ Affairs).

The court determined that even though the VA’s regulation was fine when it was originally adopted in 2009, it needed to be changed after Congress changed the corresponding statute in in 2010. It noted that the VA had the opportunity to change the regulation to comply with the statute, but “refused” to do so. The court therefore not only granted Staab’s appeal, but also struck down the VA’s regulation as invalid.

The Fallout from Staab

The fact that the Court struck down the VA’s regulation had a far-reaching impact. Staab was certainly not the only veteran who sought reimbursement for emergency, private healthcare. The VA appealed the decision of the Court of Appeals for Veterans Claims to the next highest level — the US Court of Appeals for the Federal Circuit. The case remains pending at the Federal Circuit, but the VA is clearly nervous about the economic impact of the decision by the Veteran’s Court.