CHAMPVA, 38 U.S.C. § 1781

Holle v. McDonald, docket no. 14-1235 (June 10, 2016)

HELD: Eligibility for CHAMPVA requires enrollment in Medicare Part B, subject to only one exception, and the enrollment requirements cannot be construed as a statute of limitations that would be subject to equitable tolling.

SUMMARY: The appellant in this case is the spouse of a veteran who was in receipt of a total disability rating based on individual unemployability for his service-connected PTSD. In 2002, she applied for benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). The following month, she received a letter informing her of her eligibility and explaining how to apply. In 2005, she was awarded Social Security disability benefits. She was enrolled in Medicare Part A as of December 1, 2004, and Part B as of June 1, 2009. She was subsequently informed by VA that she was not eligible for CHAMPVA during the period that she was not enrolled in Medicare Part B – and that she would receive an invoice for any benefits received during that ineligibility period.

She appealed that decision, asserted that she had had a stroke that caused memory loss and impacted her daily living, and that her husband could not assist her because of his PTSD. While sympathetic to her situation, the Board denied the appeal because the eligibility criteria for CHAMPVA require enrollment in Medicare Part B.

On appeal to the Veterans Court, Mrs. Holle argued that she is entitled to “equitable tolling” of the 2004 deadline to enroll in Medicare Part B. The Court examined the language of the statute authorizing the CHAMPVA program, 38 U.S.C. § 1781, noting that it requires enrollment in Medicare Part B unless the applicant was 65 years old as of June 5, 2001, and was not enrolled in Medicare Part B as of that date. Mrs. Holle did not satisfy this exception to the requirement – and the Court thus held that the Board properly interpreted the statute regarding CHAMPVA eligibility.

Regarding the equitable tolling argument, the Court noted that “equitable tolling is a tool used to grant relief when a potential appellant fails to file suit within a statutory limitations period.” Because this situation did not involve the question of a timely appeal to a court – but instead dealt with enrollment requirements – the Court held that equitable tolling did not apply. The Court stated that it “may not award equitable relief,” but noted that “the Secretary, in appropriate cases, may provide equitable relief,” which is entirely discretionary and not reviewable by the Court.