Heino v. Dept. Of Veterans Affairs
2012 U.S. App. LEXIS 13284
| Fed. Cir. | 2012Background
- Mr. Heino, a veteran, was prescribed 12.5 mg Atenolol daily, split from 25 mg tablets.
- Heino paid a $7 copayment for a 30-day supply of 15 tablets, arguing it was excessive relative to VA costs and parity with others.
- VA and Board decisions upheld the $7 copayment; Heino pursued review in the Veterans Court and then this court.
- Section 1722A(a)(1) imposes a $2 copayment per 30-day medication supply; subsection (a)(2) bars copayments in excess of the cost to the Secretary for medication.
- In 1999, Congress added subsection (b) authorizing increased copays and maximums; VA implemented 38 C.F.R. § 17.110 setting a $7 base and using average administrative costs and CPI
- The central question is whether the term 'the cost to the Secretary for medication' in §1722A(a)(2) includes only actual medication cost or also dispensing/administrative costs.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Meaning of 'the cost to the Secretary for medication' in §1722A(a)(2) | Heino argues it means only actual medication cost. | VA urges ambiguity allowing administrative costs to be included. | Ambiguous; agency interpretation permissible. |
| Reasonableness of 38 C.F.R. § 17.110 under Chevron | Regulation not linked to actual medication costs; inflation method flawed. | Regulation reasonable given ambiguity and Congressional discretion. | Regulation reasonable; valid. |
Key Cases Cited
- Chevron U.S.A. Inc. v. NRDC, 467 U.S. 837 (1984) (establishes two-step Chevron framework for agency deference)
- Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008) (limits review of factual determinations; focuses on law de novo)
- Verizon Communications, Inc. v. FCC, 535 U.S. 467 (2002) (cost definition ambiguity; statutory interpretation guidance)
- Russello v. United States, 464 U.S. 16 (1983) (canons of statutory construction; intentional disparate inclusion)
- Huffman v. Office of Personnel Mgmt., 263 F.3d 1341 (Fed. Cir. 2001) (post-enactment legislative history relevance; limits light on intent)
- Delverde, S.r.l. v. United States, 202 F.3d 1360 (Fed. Cir. 2000) (statutory construction methodology)