William H. Heino v. Eric K. Shinseki
24 Vet. App. 367
Vet. App.2011Background
- William H. Heino, a pro se veteran, challenged VA’s $7 copayment for a 30-day supply of Atenolol when he must split a 25 mg tablet to achieve a 12.5 mg daily dose.
- Heino’s 30-day supply consisted of 15 tablets due to tablet strength limitations, not a 30-pill quantity.
- VA charged the standard copayment under 38 C.F.R. § 17.110 (now $7 for 2002–2005, then $8); Heino argued the charge exceeded the cost to the Secretary because he splits pills.
- Statute 38 U.S.C. § 1722A(a) sets a $2 per 30-day copayment and § 1722A(a)(2) bars charges exceeding the cost to the Secretary; § 1722A(b) grants authority to increase copayments.
- Regulation 38 C.F.R. § 17.110 (2002) implements § 1722A and provides for automatic escalator increases based on CPI-P; the Board upheld the $7/$8 copayment.
- The court affirmed the Board’s decision, holding the Secretary’s interpretation of “cost to the Secretary” as including dispensing/administrative costs is reasonable and consistent with the statute; Hagel, J., filed a partial concurrence/dissent.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Interpreting cost to the Secretary under 1722A(a)(2). | Heino argues cost to Secretary does not include dispensing costs. | Secretary argues cost includes dispensing/administrative costs. | The court held the statute is ambiguous and that the Secretary’s interpretation including dispensing costs is reasonable under Chevron. |
| Definition of a 30-day supply for copayment purposes. | Copayment should reflect actual quantity (15 pills) due to split tablets. | Copayment is tied to a 30-day supply, not pill count, so $7/$8 applies. | Court held a 30-day supply triggers the standard copayment regardless of pill count. |
Key Cases Cited
- Sears v. Principi, 349 F.3d 1326 (Fed. Cir. 2003) (agency deference when statute is ambiguous (Chevron framework))
- Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837 (U.S. 1984) (establishes deferential review of agency interpretations when statute is ambiguous)
- Meeks v. West, 12 Vet.App. 352 (Vet.App. 1999) (statutory construction harmonizes related provisions)
- Sabonis v. Brown, 6 Vet.App. 426 (Vet.App. 1994) (legal standards for reviewing Board decisions; law controls if dispositive)
- Talley v. Derwinski, 2 Vet.App. 282 (Vet.App. 1992) (statutory interpretation should harmonize parts of a statute)