Nehmer v. United States Veterans AdministrationNehmer v. United States Veterans Administration
CLASS ACTION ORDER
In 1989, this Cоurt invalidated the United States Veteran Administration’s regulation governing benefits for veterans exposed to Agent Orange during their service in Vietnam. The parties subsequently settled the
Thе matter came on for hearing on Monday, November 16, 1998. Having carefully considered the parties’ oral and written arguments, and the entire record herein, the Court concludes, for the reasons set forth below, that plaintiffs’ motion should be granted in part and denied in part consistent with this Order.
BACKGROUND
In order to put the instant dispute in context, it is necessary to review the underlying litigation and our 1989 ruling. As explained in that ruling, the United States Armed Forces used Agent Orange, a chemical defoliant containing the toxic substance dioxin, to clear dense jungle land in Vietnam during the war. Many veterans believed that their exposure to Agent Orange, “ ‘one of the mostly highly toxic substances known to the scientific community,’ ”
Nehmer v. U.S. Veterans’ Admin.,
In response to the controversy over Agent Orangе, Congress in 1984 enacted the Veterans’ Dioxin and Radiation Exposure Compensation Standards Act (“the Dioxin Act”), Pub.L. 98-542 (HR 1961), 99 Stat. 2725, 98th Cong.2d Sess.,
reprinted in part at,
The Act authorized the VA tо conduct rulemaking to determine which if any diseases, claimed to be associated with Agent Orange exposure, should be deemed “service connected.” To this end, the VA was required to appoint an advisory committee which would study the medical and scientific evidence and make recommendations to the VA. The VA was then required to promulgate regulations identifying those diseases it deemed to be service connected, based on “sound scientific and medical evidence,”
id.
at 1408. Consistent with the above, the VA issued a final regulation codified at
In February 1987, plaintiffs filed this class action challenging
Two years later, in May of 1991, the parties agreed to a Final Stipulation and Order (“Stip. & Order”) which resolved the remaining issues of injunctive and monetary relief for the class. With respect to injunctive relief, the Stip. & Order set forth the VA’s responsibilities with regard to further rule-making concerning Agent Orange. As a re-suit of this rulemaking, the VA, between 1990 and 1996, found that a number of cancers are linked to Agent Orange using the appropriate standard, and, as a result, they have been accorded service connected status. 2
With respect to monetary relief, the Stip. & Order requires the VA to reopen and readjudicate previously denied claims that were voided by the Court’s May 1989 order if and when the VA issues new Agent Orange regulations service-connecting diseases other thаn chloracne. Specifically, paragraph 3 of the Stip. & Order provides that:
As soon as a final rule is issued service connecting, based on dioxin [Agent Orange], any of [certain specified diseases], and any other disease which may be service connected in the future ... the VA shall promptly thereafter readjudicate all claims for any such disease which were voided by the Court’s Order of May 3, 1989 as well as adjudicate all similar claims filed subsequent to the Court’s May 3, 1989 Order without waiting for final rules to be issued on any other diseases.
Stip. & Order at ¶ 3.
Paragraph 5 then states that, for those cases which are readjudicated because the earlier denial was “voided” by the Court’s order, the “effective date” for disability compensation shall be the date the voided claim was originally filed:
For any of [certain specified diseases], and any other disease which may be service connected in the future pursuant to paragraph 3 above, ... [a]s to any denials of claims which were voided as a result of the Court’s May 3, 1989 Order, the effective date for disability compensation or dependency and indemnity compensation (“DIC”), if the claim is allowed upon readjudication pursuant to paragraph 3 and 4 above, will be the date the claim giving rise to the voided decision was filed____
Stip. & Order at ¶ 5.
The instant dispute concerns the scope of the VA’s readjudication obligations under paragraphs 3 and 5 of the Stip. & Order. As noted above, the VA, as a result of this action and the newly applied standard, has found that a number of diseases, besides chloracne, are service connected based on their link to Agent Orange. Thus, there are many class members who, during the time period when the invalid regulation was in effect, filed a claim for service-connected benefits based on a disease that the VA did not then recognize as linked to Agent Orange — but which the VA now recognizes is so linked pursuant to its revised Agent Orange regulations. Those claims were, of course, all denied at the time they were filed.
The VA has taken the position that ¶ 3 of the Stip. & Order does not require it to readjudicate such claims unless (1) the claim specifically alleged that Agent Orange (or
The instant dispute arose when counsel for plaintiffs learned of the situation of two class members, Rosa Aponte and Janet George, who first filed aрplications in 1985 and 1987 on behalf of deceased spouses who served in Vietnam. Ms. Aponte’s application for service-connected death benefits asserted that her husband’s cause of death was “due to service” but did not expressly allege that Agent Orange or herbicides were a factor in his death. The cause of death was identified as lung cancer. The VA denied her claim for death benefits on the ground that the evidence did not show that the veteran’s death resulted from his military service. The decision made no specific reference to
In 1994, the VA recognized lung cancer as linked to Agent Orange, and Ms. Aponte filed a second claim shortly thereafter which expressly asserted that her husband’s death was connected to Agent Orange. The VA granted this claim and allowed benefits commencing the first day of the month the second claim was filed (July 1, 1994). The VA refused, however, pursuant to their current policy, to readjudicate her original claim under the Stip. & Order because Ms. Aponte could not show either that (1) her original application specifically alleged that Agent Orange or herbicides were a factor in her husband’s death, or (2) that the VA’s denial of her claim cited to
Plaintiffs now move to enforce the judgment arguing that the VA’s readjudication policy violates the Stip. & Order. 4 Specifically, plaintiffs ask the Court to: (1) declare that the VA’s readjudication policy, as described above, violates paragraphs 3 and 5 of the Stip. & Order, (2) order the VA to pay Aponte and George the retroactive benefits due them under paragraph 5 of the Stip. & Order, and (3) permit plaintiffs to obtain discovery that will assist them in identifying other class members that may be adversely affected by the VA’s failure to comply with its readjudication obligations under the Stip. 6 Order.
DISCUSSION
A. Exhaustion of Administrative Remedies
The VA рreliminarily argues that the Court should refrain from ruling on this motion until Aponte and George have fully exhausted their administrative remedies. Since there is no statute mandating exhaustion in this case, the decision whether to require exhaustion of administrative remedies is discretionary.
Nehmer v. U.S. Veterans’ Admin.,
The VA nonetheless argues that further exhaustion should be required in light of the Veterans Judicial Review Act which created an administrative-judicial scheme for obtaining review of individual benefit decisions made by thе VA.
See
The VA also points to paragraph 4 of the Stip. & Order which provides that claims will be “readjudicated with all of the procеdural rights normally applicable to such VA proceedings.” The VA argues that this provision reinforces its argument that we should defer acting until George and Aponte exhaust their administrative remedies by pursuing all of their “procedural rights normally applicable to such VA proceedings.” This argument is meritless for two reasons. One, the VA has in fact refused to readjudicate their original claims, so this provision does not even apply. Second, the plain function of paragraph 4 is to ensure that claimants retain all of their procedural rights if a claim is readjudicated. It does not deprive this Court of jurisdiction to enforce the Stip. & Order, as incorporated into the final judgment.
B. Whether the VA’s Readjudication Policy Violates the Stip. & Order
As discussed above, the Stip. & Order requires the VA to readjudicate clаims that were voided by the Court’s May 1989 Order.
See
Stip. & Order at ¶ 3 (“As soon as a final rule is issued service connecting, based on dioxin [i.e. Agent Orange] ..., [any disease] ... the VA shall promptly thereafter readjudicate
all
claims for any such disease
which were voided by the Court’s Order of May 8, 1989
”)(emphasis added). Thus the issue presented by this motion, and upon which the parties disagree, boils down to which benefit-decisions the Court voided in its 1989 order. The Court’s order on this point is quite brief. It simply states that “We also void all benefit decisions
made under 88 C.F.R. § [8].311[a](d).” Nehmer,
A determination of which benefit decisions were voided by the Court thus turns on the meaning of the phrase “made under
In striking down
(i) Failure to expressly reference Agent Orange or Herbicides
The failure of claimants, such as Aponte or George, to expressly reference Agent Orange (or herbicides) is likely attributable to one of three circumstances. One, the claimant was aware of
With respect to the first reason, the VA has forwarded no justification for penalizing a claimant for failing to make an assertion that the defendants’ own conduct rendered futile. In other words, if a veteran failed to raise the Agent Orange issue because he knew it was useless to do so under
With respect to the latter two circumstances, it is clear that such claims were also erroneously denied under the invalid regulation given the non-adversarial veterans benefits system created by Congress. Under this system, claimants are not required to assert the specific legal basis upon which benefits may be based.
See e.g. Akles v. Derwinski,
The system is thus “designed to function throughout with a high degree of informality and solicitude for the claimant,”
Walters v. Nat’l Ass’n of Radiation Survivors,
Moreover, as noted above, under
The VA concedes that the VA claims process “was never intended to be rigid and formalistic,” and is non-adversarial in nature. It emphasizes, however, that VA claim adjudicators are not mind-readers. Thus, the VA argues, it had no reason or obligation to consider the applicability of the Agent Orange regulation if the claim failed to assert that the injury or cаuse of death was connected to Agent Orange. The flaw in this argument, however, is that the VA did in fact have reason to consider the applicability of the Agent Orange application because the VA automatically presumed that every Vietnam veteran was exposed to Agent Orange. Thus, every claim involving a veteran of this war necessarily implicated the governing Agent Orange regulation.
Indeed, the very fact that the VA concedes that a claim was “made under
(ii) Lack of citation to
The VA’s second readjudication criteria— an explicit reference to
Accordingly, and for all of the reasons set forth above, the Court can not accept the VA’s contention that this Court’s May 1989 decision voided only those benefit decisions in which (1) the claimant specifically alleged Agent Orange (or herbicides) were a factor in the veteran’s death or injury, or (2) the VA’s denial of the benefits expressly cited to
This then leaves the question of exactly which benefit denials did the Court void? The VA argues that if the Court did not void
only
those decisions in which the claim or the denial expressly referenced Agent Orange or
This interpretation of the Court’s May 1989 decision is also most consistent with Congress’ purpose in enacting the 1984 Dioxin Act. Congress passed that Act to ensure that Vietnam veterans exposed to Agent Orange would obtain benefits for all disabilities that are connected to their service:
The purpose of this Act ... is to ensure that Veterans’ Administration disability compensation is provided to veterans who were exposed during service in the Armed Forces in the Republic of Vietnam to a herbicide containing dioxin ... for all disabilities arising after that service that are connected, based on sound scientific and medical evidence, to such service (and that Veterans’ Administration dependency and indemnity compensation is provided to survivors of those veterans for all deaths resulting firom such disabilities).
This Court thus holds, for all of the reasons set forth above, that the Court’s order voiding all benefits decisions “made under
C. Relief requested by Plaintiffs
—As noted above, plaintiffs request three specific types of relief by this motion.
(a) Declaratory Relief
First, plaintiffs seek a declaration that the VA’s current reajudication policy violates the Stip. & Order, as incorporated into the final judgment. For all of the reasons discussed above, this relief shall be granted.
(b) Payment to Aponte and George
Given the Court’s ruling, the claims of Aponte and George are subject to readjudication by the VA under paragraphs 3 and 4 of the Stip. & Order. Plaintiffs, however, ask the Court to skip this step and instead directly order the VA to pay Aponte and George the retroactive benefits owed them. The Stip. & Order, however, provides that the VA, and not the Court, shall “readjudicate” those claims voided by the Court’s May 1989 order. See Stip. & Order at ¶¶ 3-4. Accordingly, the Court concludes that it is more appropriate to direct the VA to readjudicate the claims of Aponte and George, consistent with this order, rather than to attempt any such readjudication itself.
(c) Discovery
Finally, plaintiffs ask for leave to conduct discovery regarding the number and identity of other class members who may have been adversely affected by the VA’s erroneous interpretation of the Stip. & Order. The VA objects on the ground that plaintiffs’ motion raises question of law, and therefore discovery is not appropriate. This objection is misplaced, however, since plaintiffs are not seeking discovery that is relevant to deciding the issue raised by this motion. They are
CONCLUSION
Accordingly, and good cause appearing, it is HEREBY ORDERED that:
1. Plaintiffs’ Motion For Enforcement of Final Judgment is GRANTED in part and DENIED in part consistent with this Order.
2. Section 7.20(d)(3) of the Veterans Administration Adjudication Procedures Manual M21-1, Part VI, Change 52 (August 26,1996) is declared to be inconsistent with, and in violation of, the Final Stip. & Order, as incorporated into the final judgment, because it erroneously instructs VA adjudicators to not readjudicate claims under the Stip. & Order, and to deny retroactive payment of service-connected benefits, if the claimant did not specifically allege that Agent Orange or herbicide exposure was a factor in the veteran’s disability or death or the claim was not expressly denied under the regulation invalidated by this Court’s Order of May 3, 1989.
3. Plaintiffs shall be permitted to take reasonable discovery designed to obtain information regarding the extent to which defendants have wrongfully denied members of the plaintiff class retroactive benefits under the Stip. & Order, and the identity of adversely affected class members. If there are disputes regarding such discovery, the parties shall meet in good faith to resolve such dispute(s). Any remaining disputes are hereby referred to a Magistrate Judge for a determination and ruling.
4. The VA shall “promptly” readjudicate the claims of Aponte and George pursuant to the Final Stip. & Order, consistent with this Order.
IT IS SO ORDERED.
Notes
. Specifically, the Court found that tire VA had improperly utilized the stricter standard of
. Specifically, the VA has found that the following cancers are service connected: non-Hodgkin’s lymphoma, 55 Fed.Reg. 43,124 (Oct. 26, 1990),
codified at
The VA has also service connected two non-cancer diseases: porphyria cutanea tarda (a liver disorder) and acute and subacute peripheral neuropathy.
. This manual is also referred to by plaintiffs as the Veterans Benefits Administration Manual.
. As noted earlier, the final judgment in this action incorporated the terms of the Stip. & Order (as well as the Court’s May 3, 1989 decision).
See
Order of Oct. 9, 1991 at 1. The Court further stated that "this case shall be closed with the defendants subject to ongoing, enforceable obligations in the future." As such, the Court retains jurisdiction to enforce the Stip. & Order and address the instant motion.
See Kokkonen v. Guardian Life Ins. Co. of America,
. As the VA points out, the 1984 Dioxin Act, Pub.L. 98-542 (HR 1961), 99 Stat. 2725, 98th Cong.2d Sess., utilizes the term "claim.”
See e.g.
section 5(a)(l)(requirmg VA to establish guidelines to resolve claims for benefits where “the
claim
of service connectiоn is based on a veteran’s exposure during service... to a herbicide containing dioxin...”) and section 5(b)(3)(re-quiring that VA regulations to include "a requirement that a claimant
filing a claim
based on a veteran’s exposure to a herbicide containing dioxin ... may not be required to produce evidence substantiating the veteran’s exposure...”) (emphasis added). The VA argues that this language shows a congressional intent to require veterans to expressly state that their claim for benefits is based on Agent Orange before they would be eligible for benefits under an Agent Orange regulation. This argument loses force, however, given that the VA, itself, did not construe the term "claim” in these provisions as requiring clаimants to assert any special "Agent Orange claim.” Rather, as discussed above, the VA’s Agent Orange regulation (
. This presumption continues under current policy as well. See Stichman Decl., Exh. 26 at § 7.20(b)("Unless there is affirmative evidence to the contrary, a veteran who served on active duty in the Republic of Vietnam during the Vietnam era is presumed to have been exposed to a herbicide agent. The last date of exposure is the last on which he or she served in the Republic of Vietnam....”).
. The VA also argues unpersuasively that paragraph 4 of the Stip. & Order sets out "what the parties understood to be the universe of claimants affected by the readjudications” and that this paragraph identifies a smaller universe of class membеrs that is consistent with the VA’s approach. Paragraph 4 provides that "prior to conducting the [readjudications] referred to in paragraph 3, above, VA will provide individual notice to each claimant denied benefits under the previous regulation (as identified from the Special Issue Rating System ("SIRS”) or as a result of a VA finding based on information brought to its attention by a claimant or claimant's representative, that, although the individual is not on SIRS, he or she had a claim denial that was voided by the Court’s Order), that the claims will be readjudicated with all of the procedural rights normally applicable to such VA proceedings.” Stip. at ¶ 4.
This Court agrees with plaintiffs that the evident purpоse of paragraph 4 was only to identify the VA’s minimum notice obligations whenever it issued a final rule service connecting a new disease under paragraph 3 of the Stip. & Order. It was not intended to define the entire universe of class members whose benefit denials were voided by the Court’s May 1989 order. Moreover, paragraph four includes persons who were not on SIRS but who the VA, nonetheless, finds had a "claim denial that was voided by the Court's Order” based on "information brought to its attention by a claimant or claimant’s representation.” On its face, this would include persons such as Aponte or George who brought their particular situation and prior claim denial to the attention of the VA.