Mr. Tim McClain
Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Mr. McClain:
For the reasons described below, we are returning to you for reconsideration
a draft proposed rule from the Department of Veterans Affairs (VA)
entitled, "Medical Care and Treatment for Which VA Will Not Seek
Reimbursement submitted to the Office of Management and Budget (OMB)
under Executive Order (E.O.) No. 12866 on February 22, 2001.
This proposed rule would create a new category of medical claims
for which the Veterans Health Administration (VHA) would not seek
reimbursement from veterans' insurance companies. Currently VA does
not charge insurance companies for care of a veteran's service -
connected disability. The proposed rule would extend this billing
policy to the "manifestations" of service-connected disabilities.
"Service - connected disabilities" are well established and clearly
defined in 38 USC 1110, and throughout regulations used by VA for
the purposes of adjudicating benefits in scores of regulations.
The Veterans Benefits Administration (VBA) manages the disability
compensation program and makes the determination as to whether a
disability is service-connected, paying the veteran a monthly amount
accordingly. "Manifestations" are not defined in statute or regulations.
VA staff have acknowledged the near impossibility of defining this
vague term. As such, the term "manifestations" is subject to interpretation
and will likely result in different practices within VHA, generating
confusion among providers, staff, and veterans. While VA staff have
argued that there are currently inconsistencies in billing practices,
OMB has not been presented with evidence of this problem or evidence
of how this rule would reduce, rather than increase inconsistency.
Furthermore, veterans may begin to equate "manifestations" with
"service-connected;" seeking and pressuring VBA for greater compensation
amounts for "manifestations" which may be found to be non-service-connected
disabilities. Due to the concerns identified above, we are returning
this rule for your reconsideration under Executive Order 12866.
Our staff is available for further discussion with you on these
John D. Graham
Office of Information and Regulatory Affairs