[Federal Register Volume 64, Number 158 (Tuesday, August 17, 1999)]
[Rules and Regulations]
[Pages 44659-44660]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-21249]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AJ03


Reconsideration of Denied Claims

AGENCY: Department of Veterans Affairs.

ACTION: Final rule.

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SUMMARY: This document amends the Department of Veterans Affairs' 
``Medical'' regulations by adding a new section to set forth 
reconsideration procedures regarding claims for benefits administered 
by the Veterans Health Administration. These procedures would not only 
allow for more reflective decisions at the local level but would also 
allow some disputes to be resolved without the need for further appeal 
to the Board of Veterans' Appeals.

DATES: Effective Date: August 17, 1999.

FOR FURTHER INFORMATION CONTACT: Troy L. Baxley, Health Administration 
Service (10C3), Department of Veterans Affairs, 810 Vermont Avenue, NW, 
Washington DC 20420, telephone (202) 273-8301. (This is not a toll-free 
number).

SUPPLEMENTARY INFORMATION: In a document published in the Federal 
Register on February 27, 1998 (63 FR 9990), we proposed to amend the 
``Medical'' regulations (38 CFR part 17) by adding a new section to set 
forth reconsideration procedures regarding claims for benefits 
administered by the Veterans Health Administration (VHA). We provided a 
60-day comment period, which ended April 28, 1998. We received comments 
from two sources.
    Both commenters asserted that the VA person rendering a decision 
upon reconsideration should not be the same person who rendered the 
original decision. We agree and have delegated the authority for making 
the reconsideration decision to the immediate supervisor of the initial 
VA decision-maker.

[[Page 44660]]

    One commenter asserted that under Sec. 17.133(a) of the proposed 
rule, the examples provided are, indeed, examples and are not all 
inclusive. We agree. We have revised the text to more clearly emphasize 
that, unless other reconsideration procedures apply, the 
reconsideration procedures of this rule apply to VHA decisions that are 
appealable to the Board of Veterans' Appeals. Also, we have clarified 
the procedures to state that they do not apply to decisions made 
outside VHA, such as rating decisions made by the Veterans Benefits 
Administration and adopted by VHA for decisionmaking.

Paperwork Reduction Act of 1995

    The Office of Management and Budget (OMB) has cleared the 
information collection and has assigned an OMB control number 2900-
0600.

Regulatory Flexibility Act

    The Secretary hereby certifies that the adoption of this final rule 
would not have a significant impact on a substantial number of small 
entities as they are defined in the Regulatory Flexibility Act (RFA), 5 
U.S.C. 601-612. Although the adoption of the final rule could affect 
small businesses, it would not have a significant impact on any small 
business. Therefore, pursuant to 5 U.S.C. 605(b), the proposed rule is 
exempt from the initial and final regulatory flexibility analysis 
requirements of Secs. 603 and 604.
    There are no Catalog of Federal Domestic Assistance program 
numbers.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Grant programs-veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, Travel 
and transportation expenses, Veterans.

    Approved: June 28, 1999.
Togo D. West, Jr.,
Secretary of Veterans Affairs.

    For the reasons set forth in the preamble, 38 CFR part 17 is 
amended to read as follows:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501(a), 1721, unless otherwise noted.

    2. In part 17, an undesignated center heading and Sec. 17.133 are 
added to read as follows:

Reconsideration of Denied Claims


Sec. 17.133  Procedures.

    (a) Scope. This section sets forth reconsideration procedures 
regarding claims for benefits administered by the Veterans Health 
Administration (VHA). These procedures apply to claims for VHA benefits 
regarding decisions that are appealable to the Board of Veterans' 
Appeals (e.g., reimbursement for non-VA care not authorized in advance, 
reimbursement for beneficiary travel expenses, reimbursement for home 
improvements or structural alterations, etc.). These procedures do not 
apply when other regulations providing reconsideration procedures do 
apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina 
bifida (38 CFR 17.904) and any other regulations that contain 
reconsideration procedures). Also, these procedures do not apply to 
decisions made outside of VHA, such as decisions made by the Veterans 
Benefits Administration and adopted by VHA for decisionmaking. These 
procedures are not mandatory, and a claimant may choose to appeal the 
denied claim to the Board of Veterans' Appeals pursuant to 38 U.S.C. 
7105 without utilizing the provisions of this section. Submitting a 
request for reconsideration shall constitute a notice of disagreement 
for purposes of filing a timely notice of disagreement under 38 U.S.C. 
7105(b).
    (b) Process. An individual who disagrees with the initial decision 
denying the claim in whole or in part may obtain reconsideration under 
this section by submitting a reconsideration request in writing to the 
Director of the healthcare facility of jurisdiction within one year of 
the date of the initial decision. The reconsideration decision will be 
made by the immediate supervisor of the initial VA decision-maker. The 
request must state why it is concluded that the decision is in error 
and must include any new and relevant information not previously 
considered. Any request for reconsideration that does not identify the 
reason for the dispute will be returned to the sender without further 
consideration. The request for reconsideration may include a request 
for a meeting with the immediate supervisor of the initial VA decision-
maker, the claimant, and the claimant's representative (if the claimant 
wishes to have a representative present). Such a meeting shall only be 
for the purpose of discussing the issues and shall not include formal 
procedures (e.g., presentation, cross-examination of witnesses, etc.). 
The meeting will be taped and transcribed by VA if requested by the 
claimant and a copy of the transcription shall be provided to the 
claimant. After reviewing the matter, the immediate supervisor of the 
initial VA decision-maker shall issue a written decision that affirms, 
reverses, or modifies the initial decision.

    Note to Sec. 17.133: The final decision of the immediate 
supervisor of the initial VA decision-maker will inform the claimant 
of further appellate rights for an appeal to the Board of Veterans' 
Appeals.

(The Office of Management and Budget has approved the information 
collection requirements in this section under control number 2900-
0600)

(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)

[FR Doc. 99-21249 Filed 8-16-99; 8:45 am]
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