## Facts

- William H. Heino, Sr., a veteran receiving VA medical care, was prescribed Atenolol at 12.5 mg per day.
- Because the VA supplied Atenolol in 25 mg tablets, his physician instructed him to split the tablets.
- For a 30-day course, Heino received 15 tablets (to be split into 30 doses) and was charged a $7 copayment.
- Heino argued the $7 copayment was unlawful and excessive because the VA’s acquisition cost for his Atenolol was allegedly less than $7 and other veterans paid the same amount for larger quantities.
- The VA applied its regulation, 38 C.F.R. § 17.110, which set a uniform copayment amount per 30-day (or less) supply of medication, subject to statutory limits.
- The Board of Veterans’ Appeals upheld the copayment; the Court of Appeals for Veterans Claims affirmed; Heino appealed to the Federal Circuit.

## Issues

1. Whether 38 U.S.C. § 1722A(a)(2) unambiguously requires a veteran’s medication copayment to be capped by the VA’s actual acquisition cost for that specific prescription, thereby invalidating 38 C.F.R. § 17.110’s flat per-30-day copayment.

## Decision

- The Federal Circuit affirmed the Veterans Court.
- The court held that the statutory phrase “cost to the Secretary for medication” in 38 U.S.C. § 1722A(a)(2) is ambiguous as to how “cost” must be calculated.
- Applying Chevron, the court deferred to the VA’s interpretation embodied in 38 C.F.R. § 17.110 as a permissible construction of the statute.
- The $7 copayment charged for Heino’s 30-day supply did not violate § 1722A(a)(2).

## Legal Principles

- When a statute administered by an agency is ambiguous on the specific question at issue, courts apply Chevron and uphold an agency’s interpretation if it is reasonable.
- The phrase “cost to the Secretary for medication” in 38 U.S.C. § 1722A(a)(2) does not clearly require prescription-by-prescription cost matching.
- A regulation setting a standardized copayment per 30-day supply of medication can be a permissible implementation of § 1722A(a)(2) where Congress has not mandated individualized cost calculations.
- Administrative workability may support the reasonableness of an agency’s interpretation where the statute does not compel a more burdensome approach.

## Conclusion

The Federal Circuit upheld the VA’s flat medication copayment regulation, concluding that § 1722A(a)(2) does not clearly require individualized prescription-cost caps and that the VA reasonably implemented the statute through a uniform per-30-day copayment schedule.


Heino v. Shinseki, 683 F.3d 1372 (Fed. Cir. 2012)