Opinion ID: 217934
Heading Depth: 2
Heading Rank: 3

Heading: Severance of Benefits

Text: On August 18, 2004, the RO sent Roberts a notifica- tion proposing to sever his benefits on the basis of fraud. The letter outlined the findings contained in the OIG report and informed Roberts that the RO found Roberts’s statements regarding Gary Holland’s death to be fraudulent. In response, Roberts submitted a statement requesting that the VA refrain from severing his benefits until the proposed severance can be appealed to the Board of Veterans Appeals. On November 10, 2004, the RO issued a decision severing Roberts’s benefits on the basis of fraud. Roberts appealed the RO’s decision to the Board, ROBERTS v. DVA 8 which affirmed the decision to sever benefits pursuant to a two-step inquiry. First, it found fraud on the basis of the OIG investigation, such that Roberts’s benefits were subject to severance even though they were in effect for more than 10 years. See 38 C.F.R. § 3.957 (benefits in effect for more than 10 years “will not be severed except upon a showing that the original grant was based on fraud . . .”). Next, under 38 C.F.R. § 3.105(d), the Board found that the government established that there was CUE in the original RO decision granting benefits. The Board also rejected Roberts’s argument that the VA should have considered his December 1969 shore patrol incident as a possible stressor before severing benefits. It found that “no additional stressors were in fact presented to the VA in connection with the veteran’s initial claim of entitlement to service connection for PTSD.” JA 931. It also noted that the May 1998 rating decision cited only the death of Gary Holland as a stressor, as did the March 1998 examination report on which the rating decision was based. Id. On April 23, 2010, the Veterans Court issued an en banc decision with two separate opinions concurring in part and dissenting in part. See Roberts v. Shinseki, 23 Vet.App. 416 (2010) (en banc). The majority affirmed the severance of benefits based on fraud but found that the CUE analysis of 38 C.F.R. § 3.105(d) does not apply to severance proceedings alleging fraud. 3 Id. at 424-29. In 3 As noted above, this holding is not at issue on ap- peal, and we do not address it. See supra, n. 1. The majority also concluded that the Board erred in denying Roberts’s separate claim for dysthymia and depression. Roberts, 23 Vet.App. at 430-31. It remanded the matter for the Board to conduct that analysis and consider additional evidence from Roberts on this point. Id. at 430. On appeal, the Secretary does not challenge the Veterans Court’s decision to remand this aspect of the case. See 9 ROBERTS v. DVA the absence of any specific regulation governing severance based on fraud, the court found that general due process safeguards of 38 C.F.R. § 3.103 set out the applicable procedures. As it pertains to this appeal, the Veterans Court was unanimous in rejecting Roberts’s argument that the VA was required to refer allegations of fraud to an administrative law judge (“ALJ”) pursuant to the PFCRA. Id. at 424. The court found that, “under § 42 of the implementing regulation, no allegations of liability may be referred to an ALJ if the false claims or false statements resulted in a monetary gain of more than $150,000.” Id. (citing 38 C.F.R. § 42.6(a)(2) and 31 U.S.C. § 3803(c)(1)). Because Roberts received over $320,000 in VA benefits, the Veterans Court found no error in not referring this case to an ALJ under the PFCRA. Id. The Veterans Court also upheld the Board’s determination that the VA was not required to consider evidence of alternate stressors before severing Roberts’s benefits, noting that Roberts failed to provide evidence of additional stressors within the 60-day period to do so. Roberts, 23 Vet.App. at 429-30. The court also noted that Roberts could pursue a separate claim based on any additional stressors, but that, in this case, “the Board did not adjudicate a claim for service connection for PTSD based on stressors other than the stressor found to be fraudulent (e.g., the shore patrol incident) and was not required to do so as part of the severance proceeding.” Id. at 430, n.6 (emphasis in original).