Price, Gordon E. v. United States

United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Decided September 26, 2000

No. 00-5185

Gordon E. Price,
Appellant

v.

United States of America, et al.,
Appellees

Appeal from the United States District Court
for the District of Columbia
(No. 99cv0306)

Gordon E. Price, pro se.

Wilma A. Lewis, United States Attorney, and R. Craig
Lawrence and Edward D. Alkalay, Assistant United States
Attorneys, were on motion for the appellees.

Before: Ginsburg, Sentelle and Henderson, Circuit
Judges.

Opinion for the court filed Per Curiam.

 Per Curiam: Gordon Price, appearing pro se, filed a com-
plaint in the district court alleging the United States Depart-
ment of Veteran Affairs (VA) wrongfully failed to reimburse
him for certain medical expenses he incurred in October 1994
while hospitalized for an emergency colon cancer operation at
a non-VA medical facility. Price also alleged Northeast Flori-
da Credit Bureau (Northeast) caused him harm when it
persistently sought to collect on the unpaid medical bills on
behalf of the medical service providers. As relief, Price
sought $5 million in damages from the government alone,
apparently for his medical expenses and emotional distress.
The district court vacated an entry of default against North-
east and dismissed the complaint for failure to state a claim.
Price appealed and both he and the government filed cross-
motions for summary disposition. Because the district court
lacked jurisdiction to consider an indirect challenge to the
government's veterans' benefits determination, we grant the
government's motion and deny Price's motion.

As amended by the Veterans Judicial Review Act, Pub. L.
No. 100-687, 102 Stat. 4105 (1988) (VJRA), the Veterans'
Benefits Act of 1957, Pub. L. No. 85-56, 71 Stat. 83, precludes
judicial review in Article III courts of VA decisions affecting
the provision of veterans' benefits, including medical expense
reimbursement. 38 U.S.C. s 511(a); see Larrabee v. Derwin-
ski, 968 F.2d 1497, 1499-1501 (2d Cir. 1992) (detailing history
of veterans' benefits legislation); see also Zimick v. West, 11
Vet. App. 45, 48 (Vet. App. 1998) (term "benefit" encompasses
medical expenses veteran incurred at non-VA facility) (citing
38 C.F.R. s 20.3(e)). The exclusive avenue for redress of
veterans' benefits determinations is appeal to the Court of
Veterans Appeals and from there to the United States Court
of Appeals for the Federal Circuit. See 38 U.S.C. ss 511,
7252, 7292; In re Russell, 155 F.3d 1012 (8th Cir. 1998) (per
curiam); Beamon v. Brown, 125 F.3d 965, 967-71 (6th Cir.
1997); Larrabee, 968 F.2d at 1501.

The district court lacked jurisdiction to consider Price's
federal claim because underlying the claim is an allegation
that the VA unjustifiably denied him a veterans' benefit.
Price alleged the VA's failure to pay his medical bills was

wrongful because the agency was under a legal obligation to
make payment on account of Price's veteran status. He
attached to his amended complaint a September 1996 letter
from the VA's Gainesville, Florida office advising Price the
office had received his request for reimbursement but could
not process his claim because Price failed to provide the
personal information necessary to verify his veteran status
and ascertain the nature of the claim. In the letter, the VA
explained the eligibility criteria for reimbursement for medi-
cal services at a non-VA facility and directed Price's attention
to an enclosed claim form. See 38 U.S.C. s 1728 (setting
forth scheme for VA reimbursement of certain medical ex-
penses incurred by veterans). Price referred to the 1996
letter in the amended complaint, asserting that he met the
eligibility criteria.

The record does not reflect whether Price pursued a formal
reimbursement claim with the VA. Nevertheless, because
Price is challenging the VA's action or inaction with respect
to a veterans' benefits matter, the district court lacked sub-
ject matter jurisdiction over the complaint. See 38 U.S.C.
s 511(a); Weaver v. United States, 98 F.3d 518, 519-20 (10th
Cir. 1996) (the substance of veteran's claims, not the labels
plaintiff assigns them, governs jurisdictional determination);
cf. Kidwell v. Department of the Army, Bd. for Correction of
Military Records, 56 F.3d 279, 284 (D.C. Cir. 1995) (plain
language of complaint does not settle question of Tucker Act
jurisdiction--court looks to the complaint's substance, not
merely its form).

Perhaps to avert a headlong collision with 38 U.S.C.
s 511(a), the district court liberally construed Price's com-
plaint as asserting a federal tort claim for intentional or
negligent failure to pay medical bills. Under the Federal
Tort Claims Act, 28 U.S.C. ss 1346(b), 2671 et seq., a tort
claim is actionable if it arises "under circumstances where the
United States, if a private person, would be liable to the
claimant in accordance with the law of the place where the act
or omission occurred." Federal Deposit Ins. Corp. v. Meyer,
510 U.S. 471, 477 (1994) (quoting 28 U.S.C. s 1346(b)). Be-
cause the alleged wrong committed by the VA took place in

Florida, liability for negligent or intentional failure to pay a
medical bill must be determined in accordance with Florida
law. See Tarpeh-Doe v. United States, 28 F.3d 120, 123
(D.C. Cir. 1994).

Florida does recognize a cause of action analogous to that
which Price appears to be asserting. By Florida statute a
person may sue an insurer when the person is damaged by an
insurer's "bad faith" failure to settle his or her claim. Fla.
Stat. ch. 624.155(1)(b)(1); see Time Ins. Co. v. Burger, 712 So.
2d 389, 391 (Fla. 1998). The Florida Supreme Court has
construed the statute as encompassing claims that the insurer
unjustifiably refused to pay an insured's medical or hospital
bills, resulting in the insured's inability to obtain additional
health care. Burger, 712 So. 2d at 392. The insured may
also recover damages for emotional distress. Id.

Nevertheless, assuming Price's damages claim is cognizable
under Florida Statute 624.155(1)(b)(1), a necessary predicate
of such a claim is a determination that the insurer acted in
bad faith. See id. Here, the propriety of the VA's purported
refusal to reimburse Price has not yet been established.
Because a determination whether the VA acted in bad faith or
with negligence would require the district court to determine
first whether the VA acted properly in handling Price's
request for reimbursement, judicial review is foreclosed by 38
U.S.C. s 511(a). The courts have consistently held that a
federal district court may not entertain constitutional or
statutory claims whose resolution would require the court to
intrude upon the VA's exclusive jurisdiction. See, e.g., Beam-
on, 125 F.3d at 972-74 (due process challenge to VA proce-
dures); Weaver, 98 F.3d at 520 (claims of fraud and misrepre-
sentation in handling of benefits claim); Hicks v. Small, 69
F.3d 967, 970 (9th Cir. 1995) (tort claims of outrage and
intentional infliction of emotional distress based on VA's
reduction of benefits); Sugrue v. Derwinski, 26 F.3d 8, 11 (2d
Cir. 1994) (due process, Privacy Act and FOIA challenges to
VA's failure to raise disability rating); Rosen v. Walters, 719
F.2d 1422, 1425 (9th Cir. 1983) (Privacy Act claim based on
destruction of medical records pertinent to claim for veterans'

disability benefits) (construing predecessor statute, 38 U.S.C.
s 211(a)).

For the preceding reasons, we conclude the district court
lacked subject matter jurisdiction over Price's federal claim.
As a consequence, the court necessarily also lacked supple-
mental jurisdiction over Price's state law claim against North-
east. See 28 U.S.C. s 1367(a); Scarfo v. Ginsberg, 175 F.3d
957, 962 (11th Cir. 1999) (collecting authorities); Harris v.
Secretary, United States Dep't of Veterans Affairs, 126 F.3d
339, 346 (D.C. Cir. 1997). Accordingly, the judgment of the
district court is

Affirmed.