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thedrifter
09-24-07, 12:49 PM
Navy doc fights ruling on spouse’s wheelchair
DoD won’t reimburse $25,000 cost because of ‘luxury’ features
By Chris Amos - camos@militarytimes.com
Posted : October 01, 2007

A Navy emergency physician who could deploy to Iraq in coming months has filed a claim against the Defense Department after Tricare refused to pay for a stair-climbing wheelchair for his wife, who was paralyzed from the waist down in a 1984 accident.

“I have been told to keep my bags packed, literally. I was on a mission that pushed out last week until about one month ago,” Lt. Cmdr. Tom VanHook, who recently completed an emergency medicine residency at Portsmouth Naval Hospital, Va., said in August.

VanHook said he worried that his wife, Deanna, would not be able to manage in the couple’s two-story Portsmouth home without him, especially since one of their two preschool-age children was born without a pituitary gland and is prone to sudden, unexpected fainting spells, and his wife would have access to only half the house.

“[The family’s well-being] is the biggest concern for me as it is for any military spouse,” he said. “When I am gone, she depends on friends and neighbors for support. Her ability to get around to them is critical.”

He noted that the stair-climbing wheelchair also will let her travel to her friends’ homes.

“That’s something that people who can walk take completely for granted,” he said.

In February, the same day they learned their second appeal of the Tricare decision had been denied, the VanHooks took out a second mortgage on their home and used the money to buy a $25,000 wheelchair that not only climbs stairs, but also can drive through sand, scale curbs and raise its seat, so Deanna VanHook can reach kitchen cabinets and shop for groceries.

Now, the VanHooks are asking Tricare to reimburse them for the cost of the wheelchair, but in a letter they released to Navy Times, Reta Michak, chief of the Defense Department’s Office of Medical Benefits and Reimbursement Systems, said the claim was declined because the wheelchair has “deluxe, luxury and immaterial features.”

Michak did not return phone calls from Navy Times about the case, but the VanHooks say the decision pushed them over the edge.
Not about the money

They say their fight is not so much about reimbursement as it is about establishing a precedent so disabled dependents who do not earn a doctor’s salary or have a doctor’s ability to navigate the Navy’s health care system will not face a similar situation down the road.

They noted that the wheelchair in question has been approved for use by the Department of Veterans Affairs, and that a doctor hired by Tricare to review the case found that the wheelchair was a medical necessity for Deanna VanHook — only to be overruled by Michak.

As to why the couple bought a two-story house in the first place, VanHook said they lived in base housing on each of their past five Navy assignments, and added that the cost to the Navy and Marine Corps to make each house wheelchair-accessible was far more than the cost of the stair-climbing wheelchair.

Heather Welch, spokeswoman for the Norfolk Family Housing Office, had no cost estimates for improvements to make military housing wheelchair-accessible, but said Navy regulations require 5 percent of new housing units on each base to comply with uniform federal accessibility standards, which say a house must have features such as widened bathroom doorways and bathroom rails.

But even when Navy housing complies with standards, issues can arise, VanHook said.

In 1995, the couple moved into a unit in a new military housing community in Landover, Md., that they were told was designed “from the ground up” to be wheelchair-accessible and comply with federal standards.

But there were no downstairs bedrooms and no lift to bring Deanna’s wheelchair to front door level. When his wife asked Navy officials if the house had a lift, she got silence on the other end, Tom VanHook said.

In other cases, they had to wait months while enlisted quarters were renovated to make them wheelchair-accessible.

A hearing on the case was held Aug. 22 at the Defense Department’s Office of Hearings and Appeals in Arlington, Va. A ruling is expected soon, VanHook said.

Ellie