Richard S. Milbauer v. United States ( 2014 )

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[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
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No. 13-14454
Non-Argument Calendar
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D.C. Docket No. 2:11-cv-00149-SPC-DNF
RICHARD S. MILBAUER,
Plaintiff-Appellant,
versus
UNITED STATES OF AMERICA,
Defendant-Appellee.
________________________
Appeal from the United States District Court
for the Middle District of Florida
________________________
(September 30, 2014)
Before TJOFLAT, JORDAN, and FAY, Circuit Judges.
PER CURIAM:
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Richard Milbauer, pro se, appeals the dismissal of his complaint, brought
against the United States for alleged negligence by the U.S. Department of
Veterans Affairs (“VA”). We affirm in part, vacate in part, and remand.
I. BACKGROUND
In September 2005, Milbauer sought treatment at a VA medical center in
Brooklyn, New York (“the Brooklyn VA”), for injuries he had sustained to his
right shoulder in two work-related accidents at a construction site. Medical staff
recommended he receive an MRI to diagnose his injuries. Because of his
claustrophobia, Milbauer requested an “open” MRI, a type of MRI that does not
require the patient to be enclosed in a tube. The Brooklyn VA, however, did not
have an open MRI machine, and Milbauer requested authorization to receive an
open MRI at a non-VA facility. Milbauer finally obtained such authorization and
received an open MRI at a non-VA facility in July 2006, ten months after Brooklyn
VA medical staff had recommended the procedure. The MRI revealed Milbauer
had a severely torn rotator cuff, and he elected to have surgery. Because the
damage was too severe, the surgery was unsuccessful.
On September 27, 2008, Milbauer filed an administrative claim with the VA
under the Federal Tort Claims Act (“FTCA”), 28 U.S.C. §§ 1346(b) and 2671-
2680. He asserted the Brooklyn VA had failed to provide an open MRI of his right
shoulder in a timely manner. Although his doctor had recommended an MRI, the
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staff did not know how to arrange an MRI at a non-VA facility. Moreover, the
staff had placed upon him the burden of completing paperwork. He argued the
delay in receiving a timely MRI had caused further damage to his shoulder. He
also asserted his rotator cuff could have been repaired if the MRI had been
performed within 30 days after his injuries had occurred. The VA denied
Milbauer’s administrative claim on August 26, 2009.
On March 17, 2011, Milbauer filed a complaint in the Middle District of
Florida and alleged negligence claims against the United States under the FTCA. 1
In his complaint, he summarized the medical treatment he had received at the
Brooklyn VA. He then alleged he was entitled to have an open MRI performed at
a non-VA facility at the VA’s expense, and he described the numerous problems
he had faced in attempting to obtain authorization for the outside MRI. Milbauer
alleged the Brooklyn VA medical staff had failed to return his telephone calls, had
directed him to departments that had no knowledge of how to arrange an open
MRI, and had failed to follow the procedures set forth in the VA’s New York
Harbor Healthcare System Policy No. 11-41 (“Policy No. 11-41”). According to
Milbauer, Policy No. 11-41 established the procedures for medical staff to order or
arrange medical tests and procedures performed at non-VA institutions.
1
Although the relevant events occurred in Brooklyn, New York, Milbauer currently
resides in Florida. The district judge denied the government’s motion to transfer venue to the
Eastern District of New York.
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Milbauer further alleged the Brooklyn VA medical staff should have offered
alternative imaging studies to an MRI to determine the extent of his injury. He
claimed the medical staff had deviated from appropriate standards of medical care
and (1) had failed “to take reasonable steps to diagnose his rotator cuff injury
within a reasonable time frame through an outside MRI,” (2) had failed “to have
the appropriate paperwork prepared to authorize the outside MRI for a period of
ten months,” and (3) had committed “other negligent acts or omissions in violation
of the applicable standards of medical care.” R1-1 at 7-8.
The government moved to dismiss the complaint under Federal Rule of Civil
Procedure 12(b)(1) for lack of subject matter jurisdiction. The government argued
Milbauer’s FTCA suit was barred by a provision in the Veterans Judicial Review
Act (“VJRA”), 28 U.S.C. § 511(a), which specifies that district judges may not
review claims involving a decision by the Secretary of the VA under a law that
affects the provision of benefits to veterans. The government argued the crux of
Milbauer’s claim concerned his frustration with the delay in obtaining a veteran’s
benefit, namely, authorization to have the VA pay for an open MRI at a non-VA
facility. The government further argued Milbauer had failed to exhaust
administratively his claim that medical staff should have offered him alternative
diagnostic imaging studies.
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In response to the latter argument, Milbauer argued he administratively had
exhausted his claim that the Brooklyn VA should have offered alternative
diagnostic procedures. Relying on our precedent in Burchfield v. United States,
168 F.3d 1252, 1255 (11th Cir. 1999), he argued he was not required to provide the
VA with every possible theory of recovery. Rather, he had to provide only enough
information to allow the agency to begin its own investigation, and he contended
the VA’s investigation should have revealed his alternative-diagnostic-procedures
claim.
The district judge granted the government’s motion to dismiss. First, the
judge concluded, because Milbauer had not exhausted his administrative remedies
with respect to his alternative-diagnostic-procedures claim, she lacked jurisdiction
over that claim. Notably, the judge did not make any factual findings as to whether
the VA’s investigation of Milbauer’s claim should have revealed that theory of
liability, pursuant to Burchfield.
As for Milbauer’s allegations regarding the delay in receiving authorization
for an open MRI, the judge concluded, although Milbauer’s allegations were
“couched in the language of tort law,” he essentially had presented a claim relating
to veterans’ benefits. R2-64 at 10. The judge found Milbauer’s grievance was
with the VA’s benefits procedure, not the medical treatment he received. Because
Milbauer had presented a claim for delay of veterans’ benefits, the judge found the
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VJRA precluded judicial review of that claim. The judge dismissed the case
without prejudice for lack of subject matter jurisdiction. Milbauer appealed.
II. DISCUSSION
We review de novo the dismissal of a complaint for lack of subject matter
jurisdiction. Motta ex rel. A.M. v. United States, 717 F.3d 840, 843 (11th Cir.
2013).
A. Subject Matter Jurisdiction under the VJRA
On appeal, Milbauer, pro se, argues the district judge erred by finding the
delay in his diagnosis was a benefits issue barred by the VJRA. He contends his
benefits were not in question; rather, his claim involved the delay of a medical
diagnosis due to medical professionals’ deviation from the standard of care.
The VJRA provides the decision of the Secretary as to any “questions of law
and fact necessary to a decision by the Secretary under a law that affects the
provision of benefits . . . shall be final and conclusive and may not be reviewed by
any other official or by any court, whether by an action in the nature of mandamus
or otherwise.” 38 U.S.C. § 511(a) (emphasis added). The term “benefit” means
“any payment, service, commodity, function, or status, entitlement to which is
determined under laws administered by the Department of Veterans Affairs
pertaining to veterans and their dependents and survivors.” 38 C.F.R. § 20.3(e).
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The VJRA does not completely eliminate judicial review of benefits
decisions. Rather, determinations of the Secretary may be appealed to the Board of
Veterans’ Appeals (“Board”), whose ruling becomes the final decision of the
Secretary. 38 U.S.C. § 7104(a). Decisions of the Board may then be reviewed
exclusively by the U.S. Court of Appeals for Veterans Claims, an Article I court
established by the VJRA. Id. §§ 7251, 7252(a), 7266(a). Decisions of the Court of
Appeals for Veterans Claims are in turn appealable only to the U.S. Court of
Appeals for the Federal Circuit. Id. § 7292(a), (c). The judgment of the Federal
Circuit is then subject to review by the Supreme Court by writ of certiorari. Id.
§ 7292(c).
Accordingly, pursuant to the VJRA, “judicial review of a particular
application of the law made by the Secretary with respect to a veteran’s
entitlement to benefits may be had only by appealing to the Board, then to the
Court of Veterans Appeals, the Federal Circuit Court of Appeals and the Supreme
Court.” Hall v. U.S. Dep’t of Veterans Affairs, 85 F.3d 532, 534 (11th Cir. 1996)
(per curiam) (emphasis added).
We have analyzed the VJRA’s jurisdictional scheme in a published opinion
on only one occasion. In Hall, a veteran filed a complaint in district court after
receiving notification that his disability benefits had been reduced in accordance
with 38 C.F.R. § 3.665, which required disability compensation be diminished
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during periods of incarceration for certain felony convictions. Id. at 532-33. The
veteran alleged the reduction in his disability benefits constituted a tort and
violated numerous constitutional provisions. Id. at 533. He specifically requested
the district judge to find that 38 C.F.R. § 3.665 violated the Constitution. Id. The
judge dismissed the complaint sua sponte for lack of subject matter jurisdiction
under the VJRA. Id. On appeal, we held the district judge lacked jurisdiction to
determine the constitutionality of § 3.665, because the VJRA precluded judicial
review of the Secretary’s decisions involving the interpretation or application of a
regulation governing veterans’ benefits. Id. at 534-35. Essentially, we held a
plaintiff may not circumvent the VJRA’s jurisdictional limitations by cloaking a
benefits claim in constitutional terms. See id.
We have not considered whether a claim alleging medical malpractice
actually concerns a benefits issue precluded by the VJRA. The D.C. Circuit,
however, has established a relevant test to determine this issue. In Thomas v.
Principi, a veteran filed suit in the district court and alleged the VA had committed
medical malpractice under the FTCA and had caused him intentional emotional
distress by failing to inform him of his “working diagnosis of schizophrenia.” 394
F.3d 970, 972 (D.C. Cir. 2005). The D.C. Circuit held the VJRA did not preclude
judicial review of those FTCA claims, because the district judge could adjudicate
those claims “without determining first whether Thomas was entitled to a certain
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level of benefits.” Id. at 974 (citation, internal quotation marks, and alteration
omitted). The D.C. Circuit also explained, “[b]ecause none of these claims alleges
that the VA failed to pay for treatment (or even to provide for treatment), they raise
no ‘questions of law or fact necessary to a decision by the Secretary under a law
that affects the provision of benefits.’” Id. (citing 38 U.S.C. § 511) (alteration
omitted).
The D.C. Circuit further acknowledged, however, that some of the plaintiff’s
claims were barred by the VJRA. Id. at 975. The VJRA barred judicial review of
his claims that the VA had “failed to render the appropriate medical care services”
and that the VA’s “continuous and persistent deprivation and denial of known
needed and necessary medical care treatment . . . caused Plaintiff severe emotional
distress.” Id. (alteration in original). The court concluded the district judge lacked
jurisdiction over those claims, because adjudicating those claims would have
required the judge to decide whether the plaintiff was entitled to medical treatment
in the face of a prior VA determination that he was not entitled to such benefit. Id.;
see also Broudy v. Mather, 460 F.3d 106, 115 (D.C. Cir. 2006) (explaining the
Thomas decision).
In deciding Thomas, the D.C. Circuit relied on its earlier decision in Price v.
United States, 228 F.3d 420, 422 (D.C. Cir. 2000) (per curiam). Thomas, 394 F.3d
at 974. In Price, the D.C. Circuit held the VJRA barred the district judge from
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considering a veteran’s claim for reimbursement of medical expenses, because in
order for the judge to resolve whether the VA had failed to reimburse the veteran,
it “would require the district court to determine first whether the VA acted properly
in handling [the veteran’s] request for reimbursement.” Price, 228 F.3d at 422.
In reviewing this issue, we must determine whether Milbauer’s claim
regarding the delay in his diagnosis alleged medical malpractice or raised a
veterans’ benefits issue. Milbauer alleged the VA failed “to take reasonable steps
to diagnose his rotator cuff injury within a reasonable time frame through an
outside MRI” and failed “to have the appropriate paperwork prepared to authorize
the outside MRI for a period of ten months.” R1-1 at 7-8. This is a benefits issue,
because Milbauer sought a particular benefit—to have the VA pay for an open
MRI performed at a non-VA facility—and he complained the process of obtaining
that benefit caused the delay in his diagnosis. See 38 C.F.R. § 20.3(e) (defining the
term “benefit”). Although the VA did not actually deny Milbauer’s request for an
outside MRI, we agree with the Eighth Circuit’s conclusion that “there is no
meaningful legal difference between a delay of benefits and an outright denial of
benefits” for purposes of the VJRA. Mehrkens v. Blank, 556 F.3d 865, 870 (8th
Cir. 2009) (emphasis in original). Accordingly, the VJRA barred judicial review,
and the district judge correctly dismissed that claim for lack of subject matter
jurisdiction. 38 U.S.C. § 511(a).
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Applying Thomas and Price to the facts of this case, we reach the same
conclusion. The district judge could not adjudicate Milbauer’s claim “without
determining first whether [Milbauer] was entitled to a certain level of benefits,”
namely, whether he was entitled to an outside MRI, paid for by the VA. Thomas,
394 F.3d at 974 (citation, internal quotation marks, and alteration omitted).
Furthermore, in order to adjudicate this claim, the judge would have to determine
whether the Brooklyn VA properly handled and processed Milbauer’s request to
have the VA pay for an open MRI at a non-VA facility. See Price, 228 F.3d at
422. Specifically, the judge would be required to determine whether the Brooklyn
VA followed Policy No. 11-41 in processing Milbauer’s request. Thus, Milbauer
raised a benefits issue, not a medical-malpractice claim. Accordingly, we affirm
the dismissal of this claim for lack of subject matter jurisdiction under the VJRA.
B. Exhaustion of Administrative Remedies
Milbauer also argues on appeal the district judge erred by dismissing his
claim regarding alternative diagnostic imaging, based on a failure to exhaust
administrative remedies. Relying on our decision in Burchfield, he contends he
provided ample information during the administrative stage to permit the VA’s
investigating attorneys to inquire why the VA had not ordered alternative tests.
A district judge has jurisdiction over an FTCA claim only if the plaintiff has
(1) given the appropriate agency written notice of his claim, sufficient to enable the
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agency to investigate the claim; and (2) placed a value on his claim. Burchfield,
168 F.3d at 1254-55. “[A] claimant must give an administrative agency only
enough information to allow the agency to begin its own investigation of the
alleged events and explore the possibility of settlement.” Id. at 1255 (citation and
internal quotation marks omitted). We do not require a claimant to provide an
agency with a preview of his lawsuit “by reciting every possible theory of recovery
or every factual detail that might be relevant.” Id. (citations omitted). Rather, the
amount of information required is “minimal.” Id. (citation and internal quotation
marks omitted). Furthermore, an administrative agency is deemed to be on notice
not only of the theories of recovery stated in the claim, but of the theories of
recovery that its reasonable investigation of the specific allegations in the claim
should reveal. Id. Nevertheless, an agency need not “undertake an independent
search for injuries or theories of liability that are not closely related to the matters
described in the claim.” Id. at 1256.
Milbauer argued in the district court, and reasserts on appeal, that he
presented enough information in his administrative complaint to place the VA on
notice of his claim regarding the failure to provide alternative diagnostic tools.
The district judge did not conduct any analysis, however, as to whether Milbauer
had provided sufficient information under Burchfield to overcome the FTCA’s bar
to unexhausted claims. Without additional findings from the district judge, we are
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unable to engage in meaningful appellate review of this issue. Danley v. Allen, 480
F.3d 1090, 1091 (11th Cir. 2007) (per curiam) (stating district judges’ orders
“should contain sufficient explanations of their rulings so as to provide this Court
with an opportunity to engage in meaningful appellate review”). Moreover,
although the government argues this claim is nevertheless barred by the VJRA, the
district judge did not make any factual findings as to that ultimate determination.
Accordingly, we remand for the district judge to analyze, in light of Burchfield,
whether Milbauer exhausted his alternative-diagnostic-procedures claim, and if so,
whether the VJRA precludes review of that claim.
AFFIRMED IN PART, VACTED IN PART, AND REMANDED.
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