BVA9505465 DOCKET NO. 93-13 902 ) DATE ) RECONSIDERATION ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office and Insurance Center in St. Paul, Minnesota THE ISSUE Entitlement to reinstatement of the veteran's National Service Life Insurance policy. ATTORNEY FOR THE BOARD Hilary L. Goodman, Counsel INTRODUCTION The veteran had active service from January 1943 to September 1946. The Board of Veterans' Appeals (Board) entered a decision in this case on March 2, 1994, which concluded that the veteran did not meet the good health requirements for reinstatement of his National Service Life Insurance (NSLI) policy. Reconsideration of the Board's March 1994 decision was ordered under the authority granted to the Chairman of the Board in 38 U.S.C.A. § 7103 (West 1991). This decision replaces the decision of March 2, 1994, as the final decision of the Board. This matter comes before the Board on appeal from an August 1992 decision of the Department of Veterans Affairs (VA) St. Paul, Minnesota, Regional Office and Insurance Center, denying the veteran's application for reinstatement of his NSLI policy. CONTENTIONS OF APPELLANT ON APPEAL The veteran requests reinstatement of his NSLI policy. He contends that his policy lapsed as he was out of the country and the person in charge of his affairs failed to pay the premiums. He asserts that, as he has not attempted to avoid payment of premiums, he should be given the opportunity to pay the back premiums and reinstate the policy. He further asserts that there is no increased risk to the VA as, at the time of his reinstatement application, he was in the same state of health he would have been in if the premiums had been timely paid. He finally contends that the basis for denying his request for reinstatement fails to take into consideration the facts of his case, including his past record of payments which demonstrate the continuity of his need for the policy. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim for reinstatement of his NSLI policy. FINDINGS OF FACT 1. The veteran, who was born in December 1922, had an NSLI policy in the face amount of $10,000 which lapsed for nonpayment of premiums in July 1991; an application for reinstatement was received in July 1992. 2. The veteran has reported that he underwent surgery for prostate cancer in April 1990, two months after the diagnosis was made. CONCLUSION OF LAW The veteran does not meet the good health requirements for reinstatement of his NSLI policy. 38 C.F.R. §§ 8.1, 8.22, 8.23 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is seeking reinstatement of his NSLI policy. The VA is required to manage the NSLI program consistent with sound underwriting principles for the benefit of all insured veterans. 38 C.F.R. § 8.23(b) specifically requires that, in the case of reinstatement of a lapsed policy after six months, the veteran must be in good health on the date of the reinstatement application. The term "good health" for insurance purposes is defined, under 38 C.F.R. § 8.1(a), to mean that an applicant for insurance is, from clinical or other evidence, free from disease, injury, abnormality, infirmity, or residuals of disease, or injury to a degree that would tend to weaken or impair normal functions of the mind or body or to shorten life. As the course of progress of specific physical defects in individual veterans cannot be accurately predicted, standards have been developed statistically from large groups. These standards are used to assess whether persons with similar defects or diseases present a significantly greater insurance risk and the standards are applied uniformly in evaluating applications for reinstatement of lapsed policies. The standards developed by the VA Chief Benefits Director are published in Part V of VA Manual M29-1. 38 C.F.R. § 8.1(b). The veteran's NSLI policy lapsed in July 1991. In his application for reinstatement, he related that a diagnosis of prostate cancer had been made in February 1990, and that he underwent surgery for this condition in April 1990. While he indicated that he had recovered, from an underwriting standpoint, prostate cancer, even in remission, must be considered to be significant. Therefore, clearly he is not in "good health" as that term is defined in the underwriting standards, and this was true as of the date of his request for reinstatement. Accordingly, he does not meet the requirements for reinstatement. 38 C.F.R. §§ 8.1, 8.22, 8.23. While the nonpayment of premiums and resultant policy lapse were apparently not due to any wrongdoing on the part of the veteran, the fact remains that the primary responsibility for the payment of premiums lies with the policy holder. The Board notes the veteran's contention with regard to his need for the policy in determining his eligibility as well as his contention that, at the time of his reinstatement application, he was in the same state of health that he would have been had the premiums been timely paid. These contentions are of no legal significance as they are not relevant to the applicable criteria; the veteran's health is such that he does not meet the criteria for reinstatement and the criteria are intended to be applied uniformly, as already stated. ORDER Entitlement to reinstatement of the veteran's NSLI policy is denied. JAMES R. ANTHONY ROBERT D. PHILIPP WAYNE M. BRAEUER EILEEN M. KRENZER EUGENE A. O'NEILL GORDON H. SHUFELT NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.