Public-domain · open source
OpenJurist

57 F.4th 1374

Van Dermark v. McDonough

U.S. Courts of Appeals

Decided January 23, 2023

U.S. Courts of Appeals · decided 2023-01-23

Cited by 1 later decisions — most recently March 2024

Applies 38 U.S.C. § 1703 · 38 U.S.C. § 1705 · 38 U.S.C. § 1712A · 38 U.S.C. § 1724 · 38 U.S.C. § 1725

Relies on Morton v. Mancari · United States v. Fausto · Johnson v. United States

Good law ✅— No negative treatment on recordhow we know

Decided 2023-01-23

View the full empirical analysis of this case →

Case: 21-2225   Document: 61     Page: 1    Filed: 01/23/2023




   United States Court of Appeals
       for the Federal Circuit
                 ______________________

                PETER VAN DERMARK,
                  Claimant-Appellant

                            v.

       DENIS MCDONOUGH, SECRETARY OF
              VETERANS AFFAIRS,
               Respondent-Appellee
              ______________________

                       2021-2225
                 ______________________

     Appeal from the United States Court of Appeals for
 Veterans Claims in No. 19-2795, Judge Coral Wong Pietsch, Judge Joseph L. Toth, Judge William S. Greenberg.
                  ______________________

                Decided: January 23, 2023
                 ______________________

     THOMAS SAUNDERS, Wilmer Cutler Pickering Hale and
 Dorr LLP, Washington, DC, argued for claimant-appellant.
 Also represented by DOMINICK HURLEY, Los Angeles, CA.

     MATTHEW JUDE CARHART, Commercial Litigation
 Branch, Civil Division, United States Department of Justice, Washington, DC, argued for respondent-appellee.
 Also represented by MICHAEL GRANSTON, REBECCA SARAH
 KRUSER, PATRICIA M. MCCARTHY, LOREN MISHA PREHEIM;
 ALEXANDRA RIGBY, BRYAN THOMPSON, Office of General
Case: 21-2225     Document: 61     Page: 2    Filed: 01/23/2023




 2                               VAN DERMARK    v. MCDONOUGH



 Counsel, United States Department of Veterans Affairs,
 Washington, DC.
                 ______________________

     Before DYK, TARANTO, and STARK, Circuit Judges.
 TARANTO, Circuit Judge.
     Peter Van Dermark is a veteran with a service-connected disability recognized by the Department of Veterans
 Affairs (VA). While abroad, he received medical treatment
 from a non-VA source for conditions not derived from that
 disability. By assumption here, the treatment was emergency treatment. Mr. Van Dermark filed claims with VA
 asking it to pay for his treatment, under 
38 U.S.C. § 1728
 (enacted in 1973) and § 1725 (enacted in 1999), either by
 paying those who treated him or by paying him (reimbursing him) for what he had paid or owed them. VA’s Office of
 Community Care denied both claims, the Board of Veterans’ Appeals maintained the denials, and the Court of Appeals for Veterans Claims (Veterans Court) affirmed the
 Board’s decision. Van Dermark v. McDonough, 
34 Vet. App. 204
, 206 (2021).
       The basis of the denial was 
38 U.S.C. § 1724
, which, as
 relevant here, took its current form in 1958, based on a
 1940 statute containing the key phrase now in dispute.
 Specifically, the Veterans Court, like VA, relied on
 § 1724(a), which prohibits VA from “furnish[ing] hospital
 . . . care or medical services” abroad, except in limited circumstances concededly not present here. On Mr. Van Dermark’s appeal, we agree with the Veterans Court that the
 “furnishing” phrase encompasses the payment for a veteran’s hospital care or medical expenses abroad at issue
 here, making the § 1724(a) prohibition applicable, and that
 §§ 1728 and 1725 do not override that prohibition. We
 therefore affirm.
Case: 21-2225     Document: 61     Page: 3    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                 3



                               I
      We decide the issue before us based on facts accepted
 by the parties for purposes of this appeal. Mr. Van Dermark served in the United States Navy from June 1963 until his honorable discharge in May 1976. VA has found Mr.
 Van Dermark to be totally and permanently disabled due
 to service-connected injuries. As relevant here, Mr. Van
 Dermark received treatment in Thailand (where he lived)
 at non-VA facilities, from physicians and others not affiliated with VA, on two occasions—first in 2016, again in
 2018—both times for cardiac conditions not related to his
 service-connected disability. For each of the two instances
 of treatment abroad, Mr. Van Dermark filed a claim with
 VA under 38 U.S.C §§ 1728 and 1725 seeking VA payment—to him or his medical creditors—for the surgical or
 other heart-related treatment he received abroad.
     Section 1728(a) says that the Secretary “shall . . . reimburse veterans eligible for hospital care or medical services
 under this chapter for the customary and usual charges of
 emergency treatment . . . for which such veterans have
 made payment, from sources other than the Department,
 where such emergency treatment was rendered to such veterans in need thereof” in specified circumstances. 
38 U.S.C. § 1728
(a). 1 One such circumstance is where the
 treatment is for “[a]ny disability of a veteran if the veteran
 has a total disability permanent in nature from a service-connected disability.” 
Id.
 § 1728(a)(3). Section 1728 allows


     1   Enacted in 1973 as 
38 U.S.C. § 628
 using “may,”
 the provision was recodified as 
38 U.S.C. § 1728
 in 1991 (as
 part of the general recodification of chapter 17, changing
 “6xy” provisions to “17xy” provisions) and has used “shall”
 since 2008. See 
Pub. L. No. 93-82, § 106
(a), 
87 Stat. 183
 (1973); 
Pub. L. No. 102-83, § 5
(a), 
105 Stat. 406
 (1991) (recodification); 
Pub. L. No. 110-387, § 402
(b)(1), 
122 Stat. 4123
 (2008) (replacing “may” with “shall”).
Case: 21-2225     Document: 61     Page: 4    Filed: 01/23/2023




 4                               VAN DERMARK    v. MCDONOUGH



 the Secretary, “in lieu of reimbursing such veteran,” to
 “make payment of the reasonable value of emergency treatment directly—(1) to the hospital or other health facility
 furnishing the emergency treatment; or (2) to the person or
 organization making such expenditure on behalf of such
 veteran.” 
Id.
 § 1728(b). The section borrows the meaning
 of “emergency treatment” from § 1725(f)(1). Id. § 1728(c).
 Section 1728 makes no reference to treatment abroad.
      Section 1725(a) says that, subject to certain conditions
 and limitations, the Secretary “shall reimburse a veteran
 described in subsection (b) for the reasonable value of
 emergency treatment furnished the veteran in a non-Department facility,” while authorizing the same direct-payment alternative to reimbursement as does § 1728. Id.
 § 1725(a)(1), (2). 2 Section 1725(b) describes the eligible
 veteran as one “who is an active Department health-care
 participant who is personally liable for emergency treatment furnished the veteran in a non-Department facility.”
 Id. § 1725(b)(1). The subsection identifies who is “an active
 Department health-care participant” in terms of enrollment in the VA health-care system under 
38 U.S.C. § 1705
(a) and recent receipt of care under chapter 17. 
Id.
 § 1725(b)(2). It further identifies being “personally liable”
 in terms that, among other things, exclude a veteran who
 has “entitlement to care or services under a health-plan
 contract” or eligibility “for reimbursement for medical care
 or services under section 1728.” Id. § 1725(b)(3). 3 Section



     2   Enacted in 1999 using “may,” the provision has
 used “shall” since 2008. See 
Pub. L. No. 106-117,
title I,
 § 111(a), 
113 Stat. 1553
 (1999) (enacting 
38 U.S.C. § 1725
);
 
Pub. L. No. 110-387,
title IV, § 402(a), 
122 Stat. 4123
 (2008)
 (changing “may” to “shall”).
     3   The term “health-plan contract” covers various insurance and other arrangements, an “insurance program”
Case: 21-2225     Document: 61     Page: 5    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                 5



 1725(c) adds that the veteran’s liability for the costs of the
 treatment is extinguished if the Secretary makes payment
 under the section on behalf of the veteran “to a provider of
 emergency treatment” unless the payment is “rejected and
 refunded by the provider within 30 days of receipt,” and it
 makes specified contractual arrangements or their absence
 immaterial to the applicability of that extinguishment provision. 
Id.
 § 1725(c)(3). Like § 1728, § 1725 makes no reference to treatment abroad.
     Mr. Van Dermark contended that he was entitled to the
 claimed payment because the treatment he received in
 2016 and 2018 in Thailand constituted “emergency treatment” under §§ 1728 and 1725. He claimed eligibility for
 payment under § 1728 because of his total-disability rating
 and under § 1725 because he was an active VA healthcare
 participant with recent enough receipt of VA care. VA’s
 Office of Community Care and the Board denied both
 claims, applying § 1724(a)’s prohibition on VA’s “furnish[ing] hospital care and medical services” “outside any
 State” where, as is undisputed here, the exceptions stated
 in § 1724 do not apply (because the treated conditions are
 not related to a service-connected disability and this matter does not involve the Philippines).
     The Veterans Court affirmed the Board’s decision. Van
 Dermark, 34 Vet. App. at 206. For purposes of its decision,
 the Veterans Court assumed arguendo that the treatment
 was “emergency treatment” under §§ 1728 and 1725. Id. at
 209–10. And the Veterans Court concluded that, as Mr.
 Van Dermark did not dispute, the phrase “medical services” of § 1724(a) covers “emergency treatment” of §§ 1728
 and 1725 and hence, by assumption for purposes of the


 specified in 42 U.S.C. § 1395c (Medicare Part A) or § 1395j
 (Medicare Part B), a state plan under 
42 U.S.C. § 1396
 et
 seq. (Medicaid), or a specified “worker’s compensation law
 or plan.” 
38 U.S.C. § 1725
(f)(2).
Case: 21-2225     Document: 61     Page: 6    Filed: 01/23/2023




 6                               VAN DERMARK    v. MCDONOUGH



 appeal, the treatment Mr. Van Dermark received in 2016
 and 2018. 
Id. at 210
.
      On the key point in dispute, the court ruled that “furnish[ing] . . . medical services” in § 1724 included VA’s paying for treatment rendered by the direct hands-on
 providers independent of VA, including when the payment
 takes the form of “reimburse[ment]” paid directly to the
 veteran for the veteran’s debt for the treatment. Id. at
 210–15. The Veterans Court reasoned that “furnish” can
 be understood to include “provide for” something indirectly,
 id. at 210–11 (quoting Webster’s New International Dictionary 1021 (2d ed. 1934)), and that § 1724 uses the broad
 sense, which includes paying for what others directly provide, as supported by the specific statutory context and its
 history and implementation: Notably, § 1724(b)’s specific
 authorization to “furnish hospital care and medical services” in certain circumstances has long been understood
 and applied to cover such payments, id. at 211–14. Having
 concluded that the prohibition of § 1724(a) applied to bar
 the requested payments for services abroad, the Veterans
 Court also concluded that §§ 1728 and 1725 did not override that prohibition because there was no basis for reading
 them to apply abroad. Id. at 214–15. Judge Greenberg dissented. Id. at 215–16.
     Mr. Van Dermark timely appealed the Veterans
 Court’s decision. Because Mr. Van Dermark raises an issue of law—statutory interpretation—we have jurisdiction
 under 
38 U.S.C. § 7292
. Carter v. McDonough, 
46 F.4th 1356, 1359
 (Fed. Cir. 2022). We review the Veterans
 Court’s statutory interpretation de novo.     Gurley v.
 McDonough, 
23 F.4th 1353, 1356
 (Fed. Cir. 2022).
Case: 21-2225     Document: 61      Page: 7    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                   7



                               II
     The question before us is the scope of the phrase “furnish hospital . . . care or medical services” in § 1724(a).
 Section 1724 is the 1991 recodification of what had been 
38 U.S.C. § 624
, 
Pub. L. No. 102-83, § 5
(a), 
105 Stat. 406
 (1991), with the only change since 1991 being the 2000 addition of subsection (e), 
Pub. L. No. 106-377, § 1
(a)(1) [title
 V, § 501(c)], 
114 Stat. 1441
, 1441A-58 (2000). Congress enacted § 624 in 1958 in a form containing the language and
 structure centrally at issue here, 
Pub. L. No. 85-857, 72
 Stat. 1105, 1144 (1958), having adopted a similar version
 as part of a recodification the year before. 4
     Section 1724 reads in full:



     4    The 1958 enactment, 
38 U.S.C. § 624
, read:
     § 624. Hospital care and medical services abroad
          (a) Except as provided in subsections (b) and
     (c), the Administrator shall not furnish hospital or
     domiciliary care or medical services outside the
     continental limits of the United States, or a Territory, Commonwealth, or possession of the United
     States.
          (b) The Administrator may furnish necessary
     hospital care and medical services for any service-connected disability—
              (1) if incurred during a period of war, to any
          veteran who is a citizen of the United States
          temporarily sojourning or residing abroad except in the Republic of the Philippines; or
              (2) whenever incurred, to any otherwise eligible veteran in the Republic of the Philippines.
          (c) Within the limits of those facilities of the
     Veterans Memorial Hospital at Manila, Republic of
Case: 21-2225    Document: 61      Page: 8    Filed: 01/23/2023




 8                               VAN DERMARK   v. MCDONOUGH



          (a) Except as provided in subsections (b) and
     (c), the Secretary shall not furnish hospital or domiciliary care or medical services outside any State.
         (b)(1) The Secretary may furnish hospital care
     and medical services outside a State to a veteran
     who is otherwise eligible to receive hospital care
     and medical services if the Secretary determines
     that such care and services are needed for the
     treatment of a service-connected disability of the
     veteran or as part of a rehabilitation program under chapter 31 of this title.
         (2) Care and services for a service-connected
     disability of a veteran who is not a citizen of the




     the Philippines, for which the Administrator may
     contract, he may furnish necessary hospital care to
     a veteran of any war for any non-service-connected
     disability if such veteran is unable to defray the expenses of necessary hospital care. The Administrator may enter into contracts to carry out this
     section.
 Pub. L No. 85-857, 
72 Stat. 1144
 (1958). This was part of
 a broad recodification of Title 38. 
Id.
 at 1105–1274.
     A 1957 codification, 
Pub. L. No. 85-56, 71
 Stat. 83–175
 (1957), included 
38 U.S.C. § 524
, 
71 Stat. 113
, which read:
          Sec. 524. The Administrator shall not furnish hospital or domiciliary care or medical
     services outside the continental limits of the
     United States, or a Territory, Commonwealth,
     or possession o f the United States, except that
     he may furnish necessary hospital care and medical services for service-connected disabilities
     incurred during a period of war to v eterans
     who are citizens of the United States temporarily sojourning or residing abroad.
Case: 21-2225     Document: 61     Page: 9    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                 9



     United States may be furnished under this subsection only—
            (A) if the veteran is in the Republic of the
         Philippines or in Canada; or
            (B) if the Secretary determines, as a matter
         of discretion and pursuant to regulations
         which the Secretary shall prescribe, that it is
         appropriate and feasible to furnish such care
         and services.
         (c) Within the limits of those facilities of the
     Veterans Memorial Medical Center at Manila, Republic of the Philippines, for which the Secretary
     may contract, the Secretary may furnish necessary
     hospital care to a veteran for any non-service-connected disability if such veteran is unable to defray
     the expenses of necessary hospital care. The Secretary may enter into contracts to carry out this
     section.
         (d) The Secretary may furnish nursing home
     care, on the same terms and conditions set forth in
     section 1720(a) of this title, to any veteran who has
     been furnished hospital care in the Philippines
     pursuant to this section, but who requires a protracted period of nursing home care.
         (e) Within the limits of an outpatient clinic in
     the Republic of the Philippines that is under the
     direct jurisdiction of the Secretary, the Secretary
     may furnish a veteran who has a service-connected
     disability with such medical services as the Secretary determines to be needed.
 
38 U.S.C. § 1724
. “State” means “each of the several
 States, Territories, and possessions of the United States,
 the District of Columbia, and the Commonwealth of Puerto
 Rico.” 
Id.
 § 101. We use “abroad” to mean “outside any
 State.”
Case: 21-2225    Document: 61      Page: 10    Filed: 01/23/2023




 10                              VAN DERMARK    v. MCDONOUGH



     The two subsections of central significance here are (a)
 and (b). Subsection (a) prohibits VA from furnishing hospital care and medical services abroad, subject only to the
 “[e]xcept[ions]” stated in subsections (b) and (c). Subsection (b) then defines an exception that allows VA to furnish
 hospital care and medical services only for service-connected disabilities. 5 The other three subsections—inapplicable here, and on which Mr. Van Dermark has not relied
 for his argument—all concern the distinctive situation presented by the Republic of the Philippines, reflecting its
 unique relationship to the United States, especially during
 World War II. See, e.g., S. Rep. No. 85-1469, at 1–12
 (1958). 6
     We conclude that the “furnish” phrase at issue covers
 what Mr. Van Dermark claims here—VA payment for a
 veteran’s treatment (i.e., hospital care or medical services),
 whether payment is made to the treated veteran or to those
 to whom the veteran owes a debt for the treatment. It is
 undisputed that, if we so conclude, the § 1724(a) prohibition applies where, as in this case, the treatment was rendered abroad and is not for a service-connected disability.
 We also conclude that §§ 1728 and 1725 do not override the
 § 1724(a) prohibition.




      5   The subsection refers also to “a rehabilitation program under chapter 31,” 38 U.S.C. §§ 3100–3122, which
 applies to “veterans with service-connected disabilities,”
 
38 U.S.C. § 3100
; see 38 U.S.C. ch. 31 heading.
      6   VA has explained that it “has had a presence in the
 Philippines since 1922” and its “Manila Regional Office and
 Outpatient Clinic is the only VA office located outside [the]
 United States or its territories,” with the Clinic offering
 various medical services. Fact Sheet, Department of Veterans     Affairs    (Sept.    2020),     https://www.benefits.va.gov/ROMANILA/docs/VAManilaFactSheet.pdf.
Case: 21-2225     Document: 61      Page: 11    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                  11



                                A
      Our analysis of the phrase at issue from § 1724(a) (“furnish hospital . . . care or medical services”) reflects the fact
 that what is substantively the same phrase appears in
 § 1724(b) (“furnish hospital care and medical services”).
 The phrase in subsection (a) is a prohibitory, “shall not”
 phrase, and so uses “or,” whereas the phrase in subsection
 (b) is an authorizing, “may” phrase, and so uses “and.” But
 Mr. Van Dermark agrees that the two phrases have the
 same meaning with respect to the disputed issue of coverage of VA’s payment for treatment provided by others, Oral
 Arg. at 1:43–50, and we see no basis for a contrary conclusion. See also Oral Arg. at 19:45–20:20 (Secretary urging
 same meaning).
     This premise is important for at least two reasons.
 First, the phrase appears in the 1940 predecessor to current § 1724(b) (and in the 1958- and 1957-enacted statutes
 quoted above)—that is, in the phrase authorizing VA to furnish treatment abroad for service-connected conditions. 7



     7    In 1933, Congress granted VA authority to “furnish
 . . . medical and hospital treatment” in existing VA facilities to certain veterans. Title I § 6, 
Pub. L. No. 73-2, 48
 Stat. 8 (1933). That authority was implemented in two
 1933 executive orders (available at 38 U.S.C. Ch. 12A
 (1934)) that by regulation authorized VA to “furnish . . .
 hospital care, including medical treatment” in VA facilities
 to certain veterans, but declared that “[n]o person shall be
 entitled to receive domiciliary, medical, or hospital care, including treatment, who resides outside of the continental
 limits of the United States or its territories or possessions,”
 Exec. Order No. 6094 §§ I, IV; see Exec. Order No. 6232
 §§ I, IV (same). In 1940, Congress “amended” § IV of the
 regulation “to read as follows,” authorizing care abroad:
Case: 21-2225    Document: 61     Page: 12    Filed: 01/23/2023




 12                               VAN DERMARK   v. MCDONOUGH



 Accordingly, we look to 1940 (or to 1933–1940) as the pertinent time of initial congressional adoption, a fact of significance in statutory interpretation, and we focus on the
 scope of Congress’s authorization of treatment abroad.
      Second, a narrowing of the “furnish” phrase would simultaneously narrow the § 1724(a) prohibition and the
 § 1724(b) authorization. With respect to what benefits veterans, the two effects are opposites—the first would relax
 a limit on possible benefits to veterans, and the second
 would constrain the provision of benefits to veterans. In
 fact, VA has long been paying for veteran-obtained care
 abroad under § 1724(b), and Mr. Van Dermark agrees that
 his interpretation would require curtailment of VA’s practice, Oral Arg. at 1:00–2:10. In the circumstances before
 us, where each of the argued-for interpretations would benefit some veterans at the expense of others, and we lack
 information to compare magnitudes, we see no role for the
 pro-veteran interpretive canon. See Burden v. Shinseki,
 
727 F.3d 1161, 1169
 (Fed. Cir. 2013).
                              1
     We start with consideration of the statutory provision’s
 “ordinary meaning at the time Congress enacted the



    No person shall be entitled to receive domiciliary,
    medical, or hospital care, including treatment, who
    resides outside of the continental limits of the
    United States or its Territories or possessions: Provided, That in the discretion of the Administrator
    of Veterans’ Affairs necessary hospital care, including medical treatment, may be furnished to veterans who are citizens of the United States and who
    are temporarily sojourning or residing abroad, for
    disabilities due to war service in the armed forces
    of the United States.
 
Pub. L. No. 76-866, § 4
, 
54 Stat. 1195
 (1940).
Case: 21-2225     Document: 61      Page: 13    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                  13



 statute.” New Prime Inc. v. Oliveira, 
139 S. Ct. 532, 539
 (2019) (cleaned up). The language permits a meaning that
 includes the meaning adopted by the Veterans Court. The
 prominent comprehensive contemporaneous dictionary,
 Webster’s Second, released in 1934, gives definitions of “furnish” that include “to provide” and (listed first among the
 non-obsolete meanings) “to provide for.” Webster’s New International Dictionary of the English Language 1021 (2d
 ed. 1937). Each definition on its face—as well as “provide
 what is necessary for,” listed next to “provide for” in the
 same definition, id.—is sufficiently broad to include, where
 context makes it appropriate, both directly delivering
 treatment and more indirectly enabling receipt of treatment by paying (in advance or after the fact) for the treatment, whether payment is made to the treater or to the
 recipient. And nothing on the face of § 1724 precludes the
 broader meaning, under which Congress barred VA from
 both the delivery and payment roles for treatment abroad,
 subject to specific exceptions for service-connected problems and the special situation presented by the Philippines.
      Thus, the expression at issue here is one that can be
 used differently in different settings—for example, to refer
 just to the actions of the direct treaters (or their principals)
 or, more broadly, to various forms of indirect provision, including by funding. Context always matters, Artis v. District of Columbia, 
138 S. Ct. 594
, 603–04 (2018); Johnson
 v. United States, 
559 U.S. 133, 139
 (2010), and “the specific
 context in which that language is used” is especially important, Merit Management Group, LP v. FTI Consulting,
 Inc., 
138 S. Ct. 883
, 892–93 (2018). Still more specifically,
 courts give effect to clear differences in context to identify
 which of the available meanings is the right one for a particular setting, even if the differences are among parts of a
 single overall statute. See Return Mail, Inc. v. U.S. Postal
 Service, 
139 S. Ct. 1853, 1863
 (2019) (requiring different
 meanings “when a statutory term is used throughout a
Case: 21-2225    Document: 61      Page: 14     Filed: 01/23/2023




 14                                VAN DERMARK   v. MCDONOUGH



 statute and takes on ‘distinct characters’ in distinct statutory provisions” (quoting Utility Air Regulatory Group v.
 EPA, 
573 U.S. 302
, 320 (2014))); Cherokee Nation v. State
 of Georgia, 
30 U.S. (5 Pet.) 1, 19
 (1831). That approach
 applies a fortiori within a chapter of a title of the U.S. Code
 when the differences are among provisions enacted at different times.
     Here, for the reasons now set forth, we conclude that
 the “specific” context supports the broader meaning within
 § 1724.
                               2
     Mr. Van Dermark effectively agrees that the narrow
 direct-provision meaning is not appropriate for § 1724. In
 particular, he accepts that § 1724(b)’s use of “furnish . . .
 medical services”—and hence, too, § 1724(a)’s use of the
 same phrase—reaches beyond VA’s own delivery of care,
 through its own facilities, employees, or agents making VA
 the principal responsible for the treatment (the “provider”
 in modern parlance). E.g., Reply Br. at 8–9; Van Dermark,
 34 Vet. App. at 211. And he does not dispute the Veterans
 Court’s explanation of the evident reason: Congress was
 seeking to enable veterans abroad to get treatment for service-connected disabilities, and VA had virtually no presence abroad. Van Dermark, 34 Vet. App. at 212–13
 (discussing both 1940 legislative history and VA non-presence abroad); see U.S. Br. at 23–24; Annual Report of the
 Administrator of Veterans’ Affairs for the Fiscal Year
 Ended June 30, 1941, at 11, 52–53 (1942). Mr. Van Dermark adds, moreover, that there are “good reasons” for a
 congressional policy against a VA expansion of its presence
 abroad that would put it “in the business of providing care
 abroad through its own facilities or through other advance
 arrangements with private providers” abroad, e.g., that
 “giving the Secretary’s medical infrastructure a global
 reach might entail unwanted complexities, including the
Case: 21-2225    Document: 61     Page: 15    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                               15



 need to reconcile such infrastructure with the healthcare
 laws of other nations.” Opening Br. at 29–30.
     These acknowledgements confirm the inappropriateness of the narrow reading of the phrase at issue in § 1724.
 They also indicate why the broader reading allows
 § 1724(b) to be more effective in furthering the evident congressional purpose of enabling veterans to receive care
 abroad for service-connected conditions. “A textually permissible interpretation that furthers rather than obstructs
 the document’s purpose should be favored,” and “evident
 purpose always includes effectiveness.” Antonin Scalia &
 Bryan A. Garner, Reading Law: The Interpretation of Legal
 Texts § 4, at 63 (2012); see also Transpacific Steel LLC v.
 United States, 
4 F.4th 1306, 1323
 (Fed. Cir. 2021). Congress allowed the Secretary to make judgments about how
 to implement the authorization, considering all relevant
 factors, including benefits to veterans, administrative
 costs, and others. The broad reading of the scope of authorization thus permits the grant of authority to be more effective in achieving the plain congressional purposes.
      Later expressions of congressional understanding lend
 further support to the broader reading of the “furnish”
 phrase in § 1724, which encompasses paying for treatment
 delivered by others for whom VA was not the principal.
 When Congress enacted 
38 U.S.C. § 624
 in 1958, it considered the proper scope of the special provisions for the Philippines. In that context, the Senate Committee recognized,
 based on the submissions of VA and the Bureau of the
 Budget, that “American veterans residing in other countries, such as France, England, or Germany, are not given
 medical care at VA expense for non-service-connected disabilities.” S. Rep. No. 85-1469, at 5 (1958) (emphasis added).
 The phrase suggests coverage, by the statutory phrase at
 issue, of the payment function here in dispute.
     Congressional action in 1987 is even more supportive
 of the broader reading of the phrase in dispute. Before
Case: 21-2225    Document: 61      Page: 16    Filed: 01/23/2023




 16                              VAN DERMARK    v. MCDONOUGH



 1988, subsection (b)—of what was then 38 U.S.C. § 624—
 permitted VA to furnish care abroad only if the veteran receiving care was “a citizen of the United States” or “in the
 Republic of the Philippines.” 
38 U.S.C. § 624
(b) (1982). In
 1988, Congress amended the subsection to cover U.S. veterans who were Canadian citizens living in Canada. See
 Title I § 105, 
Pub. L. No. 100-322, 102
 Stat. 487 (1988)
 (providing that VA may furnish care to non-citizens “only
 . . . if the veteran is in the Republic of the Philippines or
 Canada” or otherwise “as a matter of discretion”). The pertinent House Committee described the effect of the House
 bill, which included language substantially similar to that
 of the final enactment. Compare H.R. Res. 2616, 100th
 Cong. (1987), and H.R. Rep. No. 100-191, at 54, with Title I
 § 105, 
Pub. L. No. 100-322, 102
 Stat. 487 (1988). It explained that such Canadian citizens would be able to receive medical care “for their service-connected conditions
 on a reimbursable basis by the VA,” H.R. Rep. No. 100-191,
 at 11 (emphasis added), demonstrating that Congress understood § 1724(b)’s grant of authority to furnish care
 abroad to permit reimbursement. That language is used in
 § 1728 (already enacted by 1987), and in § 1725 (yet to be
 enacted), to refer to payment to the veteran, not to payments to the direct provider “in lieu of reimbursing [the]
 veteran.” 
38 U.S.C. § 1728
(b); see 
38 U.S.C. § 1725
(a)(2).
     Mr. Van Dermark advances a kind of middle position.
 He contends that VA must have some kind of contract with
 the treating persons or entities in order for its role in enabling veterans to receive services to constitute “furnishing”
 the services. Opening Br. at 28, 31–34; Reply Br. at 5, 9.
 This contention, even aside from some uncertainty about
 what Mr. Van Dermark suggests must be in the contract,
 is unpersuasive.
     The suggestion runs counter to the indications of congressional contemplation, quoted above, that the furnishing phrase covers VA bearing the “expense” and covers
 “reimbursement”—the latter term focusing on the VA-
Case: 21-2225    Document: 61      Page: 17    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                17



 veteran relationship, not a VA-treater relationship. More
 fundamentally, Mr. Van Dermark has supplied no persuasive reason that a contractual obligation, on VA’s part or
 on direct service deliverers’ part, is a necessary aspect of
 “furnishing” (e.g., “providing for”) in its available, broad
 sense, which encompasses indirect provision through paying to help enable receipt of the service. That sense might
 even encompass such paying without any obligation preexisting the service, but it readily encompasses what is invoked here—an alleged obligation to pay that preexisted
 the service—and that meaning is independent of the particular legal basis for the obligation, whether the obligation
 is contractual or, instead, as Mr. Van Dermark asserts
 here, statutory or regulatory.
      When Congress wished to focus on contracts as one
 means of implementing the “furnishing” phrase, it did so
 by including additional language, over and above the “furnishing” phrase itself. In § 1724, for example, subsection
 (c) ends with a sentence saying: “The Secretary may enter
 into contracts to carry out this section.” 
38 U.S.C. § 1724
(c). The separate mention of contracts confirms that
 the “furnishing” phrase itself does not require contracts.
 And the “may” language makes clear that all it does is declare that contracts are one way to implement the section,
 not that they are the only way.
      Sections 1703 and 1703A provide an instance in which
 Congress used additional language to refer to contracts
 when VA is furnishing care by paying for care directly delivered by others. Section 1703, in its current form, states
 that the Secretary “shall, subject to the availability of appropriations, furnish hospital care, medical services, and
 extended care services to a covered veteran through [specified] health care providers,” 
38 U.S.C. § 1703
(d)(1), which
 include “[a]ny health care provider that is participating in
 the Medicare program,” 
id.
 § 1703(c)(1), in certain enumerated circumstances, including where “the covered veteran
 and the covered veteran’s referring clinician agree that
Case: 21-2225     Document: 61      Page: 18     Filed: 01/23/2023




 18                                 VAN DERMARK   v. MCDONOUGH



 furnishing care and services through a non-Department
 entity or provider would be in the best medical interest of
 the covered veteran based upon criteria developed by the
 Secretary,” id. § 1703(d)(1)(E); see also id. § 1703(a), (e).
 This language clearly uses the “furnishing” phrase in the
 broad sense now at issue. See id. § 1703(i) (addressing
 “payment rates for care and services,” referring to Medicare rates (capitalization removed)).
     The provision then uses additional language to address
 the matter of VA-treater contracts for this indirect provision of care, seemingly (we need not here say definitively)
 to require such contracts. See id. § 1703(h) (requiring the
 Secretary to “enter into consolidated, competitively bid contracts to establish networks of health care providers specified in . . . subsection (c) for purposes of providing sufficient
 access to hospital care, medical services, or extended care
 services”); id. § 1703A(a)(1)(A), (B) (stating that, in specified circumstances, the Secretary “may furnish such care
 or service . . . through an agreement under this section,”
 giving the agreement the name, “Veterans Care Agreement”). If there is such a requirement, it is established by
 language over and above the “furnishing” phrase. Such
 provisions confirm that Mr. Van Dermark’s contract view
 is not to be read into the phrase itself.
                                3
      VA’s actions over time reflect the broad reading of the
 “furnish” phrase at issue. In 1968, VA promulgated a regulation, under the heading “Payment or reimbursement of
 the expenses of unauthorized hospital care and other medical expenses,” approving VA reimbursement to certain
 veterans for certain emergency medical treatment, related
 to service-connected disabilities, received from non-VA facilities for which those veterans did not get authorization
 from VA in advance of treatment. 
33 Fed. Reg. 19,011
 (Dec.
 20, 1968) (
38 C.F.R. § 17.80
 (1968)). At the time, VA’s only
 statutory authority for the regulation was its authority to
Case: 21-2225    Document: 61      Page: 19    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                19



 “furnish” care. 38 U.S.C §§ 610–612, 624 (1958). The reimbursement regulation rests on an understanding that
 furnishing care includes paying for emergency care received from non-VA facilities without prior VA involvement. That action preceded Congress’s enactment of 
38 U.S.C. § 1728
 (then 
38 U.S.C. § 628
) in 1973, which expanded VA’s approach and created a clearer statutory
 foundation. Compare 
Pub. L. No. 93-82, § 106
, 
87 Stat. 179
 (1973), with 
33 Fed. Reg. 19,011
. See also S. Rep. No. 92-
 776, at 29 (1972); S. Rep. No. 93-54, at 25 (1973) (similar).
     In fact, the parties do not dispute two key facts about
 VA’s longstanding practice relevant here. First, aside from
 the treatment for service-connected disabilities where subsection (b) applies, and the situations covered by the Philippines-specific subsections, VA has not paid for treatment
 abroad, even in the five decades or so after enactment of
 § 1728 (then 
38 U.S.C. § 628
) in 1973. See, e.g., S. Rep. No.
 85-1469, at 5 (quoted above: “American veterans residing
 in other countries, such as France, England, or Germany,
 are not given medical care at VA expense for non-service-connected disabilities.”). Second, VA has long paid for
 treatment abroad where subsection (b) applies (or where
 the Philippines subsections apply). Current 
38 C.F.R. § 17.35
(a) and (c)—with predecessors dating back as far as
 1959, see 
24 Fed. Reg. 8,327
 (Oct. 14, 1959) (
38 C.F.R. § 17.36
); see also 
33 Fed. Reg. 19,011
 (1968 regulations 
38 C.F.R. §§ 17.80
, 17.84)—make clear that, under the Foreign Medical Program, eligible veterans can submit claims
 for payment for reimbursement for treatment received
 abroad, if properly tied to a service-connected disability,
 even if not authorized by VA in advance. When VA adopted
 the current provision in 2018, it said that it was doing so to
 “clarify” and “reflect current VA practice and statutory
Case: 21-2225    Document: 61     Page: 20    Filed: 01/23/2023




 20                              VAN DERMARK   v. MCDONOUGH



 authority.” 
83 Fed. Reg. 29,447
 (June 25, 2018); see 
83 Fed. Reg. 4,452
 (Jan. 31, 2018) (proposed rule). 8
     Mr. Van Dermark’s position, which he acknowledges
 would require alteration of VA practice, Oral Arg. at 1:00–
 2:10, would represent a break with VA’s long practice both



      8   See Van Dermark, 34 Vet. App. at 213–14; VA
 Health Administration Center, Foreign Medical Program
 Fact     Sheet   01-17    (Nov.     2001),   https://web.archive.org/web/20020922203959/http://www.va.gov/hac/fact
 sheet/fspages/01-17fmpprovidersheet.pdf (“The Foreign
 Medical Program (FMP) . . . provides reimbursement for
 VA adjudicated service-connected conditions. . . . Claims
 are reviewed to determine whether the medical care provided is related to the service-connected condition.”); VA
 Health Administration Center, Foreign Medical Program
 Fact     Sheet   01-5    (Nov.     2001),    https://web.archive.org/web/20020922204000/http://www.va.gov/hac/fact
 sheet/fspages/01-05fmp.pdf (“The FMP is a program for
 veterans who live or travel overseas. Under the FMP, Veterans Affairs will pay 100% of the charges for any health
 care the veteran needs that is associated with a service connected disability.”); VA Health Administration Center,
 Foreign Medical Program (Aug. 2001) (explaining that
 FMP is for “US veterans with VA-rated service-connection
 conditions who are residing or traveling abroad (Canada
 and Philippines excluded),” under which “VA assumes payment responsibility for certain necessary medical services
 associated with the treatment of those service-connected
 conditions”); VA, Federal Benefits for Veterans and Dependents (Jan. 1981) (“The Veterans Memorial Hospital in
 Manila is the only overseas hospital where VA-paid care is
 available to veterans with nonservice-connected disabilities.”).
Case: 21-2225    Document: 61      Page: 21     Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                 21



 of not paying for non-service-connected-disability emergency treatment abroad and of paying (without contracts)
 for service-connected-disability treatment abroad. That
 consequence provides additional reason to reject Mr. Van
 Dermark’s interpretation. See National Labor Relations
 Board v. Noel Canning, 
573 U.S. 513
, 525 (2014) (“The
 longstanding practice of the government can inform our determination of what the law is.” (cleaned up)).
                               4
      Mr. Van Dermark points to other provisions within
 chapter 17 of Title 38 of the U.S. Code for support for his
 view, either because they use “furnish medical services” or
 a similar phrase to refer only to the direct treatment providers to whom a patient owes payment for the treatment
 or because they refer to VA contracts with the treaters (or
 their principals). Such provisions do not alter the conclusion about the meaning in § 1724. The essence of the context-dependency principle most recently stated in Return
 Mail, as quoted above, is that a term with one meaning in
 one provision can take on a different meaning in a different
 provision that contains surrounding words that require the
 different meaning. That principle differentiates the “furnish” provisions on which Mr. Van Dermark relies from
 § 1724. And the “contract” provisions to which he points
 depend not on a narrow meaning of the “furnish” phrase
 but on additional language for their contract prescriptions.
     Sections 1725 and 1728 contain surrounding words
 that establish they use “furnish,” with “treatment” as the
 object, to refer to the direct provision (and only the direct
 provision) of emergency treatment. Section 1728 permits
 VA to, “in lieu of reimbursing [an eligible] veteran,” directly
 pay “the hospital or other health facility furnishing the
 emergency treatment.” 
38 U.S.C. § 1725
(b)(1). And § 1725
 speaks expressly of “reimburse[ment]” for the reasonable
 value of the emergency “treatment furnished,” id
 § 1725(a)(1); see id. § 1725(b). The same is true of 38 U.S.C.
Case: 21-2225    Document: 61      Page: 22    Filed: 01/23/2023




 22                                VAN DERMARK   v. MCDONOUGH



 § 1720J(a), which directs the Secretary, in a three-item list,
 to “furnish emergent suicide care to an eligible individual
 at a medical facility of the Department,” to “pay for emergent suicide care provided to an eligible individual at a non-Department facility,” and to “reimburse an eligible individual” for such non-VA-facility care. The “furnish” phrase
 there, because of the surrounding words, refers to direct
 provision.
     Other provisions cited by Mr. Van Dermark are akin to
 §§ 1703 and 1703A, discussed above, which authorize the
 Secretary to furnish services through third-party providers
 and which use additional language to authorize or perhaps
 require contracts to do so. See 38 U.S.C. § 1712A(e)(1)
 (granting the Secretary “the same authority to enter into
 contracts or agreements with private facilities” when “furnishing counseling and related mental health services under subsections (a) and (b)”); id. at § 1720I(c)(1)–(2)
 (granting the Secretary the authority “to enter into contracts or agreements” pursuant to § 1703 “or any other provision of law” when “furnishing mental or behavioral
 health care services” to certain individuals); id. at
 § 1720C(a), (b)(1) (granting the Secretary authority to “furnish medical, rehabilitative, and health-related services in
 noninstitutional settings” or eligible veterans “in need of[]
 nursing home care” “solely through contracts with appropriate public and private agencies”); id. at § 1788(c) (granting the Secretary authority to “furnish to [a] live donor”
 certain “care and services . . . at a non-Department facility
 pursuant to an agreement entered into by the Secretary
 under [Title 38]”). None of the provisions cited by Mr. Van
 Dermark imply that, in § 1724, the “furnish” phrase is less
 broad than we have concluded.
                               B
     Having concluded that § 1724(a) prohibits the requested VA payment for treatment abroad, we also conclude that the prohibition is not overridden by the later-
Case: 21-2225    Document: 61      Page: 23    Filed: 01/23/2023




 VAN DERMARK    v. MCDONOUGH                                23



 enacted §§ 1728 or 1725. Mr. Van Dermark contends that,
 even if the “furnish” phrase in § 1724(a)’s prohibition includes “reimbursement,” §§ 1725 and 1728 conflict with the
 prohibition and that the proper resolution of the conflict is
 that §§ 1725 and 1728 govern. We reject that contention at
 the threshold, finding no conflict needing to be resolved.
     The threshold task is to determine if the provisions can
 be harmonized.
     When confronted with two Acts of Congress allegedly touching on the same topic, this Court is not
     at “liberty to pick and choose among congressional
     enactments” and must instead strive “‘to give effect
     to both.’” Morton v. Mancari, 
417 U.S. 535, 551
     (1974). A party seeking to suggest that two statutes cannot be harmonized, and that one displaces
     the other, bears the heavy burden of showing “‘a
     clearly expressed congressional intention’” that
     such a result should follow. Vimar Seguros y Reaseguros, S.A. v. M/V Sky Reefer, 
515 U.S. 528, 533
     (1995). The intention must be “‘clear and manifest.’” 
Morton, supra, at 551
. And in approaching a
     claimed conflict, we come armed with the “stron[g]
     presum[ption]” that repeals by implication are “disfavored” and that “Congress will specifically address” preexisting law when it wishes to suspend
     its normal operations in a later statute. United
     States v. Fausto, 
484 U.S. 439, 452, 453
 (1988).
 Epic Systems v. Lewis, 
138 S. Ct. 1612, 1624
 (2018) (alterations in original) (citations in original, but parallel citations omitted); see Scalia & Garner, Reading Law § 27, at
 180 (“[T]here can be no justification for needlessly rendering provisions in conflict if they can be interpreted harmoniously.”).
     Here, harmonization is straightforward. Section 1724
 requires VA to furnish care abroad in limited circumstances and bars VA from furnishing care abroad in all
Case: 21-2225     Document: 61      Page: 24    Filed: 01/23/2023




 24                                 VAN DERMARK   v. MCDONOUGH



 other circumstances. Section 1728 requires that VA reimburse certain veterans for emergency treatment they receive at non-VA facilities, under VA’s power to furnish care,
 but there is no mention of treatment abroad. The same is
 true of section 1725. The simple textual harmonization of
 the three provisions is that §§ 1728 and 1725 do not apply
 to treatment abroad when such treatment is outside the
 limited authorization of § 1724(b) to furnish such treatment.
     There is, accordingly, no conflict of provisions that
 must be resolved by reference to an identification of greater
 specificity or on any other basis. And there is no occasion
 to test §§ 1728 and 1725 against the presumption against
 extraterritoriality.
                              III
     For the foregoing reasons, we affirm the Veterans
 Court’s decision, concluding that 
38 U.S.C. § 1724
(a) bars
 VA from reimbursing Mr. Van Dermark for the treatment
 he received abroad.
      The parties shall bear their own costs.
                         AFFIRMED

/57/f4th/1374 · .json · Public domain