Citation Nr: 1306004 Decision Date: 02/21/13 Archive Date: 02/27/13 DOCKET NO. 11-18 136 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical Center in Columbus, Ohio THE ISSUE Entitlement to payment or reimbursement of unauthorized medical expenses incurred during a hospitalization at Riverside Methodist Hospital from March 13, 2010 through March 16, 2010. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD Paul S. Rubin, Counsel INTRODUCTION The Veteran had active service from June 1972 to June 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from May 2010 decisions by the Department of Veterans Affairs (VA) Medical Center (VAMC), in Columbus, Ohio. The VAMC is the Agency of Original Jurisdiction (AOJ) in the present matter. In February 2012, the Veteran presented testimony at a Travel Board hearing at the RO before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims folder. After this hearing, the appellant was given 30 days to submit additional evidence. See 38 C.F.R. § 20.709 (2012). He submitted additional argument and private medical records in March 2012, in a timely fashion. At the hearing, he had previously waived his right to have the RO initially consider this additional evidence. See 38 C.F.R. §§ 20.709, 20.800, 20.1304(c) (2012). Thus, the Board accepts this evidence for inclusion in the record and consideration by the Board at this time. A review of the Virtual VA paperless claims processing system does not reveal any additional documents pertinent to the present appeal. FINDINGS OF FACT 1. The Veteran was treated at Riverside Methodist Hospital from March 11, 2010 through March 16, 2010, for a nonservice-connected disability (a stroke). 2. The VA already granted payment or reimbursement of unauthorized medical expenses incurred during his hospitalization at Riverside Methodist Hospital from March 11, 2010 through March 12, 2010. 3. The totality of the evidence reveals that the Veteran could have been safely transferred to a VA facility on March 13, 2010, for continuation of treatment. In other words, the Veteran's condition was stable as of March 13, 2010 through March 16, 2010. 4. The totality of the evidence reveals that Riverside Methodist Hospital did not make or document any reasonable attempts to request transfer of the Veteran to a VA facility. There is also no probative evidence of record that a VA medical facility rejected any potential transfer. CONCLUSION OF LAW The criteria for payment or reimbursement of unauthorized medical expenses incurred during a hospitalization at Riverside Methodist Hospital from March 13, 2010 through March 16, 2010 are not met. 38 U.S.C.A. §§ 1703, 1725, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.159, 17.52, 17.1001(d), 17.1002, 17.1005 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Duties to Notify and Assist Review of the medical expenses folder, more commonly known as the duplicate Consolidated Health Record (CHR) file or Medical Administration Service (MAS) folder, does reveal compliance with the Veterans Claims Assistance Act of 2000 (VCAA), 38 U.S.C.A. § 5100 et seq. See also 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The duty to notify was accomplished by way of a VCAA letter from the VAMC to the Veteran dated in April 2011. This letter effectively satisfied the notification requirements of the VCAA consistent with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) by: (1) informing him about the information and evidence not of record that was necessary to substantiate his medical expense reimbursement claim; (2) informing him about the information and evidence the VA would seek to provide; and (3) informing him about the information and evidence he was expected to provide. See also Pelegrini v. Principi, 18 Vet. App. 112 (2004) (Pelegrini II); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). In any event, the Veteran's personal statements and hearing testimony demonstrate he has actual knowledge of what evidence is required to establish payment or reimbursement of unauthorized medical expenses. See Mlechick v. Mansfield, 503 F.3d 1340, 1345 (Fed. Cir. 2007) (any notice error not prejudicial when claimant has actual knowledge of the evidence needed to substantiate claim). Specifically, the Veteran has stated that he was not stable from March 13, 2010 through March 16, 2010 during his private hospitalization, such that his continued hospitalization was rendered in a continuing "medical emergency." From March 13, 2010 through March 16, 2010, he states that he required frequent medical testing subsequent to his stroke, as well as surgery due to a clogged artery. Notably, the Veteran was advised by the undersigned at the hearing that he needed to submit evidence from the private hospitals showing that he was not stable for transfer - revealing that it would have been unsafe. The Veteran's representative at the hearing argued that the Veteran may have been at risk of another stroke if he was transferred, and that he needed the surgery promptly. In the alternative, the Veteran also states he is being penalized for VA's failure to transfer him to a private facility. He indicates that VA failed to contact him and take adequate measures to transfer him. He also argues that he did not sign a transfer consent to a VA facility because he wanted a doctor to make that determination, as opposed to a social worker from the private hospital. See April 2011 VA Form 9; March 2012 Veteran's statement; February 2012 hearing testimony. So the Board is satisfied the Veteran was afforded a meaningful opportunity to participate in the adjudication of his claim. Overton v. Nicholson, 20 Vet. App. 427, 435 (2006). As such, the Board concludes prejudicial error in the content of VCAA notice has not been established as any alleged error was not outcome determinative. See Shinseki v. Sanders, 556 U.S. 396 (2009) (An error in VCAA notice should not be presumed prejudicial and the burden of showing harmful error rests with the party raising the issue, to be determined on a case-by-case basis). As for the duty to assist, the Board is satisfied that the duty to assist has been met, as well, as all pertinent private hospitalization records and medical bills were submitted or obtained. In addition, VA secured March 2010 VA nurse telephone notes regarding notification from the private facility to VA of the Veteran's unauthorized hospitalization in March 2010. VA also secured an April 2010 Chief of Staff opinion from VA medical personnel to address the critical issue of the time of the medical emergency. The Veteran has also submitted medical evidence, personal statements, and hearing testimony. At the February 2012 hearing, the undersigned Veterans Law Judge, representative for the Veteran, and Veteran himself outlined the issue on appeal and engaged in a colloquy as to substantiation of the claim. The Veteran was properly advised what favorable evidence he needed to submit. The file was left open for 30 days for the submission of additional evidence. The actions of the Veterans Law Judge supplement VCAA and comply with any duty that is owed during a hearing. In short, the Travel Board hearing was legally sufficient. In summary, the Board is satisfied that the duty to assist has been met. 38 U.S.C.A. § 5103A. Background Facts and Contentions The Veteran was hospitalized on the evening of Wednesday March 10th, 2010, at a private facility, Mount Carmel St. Ann's Hospital, after experiencing complete loss of vision in his left eye, and weakness to the right side. He also complained of intermittent paresthesias of the right foot. He had slurred speech. He was diagnosed with having a stroke / cerebral vascular accident (CVA). This private hospitalization was for a nonservice-connected condition. The St. Ann's Hospital hospitalization on March 10, 2010 is not at issue for reimbursement here. In the early morning of Thursday, March 11th, 2010, the Veteran was transferred by EMT personnel at St. Ann's Hospital to Riverside Methodist Hospital. St. Ann's Hospital indicated in a discharge report that it was unable to perform the emergency procedures needed, thus necessitating the transfer to Riverside. He was taken by ambulance with a mobile intensive care unit. VA authorized reimbursement of medical expenses for his hospitalization at Riverside Methodist Hospital for March 11th to March 12th, 2010, on the basis that his care was rendered in a "medical emergency." This issue is not in dispute. During the Veteran's subsequent hospitalization at Riverside Methodist Hospital from March 13, 2010 through March 16, 2010, he was found to have acute left frontal lacunar infarct and high-grade stenosis of the proximal left internal carotid artery. From March 13, 2010 through March 16, 2010, the Veteran had further evaluation and testing of the brain performed. On March 15, 2010, he underwent a left carotid endarterectomy procedure. Subsequent to surgery he was completely asymptomatic and ambulating without any problems, with no further neurological symptoms. However, VA has denied payment or reimbursement of unauthorized medical expenses incurred during his hospitalization at Riverside Methodist Hospital from March 13, 2010 through March 16, 2010, on the basis that beginning March 13, 2010, his hospitalization was not "emergency treatment" since the Veteran's condition had "stabilized." In other words, his claim was only approved for authorization of payment up until the point the medical condition had stabilized. The VAMC determined that since the Veteran's medical condition had stabilized on March 13, 2010, with VA facilities feasibly available for care, transfer to a VA treatment facility could have been safely accomplished. See May 2010 administrative decisions of the VAMC in Columbus, Ohio, and April 2011 SOC. The Veteran and his providers, however, request reimbursement of these unauthorized medical expenses from Riverside Methodist Hospital dated from March 13, 2010 through March 16, 2010. He contends that he was not stable for transfer to a VA facility on March 13, 2010 - that it would have been unsafe. He believes he was still receiving emergency treatment on March 13, 2010 and thereafter. The Veteran's representative at the hearing argued that the Veteran may have been at risk of another stroke if he was transferred to a VA facility, and that he needed the surgery to be performed promptly. In the alternative, to the extent he was stable, the Veteran also states he is being penalized for VA's failure to transfer him. He indicates that VA failed to contact him, and take adequate measures to transfer him to a VA facility. He also argues that he did not sign a transfer consent to a VA facility because he wanted a doctor to make that determination, as opposed to a social worker from the private hospital. See April 2011 VA Form 9; March 2012 Veteran's statement; February 2012 hearing testimony. Governing Laws and Regulations Initially, under 38 U.S.C.A. § 1703, when VA facilities or other government facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility or are not capable of furnishing care or services required, VA may authorize or contract with non-VA facilities for care. 38 U.S.C.A. § 1703(a) (West 2002 & Supp. 2012); 38 C.F.R. § 17.52(a) (2012). However, the Veteran has never contended, and the evidence does not demonstrate, that he received prior VA authorization for his private hospitalization. Therefore, application of 38 U.S.C.A. § 1703(a) for reimbursement of "authorized" private hospitalization is unwarranted. In short, the issue of prior authorization is not applicable here. Regardless, when the Veteran receives treatment at a non-VA facility without prior authorization, such as the case here, there are two statutes that allow for claimants to be paid or reimbursed for the medical expenses incurred for that treatment - specifically, 38 U.S.C.A. § 1728 and 38 U.S.C.A. § 1725. Application of either statute is generally dependent on whether the Veteran has an adjudicated service-connected disability or not. Since the treatment in question was rendered for a nonservice-connected disability (a stroke), the Veteran is not eligible for payment or reimbursement of "unauthorized" medical expenses incurred at a non-VA facility under 38 U.S.C.A. § 1728(a). There is also no evidence or allegation he is participating in a vocational rehabilitation program under 38 U.S.C. Chapter 31, which in certain instances might have qualified him under 38 U.S.C.A. § 1728. Consequently, the only conceivable route to entitlement to unreimbursed medical expenses in this case stems from 38 U.S.C.A. § 1725, for treatment of a nonservice-connected disorder, pursuant to the Veterans Millennium Health Care and Benefits Act. See also 38 C.F.R. §§ 17.1000-17.1008 (2012). Effective October 10, 2008, the provisions of 38 U.S.C.A. § 1725 and § 1728 were amended. See Veterans' Mental Health and Other Care Improvements Act of 2008, Pub. L. No. 110-387, § 402, 122 Stat. 4110 (2008). This bill made various changes to Veteran's mental health care and also addresses other health care related matters. The changes are liberalizing in that they make reimbursement for medical expenses mandatory instead of discretionary, as well as expand the definition of "emergency treatment" beyond the point of stabilization. In addition, the changes apply the more liberal prudent layperson standard for determining whether an actual medical emergency existed under either 38 U.S.C.A. § 1725 and § 1728. The amended law expands the meaning of "emergency treatment" under section 1725(f)(1) by stating: (1) The term "emergency treatment" means medical care or services furnished, in the judgment of the Secretary-- (A) when Department or other Federal facilities are not feasibly available and an attempt to use them beforehand would not be reasonable; (B) when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and (C) until-- (i) such time as the Veteran can be transferred safely to a Department facility or other Federal facility and such facility is capable of accepting such transfer; or (ii) such time as a Department facility or other Federal facility accepts such transfer if-- (I) at the time the Veteran could have been transferred safely to a Department facility or other Federal facility, no Department facility or other Federal facility agreed to accept such transfer; and (II) the non-Department facility in which such medical care or services was furnished made and documented reasonable attempts to transfer the Veteran to a Department facility or other Federal facility. See 38 U.S.C.A. § 1725 (West 2002 & Supp. 2012). Effective January 20, 2012, VA regulations implementing 38 U.S.C.A. § 1725 and § 1728 were amended to conform to the statutory changes. See 76 Fed. Reg. 79,067-79,072 (December 21, 2011). The amendments affected the following Title 38 regulations: 38 C.F.R. §§ 17.120 , 17.121, 17.1001, 17.1002, 17.1005, 17.1006, and 17.1008. Pursuant to 38 C.F.R. § 17.1002(a)-(h), to be eligible for payment or reimbursement for emergency services for nonservice-connected conditions in non-VA facilities under the statute and the implementing regulations, the Veteran must satisfy all of the following conditions: (a) The emergency services were provided in a hospital emergency department or a similar facility held out as providing emergency care to the public; (b) The claim for payment or reimbursement for the initial evaluation and treatment is for a condition of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health (this standard would be met if there were an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part); (c) A VA or other Federal facility/provider that VA has an agreement with to furnish health care services for Veterans was not feasibly available and an attempt to use them beforehand would not have been considered reasonable by a prudent layperson (as an example, these conditions would be met by evidence establishing that a Veteran was brought to a hospital in an ambulance and the ambulance personnel determined the nearest available appropriate level of care was at a non-VA medical center); (d) At the time the emergency treatment was furnished, the Veteran was enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. Chapter 17 within the 24-month period preceding the furnishing of such emergency treatment; (e) The Veteran is financially liable to the provider of emergency treatment for that treatment; (f) The Veteran has no coverage under a health-plan contract for payment or reimbursement, in whole or in part, for the emergency treatment (this condition cannot be met if the Veteran has coverage under a health-plan contract but payment is barred because of a failure by the Veteran or the provider to comply with the provisions of that health-plan contract, e.g., failure to submit a bill or medical records within specified time limits, or failure to exhaust appeals of the denial of payment); (g) If the condition for which the emergency treatment was furnished was caused by an accident or work-related injury, the claimant has exhausted without success all claims and remedies reasonably available to the Veteran or provider against a third party for payment of such treatment; and the Veteran has no contractual or legal recourse against a third party that could reasonably be pursued for the purpose of extinguishing, in whole, the Veteran's liability to the provider; and (h) The Veteran is not eligible for reimbursement under 38 U.S.C. 1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA payment or reimbursement for emergency treatment to a limited group of Veterans, primarily those who receive emergency treatment for a service-connected disability). See 38 C.F.R. § 17.1002(a)-(h) (2012). All of the above elements must be satisfied for a claimant to qualify for payment or reimbursement. Zimick v. West, 11 Vet. App. 45, 49 (1998); Malone v. Gober, 10 Vet. App. 539, 544 (1997). That is, these criteria under 38 U.S.C.A. § 1725 and 38 C.F.R. § 17.1002(a)-(h) are conjunctive, not disjunctive; thus, all criteria must be met. See Melson v. Derwinski, 1 Vet. App. 334 (June 1991) [use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met]; compare Johnson v. Brown, 7 Vet. App. 95 (1994) [only one disjunctive "or" requirement must be met in order for an increased rating to be assigned]. The Court also held that both medical and lay evidence may be considered in a prudent layperson evaluation for determining what constitutes a "medical emergency." That is, VA should weigh "the totality of the circumstances" to determine whether a prudent layperson would consider the situation emergent. Swinney v. Shinseki, 23 Vet. App. 257, 264-266 (2009). With regard to the issue of stabilization, VA regulation provides the term stabilized means that no material deterioration of the emergency medical condition is likely, within reasonable medical probability, to occur if the Veteran is discharged or transferred to a VA or other Federal facility that VA has an agreement with to furnish health care services for Veterans. 38 C.F.R. § 17.1001(d) (2012). With regard to stabilization, VA regulation provides that VA will not approve claims for payment or reimbursement of the costs of emergency treatment not previously authorized for any period beyond the date on which the medical emergency ended. For this purpose, VA considers that an emergency ends when the designated VA clinicians at the VA facility has determined that, based on sound medical judgment, a Veteran who received emergency treatment: (1) could have been transferred from the non-VA facility to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for Veterans) for continuation of treatment, or (2) could have reported to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for Veterans) for continuation of treatment. 38 C.F.R. § 17.1005(b) (2012). However, claims for payment or reimbursement of the costs of emergency treatment not previously authorized may be approved for continued, non-emergent treatment (that is, beyond the point of stabilization), only if: (1) the non-VA facility notified VA at the time the Veteran could be safely transferred to a VA facility (or other Federal facility that VA has an agreement with to furnish health care services for Veterans) and the transfer of the Veteran was not accepted, and (2) the non-VA facility made and documented reasonable attempts to request transfer of the Veteran to VA (or request transfer of the Veteran to VA (or to another Federal facility that VA has an agreement with to furnish health care services for Veterans), which means the non-VA facility contracted either the VA Transfer Coordinator, Administrative Officer of the Day, or designated staff responsible for accepting transfer of patients at a local VA (or other Federal facility) and documented such contact in the Veteran's progress/physicians' notes, discharge summary, or other applicable medical record. 38 C.F.R. § 17.1005(c) (2012). Finally, under VA regulation, if a stabilized Veteran who requires continued non-emergency treatment refuses to be transferred to an available VA facility (or other Federal facility that VA has an agreement with to furnish health care services for Veterans), VA will make payment or reimbursement only for the expenses related to the initial evaluation and the emergency treatment furnished to the Veteran up to the point of refusal of transfer by the Veteran. 38 C.F.R. § 17.1005(d) (2012). In short, under the new version of 38 U.S.C.A. § 1725, effective October 10, 2008, and its implementing regulation, 38 C.F.R. § 17.1005, VA is authorized to make payment beyond the point of stabilization if certain criteria are met. The public policy behind the change in law is that if VA fails to promptly transfer the Veteran to a VA facility upon request, once he has stabilized, it is unjust to make the Veteran liable for additional expense at the non-VA facility due to no fault of his own. In determining the claim at issue, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis The Veteran has already met the initial substantive criteria for payment or reimbursement listed under 38 C.F.R. § 17.1002(a)-(h) (2012). That is, it has been already determined by the VAMC that the claim for reimbursement was timely filed by the private provider; the Veteran is financially liable to the private provider of treatment; the Veteran is without health insurance; the Veteran was enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. Chapter 17 within the 24-month period preceding the furnishing of such emergency treatment; the Veteran is not eligible for reimbursement under 38 U.S.C. 1728 for the emergency treatment provided; the services in question were provided in a hospital emergency department; the claim for payment or reimbursement for the initial evaluation and treatment is for a condition of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health; and initially a VA facility was not feasibly available and an attempt to use it beforehand would not have been considered reasonable by a prudent layperson (established by the Veteran's initial use of an ambulance). See 38 C.F.R. § 17.1002(a)-(h) (2012). However, the remaining issues in the present case are the following: (1) whether from March 13, 2010 to March 16, 2010, the medical emergency had ended, with stabilization of the Veteran's condition, such that he could have been transferred from Riverside Methodist Hospital to a VA facility for continuation of treatment; and (2) if the Veteran was stable, whether Riverside Methodist Hospital made and documented reasonable attempts to request transfer of the Veteran to a VA facility, but the transfer of the Veteran was not accepted by the VA facility. See 38 U.S.C.A. § 1725(f)(1)(C); 38 C.F.R. §§ 17.1001(d), 17.1005(b), (c). Simply stated, the Veteran prevails if the Board concludes he was not stable on March 13, 2010, or, if he was stable, Riverside Methodist Hospital still made and documented reasonable attempts to transfer the Veteran to a VA facility but he was not accepted. Upon review of the evidence, the Board finds that the requirements for payment or reimbursement for unauthorized emergency medical treatment from March 13, 2010 to March 16, 2010 at Riverside Methodist Hospital under 38 U.S.C.A. § 1725 are not met. In this regard, the totality of the circumstances demonstrates that the Veteran's condition had stabilized as of March 13, 2010. In addition, Riverside Methodist Hospital did not make or document reasonable attempts to transfer the Veteran to a VA facility. There is also no indication a VA facility rejected any transfer attempts. As to stability, an earlier St. Ann's Hospital report dated on March 10, 2010 assessed that even at that earlier time, the Veteran's condition had stabilized such that within a reasonable medical probability no material deterioration ot the patient would likely result from his transfer to Riverside Methodist Hospital. Despite the noted transfer risks of stroke with paralysis or the cessation of breathing, the transfer was successfully undertaken on March 10, 2010. As to stability, daily progress notes from Riverside Methodist Hospital dated from March 13, 2010 to March 15, 2010 describe that the Veteran's vision disturbances are "better"; his right upper extremity weakness was "better" and "improved"; his cardiovascular, respiratory, and GI systems were "within normal limits"; he was "awake and alert"; his cranial nerves were grossly intact; he had "no overnight issues"; and no clubbing, edema, or cyanosis of the extremities was noted. Moreover, flow sheets from Riverside Methodist Hospital dated from March 13, 2010 to March 14, 2010 describe the Veteran as calm, cooperative, alert, awake, oriented, with clear speech, with no eye deficit, no facial droop, no facial tingling or numbness, no extremity drift, normal upper and lower extremity strength, normal breathing, normal cardiac function, normal tissue integrity, steady gait, and no problem with mobility. As to stability, a Riverside Discharge Summary dated on March 16, 2010 notes that the Veteran "remained stable after his surgery" which was on March 15, 2010. He did not have any further significant neurological deficit. He was described as completely asymptomatic, with no neurological deficit, ambulating without any problem, such that he was discharged on March 16, 2010. As to stability, in April 2010 the Chief of Staff from a Columbus, Ohio VA outpatient clinic, after reviewing the Veteran's private hospital records discussed above, opined that the Veteran was only authorized reimbursement from March 11, 2010 to March 12, 2010. There was no authorization after that point. Notably, there is no contrary medical opinion on file that he was not stable. As to stability, with regard to lay evidence, the Veteran contends that he was not stable for transfer to a VA facility on March 13, 2010 - that it would have been unsafe. The Veteran's representative at the hearing suggested that the Veteran may have been at risk of another stroke if he was transferred to a VA facility, and that he needed the surgery performed promptly. See April 2011 VA Form 9; March 2012 Veteran's statement; February 2012 hearing testimony. Although the Veteran and his representative are competent to describe his symptoms from March 13, 2010 to March 16, 2010, the Board finds the medical observations discussed in detail above to be more probative. That is, the observation of unbiased, skilled medical professionals is more probative as to the Veteran's condition from March 13, 2010 to March 16, 2010. There was simply no documentation of instability of his medical status as of March 13, 2010. The Veteran's symptoms had clearly dissipated since his emergency admission on March 10, 2010. The medical evidence clearly shows that material deterioration of the Veteran's medical condition would not have been likely upon transfer, as of March 13, 2010. Medical evidence merely documents that the Veteran remained at Riverside Methodist Hospital for further testing and for his surgery from March 13, 2010 to March 16, 2010. There is no persuasive medical or lay evidence of record that the Veteran could not have been safely transferred to a VA facility as of March 13, 2010. There is no evidence of record VA rejected a transfer. In summary, the totality of the evidence establishes that the Veteran was stable and could have been transferred from the non-VA facility to a VA medical center for continuation of treatment. 38 C.F.R. § 17.1005(b). The Board now turns to the issue of VA's authorization to make payment beyond the point of stabilization if certain criteria are met. 38 C.F.R. § 17.1005(c). (2012). As to the lay evidence on this issue, the Veteran states he is being penalized for VA's failure to transfer him to a private facility. He says he advised a social worker at Riverside Methodist Hospital to inform VA that he was at a private facility. He indicates that VA failed to contact him after being informed, and did not take adequate measures to transfer him to a VA facility. He adds that he did not sign a transfer consent to a VA facility because he wanted a doctor to make that determination, as opposed to a social worker from the private hospital. See March 2012 Veteran's statement; February 2012 hearing testimony. To the extent the Veteran is saying he would not cooperate in any transfer by not signing a consent form, this particular statement is probative, because under VA regulation, if a stabilized Veteran who requires continued non-emergency treatment refuses to be transferred to an available VA facility, VA will make payment or reimbursement only for the expenses related to the initial evaluation and the emergency treatment furnished to the Veteran up to the point of refusal of transfer by the Veteran. See 38 C.F.R. § 17.1005(d). Overall, the Veteran's lay assertions on this matter are not particularly helpful to his claim. A VA nurse telephone note dated March 11, 2010 reflects that VA was indeed notified of the Veteran's private emergency hospitalization at Riverside Methodist Hospital for his stroke. Significantly, the nurse wrote "[w]ill follow-up for possible transfer to VA if patient agrees." (Emphasis added). A latter VA nurse telephone note indicates that the following day, on March 12, 2010, a social worker from Riverside Methodist Hospital contacted VA and stated that transfer to VA "would not be needed." This statement, in particular, provides strong evidence against the Veteran's claim that VA was at fault for the lack of transfer. These VA telephone notes fail to establish that a VA facility rejected any transfer attempts from Riverside Methodist Hospital, or would not have been able to accept a transfer. The records from RMH do not conflict with the log prepared by VA. Therefore, under the amended provisions of 38 U.S.C.A. § 1725, the preponderance of the evidence is against the Veteran's unauthorized medical expenses claim, such that it must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). ORDER Payment or reimbursement of unauthorized medical expenses incurred during a hospitalization at Riverside Methodist Hospital from March 13, 2010 through March 16, 2010 is denied. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs