Citation Nr: 18145164
Decision Date: 10/26/18	Archive Date: 10/26/18

DOCKET NO. 16-10 999
DATE:	October 26, 2018
ORDER
Payment or reimbursement for medical expenses incurred due to non-VA medical care at River Region Medical Center (RRMC) from November 18, 2014, through November 19, 2014, is granted.
FINDINGS OF FACT
1.  The Veteran received emergency services for chest pain at RRMC from November 18, 2014 through November 19, 2014.  
2.  The Veteran’s coverage under third-party insurance paid at least a portion of the private medical expenses incurred at RRMC from November 18, 2014 through November 19, 2014; and he is liable for the remainder of the costs.
CONCLUSION OF LAW
The criteria for establishing entitlement to reimbursement or payment of that part of private medical expenses incurred at RRMC for which the Veteran remains liable, other than any deductible, copayment, or similar payment owed under his third-party medical coverage, are met.  38 U.S.C. § 1725 (2012); 38 C.F.R. §§ 17.1002, 17.1005 (2017); Staab v. McDonald, 28 Vet. App. 50 (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Veteran served on active duty from October 1963 to October 1966 and from October 1970 to November 1971.  
This appeal to the Board of Veterans’ Appeals (Board) is from an August 2015 decision by the Department of Veterans Affairs (VA) Veterans Integrated Service Network (VISN 16) Fee Unit in Flowood, Mississippi.  
Entitlement to payment or reimbursement for medical expenses incurred due to non-VA medical care at RRMC from November 18, 2014 through November 19, 2014
The Veteran contends that reimbursement or payment of that portion of unauthorized medical expenses that he incurred at RRMC due to chest pain in November 2014 is warranted. The record reflects that from November 18, 2014, through November 19, 2014, the Veteran received treatments for chest pain, for which he is not service-connected.  See 38 U.S.C. § 1725 (2012). 
The Agency of Original Jurisdiction (AOJ) denied the present claim based on the Veteran’s third-party medical coverage (Medicare), which the AOJ found to be a bar from reimbursement or payment from VA based on applicable statutes and regulations at that time.  See December 2015 Statement of the Case.  There is no dispute that the Veteran has satisfied the remaining conditions that allow for reimbursement or payment of his unauthorized medical expenses under 38 U.S.C. § 1725.
Since the AOJ’s determination, in April 2016, the United States Court of Appeals for Veterans Claims (Court) invalidated and set aside 38 C.F.R. § 17.1002(f) to the extent that the regulation acts as a bar to reimbursement in cases where a Veteran has only partial coverage under a health plan.  See Staab v. McDonald, 28 Vet. App. 50 (2016).  Accordingly, in cases where a Veteran seeks reimbursement or payment and had partial coverage, such as private insurance for the medical care at issue, VA reimbursement or payment is not precluded as a matter of law.  See id. 
Given the foregoing, entitlement to reimbursement or payment for that part of medical expenses incurred at RRMC from November 18, 2014, through November 19, 2014, for which the Veteran remains liable under his third-party medical coverage, other than any deductible, copayment, or similar payment, see 38 C.F.R. § 17.1005(f), is warranted.  38 U.S.C. § 1725; 38 C.F.R. § 17.1002; Staab, supra.  His appeal is granted to this extent. 

 
MARJORIE A. AUER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. Kim, Associate Counsel