Citation Nr: 18150895 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 16-15 291A DATE: November 16, 2018 ORDER Payment or reimbursement of medical expenses incurred from April 1 to 5, 2015, at Flagler Hospital (FH) is granted. FINDING OF FACT The Veteran’s treatment from April 1 to 5, 2015, at FH was for a medical emergency requiring immediate medical attention; an attempt to use a Department of Veterans Affairs (VA)-related facility beforehand would not have been reasonable; the Veteran did not stabilize during this period and could not have been transferred to a VA-related facility; and he submitted a claim for payment or reimbursement of the medical expenses of such treatment within 90 days of such treatment. CONCLUSION OF LAW The criteria for payment or reimbursement of medical expenses incurred from April 1 to 5, 2015, at FH been met. 38 U.S.C. §§ 1725, 5107; 38 C.F.R. §§ 17.1000-1008. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1978 to February 1985. This appeal is before the Board of Veterans’ Appeals (Board) from an August 2015 decision of the VA Veterans Health Administration (VHA). Pursuant to 38 U.S.C. § 1725, under certain circumstances, VA shall reimburse a veteran for the reasonable value of emergency treatment furnished the veteran in a non-Department facility. VA regulations at 38 C.F.R. §§ 17.1000 through 17.1008 constitute the requirements under 38 U.S.C. § 1725 that govern VA payment or reimbursement for non-VA emergency services furnished to a veteran for nonservice-connected conditions. 38 C.F.R. §§ 17.1000. For purposes relevant to the facts of this case, to receive payment or reimbursement for emergency services under 38 U.S.C. § 1725, a claimant must file a claim within 90 days after the latest of the following: the date that the veteran was discharged from the facility that furnished the emergency treatment; or the date the veteran finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party. 38 C.F.R. § 17.1004(d). The Veteran received emergency treatment on April 1, 2015, from FH for altered mental status with onset four hours earlier, and reported syncopal episode. He presented appearing very ill with blood in vomit. He was found to be in acute renal failure, marked leukocytosis, and metabolic acidosis, and was admitted to critical care with hypovolemic shock. He was hospitalized and discharged on April 5. VA administrative notes indicate that VA was contacted regarding the Veteran’s hospitalization on April 1, but did not attempt to transfer the Veteran prior to his discharge on April 5. As reflected in the VA treatment records and administrative notes of record, VA has acknowledged that almost all requirements for VA payment or reimbursement for non-VA emergency services under 38 U.S.C. § 1725 had been met for the Veteran’s treatment at FH from April 1 to 5, 2015. Notably, the Veteran’s treatment at that time was for a medical emergency requiring immediate medical attention; an attempt to use VA-related facilities beforehand would not have been reasonable; and the Veteran did not stabilize during this period such that he could have been transferred to a VA-related facility. See 38 C.F.R. §§ 17.1002, 17.1005. However, as reflected in the agency of original jurisdiction’s (AOJ’s) March 2016 statement of the case, the Veteran’s claim for payment or reimbursement was denied on the basis that it had been initially filed in July 2015, after the 90-day period following the Veteran’s April 5, 2015, discharge from FH. As reflected in the February 2016 notice of disagreement and April 2016 substantive appeal, the Veteran wife asserts that she properly submitted a claim for reimbursement for the treatment at FH, along with all appropriate bills, within 60 days of the Veteran’s treatment, toward the end of May 2015. VA administrative records reflect that VA had received the Veteran’s claim and bills regarding his April 2015 treatment at FH within 90 days of the treatment; in this regard, notes dated as early as June 20, 2015, discuss the claim. There is no explanation in the record for the disparity between these administrative notes and the AOJ’s determination that the Veteran had not timely filed a claim. Therefore, resolving reasonable doubt in the Veteran’s favor, the Board finds that he submitted a claim for payment or reimbursement of medical expenses incurred from April 1 to 5, 2015, for treatment at FH within 90 days of such treatment. Again, the record reflects—and VA appears to have conceded—that the remaining requirements for VA payment or reimbursement for non-VA emergency services under 38 U.S.C. § 1725 have been met.   Accordingly, payment or reimbursement of medical expenses incurred from April 1 to 5, 2015, at FH must be granted. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Andrew Mack, Counsel