Citation Nr: 18151905
Decision Date: 11/20/18	Archive Date: 11/20/18

DOCKET NO. 16-19 316A
DATE:	November 20, 2018
ORDER
Payment or reimbursement of private medical expenses incurred at a clinic in St. Cloud, Minnesota, on October 13, 2015, is denied.
FINDINGS OF FACT
1. The Veteran served on active duty from December 1968 to July 1970.
2.  The Veteran received private medical services at a clinic in St. Cloud Minnesota on October 13, 2015 for his service-connected Parkinson’s disease.
3. The medical services were rendered during a regularly scheduled office visit and not in a medical emergency of such a nature that delay would have been hazardous to life or health, or in a situation in which federal facilities were not feasibly available and an attempt to use them beforehand would not have been reasonable.
4. Neither the Veteran nor the private physician contacted VA prior to the October 13, 2015 appointment to obtain prior authorization for non-VA care.
CONCLUSION OF LAW
The criteria for payment or reimbursement of private medical treatment received on October 13, 2015 have not been met. 38 U.S.C. §§ 1703, 1728, 5107 (2012); 38 C.F.R. §§ 17.53, 17.120, 17.130, 17.1002(a)-(c)2, 17.1510-17.1535. 
REASONS AND BASES FOR FINDINGS AND CONCLUSION
VA is authorized to reimburse veterans for emergency medical treatment under 38 U.S.C. § 1725 and 38 U.S.C. § 1728. To be eligible for reimbursement under 38 U.S.C. § 1728, the treatment must have been for associated with a service-connected disability or the veteran must be a participant in a vocational rehabilitation program. 38 U.S.C. § 1728 (a); 38 C.F.R. § 17.120.  
In this case, the private treatment on October 13, 2015 for which the Veteran seeks payment or reimbursement was for his service-connected Parkinson’s disease.  However, medical records clearly show that the treatment occurred during a regularly scheduled office visit and not on an emergent basis.  Moreover, he does not contend that he had sought treatment in an emergency.  Therefore, 38 U.S.C. § 1728 does not apply.  
Rather, the applicable law is the Veterans Choice Program, through which VA furnishes hospital care and medical services through non-VA health care providers to Veterans who either cannot be seen within the wait-time goals of the Veterans Health Administration or who qualify based on their place of residence. See 38 C.F.R. § 17.1510-17.1535. There are several ways in which a veteran may qualify for care under the Veterans Choice Program; however regardless of whether the Veteran is otherwise eligible for such benefits, the care must be pre-authorized.  In this case, the record does not reflect that VA pre-authorized the care the Veteran received on October 13, 2015, or that VA was even contacted before the appointment.  
The Veteran asserts that he should not be responsible for any failure on the part of his private physician to get the appropriate referrals or authorizations.  However, ultimately, responsibility for payment of his medical bills lies with Veteran, and any dispute he has with his physician regarding VA authorizations is outside the Board’s purview.  As the treatment was not emergent and not pre-authorized, payment or reimbursement of private medical expenses incurred at a clinic in St. Cloud, Minnesota on October 13, 2015 is denied.
Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).
 
L. HOWELL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. M. Schaefer, Counsel