Citation Nr: 18152992 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-19 563A DATE: November 27, 2018 ORDER Entitlement to payment or reimbursement of the cost of medical services received at Sarasota Memorial Hospital (SMH) in Sarasota, Florida on June 25, 2015 is granted subject to the regulations governing such payment or reimbursement. FINDING OF FACT Treatment was received in the SMH emergency room (ER) on June 25, 2015 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 a VA or other federal facility was not feasibly available to provide this treatment. CONCLUSION OF LAW The criteria for payment or reimbursement for the cost of the medical services received at SMH on June 25, 2015 are met. 38 U.S.C. § 1725; 38 C.F.R. § 17.1003. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1992 to August 1995. This matter is on appeal before the Board of Veterans Appeals (Board) from an October 2015 decision of the Department of Veterans Affairs Medical Center (VAMC) in Bay Pines, Florida. Entitlement to payment or reimbursement of the cost of medical services received at Sarasota Memorial Hospital (SMH) in Sarasota, Florida on June 25, 2015. The Veteran has claimed payment or reimbursement for the cost of treatment he received at SMH on June 25, 2015. This treatment was not pre-authorized by VA. See 38 C.F.R. § 17.52(a), generally indicating that VA must authorize non-VA treatment at private facilities. Also, the Veteran does not have a total and permanent service-connected disability rating and this treatment was not for any service-connected disability or for any disability that was aggravating a service-connected disability. Likewise, the treatment was not for any injury or illness incurred in relation to participation in a vocational rehabilitation program. Consequently, the Veteran is not eligible for payment or reimbursement for the claimed emergency treatment under 38 U.S.C. § 1728. See 38 C.F.R. § 17.120. Nonetheless, payment or reimbursement for private emergency medical treatment may be considered under 38 U.S.C. § 1725. The primary requirements for payment or reimbursement under this statute are that the Veteran is treated in an emergency department or similar facility held out as providing emergency treatment to the public; the treatment received 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 a VA or federal facility was not feasibly available to provide the treatment. 38 C.F.R. § 17.1002(a-c). SMH ER physician notes dated June 25, 2015 indicate that the Veteran had been drinking extremely large quantities of alcohol over a period of 2 days. Consequently, on the morning of June 25, 2015, he was in a state of extreme intoxication. As a result, his wife called 911 for assistance. The police were dispatched to the Veteran’s house with the initial thought that the Veteran could be taken to First Step, a local 24-hour specialized inpatient alcohol detoxification and treatment center. However, upon assessing the Veteran’s level of intoxication, the officers determined that the Veteran was too intoxicated to be taken directly to First Step. Consequently, they had the local emergency medical services (EMS) transport him via ambulance to the ER at SMH. At the ER, the Veteran was given intravenous fluids and laboratory and EKG testing were performed. After a short stay at the ER, he was medically cleared to be transferred for detoxification treatment at First Step. The above summarized evidence indicates that the Veteran was treated at an emergency department, the SMH ER. Also, the responding police officers determined that the Veteran’s level of intoxication was so acute that he required immediate medical treatment and/or screening before he could be brought to a specialized 24-hour inpatient alcohol detoxification center. Thus, the evidence reasonably indicates that the Veteran’s condition was of such a nature that a prudent layperson would have reasonably expected that delay in seeking this immediate medical attention would have been hazardous to his health. Additionally, the nearest VA ER to the Veteran’s home, the Bay Pines VAMC ER, is approximately 50 miles away whereas the SMH ER is approximately 7 miles away. Moreover, there is no indication that the Veteran had the option to be transported by the ambulance to the Bay Pines ER or to any other federal facility in lieu of transport to SMH, which appears to have been the closest ER. Thus, it is also reasonably established that a VA or other federal facility was not feasibly available to provide the treatment and evaluation the Veteran received at SMH ER. Consequently, all the primary criteria for payment or reimbursement for the cost of the treatment received have been met. 38 C.F.R. § 17.1002(a-c). Moreover, while there are additional criteria that must be met to warrant payment or reimbursement unde 38 U.S.C. § 1725, the VAMC has not found that any of these additional criteria are not met and there is no evidence of record to suggest that any of these criteria are not met. See 38 C.F.R. § 17.1002 (d-h). Accordingly, resolving any reasonable doubt in the Veteran’s favor, payment or reimbursement for the cost of the medical services received at SMH on June 25, 2015 is warranted subject to the provisions of 38 C.F.R. § 17.1005(a), which govern the amount of payment or reimbursement that VA is authorized to provide. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Dan Brook, Counsel