Citation Nr: 18156601 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 14-40 550 DATE: December 11, 2018 ORDER Entitlement to payment or reimbursement for the cost of non-VA medical care provided on January 27, 2014, at The Villages Regional Hospital in The Villages, Florida is granted. FINDING OF FACT The medical services provided at a private hospital on January 27, 2014, were rendered in a medical emergency of such a nature that delay would have been hazardous to life or health, and the situation was analogous to one where federal facilities were not reasonably available and an attempt to use them beforehand would not have been reasonable. CONCLUSION OF LAW The criteria for payment or reimbursement for unauthorized medical expenses incurred at The Villages Regional Hospital on January 27, 2014, are met. 38 U.S.C. §§ 1703, 1725, 1728 (2012); 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120, 17.121, 17.1002 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the United States Marine Corps (USMC) from August 1972 to August 1974. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 administrative decision issued by the Department of Veterans Affairs (VA) Medical Center in Gainesville, Florida. Medical reimbursement At the outset, the Board notes the following fact is not disputed: at the time the medical services were provided the Veteran had a total disability, permanent in nature, resulting from a service-connected disability. As such, the Board must determine whether reimbursement is warranted under 38 U.S.C. § 1728. In that regard, the Board notes the determinative issues of the matter are whether treatment was for a medical emergency, and whether a VA facility was feasibly available. In this case, the Veteran asserted that he should be reimbursed for the cost of non-VA medical expenses incurred for treatment at The Villages Regional Hospital on January 27, 2014. The Veteran stated that he began to feel a lot of pain on the left side of his back, and that he urinated blood a week prior to January 27, 2014; however, he reported that his symptoms worsened on January 26, 2014. He asserted that his wife called VA and spoke with a nurse about his symptoms and that the nurse told his wife that the Veteran should go to the nearest emergency room. Indeed, the record reflects that the Veteran called VA on January 27, 2014, to discuss his symptoms. The Veteran stated that he initially went to The Villages Outpatient Clinic; however, that the VA facility was closed. From there, the Veteran went to a non-VA facility, specifically The Villages Regional Hospital. The Veteran stated that he received some initial treatment, explaining that the non-facility took blood, checked his urine, inserted a PICC line in his arm, and found that he had a fever. He stated that after the initial evaluation, he stayed in the non-VA facility for hours without seeing a doctor. He then stated that the emergency room was being closed, and that he was told to leave the facility. He reported that he left, and went to the VA medical center emergency room in Gainesville, Florida. Indeed, the medical record confirms that the Veteran reported to the non-VA facility with complaints of left flank pain, and dark and cloudy urine. The primary diagnosis was flank pain. The medical record also confirms the Veteran’s contention that the he left the non-VA facility without being seen. However, the medical record notes that the non-VA facility was unclear why the Veteran left. The Board finds the Veteran’s lay statements are credible. In that regard, the Veteran’s statements are consistently supported by the record, and there is no evidence to refute his statements. In light of the above facts, the Board finds that when the Veteran initially went to the non-VA facility that the Veteran’s symptoms were such that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. Further, the Board concludes that, at that time, it was unreasonable to expect the Veteran to have traveled additional miles to a VA facility for emergency treatment. Therefore, the Board determines that VA facilities were not feasibly available for the treatment that occurred on January 27, 2014, and reimbursement for payment of medical expenses incurred at a private hospital on January 27, 2014, is warranted. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD I. Cannaday, Associate Counsel