Citation Nr: 18157578 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-24 582A DATE: December 13, 2018 ORDER Payment or reimbursement of unauthorized medical expenses incurred at a private hospital from December 29, 2015 to December 31, 2015 is denied. FINDINGS OF FACT 1. The Veteran served on active duty from December 1966 to December 1969. 2. The Veteran is in receipt of a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), effective April 18, 2005, and is service-connected for coronary artery disease, among other disabilities. 3. VA facilities were feasibly available to the Veteran from December 29, 2015 to December 31, 2015, and he was stable enough to transfer for continuation of treatment at the end of his emergency room (ER) visit on December 29, 2015. CONCLUSION OF LAW The criteria for payment or reimbursement of unauthorized medical expenses incurred at a private hospital from December 29, 2015 to December 31, 2015 are not met. 38 U.S.C. §§ 1703, 1725, 1728, 5107 (2012); 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120, 17.121, 17.1002,17.1005 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran has been in receipt of a TDIU since April 18, 2005. The applicable statute and regulations direct that, in the absence of prior appropriate authorization under 38 C.F.R. §§ 17.53 and 17.54, payment or reimbursement may be made for any disability of a veteran who has a total disability, permanent in nature, resulting from a service-connected disability if the services were rendered in a medical emergency of such nature that delay would have been hazardous to life or health; and, no VA or other Federal facilities were feasibly available and an attempt to use them beforehand would not have been reasonable. 38 U.S.C. § 1728; 38 C.F.R. § 17.120. If any one of the foregoing requirements is lacking, the benefit sought may not be granted. See Zimick v. West, 11 Vet. App. 45, 49 (1998); Malone v. Gober, 10 Vet. App. 539, 547 (1997); see also Melson v. Derwinski, 1 Vet. App. 334, 337 (the use of the conjunctive “and” in a statutory provision meant that all the conditions listed in the provision must be met). “Emergency treatment” requires a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. 38 C.F.R. § 17.120 (b); see also 38 U.S.C. § 1728 (c) (providing that the term “emergency treatment” in this section has the same meaning as given to this term in § 1725(f)(1) of the statute). This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. 38 C.F.R. § 17.120 (b). On December 29, 2015, the Veteran was seen in the ER of a private hospital in Iowa City, Iowa for chest pain with a history of coronary artery disease and a myocardial infarction (MI) in 2011. He was admitted, and a cardiac catheterization and echocardiogram were performed. The diagnosis was ST-elevation MI. Private treatment records reflect that the Veteran was transferred to the Iowa City hospital after initially presenting to the Ottumwa, Iowa ER. Ottumwa ER records lists “Veterans” as one of his insurance providers. Therefore, the Ottumwa hospital was aware of the Veteran’s status; however, there is no discussion of his being transferred to the Iowa City VA Medical Center (VAMC). The only mention of a transfer refers to the transfer to the Iowa City private hospital. The Veteran asserts that he advised hospital staff that he needed to be transferred to the VAMC, and Iowa City private treatment notes reflect that staff were aware that he was normally treated within the VAMC and associated outpatient clinics. However, Iowa City treatment notes also do not discuss any efforts to transfer the Veteran to the VAMC. The clinical tracking notes from the VAMC adjudicating the appeal indicate that the VAMC was first notified of the Veteran’s hospitalization by the private hospital in Iowa City on December 31, 2015. It is not clear why neither the Ottumwa hospital nor the Iowa City hospital contacted the VAMC with regard to the Veteran’s care until the date of his discharge. Nevertheless, it is ultimately the Veteran’s responsibility to ensure that he is transferred to a VA facility or otherwise receives authorization for non-VA care. Thus, while the Veteran’s symptoms on December 29, 2015 required emergency care, VA facilities were feasibly available, and he should have been transferred to a VA hospital after the initial emergency care he received in Ottumwa, Iowa. Therefore, the criteria for payment or reimbursement of medical expenses are not met for the care received from December 29, 2015 to December 31, 2015, and the appeal is denied. 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). U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. M. Schaefer, Counsel