Citation Nr: 18158790 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 16-24 676A DATE: December 17, 2018 ORDER Reimbursement or payment for medical expenses incurred due to non-VA medical care, from January 19, 2015, through January 27, 2015, at Lakeland Regional Medical Center (LRMC), is denied. FINDING OF FACT The Veteran did not file a timely claim for reimbursement or payment for medical expenses incurred due to non-VA medical care from LRMC. CONCLUSION OF LAW The criteria for entitlement to reimbursement or payment for medical expenses due to non-VA medical care from LRMC, from January 19, 2015, through January 27, 2015, are not met. 38 U.S.C. § 1725 (2012); 38 C.F.R. § 17.1004(d) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1959 to July 1962. This appeal to the Board of Veterans’ Appeals (Board) is from an August 2015 decision by the Department of Veterans Affairs (VA) medical facility in Tampa, Florida. In his June 2016 substantive appeal (via a VA Form 9), the Veteran requested a Board hearing. While the requested hearing was scheduled for November 2018, a November 2018 statement from his representative reflects the Veteran’s desire withdraw such hearing request. There is no outstanding hearing request. 38 C.F.R. § 20.704(e) (2017). Entitlement to reimbursement or payment for medical expenses incurred due to non-VA medical care, from January 19, 2015, through January 27, 2015, at LRMC. When VA facilities or other government facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility or because they are not capable of furnishing care or services required, VA may contract with non-VA facilities to provide the appropriate care. 38 U.S.C. § 1703 (West 2014); 38 C.F.R. § 17.52 (2017). Further, in general, if VA is to provide payment or reimbursement of medical expenses incurred in connection with a Veteran’s care at a non-VA hospital, the care must be authorized in advance. See 38 U.S.C. § 1703; 38 C.F.R. § 17.54. In the case of an emergency that existed at the time of admission, an authorization may be deemed a prior authorization if an application is made to VA within 72 hours after the hour of admission. 38 C.F.R. § 17.54. When, however, a Veteran receives treatment at a non-VA facility without prior authorization, two statutes allow for payment or reimbursement for the medical expenses incurred for that treatment, specifically, 38 U.S.C. §§ 1725 and 1728 (West 2014). Application of either statute is generally dependent on whether the Veteran has an adjudicated service-connected disability. In the present case, the Veteran has not established service connection for any disability. Therefore, 38 U.S.C. § 1725 applies. As relevant, for time limits for payment or reimbursement claims under 38 U.S.C. § 1725, such claim must be filed within 90 days since the date of the Veteran’s discharge from the non-VA facility. 38 C.F.R. § 17.1004(d) (2017). The Veteran generally contends that reimbursement or payment for the January 2015 non-VA medical care is warranted based on the emergent nature of the claimed non-VA medical care. See January 2016 Notice of Disagreement; June 2016 Substantive Appeal. The Veteran’s claim for payment or reimbursement was previously denied because that claim was found to have been filed untimely, see March 2016 Statement of the Case. Upon review of the evidence, the Board finds that reimbursement or payment for expenses associated with the January 2015 non-VA medical care at LRMC must be denied. The record reflects that the Veteran filed an application for reimbursement or payment for the claimed January 2015 non-VA medical care on May 26, 2015. See March 2016 Statement of the Case. The Veteran has not contended otherwise. As noted, the governing legal authority mandates that claims under 38 U.S.C. § 1725 must be filed within 90 days after the date the claimed medical service was rendered. 38 C.F.R. § 17.1004(d). The Veteran’s May 2015 application was filed past the 90-day time limit after the date of medical service (i.e. after January 27, 2015). There is no provision of law in which the Board may grant the Veteran the benefits sought. Accordingly, the claim for reimbursement or payment for medical expenses for the non-VA medical care, from January 19, 2015, through January 27, 2015, at LRMC, must be denied as a matter of law. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). The Board notes that, while retroactive reimbursement is available under 38 C.F.R. § 17.1004(f), such provision applies for emergency treatment received by the Veteran on or after July 18, 2001, but more than 90 days before May 21, 2012. That provision is inapplicable to the facts of this case. The Board is grateful for the Veteran’s honorable service and regrets that a more favorable outcome could not be reached. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kim, Associate Counsel