Citation Nr: 18159147 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-47 548 DATE: December 18, 2018 ORDER Payment or reimbursement for unauthorized medical expenses incurred at Flagstaff Medical Center (FMC) from March 22, 2014 through March 29, 2014, is denied. FINDING OF FACT The did not receive medical services from VA within the 24 months preceding March 22, 2014. CONCLUSION OF LAW The criteria for payment or reimbursement for unauthorized medical expenses incurred at FMC from March 22, 2014 through March 29, 2014, are not met. 38 U.S.C. §§ 1703, 1725, 1728, 5107; 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120, 17.121, 17.1002. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from March 1972 to January 1976; he has several disabilities for which service connection has been established. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 letter of determination by a Department of Veterans Affairs (VA) Medical Center, although a copy of that initial denial letter is unavailable as noted in the relevant VA memorandum associated with the claims file. The Veteran received treatment at FMC from March 22, 2014 through March 29, 2014. The Agency of Original Jurisdiction (AOJ) has denied this case on the basis that the Veteran was not enrolled and did not receive medical services under 38 U.S.C. chapter 17 within the 24 months preceding his medical treatment at issue in this case. On appeal, the Veteran has indicated that he contacted the Phoenix VA Medical Center in October 2013 and December 2013; he was told that he was enrolled at that time, although he was informed that he would be scheduled for a primary care appointment when a primary care physician was available. He stated that prior to being scheduled by VA for any medical appointments, he suffered a fall and was admitted to FMC for treatment related to that accident on March 22, 2014. The Veteran specifically noted in his substantive appeal VA Form 9, that the Phoenix VA Medical Center’s history of problems timely scheduling Veterans for appointments; he has argued that if but for VA’s delays in scheduling him for his requested appointments upon enrollment, he would not have been denied payment in this instance and the appeal would not have occurred. As the Veteran did not have any service-connected disabilities on March 22, 2014, and as his treatment was not for any injury or illness contracted in the course of a rehabilitative program, payment or reimbursement under 38 U.S.C. § 1728 is not applicable in this case. See 38 C.F.R. § 17.120. Nonetheless, the Veterans Millennium Health Care and Benefits Act also provides general authority for reimbursement for the reasonable value of emergency treatment furnished in a non-VA facility to those Veterans who are active VA health-care participants (i.e., enrolled in the annual patient enrollment system and recipients of a VA hospital, nursing home, or domiciliary care under such system within the last 24-month period) and who are personally liable for such non-VA treatment and not eligible for reimbursement under the provisions of 38 U.S.C. § 1728. 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000-1008. Payment or reimbursement under 38 U.S.C. § 1725 for emergency treatment (including medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged)) will be made only if all of the following conditions are met when “(d) At the time the emergency treatment was furnished, the veteran was enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. chapter 17 within the 24-month period preceding the furnishing of such emergency treatment. . . .” 38 C.F.R. § 17.1002. The Board must deny the Veteran’s claim for payment or reimbursement of medical expenses incurred at FMC. The evidence demonstrates that, although the Veteran may have been enrolled in the VA healthcare system prior to March 22, 2014, he did not receive any medical services from VA within the 24 months preceding that date. The Veteran’s statements in this case confirm that he did not receive any medical services from VA prior to his accident. Accordingly, as the Veteran did not receive medical services from VA under 38 U.S.C. chapter 17 in this case within the 24 months preceding March 22, 2014, the Board must deny the Veteran’s claim for payment of unauthorized medical expenses incurred at FMC from March 22, 2014 through March 29, 2014, at this time based on the evidence of record. See 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1002 JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel