Citation Nr: 18160236
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 16-44 660
DATE:	December 26, 2018
ORDER
Entitlement to payment or reimbursement for unauthorized medical expenses incurred at Pitt County General Hospital on March 17, 2012, is granted.
FINDING OF FACT
The Veteran received care for a nonservice-connected disability at Pitt County General Hospital on March 17, 2012.  That care constituted emergency treatment and a VA facility was not feasibly available at the time.
CONCLUSION OF LAW
The criteria for payment or reimbursement for unauthorized medical expenses incurred at Pitt County General Hospital on March 17, 2012, have been met. 38 U.S.C. §§ 1725, 1728, 5103A, 5107 (2012); 38 C.F.R. §§ 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 May 1974 to March 1976.
This case comes before the Board of Veterans’ Appeals (Board) on appeal from an February 2013 administrative decision issued by the Department of Veterans Affairs (VA) Medical Center in Durham, North Carolina.  
Medical reimbursement
The record does not show that the Veteran is service connected for left arm pain and weakness, his left arm pain and weakness has not been associated with and held to be aggravating an adjudicated service-connected disability, at the time of treatment he did not have a total disability permanent in nature resulting from a service-connected disability, nor is he a participant in an eligible rehabilitation program.  Therefore, the Veteran did not meet the criteria for payment of authorized or unauthorized medical expenses of 38 U.S.C. § 1728 (2012); thus, the Veteran’s claim for payment must be considered under criteria for determining entitlement under the Veterans Millennium Healthcare and Benefits Act (Act), 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000 - 17.1008. 
The Veteran reported that he sought treatment at the Pitt County General Hospital on March 17, 2012, for what he believed to be a heart attack.  He reported that he went to the closest emergency room for treatment.  The Veteran’s wife also stated that the nearest VA facilities were geographically unfeasible for his emergent condition. The claim was denied on the basis of feasibility of a VA facility and non-emergent treatment.
Medical treatment records note that upon arrival to the emergency department, the Veteran had symptoms of left arm pain and weakness that began 3 days prior to treatment.  He stated that morning he woke up with dry mouth, and felt his tongue swollen. The Veteran stated that he then took medication at home which helped his symptoms. However, that he subsequently developed tingling in his left arm along with the previous symptoms of pain and weakness. Further, after the Veteran’s initial emergency department evaluation, the hospital determined that the Veteran required further evaluation and treatment. In fact, the medical record noted that the Veteran left the private hospital against the advice of his physician.
Moreover, as mentioned above, the Veteran’s wife indicated that there were not any VA medical facilities near the private hospital that the Veteran sought treatment. Indeed, the file suggests that the VA facility was father from his home than the Pitt County General Hospital.
In light of the above facts, the Board finds 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 it is 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 March 17, 2012.  Thus, the claim for reimbursement or payment of medical expenses incurred at a private hospital is granted.
 
Kristin Haddock
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	I. Cannaday, Associate Counsel