Citation Nr: 18113294
Decision Date: 06/21/18	Archive Date: 06/21/18

DOCKET NO. 11-13 617
DATE:	June 21, 2018
ORDER
Payment or reimbursement for that part of medical expenses for which the Veteran remains liable, incurred due to his medical care at Citrus Memorial Hospital (CMH) on December 19, 2010, is granted.
FINDINGS OF FACT
1.  The Veteran received emergency services at CMH on December 19, 2010. 
2.  The Veteran’s coverage under Medicare paid at least a portion of the private medical expenses incurred at CMH on December 19, 2010; and he is liable for the remainder of the costs.
CONCLUSION OF LAW
The criteria for establishing entitlement to reimbursement or payment of that part of private medical expenses, incurred at CMH, for which the Veteran remains liable, are met.  38 U.S.C. § 1725 (2012); 38 C.F.R. § 17.1002 (2017); Staab v. McDonald, 28 Vet. App. 50 (2016).

REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Veteran served on active duty from October 1965 to October 1968.  
This appeal to the Board of Veterans’ Appeals (Board) is from a March 2011 decision by the Department of Veterans Affairs (VA) Health System in North Florida/South Georgia.  
In a December 2015 Board decision, the Board denied the issue of entitlement to payment or reimbursement for medical expenses incurred due to the Veteran’s medical care at CMH on December 19, 2010.  The Veteran subsequently appealed the December 2015 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In a November 2017 Order, the Court granted the parties’ October 2017 Joint Motion for Remand (JMR), vacating the Board’s December 2015 decision under Staab v. McDonald, 28 Vet. App. 50 (2016) and remanded the appeal to the Board for readjudication.   
Entitlement to payment or reimbursement for medical expenses incurred in connection with the Veteran’s medical care at CMH on December 19, 2010
The Veteran contends that reimbursement or payment of that portion of unauthorized medical expenses that he incurred at CMH on December 19, 2010, that have not been paid by his medical coverage under Medicare, is warranted. The record reflects that he received this treatment for chest pain, for which he is not service-connected.  See 38 U.S.C. § 1725. 
In December 2015, the Board denied the present claim based on the Veteran’s medical coverage under Medicare, which the Board found to be a bar from reimbursement or payment from VA pursuant to the applicable statutes and regulations at that time.  There is no dispute that the Veteran has satisfied the remaining conditions that allow for reimbursement or payment of his unauthorized medical expenses under 38 U.S.C. § 1725. 
As pointed out in the October 2017 JMR, in April 2016, the Court invalidated and set aside 38 C.F.R. § 17.1002(f) to the extent that the regulation acts as a bar to reimbursement in cases where a Veteran has only partial coverage under a health plan.  See Staab, 28 Vet. App. at 55.  Accordingly, in cases where a Veteran seeks reimbursement or payment and had partial coverage, such as private insurance or Medicare for the medical care at issue, VA reimbursement or payment is not precluded as a matter of law.  See id. 
Given the foregoing, entitlement to reimbursement or payment for that part of the private medical expenses incurred at CMH on December 19, 2010, unpaid by the Veteran’s Medicare, for which he remains liable, is warranted.  38 U.S.C. § 1725; 38 C.F.R. § 17.1002; Staab, supra.  His appeal is granted. 

 
M. E. KILCOYNE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. Kim, Associate Counsel