Citation Nr: 18138299 Decision Date: 09/25/18 Archive Date: 09/25/18 DOCKET NO. 15-39 020A DATE: September 25, 2018 ORDER Payment or reimbursement of unauthorized medical expenses incurred at a private hospital in Jacksonville, Florida from November 22, 2013 through November 23, 2013 is denied. FINDING OF FACT 1. The Veteran served on active duty from March 1987 to May 1996. 2. The medical services provided at a private hospital in Jacksonville, Florida from November 22, 2013 through November 23, 2013 were not rendered in a medical emergency of such a nature that delay would have been hazardous to life or health, or in a situation in which federal facilities were not feasibly available and an attempt to use them beforehand would not have been reasonable. CONCLUSION OF LAW The criteria for entitlement to reimbursement of medical expenses incurred at a private hospital in Jacksonville, Florida from November 22, 2013 through November 23, 2013 have not been met. 38 U.S.C. §§ 1703, 1725, 1728 (2012); 38 C.F.R. §§ 17.120-17.121 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION 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 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). The Veteran has been in receipt of a total disability rating due to individual unemployability since May 31, 2003. Thus, he is eligible for payment or reimbursement of unauthorized private medical expenses under 38 U.S.C. § 1728 if they were incurred in an emergency situation and VA facilities were not feasibly available. With regard to the second criterion, “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 November 22, 2013, the Veteran was seen in the emergency department of a private hospital for symptoms of what was eventually diagnosed as a left inguinal hernia. The final report documents that he was seen by a physician at 23:44 for a one-to-two-week history of left groin pain that was worse with lifting, bearing down, and getting up from a seated position. The Veteran denied any injury to the area, as well as nausea, vomiting, and diarrhea. He reported occasional constipation, but had no urinary complaints or complaints of penile discharge or testicular pain. He was discharged approximately one-half hour later with orders to follow-up with a general surgeon. The Veteran argues that he needed emergency care because he did not know what was going on with his body and that the VA facility was not available at 11:00 pm. A check of the current hours of operation for the VA clinics in the Jacksonville, Florida area indicates that they do not have evening hours on any day of the week. Thus, he is correct that a VA facility was not available in Jacksonville, Florida at the time he sought treatment. However, VA hospitals have emergency departments that are open 24 hours each day. A simple internet map search confirms that the Lake City VA hospital is the closest VA facility with an emergency room and is located approximately one hour away from Jacksonville. The Gainesville VA facility is approximately 90 minutes away. Thus, the questions before the Board are whether the Veteran’s situation was emergent and whether the distance rendered the VA facilities not feasibly available. At the time the Veteran sought medical care, he had several options available: visit a private facility, drive one hour to the nearest VA emergency room, or wait until the next day to make an appointment to visit a Jacksonville clinic. However, he also had had the option to seek VA treatment during the one-to-two weeks he had been experiencing left groin pain and did not find that his symptoms warranted professional medical care of any kind during that time. The Veteran argues that his symptoms had increased to an unbearable level when he sought private treatment; however, while he perceived an increase in severity of his symptoms on the evening of November 22, 2013, such that he believed he needed care on an emergent basis, the increase in symptomatology did not constitute a medical emergency of such nature that it was not reasonable for him to travel to the VA emergency room in for treatment. The private treatment notes do not convey distress or sense of urgency on his part. In fact, the private hospital found the Veteran to be in no acute distress. His heart rate was regular and his respirations were non-labored. The physicians noted nothing unusual or extreme about the left groin pain the Veteran was experiencing. In light of the above facts, the Veteran’s determination that his symptoms were manifestations of a condition for which he should not wait to seek treatment was reasonable, but that his condition was not emergent to the extent that VA facilities were not feasibly available and an attempt to use them beforehand would not have been reasonable at the time given the distance to the VA facility. Accordingly, the criteria for payment or reimbursement of medical expenses incurred from November 22, 2013 through November 23, 2013 are not met, and the claim is denied. Finally, 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). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. M. Schaefer, Counsel