Citation Nr: 21001435 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 16-11 530A DATE: January 8, 2021 ORDER Payment or reimbursement of medical expenses incurred on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management and Klickitat County EMS, Yakima Washington is granted. FINDINGS OF FACT 1. A prudent layperson would have reasonably expected that delay in seeking immediate medical attention for the Veteran’s condition on April 21, 2015 through April 23, 2015, would have been hazardous to life or health; a Department of Veterans Affairs (VA)-related medical facility was not feasibly available during his emergency, and an attempt to use one beforehand would not have been considered reasonable by a prudent layperson. 2. The Veteran received VA health care or “medical services” within the 24-month period preceding the furnishing of his non-VA emergency treatment on April 21, 2015 through April 23, 2015. CONCLUSION OF LAW The criteria for payment or reimbursement of medical expenses incurred on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management, and Klickitat County EMS, Yakima Washington have been met. 38 U.S.C. §§ 1701, 1725, 5107; 38 C.F.R. §§ 17.1000-1008. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Navy from June 1972 to June 1976. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2015 and August 2015 denials by the Department of Veterans Affairs (VA) Northwest Network and Payment Center in Portland Oregon. The Veteran testified before the undersigned Veterans Law Judge in a hearing. The transcript has not yet been associated with the claims file, but for the reasons below, one is not necessary for a decision on the claim. The Board notes the Veteran expressed concern regarding the manner of reimbursement, given that he has already paid medical bills for his episode of care from April 21, 2015 through April 23, 2015. In cases where medical expenses were not already paid by third party insurance carriers, medical reimbursement payments are generally governed by 38 C.F.R. § 17.1005(a)(1), which provides for reimbursement to the Veteran with certain limitations. 1. Payment or reimbursement of medical expenses incurred on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management and Klickitat County EMS, Yakima Washington is granted. Pursuant to 38 U.S.C. § 1725, under certain circumstances, VA shall reimburse a veteran for the reasonable value of emergency treatment furnished the veteran in a non-Department facility. VA regulations at 38 C.F.R. §§ 17.1000 through 17.1008 constitute the requirements under 38 U.S.C. § 1725 that govern VA payment or reimbursement for non-VA emergency services furnished to a veteran for nonservice-connected conditions. 38 C.F.R. § 17.1000. Under such regulations, payment or reimbursement under 38 U.S.C. § 1725 for emergency treatment will be made only if certain conditions are met, which are listed under 38 C.F.R. § 17.1002. The Veteran received emergency treatment on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management and Klickitat County EMS, Yakima Washington. On April 21, 2015 the Veteran presented to the emergency department (ED) at Yakima Regional Medical and was transferred from Klickitat for chest pain. An April 2015 assessment report indicated the disposition was the Veteran was a full admit in critical condition to the telemetry unit at high risk for complications. During the course of his episode of care from April 21, 2015 through April 23, 2015, treatment included oxygen, oral medications, and intravenous medication. He underwent examination including X-ray and cardiac testing. The diagnosis was myocardial infarction (MI) and he required cardiac EKG monitoring. The agency of original jurisdiction (AOJ), in denying the Veteran’s claim for payment or reimbursement, did not find and the record does not reflect that his treatment on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management and Klickitat County EMS, Yakima Washington, for his MI was not for an emergency condition, or that a VA facility was feasibly available during the emergency. The AOJ, moreover, did not find, and it has not been contended, that the Veteran otherwise did not meet any of the conditions of 38 C.F.R. § 17.1002 for payment or reimbursement under 38 U.S.C. § 1725, except one: the AOJ found that the Veteran had not received medical services from the VA health care system within the 24-month period preceding April 21, 2015. See January 2016 statement of the case (SOC) and January 2016 VA Northwest Health Network Payment Center response to request for reconsideration. To be eligible for benefits under 38 U.S.C. § 1725, a Veteran must be an active Department health-care participant, meaning that the Veteran is both enrolled in the VA health care system and received VA health care or “medical services” within the 24-month period preceding the furnishing of such emergency treatment, under the provisions of 38 U.S.C. Chapter 17. 38 U.S.C. § 1725(b); 38 C.F.R. § 17.1002(d). As reflected in his February 2016 substantive appeal, the Veteran asserts that he was enrolled in the VA healthcare system, and received the Veterans Health Benefits Handbook in 2014, which he cited language from in support of his claim. The Board finds the Veteran’s reports that he received the Veterans Health Benefits Handbook in 2014 competent and credible. The Board takes notice that even a generic version of the Veterans Health Benefits Handbook available online provided to veterans specifically in connection with, and due to, their VA health care under 38 U.S.C. Chapter 17 contains such information as general advice regarding properly taking medications, including prevention of adverse effects that could result from using medications, and other general health and medicine educational material. For purposes of 38 U.S.C. § 1725 and Chapter 17 generally, the term “medical services” includes, in addition to medical examination, treatment, and rehabilitative services, “preventive health services” including “patient health education (including nutrition education)” and “such other health-care services as the Secretary may determine to be necessary to provide effective and economical preventive health care.” 38 U.S.C. § 1701(6)(D), (9)(B), (L). Reading the governing statutes and regulations in the light most favorable to the Veteran in this case, and resolving reasonable doubt in this favor, the Board finds that the Handbook provided by VA pursuant to Chapter 17 included patient health education materials. Thus, VA’s issuance of the Handbook to the Veteran in 2014, as credibly reported by the Veteran in his February 2015 substantive appeal, constituted “care” or “medical services” under 38 U.S.C. § 1725(b) and 38 C.F.R. § 17.1002(d). See Fritz v. Nicholson, 20 Vet. App. 507, 511 (2006) (finding that “‘care’ as used in section 1725 is synonymous and, thus interchangeable, with ‘medical services,’“ and adopting the ordinary meaning of “care” as set forth in Dorland’s Illustrated Medical Dictionary of the “services rendered by members of the health professions for the benefit of a patient” as the correct interpretation of “care” as used in 38 U.S.C. § 1725(b)); see also DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 298 (30th ed. 2003). Therefore, the Board finds that the Veteran received VA health care or “medical services” within the 24-month period preceding the furnishing of his non-VA emergency treatment on April 21, 2015 through April 23, 2015, and thus met the eligibility requirements under 38 U.S.C. § 1725 and 38 C.F.R. § 17.1002 for payment or reimbursement of the expenses of such treatment. Accordingly, payment or reimbursement of medical expenses incurred on April 21, 2015 through April 23, 2015, at Klickitat Valley Health, Yakima Regional Medical, Washington EM Physician Partners, Washington Hospitalist, Yakima HMA Physical Management, and Klickitat County EMS, Yakima Washington is granted. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Schick, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.