Citation Nr: A21018690 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 210208-184992 DATE: November 23, 2021 ORDER Payment or reimbursement of medical expenses incurred on February 11, 2020, at Columbia Basin Hospital (CBH) is denied. FINDINGS OF FACT 1. The Veteran was treated for a medical emergency at CBH on February 11, 2020. 2. The earliest claim filed for payment or reimbursement of medical expenses incurred at CBH for the Veteran's February 11, 2020, treatment, was not within 90 days of either that treatment date or a date on which he or CBH exhausted action to obtain payment or reimbursement from a third party. CONCLUSION OF LAW The criteria for payment or reimbursement of medical expenses incurred on February 11, 2020, at CBH are not met. 38 U.S.C. §§ 1725, 5107; 38 C.F.R. §§ 17.1000-1008. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1960 to March 1964. This appeal is before the Board of Veterans' Appeals (Board) from a January 2021 decision of the Department of Veterans Affairs (VA) Veterans Health Administration, which constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. See 38 C.F.R. § 3.2400(a)(1). In his February 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Evidence was added to the claims file during a period of time when new evidence may not be considered by the Board. As the Board is deciding the medical reimbursement claim on appeal, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Veteran seeks payment or reimbursement of expenses incurred for medical treatment on February 11, 2020, at CBH. The record does not reflect that, at the time of the February 11, 2020, treatment in question, the Veteran had any service-connected disabilities, or that the Veteran's treatment was for any injury or illness contracted in the course of a rehabilitative program. Therefore, the Veteran is not eligible for payment or reimbursement under 38 U.S.C. § 1728 in this case. See 38 U.S.C. § 1728; 38 C.F.R. § 17.120. The Veterans Millennium Health Care and Benefits Act 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. 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. To receive payment or reimbursement for emergency services under 38 U.S.C. § 1725, a claimant must file a claim within 90 days after the latest of the following: the date that the veteran was discharged from the facility that furnished the emergency treatment; the date of death, if the death occurred during transportation to a facility for emergency treatment or during the stay in the facility that included the provision of the emergency treatment; or the date the veteran finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party. 38 C.F.R. § 17.1004(d). If after reviewing a claim the decisionmaker determines that additional information is needed regarding the claim, such official will contact the claimant in writing and request additional information. The additional information must be submitted to the decisionmaker within 30 days of receipt of the request or the claim will be treated as abandoned, except that if the claimant within the 30-day period requests in writing additional time, the time-period for submission of the information may be extended as reasonably necessary for the requested information to be obtained. 38 C.F.R. § 17.1004(e). The date of filing any claim for payment or reimbursement of the expenses of medical care and services not previously authorized shall be the postmark date of a formal claim, or the date of any preceding telephone call, telegram, or other communication constituting an informal claim. 38 C.F.R. § 17.127. Payment or reimbursement of medical expenses incurred on February 11, 2020, at CBH is denied The Veteran received emergency treatment for complaints of dyspnea on exertion, getting short-winded when walking, and recent weight gain the CBH on February 11, 2020. He was diagnosed with congestive heart failure. See 38 C.F.R. § 17.1002(a). CBH initially filed a claim for VA payment of this treatment in January 2021; a copy of the claim form is of record. The available evidence does not show that, within 90 days prior to the January 2021 filing of the claim, the Veteran or CBH finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party. As reflected in its January 2021 decision, the AOJ denied the claim for payment on the basis that it was not timely filed. As reflected in a February 2021 statement, the Veteran asserts that, despite his repeated efforts to send his VA authorization number to CBH, CBH did not submit his bill to VA in a timely fashion. The Board acknowledges the Veteran's contentions, but is bound by VA regulations regarding limitations on reimbursement, including time limitations for filing claims. See 38 U.S.C. § 1725(c)(1)(B); 38 C.F.R. § 17.1004(d). The record, as it stands, reflects that the Veteran did not meet the basic filing requirements for his medical reimbursement claim under 38 C.F.R. § 17.1004specifically, regarding the time limitations for filing claimsand the there is no reviewable evidence to the contrary. Accordingly, payment or reimbursement of medical expenses incurred February 11, 2020, at CBH must be denied. See 38 U.S.C. § 5107. As a final matter, the Board again notes that evidence was added to the claims file during a period of time when new evidence was not allowed, which the Board may not consider here. See 38 C.F.R. § 20.300. The Board also again notes the Veteran's argument that he repeatedly sought to have CBH bill VA for the expenses in question, to no avail. While the Veteran could show that his claim may not have been untimely if he or CBH were to demonstrate that CBH attempted to bill VA within 90 days of his February 11, 2020, treatment, or within 90 days of the exhaustion of an attempt to obtain reimbursement from a third party, such evidence is currently not part of the reviewable record. Again, in this regard, the Veteran may file a Supplemental Claim and submit or identify relevant evidence not considered in this decision, and VA would issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Andrew Mack, 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.