Citation Nr: 21076025 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 18-05 969 DATE: December 22, 2021 ORDER Entitlement to payment or reimbursement for unauthorized, non-VA medical expenses incurred on July 1, 2016 at Lake Regional Hospital is granted. FINDING OF FACT The Veteran received non-VA medical treatment on July 1, 2016 at Lake Regional Hospital for a condition that a prudent layperson would have reasonably expected would have been hazardous to life or health if treatment was delayed; VA emergency facility was not feasibly available. CONCLUSION OF LAW The criteria for payment or reimbursement for unauthorized medical expenses incurred on July 1, 2016 at Lake Regional Hospital, have been met. 38 U.S.C. §§ 1703, 1725, 1728, 5107; 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty in the Army from May 1973 to March 1987. The issue is on appeal from a December 2016 denial from Harry S. Truman Memorial Veterans' Hospital or the Agency of Original Jurisdiction (AOJ). Although the Veteran requested a hearing on her substantive appeal, the Veteran withdrew her hearing request in March 2021. Therefore, the hearing request is considered withdrawn. The Veteran seeks payment or reimbursement for non-VA medical expenses incurred on July 1, 2016 at Lake Regional Hospital. This treatment was not authorized by VA. See 38 C.F.R. § 17.52(a). Also, the Veteran does not have a total and permanent service-connected disability rating and this treatment was not for any service-connected disability or for any disability that was aggravating a service-connected disability. Likewise, the treatment was not for any injury or illness incurred in relation to participation in a vocational rehabilitation program. Consequently, the Veteran is not eligible for payment or reimbursement for claimed emergency treatment under 38 U.S.C. § 1728. See 38 C.F.R. § 17.120. Nonetheless, payment or reimbursement may be considered for claimed private emergency medical treatment under 38 U.S.C. § 1725. A threshold requirement for payment or reimbursement under this statute is that the treatment received is for a condition of such a 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. § 17.1002(b). Based on review of the record, the Board finds that the criteria for reimbursement of medical expenses incurred by the Veteran on July 1, 2016 for non-VA medical services have been met. Medical records from Lake Regional Hospital on July 1, 2016 shows that the Veteran pulled up to a gas station when she felt very dizzy and began experiencing a sudden pain in her back, right chest, and right back. She also presented with shortness of breath at the emergency room. The Veteran denied nausea and chest pain diaphoresis. After a series of tests including chest x-ray, bloodwork, EKG, and CT scan, the Veteran was diagnosed with back pain, chest wall pain, and chest pain. She was released home the same day. The Veteran contends that an EKG was ordered because the emergency room physician initially thought she was having a heart attack. The Veteran has also consistently stated that she thought she was having a heart attack. The Board notes that the Veteran has some medical training as she was a combat medic during active duty according to her DD-214, Certificate of Release or Discharge. Additionally, the Veteran included an article on heart attack symptoms in women from a credible health website, www.verywellhealth.com, in her substantive appeal. The article stated that women may experience the same or different symptoms of a heart attack as men. Ultimately, the article instructs the reader to seek immediate treatment upon any new discomfort in the torso, upper arms, middle of back, or middle of chest. The Veteran states that the closest VA clinic is Osage Beach and that the clinic closed at 4 PM. She presented to Lake Regional Hospital at 4:32 PM, thus the clinic was closed when she needed treatment on July 1, 2016. The closest VA medical facility other than the clinic was a VA hospital over 100 miles from her home. Based on VA's website, the Board confirms that the closest VA clinic to the Veteran is Osage Beach and that it closes at 4 PM; and that the Harry S. Truman Memorial Hospital (the AOJ) in Columbia, Missouri is more than 100 miles from the Veteran's home. Finally, the Veteran's emergency room physician documentation shows a 4:32 PM time stamp for when her vitals were taken. Applying the regulatory framework to this case, the Board finds each criterion met. The provisions of 38 U.S.C. § 1725 provide for reimbursement if the treatment is for a condition of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. In light of the circumstances at the time, the Board finds that a prudent layperson could have reasonably expected that delay in seeking medical attention would have been hazardous to life or health and that VA treatment was not feasibly available for his condition. The Veteran was experiencing severe pain, of a sudden onset, and reasonably believed her condition required emergency medical treatment as she thought it was a heart attack. She also had prior medical training for her military occupational specialty as a combat medic. The closest VA clinic was closed by the time she sought treatment. See 38 C.F.R. § 17.1002. The Board finds that, under these circumstances, it was reasonable for the Veteran to seek treatment at a private hospital. Resolving any doubt in the Veteran's favor, the criteria for payment or reimbursement of unauthorized, non-VA medical expenses incurred on July 1, 2016 at Lake Regional Hospital, is granted. 38 U.S.C. § 1725(f)(1). L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee 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.