Citation Nr: 21011121 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 16-03 912A DATE: March 1, 2021 ORDER Entitlement to payment or reimbursement for the cost of medical services received at Copper Queen Community Hospital on May 5, 2014, is denied. FINDING OF FACT The Veteran was not treated in the VA healthcare system within the 24 months preceding May 5, 2014. CONCLUSION OF LAW The criteria for payment or reimbursement for the cost of medical services received at Copper Queen Community Hospital on May 5, 2014, have not been met. 38 U.S.C. § 1725; 38 C.F.R. § 17.1002. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1975 to August 1980. This claim was previously before the Board in October 2018, at which time the Board remanded it for additional development. The requested development has been completed, and the claim is properly before the Board for appellate consideration. Entitlement to payment or reimbursement for the cost of medical services received at Copper Queen Community Hospital on May 5, 2014 Initially, under 38 U.S.C. § 1703, when VA facilities or other government facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility or are not capable of furnishing care or services required, VA may authorize or contract with non-VA facilities for care. 38 U.S.C. § 1703(a); 38 C.F.R. § 17.52(a). However, the Veteran has never contended, and the evidence does not demonstrate, that he received prior VA written authorization for his private treatment on May 5, 2014. Therefore, application of 38 U.S.C. § 1703(a) for reimbursement of authorized private treatment is unwarranted. The issue of prior authorization is thus not applicable. Service connection is not in effect for any disabilities. The Veteran does not have a total and permanent service-connected disability rating, and this treatment was not for a service-connected disability or for a disability that was aggravating a service-connected disability. Likewise, the treatment was not for any injury or an illness incurred in relation to participation in a vocational rehabilitation program. Consequently, the Veteran is not eligible for payment or reimbursement for the claimed emergency treatment under 38 U.S.C. § 1728. See 38 C.F.R. § 17.120. Payment or reimbursement for private emergency medical treatment may be considered under 38 U.S.C. § 1725. The primary requirements for payment or reimbursement under this statute are that the Veteran is treated in an emergency department or similar facility held out as providing emergency treatment to the public; 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; and a VA or other federal facility was not feasibly available to provide the treatment. 38 C.F.R. § 17.1002(a-c). A condition that a prudent layperson would reasonably expect that delay in seeking medical attention would be hazardous to life or health can include one manifested by severe pain that results in serious dysfunction of a body part. 38 C.F.R. § 17.1002(b). At the time of the emergency treatment the veteran must be enrolled in the VA healthcare system and have received medical services within the preceding 24-month period. 38 C.F.R. § 17.1002(d). Under the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 (H.R. 3230; Pub. L. 113146), also known as the “Veterans Choice Act,” effective November 5, 2014, VA will pay for non-VA medical services for veterans who are determined by VA to meet the eligibility criteria of the Veterans Choice Program. See 38 C.F.R. §§ 17.1500-1540. The record does not reflect that the May 5, 2014, treatment at Copper Queen Community Hospital was provided through the VA Choice Program or that the Veteran was enrolled in the program at the time of the treatment. On May 5, 2014, the Veteran presented to the Copper Queen Community Hospital emergency department with a gunshot wound to the right leg. A May 2014 VA non-VA care hospital notification states that the Veteran had presented to Copper Queen Community Hospital. The May 2014 VA record also notes that the Veteran had not received VA treatment within the past 24 months. In October 2014, a representative from the Arizona Department of Veterans’ Services wrote that the Veteran called VA on May 5, 2014, and was told to go to the nearest emergency room for treatment. The Veteran was not aware and was not told that he would not qualify for VA covering his expenses for private treatment due to not receiving VA medical care in the past 24 months. In February 2016 the Veteran noted that he had only enrolled in the VA healthcare system in December 2013 and was unaware in May 2014 that he could not receive emergency treatment without proper authorization. Unfortunately, VA records do not show that the Veteran was treated in the VA healthcare system within the 24-month period preceding May 5, 2014. Since the Veteran was not treated in the VA healthcare system within the 24-month period preceding May 5, 2014, the claim must be denied as a matter of law. See 38 C.F.R. § 17.1002(d). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Scott Shoreman, 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.