Citation Nr: 21012876 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-22 980A DATE: March 5, 2021 ORDER The claim for payment or reimbursement of medical expenses incurred on February 28, 2014, at Mercy Gilbert Medical Center (MGMC) was timely filed. FINDING OF FACT It is at least as likely as not that the Veteran filed a claim for payment or reimbursement of medical expenses incurred at MGMC for treatment on February 28, 2014, within 90 days of when he had notice that such an application was necessary. CONCLUSION OF LAW The criteria for timely filing of a claim for payment or reimbursement of medical expenses incurred on February 28, 2014, at MGMC are met. 38 U.S.C. §§ 1725, 5107; 38 C.F.R. §§ 17.127, 17.1000-1008. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1967 to August 1968. This appeal is before the Board of Veterans’ Appeals (Board) from a December 2014 decision of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). In August 2018, the Veteran and his daughter testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. The Board remanded the appeal to the agency of original jurisdiction (AOJ) in September 2018. 1. Payment or reimbursement of medical expenses incurred on February 28, 2014. The Veteran seeks payment or reimbursement of expenses incurred for medical treatment on February 28, 2014, at MGMC. As an initial matter, the record does not reflect that, at the time of the February 28, 2014, treatment, the Veteran was permanently and totally disabled due to any service-connected disability or disabilities, or that his treatment at that time was for any service-connected disability or for any disorder that was aggravated by any service-connected disability. Likewise, the Veteran’s treatment was not for any injury or illness contracted in the course of a rehabilitative program. Indeed, the Veteran has not argued that he is entitled to benefits on this basis. See 38 U.S.C. § 1728; 38 C.F.R. § 17.120. However, 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. However, to obtain payment or reimbursement for emergency treatment under 38 U.S.C. § 1725, a claimant must submit to the VA medical facility of jurisdiction a completed standard billing form, and such form must have been submitted no later than 90 days from 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). 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. In this appeal, the facts of the case are not in dispute. VA treatment records from February 27, 2014 reflect that the Veteran called reporting left leg pain for the past three days. The VA nurse advised the Veteran to call 911, as he needed to be evaluated immediately for a possible leg fracture that could lead to blood clot, and that visiting his nearest VA facility was not feasible under the circumstances. The Veteran received emergency treatment for left leg pain at MGMC the next day on February 28, 2014. It is also not in dispute that the Veteran’s formal claim for reimbursement was not received by VHA until October 29, 2014, and well past the 90-day limit. During his August 2018 hearing before the Board, he testified that he did not know about the 90-day time limit for submitting claims to VA, but that he forwarded the bill (which appears to be in the amount of $1,038) to his VA social worker, who forward to VA collections. He also testified that he believed he had gotten the bills about a month after treatment and submitted them in person the next time he had an appointment at VA, within approximately 30 to 90 days. He further stated that he did not know why the hospital did not send the bills to VA directly. Although this appeal has been previously remanded for additional development, a number of issues remain unclear. First it is unclear precisely who’s responsibility it was to seek reimbursement. The evidence of record suggests that while it is the Veteran’s ultimately responsibility, it also appears that a private facility (such as MGMC) has the ability to seek reimbursement directly from VA, and the Veteran may have been led to rely on this practice. Second, it is also unclear in the record precisely how the Veteran is supposed to know that he has 90 days from the date of his treatment to submit a claim for reimbursement. From the record, it does not appear that he was told this when he first contacted VA the day prior to going to MGMC, and there are no treatment records from MGMC that show he was so informed of this when he was discharged. Indeed, as the Veteran noted, it is not clear that he would have even known that he needed to seek reimbursement from VA until he got the bill and, despite the Board’s prior remand, it is not clear in the record when he received it. The Board is aware that the Veterans Claims Assistance Act applies only to claims for benefits filed under Chapter 51 of Title 38, United States Code. See e.g. Barger v. Principi, 16 Vet. App. 132, 138 (2002); Lueras v. Principi, 18 Vet. App. 435 (2004); Livesay v. Principi, 15 Vet. App. 165, 179 (2001) (en banc). As such, there is no on-point law or regulation requiring that VA help Veterans navigate the VHA reimbursement process. However, the evidence or record does not reflect that he received any assistance or information at all. Moreover, it does appear that he tried to pursue this claim, as the evidence of record reflects that VA contacted his health insurance provider, which noted that the Veteran was pursuing a claim with VA as early as July 2014. As a result, given that the Veteran may not have been notified that he had an outstanding balance to settle with VA until a considerable amount of time after his treatment was concluded, and given the evidence that he was attempting to sort out his expenses as early as July 2014, that his claim for reimbursement should be considered timely. However, the Board makes no determination as to whether reimbursement may or may not be warranted on any other basis under the law. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.M., Counsel