Citation Nr: 21013107 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-23 455 DATE: March 8, 2021 ORDER Entitlement to reimbursement for medical services provided at Smith Northview Hospital from October 7, 2013 through October 8, 2013 is granted. FINDING OF FACT From October 7, 2013 through October 8, 2013, the Veteran sought emergency treatment at Smith Northview Hospital; the Veteran’s symptoms at the time she presented for such treatment were such that a prudent layperson would have reasonably viewed the visit as an emergency or thought that a delay in seeking immediate attention would have been hazardous to life or health, and VA treatment facilities were not reasonably available for treatment of the symptoms. CONCLUSION OF LAW The criteria for entitlement to reimbursement for medical services provided at Smith Northview Hospital from October 7, 2013 through October 8, 2013 are met. 38 U.S.C. §§ 1725, 1728; 38 C.F.R. §§ 17.120, 17.121, 17.1000-1002. REASONS AND BASES FOR FINDING AND CONCLUSION The matter comes to the Board of Veterans’ Appeals (Board) from a November 2013 decision of the Veterans Health Administration. In January 2021, the Veteran participated in a virtual hearing before the undersigned Veterans Law Judge (VLJ), a transcript of which is of record. The Veteran seeks medical reimbursement for bills incurred from a period of treatment commencing on October 7, 2013 at Smith Northview Hospital in the emergency department. 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. 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 only two such conditions at issue in this case are as follows: (b) The claim for payment or reimbursement for the initial evaluation and 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 (this standard would be met if there were an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part); (c) A VA or other Federal facility/provider that VA has an agreement with to furnish health care services for veterans was not feasibly available and an attempt to use them beforehand would not have been considered reasonable by a prudent layperson (as an example, these conditions would be met by evidence establishing that a veteran was brought to a hospital in an ambulance and the ambulance personnel determined the nearest available appropriate level of care was at a non-VA medical center). Whether a VA facility was “feasibly available” is determined after consideration of such factors as the urgent nature of the veteran’s medical condition and the length of any delay that would have been required to obtain treatment from a VA facility. Cotton v. Brown, 7 Vet. App. 325, 327-28 (1995). Regarding the relative distance of the travel involved, the Board may take judicial notice of facts, as compared to evidence, which are not subject to interpretation. See Yeoman v. West, 140 F.3d 1443 (Fed. Cir. 1998); Dedicatoria v. Brown, 8 Vet. App. 441 (1995). On October 7, 2013, the Veteran, who had suffered from numbness in the face for a number of days, had a worsening of the condition, and also had a sudden onset of severe head pain and slurred speech. The Veteran reported for emergency room treatment at the nearest open emergency facility, fearing she was experiencing a stroke. The closest open VA facility was over 50 miles away. After examination and diagnostic testing was performed to rule out a hemorrhage, the Veteran was diagnosed with parasthesia. See Emergency Department Treatment Record; Hearing Testimony. The condition is not service-connected, but the Veteran is enrolled in VA healthcare and has service-connected disabilities. She had no healthcare insurance other than VA at the time. She is financially liable for the costs incurred. See Hearing Testimony. Resolving reasonable doubt in the Veteran’s favor, the Board finds the conditions for reimbursement are met. First, the condition was 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. This element is not outcome determinative: as the evidence shows the prudent person would have expected such to be hazardous at the time she reported for treatment, this element is met. It is noted that while there was numbness that had persisted for a number of days, the sudden worsening of such along with symptoms of slurred speech and headache warranted immediate attention. Further, it appears from the Veteran’s testimony and review of the record that a VA-related emergency facility would not have been feasibly available during her emergency, and an attempt to use one beforehand would not have been considered reasonable by a prudent layperson, given the suspected condition. Generally, the Veteran’s pleadings are not contradicted by and are consonant with the record and are viewed to be credible. These pleadings confirm she meets the other necessary elements to grant the benefit sought. Given the above, the Board finds the evidence to weigh in favor of the Veteran’s claim. Accordingly, payment or reimbursement of emergency room medical expenses incurred on October 7 and 8, 2013 at Smith Northview Hospital is granted. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. C. King 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.