Citation Nr: 21021333 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-42 746A DATE: April 12, 2021 ORDER A claim for reimbursement of non-VA medical expenses incurred by the Veteran for his episode of care beginning July 3, 2017 at Meadville Medical Center IP (MMC), has been timely filed. REMANDED Payment or reimbursement of non-VA medical expenses incurred by the Veteran for his episode of care beginning July 3, 2017 at MMC is remanded. FINDING OF FACT The Veteran filed a claim for reimbursement of medical expenses within 90 days after his July 3, 2017, date of emergency treatment from Meadville Medical Center. CONCLUSION OF LAW A claim for reimbursement of non-VA medical expenses incurred by the Veteran for his episode of care beginning July 3, 2017, has been timely filed. 38 U.S.C. §§ 1725, 5107 (2012); 38 C.F.R. §§ 17.1000-17.1008 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1974 to October 1977. 1. A claim for reimbursement of non-VA medical expenses incurred by the Veteran for his episode of care beginning July 3, 2017 at MMC has been timely filed. The Veteran seeks payment or reimbursement for the cost of emergency room treatment received from MMC as a result of experiencing a heart attack while he was at the dentist. See October 2018 VA Form-. This treatment was not pre-authorized for payment by VA. See e.g. 38 C.F.R. § 17.52(a), generally indicating that VA may pre-authorize payment for non-VA treatment at private facilities under certain circumstances. Also, at the time of the treatment, the Veteran did not have a total and permanent service-connected disability rating. Additionally, 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 the claimed emergency treatment under 38 U.S.C. § 1728. See 38 C.F.R. § 17.120. Nonetheless, payment or reimbursement for private emergency medical treatment may be considered under 38 U.S.C. § 1725. A threshold requirement under this statute is that the claim for payment or reimbursement be filed within 90 days after the latest of the following: (1) The date the veteran was discharged from the facility that furnished the emergency treatment; (2) The date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or (3) 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). Proper claimants include the Veteran who received the treatment and the entity that furnished the treatment. 38 C.F.R. § 17.1004(a). In the December 2017 decision and in a March 2018 statement of the case (SOC), the VAMC found that a claim for VA payment or reimbursement for the cost of the July 3, 2017 MMC treatment was not timely filed. According to the AOJ as reflected in December 2017 and March 2018 denials, the Veteran’s claim for reimbursement was not received within 90 days of his treatment at MMC in July 2017. Further, a Health Insurance Claim Form for the Veteran’s episode of care beginning July 3, 2017 is date-stamped as received on November 17, 2017. However, the Veteran has credibly reported that he contacted VA within 72 hours of his heart attack and private treatment beginning July 3, 2017 to notify VA that he was being cared for at MMC. See October 2018 VA Form 21-4138. Thereafter, he notified his VA medical provider at the VAMC in Erie of his claim and was “assured” that “everything was taken care of.” Id. Further, the Board notes that the record includes a notation of “Date Filed: 7/18/17” for the Veteran’s episode of care beginning July 3, 2017 for treatment at MMC. Moreover, a clinical tracking record documented, “1725MB (90 days): Yes.” Considering the Veteran’s account of timely reporting his private treatment on July 2017 to VA and initiating a claim with the Erie VAMC, along with the clinical tracking history noting a July 17, 2017 date of claim that was within the required 90 days under 38 U.S.C. § 1725, the Board finds the records supports his claim was timely filed with the Erie VAMC in July 2017. Thus, it appears that the Veteran filed his reimbursement claim within 90 days of his episode of care beginning July 3, 2017, at MMC. After resolving reasonable doubt in the Veteran’s favor, the Board finds that he filed a claim for reimbursement of medical expenses within 90 days after of his episode of care from July 3, 2017 to July 6, 2017, at MMC. Accordingly, the claim was timely filed, and the RO should consider entitlement to benefits on the merits of the claim. 38 U.S.C. § 1725; 38 C.F.R. § 17.1004(d). REASONS FOR REMAND 1. Payment or reimbursement of non-VA medical expenses incurred by the Veteran for his episode of care beginning July 3, 2017 at MMC is remanded. is remanded. Having determined that the Veteran’s claim for payment or reimbursement of the medical services received at MMC was timely filed, the VAMC must expeditiously address the underlying merits of the claim. That is, it should be decided whether the Veteran satisfies all of the criteria enumerated in 38 C.F.R. § 17.1002. See also 38 U.S.C. § 1725. Accordingly, this case is REMANDED for the following action: 1. Return this matter to the agency of original jurisdiction to decide the claim for payment or reimbursement for the Veteran’s episode of care beginning July 3, 2017 at MMC on the merits. 2. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Schick, 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.