Citation Nr: 21029535 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 18-00 158A DATE: May 13, 2021 ORDER Entitlement to payment or reimbursement of unauthorized medical expenses incurred at Riverview Regional Medical Center in March 2017 is granted. FINDING OF FACT In March 2017, the Veteran received medical treatment at a non-VA facility; the treated condition was one that a prudent layperson in the circumstances would expect to be hazardous to health if medical attention was delayed and seeking treatment at a VA or federal facility was not feasibly available. CONCLUSION OF LAW The criteria for reimbursement of unauthorized, non-VA medical expenses incurred at Riverview Regional Medical Center in March 2017, are met. 38 U.S.C. §§ 1703, 1725, 5107; 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1988 to March 1990. The Veteran appealed a July 2017 denial of reimbursement or payment decision. In May 2021, the Veteran testified before the undersigned Veterans' Law Judge. A transcript of the hearing will be associated with the claims file at a later date. Reimbursement of unauthorized medical expenses Generally, the admission of a veteran to a non-VA hospital at VA expense must be authorized in advance. 38 C.F.R. § 17.54. Here, the Veteran's treatment at the non-VA facility was not authorized in advance as there is no indication that VA authorization was obtained prior to this particular admission, or within 72 hours thereafter, for the medical services provided to the Veteran for which she is now seeking payment or reimbursement. Congress, however, has authorized the reimbursement or payment for unauthorized emergency medical treatment of veterans, under two statutory provisions, 38 U.S.C. §§ 1725 and 1728. Payment or reimbursement for emergency services for nonservice-connected conditions in non-VA facilities may be authorized under 38 U.S.C. § 1725 and 38 C.F.R. §§ 17.1000-17.1002 016. Under 38 U.S.C. § 1725, payment or reimbursement of non-VA emergency medical services for nonservice-connected disabilities for veterans without adequate insurance is available if certain conditions are met. 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000-17.1008. Conditions required under § 1725 include: (1) that there is a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health; and (2) that VA or other federal facilities were not feasibly available to treat the veteran. Veteran's Treatment In this matter, the Veteran is a registered nurse. She has stated that in March 2017 she had recently moved and was not in close proximity to a VA facility and that the two nearest VA clinics to her location in March 2017 had informed her they were not accepting new patients. In March 2017, the Veteran received emergency room care at Riverview Regional Medical center for respiratory conditions she believed in her medical opinion would be hazardous to her life or health had she delayed in seeking treatment. Applying the regulatory framework to this case, the Board finds the criterion for reimbursement or payment of the medical expenses incurred by the Veteran at Riverview Medical Center in March 2017 are met. 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 her condition. The Board affords great weight to the Veteran's opinion as a registered nurse that her respiratory conditions in March 2017 required emergency care. Further, the distance to a VA hospital along with the information she received that the VA clinics in her area were not accepting new patients satisfies the criteria that treatment at a VA facility for her respiratory conditions was not feasibly available. It is clear that the Veteran reasonably believed her condition required emergency medical 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. (Continued on the next page) Accordingly, the Board finds that affording the Veteran the benefit of any reasonable doubt, the weight of the competent and probative evidence is at least in equipoise as to whether a reasonably prudent person would have believed that further delay would have been hazardous to life or health. Accordingly, the Board concludes that the criteria for the payment or reimbursement of unauthorized, non-VA medical expenses incurred at Riverview Medical Center in March 2017 are met. 38 U.S.C. § 1725; 38 C.F.R. §§ 17.120. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish, 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.