Citation Nr: 22014505 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 18-28 620 DATE: March 14, 2022 ORDER Payment or reimbursement of medical expenses incurred from January 8 to 9, 2017, at Munroe Regional Medical Center (MRMC) is denied. FINDING OF FACT 1. The Veteran was treated for a medical emergency at MRMC from January 8 to 9, 2017. 2. The earliest claim filed for Department of Veterans Affairs (VA) payment or reimbursement of medical expenses incurred at MRMC for the Veteran's January 8 to 9, 2017, treatment, was not within 90 days of either the final treatment date or a date on which he or MRMC exhausted action to obtain payment or reimbursement from a third party. CONCLUSION OF LAW The criteria for payment or reimbursement of medical expenses incurred from January 8 to 9, 2017, at MRMC are not met. 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000-1008. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1971 to August 1973. This appeal is before the Board of Veterans' Appeals (Board) from a July 2017 decision of the VA Veterans Health Administration. In October 2021, the Veteran and his wife testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. The Veteran seeks payment or reimbursement of expenses incurred for medical treatment from January 8 to 9, 2017, at MRMC. The record does not reflect that, at the time of the January 8 to 9, 2017, treatment in question, the Veteran was permanently and totally disabled due to any service-connected disability or disabilities, or that his treatment 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. Therefore, the Veteran is not eligible for payment or reimbursement under 38 U.S.C. § 1728 in this case. See 38 U.S.C. § 1728; 38 C.F.R. § 17.120. 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. 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 (such as a UB92 or a HCFA 1500), and must file a claim within 90 days after 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(b), (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. Payment or reimbursement of medical expenses incurred from January 8 to 9, 2017, at MRMC is denied. The Veteran received emergency treatment at MRMC beginning January 8, 2017, for atrial fibrillation and chest pain. He was discharged on January 9, 2017, following treatment including cardiac catheterization. The initial claim for payment of this treatment was received by VA on April 21, 2017; a copy of the claim form is of record and indicates that the creation date of the claim was April 12, 2017. The evidence does not show that, within 90 days prior to the April 21, 2017, filing of the claim, the Veteran or MRMC finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party. As reflected in its July 2017 decision and April 2018 statement of the case, the agency of original jurisdiction denied the claim for payment on the basis that it was not timely filed. As reflected in his July 2018 notice of disagreement and October 2017 testimony before the Board, the Veteran contends that, on arriving at MRMC for his emergency treatment on January 8, 2019, he provided the appropriate insurance information and made MRMC aware that he was a VA patient. He contends that he was unaware that MRMC did not submit a timely claim until he received a collection notice from them for nonpayment. The evidence of record, including a document associated with the January 8 and 9, 2017, treatment records from MRMC containing the Veteran's insurance information, is generally consistent with the Veteran's contentions. The Veteran appears not to have been at fault for the untimely submission of the claim for payment for the January 8 to 9, 2017, treatment at MRMC, and the Board is sympathetic to his position in this matter. However, the Board is also bound by VA regulations regarding limitations on reimbursement, including time limitations for filing claims. See 38 U.S.C. § 1725(c)(1)(B); 38 C.F.R. § 17.1004(d). The record reflects that the basic claim filing requirements for medical reimbursement under 38 C.F.R. § 17.1004specifically, regarding the time limitations for filing claimswere not met in this case, and the Veteran has not made any assertions to the contrary. Accordingly, payment or reimbursement of medical expenses incurred from January 8 to 9, 2017, at MRMC, must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Andrew Mack, 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.