Citation Nr: 22015155 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 19-15 864A 421920542DATE: March 16, 2022 ORDER Entitlement to reimbursement or payment of cost of non-VA medical care provided in conjunction with treatment at McKee Medical Center on December 18, 2017, is denied. FINDINGS OF FACT 1. The Veteran received emergency medical treatment at McKee Medical Center on December 18, 2017, for a nonservice-connected disability. 2. At the time of the December 18, 2017, non-VA medical evaluation and treatment, the Veteran had no service-connected disabilities, had not received VA medical evaluation or treatment within the 24 months preceding the non-VA emergency medical care, and was neither a participant in a VA rehabilitation program nor was he receiving VA nursing home care; he did not meet the statutory requirements for pre-authorization of payment of non-VA medical care. CONCLUSION OF LAW The criteria for payment or reimbursement for unauthorized medical expenses incurred in connection with non-VA emergency medical care provided at McKee Medical Center on December 18, 2017, are not met. 38 U.S.C. §§ 1703, 1725, 1728; 38 C.F.R. §§ 17.52, 17.53, 17.54, 17.120, 17.121, 17.1000-17.1008. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 2012 to July 2015. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 decision of the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). Entitlement to reimbursement of non-VA medical care McKee Medical Center on December 18, 2017 The Veteran seeks payment for costs related to medical treatment at a non-VA hospital on December 18, 2017 for a seizure. The Veteran acknowledges that he had no service-connected disabilities at the time of the accident in question, and had not sought treatment from VA within the 24 months prior to the accident. When VA facilities are not capable of furnishing required care or services, VA may contract with non-VA facilities in order to furnish certain care, including hospital care or medical services for the treatment of medical emergencies that pose a serious threat to the life or health of a Veteran receiving medical services in a VA facility, until such time following the furnishing of care in the non-VA facility as the Veteran can be safely transferred to a VA facility. 38 U.S.C. § 1703 (a)(3); 38 C.F.R. § 17.52. The admission of a Veteran to a non-VA hospital at the expense of VA generally must be authorized in advance. 38 C.F.R. § 17.54. In relevant part, in the case of an emergency that existed at the time of admission, an authorization may be deemed a prior authorization if an application is made to VA within 72 hours after the hour of admission. 38 C.F.R. § 17.54. 38 U.S.C. § 1703 and 38 C.F.R. § 17.52 specify that authorization for non-VA care, may only be given for hospital care or medical services to a veteran under specific circumstances, including those relating to service-connected disability, emergency non-VA care during or following a course of VA care, care for veterans who are participating in a VA rehabilitation program or who are receiving VA nursing home care, and dental care for former prisoners of war. The record does not demonstrate, and the Veteran does not contest, that he did not have a service-connected disability and had not received VA treatment prior to the date of his December 18, 2017, non-VA emergency medical care. The evidence further does not demonstrate that he was a participant in a VA rehabilitation program or was receiving VA nursing home care. Therefore, he does not meet the statutory requirements for reimbursement of authorized non-VA hospital care and medical services. When a Veteran receives treatment at a non-VA facility without prior authorization, two statutes allow for payment or reimbursement for the medical expenses incurred for that treatment, 38 U.S.C. §§ 1725 and 1728. In the present case, the Veteran was not in receipt of service connection benefits for any disability at the time of the treatment in question. The treatment therefore was not for a service-connected disability or for a non-service-connected disability associated with and held to be aggravating a service-connected disability. Moreover, the Veteran did not have a total disability permanent in nature from a service-connected disability, and was not a participant in a vocational rehabilitation program. Thus, reimbursement pursuant to 38 U.S.C. § 1728 is not warranted, and the appellant does not contend as such. Under 38 U.S.C. § 1725, payment or reimbursement for emergency services for non-service-connected conditions in non-VA facilities may also be awarded under certain circumstances. 38 C.F.R. §§ 17.1000-03. Among the eight conditions that must be met to be eligible for reimbursement under this authority, the Veteran must have been enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. Chapter 17 within the 24-month period preceding the furnishing of such emergency treatment. See 38 C.F.R. § 17.1002(d). The Veteran received emergency care on December 18, 2017, at McKee Medical Center after suffering a seizure. VA treatment records in the file show that the Veteran was not seen for VA treatment in the two years preceding his December 18, 2017, non-VA emergency medical treatment. The Board therefore finds that the evidence weighs against a finding that the Veteran had received VA medical services within the 24-month period preceding the furnishing of the December 18, 2017, non-VA emergency medical treatment. He thus does not meet the conditions for eligibility for reimbursement of expenses of non-VA emergency medical care under 38 U.S.C. § 1725. The Board acknowledges the Veteran's contentions that he received treatment at a VA facility on December 22, 2017, and January 3, 2018. However, these dates are subsequent to the emergency non-VA medical treatment on December 18, 2017, and thus does not satisfy 38 C.F.R. § 17.1002. While sympathetic to the Veteran's situation, the Board is bound by the statutory limitations on reimbursement of non-VA medical services by VA. As the Veteran did not have any service-connected disabilities at the time of the December 18, 2017, non-VA emergency medical care, was not part of a vocational rehabilitation program, and had not received VA health care in the 24 months prior to the treatment in question, he does not meet the criteria for reimbursement of non-VA medical expenses under 38 U.S.C. §§ 1703, 1725, or 1728. Accordingly, payment or reimbursement for costs of non-VA emergency medical care provided in connection with treatment at McKee Medical Center on December 18, 2017, must be denied. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Uller, Associate 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.