The veteran's claim for reimbursement of unauthorized medical expenses incurred at a private facility on November 23, 2004 is denied as prior authorization was not obtained and the treatment did not meet the criteria for emergency services.
The deciding factor: Prior authorization for the non-VA medical care was not provided in accordance with VA regulations. The veteran's condition did not constitute an emergency that would have required immediate attention at a private facility.
- Claimed conditions
- diverticulitis, major depressive disorder
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- 100%
- Decision date
- March 16, 2006
- Citation
- 0607654
What this means for you
A denial is a starting point, not the end of the road. You can see why this claim fell short — and, if you are still inside the one-year window, the appeal lanes that may remain open to you.
What you can do next
Related decisions
Other Board decisions on a similar condition or argued the same way.
- Dismissed
The claim for an earlier effective date for service connection for major depressive disorder is dismissed as moot because the earliest effective date was granted during the pendency of this appeal.
- Granted
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- Partly granted
The Board granted service connection for right and left hip degenerative arthritis as secondary to the Veteran's service-connected right ankle and knee conditions, and major depressive disorder as secondary to his service-connected knee and ankle conditions. The Board also granted a 10 percent rating for allergic rhinitis.
- Granted
The Board granted service connection for major depressive disorder as secondary to the Veteran's service-connected tinnitus.
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