The Veteran's private medical expenses incurred from October 25, 2007 to October 31, 2007 at University Hospital were not covered by VA due to lack of prior authorization and the Veteran's Medicare coverage.
The deciding factor: VA regulations do not allow for payment or reimbursement of private medical expenses when a Veteran has other health coverage like Medicare that can provide at least partial payment or reimbursement.
- Claimed conditions
- residuals of a fractured left tibia
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- July 2, 2009
- Citation
- 0924956
This is a plain-language summary generated by AI from a public Board of Veterans’ Appeals decision. It can contain errors — always verify against the original. Look up the original decision on VA.gov (opens in a new tab) using citation 0924956.
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.
- Denied
The Board denied the Veteran's claims of service connection for a left knee disability, residuals of a fractured left tibia, and a left metatarsal disability due to lack of current disabilities. The Veteran was provided with VA examinations but no new examination is required as this claim has been decided.
- Remanded (sent back)
The Veteran's appeal is being remanded for additional development, including scheduling a new VA examination to address the issues of increased evaluation for residuals of a fractured left tibia and service connection for right leg and foot disabilities.
- Remanded (sent back)
The Veteran's appeal is being remanded for additional development, including obtaining VA and private medical records, scheduling an orthopedic examination, and attempting to obtain SSA disability determination(s).
- Remanded (sent back)
The Veteran's appeal is being remanded to obtain additional medical records and for a VA examination at the Lyons VAMC. The claims include seeking increased ratings for his service-connected left tibia fracture, as well as secondary service connection for right leg and foot conditions.
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