The Board denied the appellant's claim for reimbursement of unauthorized medical expenses incurred from June 1998 to April 2003 at Premier Medical Ear, Nose, and Throat Group. The denial was based on the absence of prior authorization, non-emergent nature of the treatment, and lack of feasibly available VA facilities.
The deciding factor: The appellant did not obtain prior authorization for the private medical expenses incurred and the treatment provided was not for an emergent condition or a service-connected disability requiring immediate care. Additionally, there were feasible VA facilities that could have provided similar services.
- Claimed conditions
- allergic sinusitis, degenerative joint disease of the right knee, degenerative disc disease at C5-C7, degenerative joint disease of the left knee, low back syndrome, residuals of a left inguinal herniorrhaphy, residuals of hepatitis, symptomatic hallux valgus of the right foot, residuals of a right inguinal herniorrhaphy
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- September 13, 2011
- Citation
- 1134117
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 1134117.
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 Veteran's appeals were dismissed due to the death of the appellant. The issues related to service connection for various conditions and disability ratings.
- Remanded (sent back)
The Veteran's claims for increased ratings for his bilateral hips and right knee are being remanded due to duty-to-assist errors. The VA is required to obtain the Veteran's SSA disability benefits records, provide supplemental opinions regarding the ameliorative effects of medication on his hip and knee disabilities, and correct any duty-to-assist errors.
- Remanded (sent back)
The Board has remanded the Veteran's claims for increased ratings for his right and left knee disabilities, as well as his right knee scar. The RO must attempt to obtain all available private treatment records from the Tennessee Orthopedic Clinic.
- Remanded (sent back)
The Veteran's claims for increased ratings for degenerative joint disease of the left (non-dominant) shoulder, right knee, and left knee are being remanded due to a failure to issue a Supplemental Statement of the Case (SSOC).,The Veteran's claim for TDIU is also being remanded as it was denied in the most recent rating decision without an SSOC having been issued.
Free starter guide for your own claim
Reading this because you were denied or under-rated? Get the plain-English next steps — your appeal options, the deadline that protects you, and how appeals like yours turn out. One email, no spam.
We will only use this to send the guide. No spam, unsubscribe any time. We never sell your information.
We are not the VA. Veterans’ Rights is an independent resource built for veterans. We are not the U.S. Department of Veterans Affairs, not part of the government, and not endorsed by any government agency.
This is general information, not legal advice. For advice about your own situation, talk to a VA-accredited representative — many help for free.