The Veteran's unauthorized medical expenses incurred from May 6, 2009 through May 8, 2009 at Maine Medical Center were approved due to the emergent nature of his condition and the unavailability of VA facilities that could have provided the necessary care.
The deciding factor: A prudent layperson would have reasonably expected that delay in seeking immediate medical attention for the Veteran's unstable coronary syndrome would have been hazardous to his life or health, given the critical stenosis found during cardiac catheterization and ongoing symptoms. The nearest VA facility was not feasibly available, and an attempt to use them beforehand would not have been reasonable.
- Claimed conditions
- Posttraumatic Stress Disorder (PTSD), Fibromyalgia with Irritable Bowel Syndrome, Muscle Fatigue, Joint Pains, Lumbar Degenerative Joint Disease, Cervical Spine Strain with Degenerative Changes, Joint Pain and Fatigue of the Left Knee, Irritable Bowel Syndrome, Bilateral Upper Extremity Radiculopathy, Bilateral Lower Extremity Radiculopathy, Right Inguinal Hernia Repair
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- June 5, 2013
- Citation
- 1318230
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 1318230.
What this means for you
A grant means the Board agreed the veteran was entitled to the benefit. Decisions like this show the kind of evidence and arguments that tend to succeed for claims like it.
What you can do next
Related decisions
Other Board decisions on a similar condition or argued the same way.
- Granted
The Veteran's claim for service connection for PTSD is granted as the evidence shows a current diagnosis of PTSD, an in-service stressor, and a medical link between the two.
- Denied
The Veteran's PTSD has been rated at 50% since March 23, 2004. The Board found that a higher rating is not warranted prior to February 15, 2005 due to the severity of his symptoms and their impact on his social and occupational functioning.
- Denied
The Board denied the Veteran's claims for service connection for PTSD and any acquired psychiatric disorder, finding that there was no evidence to support a link between his current mental health conditions and his military service.
- Granted
The Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity, warranting a 70% disability rating. The Veteran also met the criteria for a TDIU due to his service-connected disabilities preventing him from securing or following a substantially gainful occupation.
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