The Veteran's claim for payment or reimbursement of unauthorized medical expenses is denied because he has Medicare coverage, which makes him ineligible under the law.
The deciding factor: The Veteran has a health-plan contract (Medicare) that covers the cost of the unauthorized medical treatment provided by private providers, making him ineligible for VA reimbursement.
- Claimed conditions
- right upper quadrant pain, ureterolithiasis, hydronephrosis, renal insufficiency
- How they argued it
- Not specified
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- March 7, 2016
- Citation
- 1608969
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 1608969.
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.
- Remanded (sent back)
The Veteran's kidney condition, including hydronephrosis and/or renal cyst, is remanded for further review due to a failure to obtain an adequate medical opinion regarding the etiology of his condition. The examiner must consider all potential exposures, including contaminated water at Camp Lejeune and fuels as a result of his MOS as a bulk fuel man.
- Dismissed
The appeal for service connection of end stage renal disease and ureterolithiasis is dismissed due to the death of the appellant while the appeal was pending.
- Remanded (sent back)
The Veteran's hydronephrosis is granted with a 10 percent evaluation effective August 23, 2011. The Board remanded the case for further development and consideration of increased evaluations.
- Remanded (sent back)
The Board has decided to remand the claims for service connection due to errors in obtaining evidence and medical opinions related to the Veteran's reported exposures during service and their potential impact on his claimed conditions.
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