The Veteran's unauthorized medical expenses for a laparoscopic cholecystectomy and umbilical herniorrhaphy on April 18-19, 2014 are denied as the treatment was not provided in an emergency setting and no prior authorization from VA was obtained.
The deciding factor: The surgery was scheduled four days in advance and did not occur immediately after a previous emergency room visit. The Veteran failed to contact VA for pre-authorization of the procedure, which is required by law.
- Claimed conditions
- Cholelithiasis (gallstones), Umbilical hernia
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- June 5, 2018
- Citation
- 18108453
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 18108453.
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.
- Partly granted
The Board granted a 70 percent disability rating for PTSD, but denied compensable ratings for umbilical hernia, nephrolithiasis, and dermatitis.
- Remanded (sent back)
The Board remands the claims for service connection for umbilical and inguinal hernia, as well as degenerative arthritis of the left and right hands, due to a lack of medical evidence linking these conditions to the Veteran's military service.
- Partly granted
The Board denied increased ratings for the Veteran's lumbar spine and sciatic nerve disabilities, granted a 30 percent rating for pseudofolliculitis barbae (PFB), and granted service connection for degenerative disc disease of the cervical spine.
- Granted
The Board has granted service connection for umbilical hernia, hiatal hernia, RLS and periodic leg movement disorder (left knee), and awarded a 10% disability rating effective October 5, 2016.
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