The Board denied payment or reimbursement of unauthorized medical expenses incurred for non-VA care at UMPC on September 13, 2018 due to lack of prior authorization and failure to meet the emergency treatment criteria.
The deciding factor: The treatment was not for a condition that would have been hazardous if delayed, and there was no emergency situation requiring immediate medical attention.
- Claimed conditions
- Left elbow condition
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- April 10, 2019
- Citation
- 19127900
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.
- Granted
The Board granted service connection for bilateral hearing loss, arthritis of the cervical spine, cervical radiculopathy of the left arm, back disability, left elbow condition, left shoulder condition, left wrist condition, left hand condition, hypertension, and an initial rating of 10 percent for coronary arteriosclerosis prior to September 24, 2024.
- Remanded (sent back)
The Board remands the claims for service connection for an acquired psychiatric disorder, a heart condition, and left and right knee conditions to obtain additional evidence.
- Remanded (sent back)
The Board remands the claims for service connection for various conditions, including psychiatric disabilities and musculoskeletal issues, due to deficiencies in prior examinations and the need for additional evidence related to toxic exposure during service.
- Partly granted
The Board granted service connection for left and right elbow conditions, but denied increased ratings for left and right shoulder strains.
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