The Veteran's private hospitalization at St. Luke’s Elmore on September 30, 2017 was for a nonservice-connected disorder and the AOJ denied payment or reimbursement due to untimeliness of claims.,The Veteran alleges prior authorization from his VA primary care doctor for his private medical services and outpatient procedure at St. Alphonsus Medical Group and St. Alphonsus Regional Medical Center on November 15th-16th, 2017. The AOJ denied this claim.
The deciding factor: The claims were untimely filed due to the private providers not submitting their claims within 90 days of the Veteran's discharge from St. Luke’s Elmore on September 30, 2017.
- Claimed conditions
- left acetabular fracture, left gluteal pseudoaneurysm with hemorrhage, deep vein thrombosis (DVT), pulmonary embolism (PE)
- How they argued it
- Not specified
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- April 16, 2019
- Citation
- 19129044
What this means for you
A remand is not a loss. The Board sent the case back for more development — often a new exam or missing records — before making a final decision. Many remands later end in a grant, and the decision spells out exactly what the Board wanted to see.
What you can do next
Related decisions
Other Board decisions on a similar condition or argued the same way.
- Partly granted
The Board granted service connection for hypothyroidism, DVT, and a heart disability as secondary to residuals of acute renal failure. The claim for an initial compensable rating for acute hepatocellular necrosis was denied.
- Granted
The Board granted payment and reimbursement for non-VA care provided from November 28, 2016, to May 23, 2017, related to a fractured left femur and DVT.
- Partly granted
The Board denied the Veteran's 38 U.S.C. § 1151 claim for additional disability resulting from VA treatment of a March 2009 right ankle fracture, finding that the evidence did not establish negligence or an unforeseeable event. The Board remanded multiple service connection claims for respiratory disorder, bilateral knee disorders, right ankle disorder, low back disorder, bilateral shoulder disorders, depression, hypertension, and headache disorder for further development.
- Granted
The Veteran's service connection claim for bilateral hearing loss is granted. The appeal regarding the initial rating of PTSD was denied due to a lack of timely substantive appeal. Service connection claims for DVT and pulmonary embolism are remanded.
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