The Board denied payment or reimbursement for unauthorized medical expenses incurred at a private hospital from April 6, 2016, to April 7, 2016, as the treatment was not rendered in a situation where delay would have been hazardous to life or health and it was reasonable to attempt to use the local VA clinic.
The deciding factor: The medical services provided at a private hospital were not authorized by VA and did not meet the criteria for payment under 38 U.S.C. § 1725 due to lack of emergency nature and delay in treatment would not have been hazardous to life or health.
- Claimed conditions
- Hematuria
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- June 3, 2019
- Citation
- 19142335
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 service connection for monoclonal gammopathy of undetermined significance (MGUS) and anemia, but remanded claims for chronic kidney disease, hematuria, and multiple myeloma.
- Remanded (sent back)
The Veteran's service-connected TBI, bilateral knees, left metatarsal avulsion residuals, left wrist condition, and migraines are being remanded for further evaluation due to the potential worsening of these conditions.,The Veteran's rib/sternum condition, left ankle condition, bilateral shoulder conditions, insomnia, and kidney condition (claimed as rhabdomyolysis) are also being remanded for further evaluation.
- Granted
The Board has granted payment or reimbursement for medical expenses incurred at Allegheny General Hospital from December 9, 2016 through December 13, 2016 due to the Veteran's condition remaining emergent until his discharge on December 13, 2016.
- Partly granted
The veteran's claim for service connection for a low back disability was reopened and granted, while the other claims were denied.
We are not the VA. Veterans’ Rights is an independent resource built for veterans. We are not the U.S. Department of Veterans Affairs, not part of the government, and not endorsed by any government agency.
This is general information, not legal advice. For advice about your own situation, talk to a VA-accredited representative — many help for free.