The Veteran's unauthorized medical expenses incurred at a private hospital for his nonservice-connected left knee fracture are denied as he did not receive VA 'medical services' within the 24-month period preceding the emergency treatment.
The deciding factor: The Veteran was enrolled in the VA healthcare system but did not receive VA medical services during the relevant time frame, failing to meet one of the conditions for payment or reimbursement under 38 U.S.C. § 1725.
- Claimed conditions
- left knee fracture
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- September 19, 2019
- Citation
- 19172978
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 19172978.
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.
- Denied
The Board has denied the Veteran's claims for compensation under 38 U.S.C. § 1151 for left knee fracture residuals and traumatic brain injury residuals, finding that the additional disabilities were not caused by VA care or treatment.
- Granted
The Board granted the restoration of a 30 percent rating for the Veteran's service-connected left knee fracture disability, effective November 1, 2023.
- Denied
The Board denied the Veteran's claims of service connection for patellofemoral pain syndrome, with left knee fracture, status-post open reduction and internal fixation (ORIF), patellofemoral pain syndrome, with right knee status post-surgical growth plate arrest and patellofemoral joint arthropathy, and a left foot condition. The Board found no evidence of aggravation during service and insufficient medical evidence to support the Veteran's claims.
- Remanded (sent back)
The Veteran is seeking compensation under 38 U.S.C.A. § 1151 for a left knee fracture resulting from VA hospitalization in March to June 2006. The case has been remanded due to the need for an additional medical opinion regarding whether the injury was caused by carelessness, negligence, or similar fault on the part of VA.
Free starter guide for your own claim
Reading this because you were denied or under-rated? Get the plain-English next steps — your appeal options, the deadline that protects you, and how appeals like yours turn out. One email, no spam.
We will only use this to send the guide. No spam, unsubscribe any time. We never sell your information.
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.