The Board denied payment or reimbursement for medical expenses incurred at Tomah Memorial Hospital on April 11, 2018 due to lack of prior authorization and the fact that a VA facility was feasibly available but not used by the Veteran.
The deciding factor: The Board found that the preponderance of evidence did not meet the requirements under 38 U.S.C. § 1725 for reimbursement, as there was no emergency condition requiring immediate medical attention and the nearest VA facility was less than a mile away but not used by the Veteran.
- Claimed conditions
- unknown
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- October 3, 2019
- Citation
- 19176528
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.
- Remanded (sent back)
The Veteran's appeal is being remanded to address his challenge to the validity of the overpayment amount and his claim for apportionment of benefits. The Board cannot proceed with these issues until they are resolved.
- Dismissed
The Veteran withdrew their appeal, and the Board dismissed it due to the withdrawal.
- Remanded (sent back)
The Board has remanded the cases for further development due to insufficient notice of a VA examination.
- Dismissed
The Board dismissed the issue of entitlement to waiver of overpayment created by the removal of the Veteran's former spouse, O.H., as there was no case or controversy regarding this matter. The COWC granted a waiver of the full amount of the Veteran’s overpayment debt.
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