The Board has determined that the Veteran's knee pain did not constitute an emergency medical condition at the time of her treatment on November 29, 2015 and December 2, 2015. As a result, she is not eligible for reimbursement under 38 U.S.C. § 1725 or 1728.,The Veteran's appeal to reimburse costs of non-VA medical care received on May 28, 2014 was timely filed.
The deciding factor: The Board found that the Veteran did not meet the criteria for an emergency medical condition as defined by VA regulations. The knee pain she experienced was chronic and not indicative of a severe acute exacerbation.,There is no indication that the Veteran called or received prior authorization from VA before seeking treatment at St. Luke's Hospital on May 28, 2014.
- Claimed conditions
- Knee pain
- How they argued it
- Not specified
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- February 11, 2021
- Citation
- 21008052
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 21008052.
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.
- Denied
The Board has determined that the Veteran is not in need of personal care services for a minimum of six continuous months due to her ability to perform ADLs independently and does not require supervision or protection based on symptoms or injuries. Therefore, eligibility to enroll in the PCAFC program is denied.
- Remanded (sent back)
The Board has determined that the VA Centralized Eligibility and Appeals Team (CEAT) decision denying eligibility for PCAFC benefits was inadequate, as it did not address whether the Veteran requires personal care services each time he completes one or more activities of daily living (ADLs). The case is being remanded to conduct an updated medical review.
- Granted
Service connection is granted for left ear hearing loss and right ear hearing loss based on in-service noise exposure.,Service connection is granted for chest pain, head injury, knee pain, acquired psychiatric disability (including PTSD), headaches (due to treatment for PFB), hypertension, and dizziness secondary to service-connected tinnitus.
- Remanded (sent back)
The Board has decided to remand the case due to insufficient medical evidence regarding whether the Veteran's preexisting right knee injury worsened during service.
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