The Board denied the Veteran's claim for payment or reimbursement of medical services received at Erlanger Hospital in Chattanooga, Tennessee on December 16, 2011 due to lack of pre-authorization and failure to meet the criteria for a medical emergency.
The deciding factor: The treatment was not pre-authorized according to VA regulations and did not meet the definition of a medical emergency as defined by VA regulations.
- Claimed conditions
- Ureteral stone, Renal colic
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- February 3, 2023
- Citation
- 23007145
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 23007145.
What this means for you
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What you can do next
Related decisions
Other Board decisions on a similar condition or argued the same way.
- Granted
The Veteran's medical emergency due to a ureteral stone was treated at Albany Medical Center (AMC) on October 15, 2016. The treatment met the criteria for VA payment or reimbursement under 38 U.S.C. § 1725 and related regulations.
- Granted
The Veteran's claim for reimbursement of medical expenses incurred on July 28, 2014, was denied due to her having third-party insurance coverage. The Board has determined that the denial is not valid and remanded the case for readjudication in light of the invalid regulation.
- Granted
The Veteran's nephrolithiasis has been rated at 30 percent since October 25, 2005. The Board finds that the Veteran met the schedular criteria for consideration of TDIU from October 25, 2005 to February 8, 2006, and from September 1, 2006 to July 21, 2011, and from September 30, 2011 to August 29, 2012. The Veteran's service-connected disabilities have resulted in unemployability during these periods.
- Denied
The Veteran's claim for payment or reimbursement of medical expenses incurred at a non-VA facility is denied as the emergency condition did not last long enough to meet the criteria under VA regulations.
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