The Veteran's treatment at JTDMH for a kidney stone was not preauthorized by VA, and the Board denied payment or reimbursement because it was not an emergency.
The deciding factor: VA regulations require preauthorization for non-VA medical care. The treatment was not in response to an emergency.
- Claimed conditions
- Left sided abdominal pain, Kidney stone
- How they argued it
- Direct service connection
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- February 20, 2024
- Citation
- 24008338
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 24008338.
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 unauthorized medical services provided on August 9, 2013 were for a condition of such nature that a prudent layperson would have reasonably expected delay in seeking immediate medical attention to be hazardous. The closest VA facility was not feasibly available and an attempt to use it beforehand would not have been considered reasonable by a prudent layperson.
- Granted
The Veteran's severe abdominal pain on July 25, 2010 was of such a nature that a prudent layperson would have reasonably expected delay in seeking immediate medical attention to be hazardous. The closest VA emergency room was approximately two hours away and the Veteran had already attempted to seek treatment at a VA facility.
- Denied
The Board found that the veteran's disabilities do not render him unemployable due to his alcohol and substance abuse, which led to periods of unemployment. The veteran was therefore denied a permanent and total disability rating for pension purposes.
- Denied
The Board denied the veteran's claims for increased ratings for his service-connected lumbar myositis, psychoneurosis and conversion hysteria, residuals of shrapnel wounds of the left thigh and pelvis with retained foreign bodies and scars, and residuals of shell fragment wounds of the right thigh and left leg. The veteran was also denied entitlement to a total disability rating based on individual unemployability due to service-connected disabilities.
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