The Board denied the Veteran's claim for payment or reimbursement of medical expenses incurred from March 7 to 9, 2013, at Parma Community General Hospital due to the Veteran having coverage under a health-care plan at the time of treatment and not exhausting all remedies against his health-care plan.
The deciding factor: The Board found that without evidence establishing what portion of the expenses were paid by the Veteran's health-care plan or if any portion was not covered, VA could not make payment on the claim. Additionally, subsequent to the December 2019 remand, the Federal Circuit ruled that a deductible is considered a 'similar payment' under 38 U.S.C. § 1725(c)(4), thus prohibiting reimbursement for such expenses.
- Claimed conditions
- Not specified in this decision
- How they argued it
- Not specified
- Exposure basis
- None
- Rating assigned
- None in this decision
- Decision date
- November 29, 2024
- Citation
- 24033613
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
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.