CAVC Case 02-0682: Back

CAVCReal U.S. Court of Appeals for Veterans Claims (CAVC) decision · · FARLEY

This is a decision of the U.S. Court of Appeals for Veterans Claims — the federal court that reviews Board of Veterans' Appeals decisions, one level above the Board. Court decisions can vacate, reverse, or affirm what the Board did.

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40%$795.84
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60%$1,435.02
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Outcome
Reversed / Remanded
Decision Date
Unknown
Judge
FARLEY
Service Era
March 1967 to October 1968

Conditions Claimed

BackDiabetesGIEye

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Issues on Appeal

BackDiabetesGIEye

Why It Was Decided This Way

In January 1994, VA issued a Statement of the Case (SOC), which noted, among other things, that on January 28, 1993, the veteran was not service connected, that the veteran had “refused to sign acknowledgment” that his referral to MMC would be at his own expense, and that on January 29, 1993, the MMC “contacted Fee Basis regarding payment of veteran’s hospitalization” and the “hospital was informed [that] the veteran was not eligible for payment of private hospital costs.

On remand, the chief medical officer at the AM VAMC determined in July 1997 and January 1998 that the veteran’s hospital admission for pancreatic pseudocysts was not related to a service-connected disability.

In a June 1999 BVA decision, the Board concluded that the veteran’s claim of entitlement to payment by VA of unauthorized medical expenses was not well grounded.

In the January 17, 2002, BVA decision here on appeal, the Board denied the veteran's claim for entitlement to payment of medical expenses incurred during hospitalization at MMC from January 28 to February 3, 1993.

The Board found that, “[a]t the time of the hospitalization, service[ ]connection was in effect for epistaxis.

§ 1710, the Court should remand the matter to allow the Board, which did not address the appellant's eligibility for hospital care under section 1710, to make specific findings of fact in that regard in the first instance.

The appellant also argues that regardless of any change brought about by the VBA, there is no plausible basis for the Board's determinations as to a medical emergency and VA authorization, and that those determinations should be reversed as clearly erroneous.

It is undisputed that the treatment he received at MMC was not related to epistaxis, but that was not disqualifying under section 1710(a) in 1993 at the time of the hospitalization.

Authorities Cited

Anderson v. CityDegmetich v. BrownGilbert v. DerwinskiHersey v. DerwinskiHicks v. BrownMalone v. GoberMariano v. PrincipiSee Ford v. GoberSee Marsh v. WestSee Roberson v. PrincipiSee Stegall v. WestSimiles v. BrownZimick v. West

Regulations Cited (38 CFR / 38 USC)

38 CFR 17.50b38 CFR 17.50b(a) (1992)38 CFR 17.50d (1992)38 CFR 17.5238 CFR 17.52(a)38 CFR 17.52(a)(3)38 CFR 17.5438 CFR 17.54(a)38 USC 1701(6)38 USC 170338 USC 1703(a)(1)38 USC 1703(a)(3)38 USC 171038 USC 1710(a)(1)38 USC 1710(a)(1) (1991)38 USC 1722(a)38 USC 726138 USC 7261(a)(4)

Denial Type

Not Service Connected

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Referral disclosure: VetAid earns a referral fee if you become a paying REE Medical client through this link — it helps keep this site free. REE Medical provides paid medical evidence; it is not a law firm, VSO, or claims agent, and VetAid has not independently verified its services. VSOs and VA-accredited representatives will help you file your claim at no cost, and no one can guarantee a rating increase.