BVA9508319 DOCKET NO. 93-10 627 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs (VA) Medical Center in Minneapolis, Minnesota. Received from the VA Regional Office & Insurance Center in St. Paul, Minnesota. THE ISSUE Entitlement to reimbursement or payment for the cost of unauthorized private hospitalization from July 26 to July 28, 1992. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Hilary L. Goodman, Counsel INTRODUCTION The veteran had active service from January 1949 to June 1949 and from November 1954 to August 1956. This appeal arises from an August 1992 determination that the treating hospital could not be paid by the Department of Veterans Affairs (VA) for the veteran's hospitalization from July 26 to July 28, 1992, as he was not service-connected for the disability treated. The veteran's claim was administratively remanded by the Board of Veterans' Appeals (Board) in September 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he had a bleeding problem that the VA knew about but failed to treat. He asserts that, when he was hospitalized at a VA hospital in April 1992, testing revealed the hole, but the VA did not repair it. He further asserts that he had to go to Saint Marys Hospital in July 1992 because of severe bleeding and the hole was repaired. He finally contends that, if the VA had taken appropriate action in April 1992, the life- threatening bleeding problem and the need for his private hospitalization in July 1992 would not have occurred. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the veteran's claim for reimbursement or payment for the cost of unauthorized private hospitalization from July 26 to July 28, 1992. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the originating agency. 2. Service connection has not been established for any disability. 3. At the time of the veteran's hospitalization from July 26 to July 28, 1992, at Saint Marys Hospital, Rochester, Minnesota, for upper gastrointestinal bleeding, he was not participating in a rehabilitation program under 38 U.S.C. ch. 31. CONCLUSION OF LAW The criteria for reimbursement or payment of the medical expenses incurred in connection with treatment of the veteran at Saint Marys Hospital, Rochester, Minnesota, from July 26 to July 28, 1992, have not been met. 38 U.S.C.A. §§ 1728, 5107 (West 1991); 38 C.F.R. § 17.80 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board finds that the veteran's claim for reimbursement or payment for the cost of unauthorized medical services is "well grounded" within the meaning of 38 U.S.C.A. §§ 5107(a). That is, he has presented a claim which is plausible. The Board is also satisfied that all relevant facts have been properly developed and that no further assistance to the veteran is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). For the veteran to establish entitlement to reimbursement or payment of the cost of unauthorized medical services, all of the three criteria under 38 U.S.C.A. § 1728 and 38 C.F.R. § 17.80 must be satisfied. Not only must it be shown that a medical emergency existed with delay being hazardous to life or health, and that a VA or other Federal facility was not feasibly available but treatment must be for (1) an adjudicated service- connected disability; (2) a nonservice-connected disability associated with and held to be aggravating an adjudicated service-connected disability; (3) any disability of a veteran who has a total disability permanent in nature resulting from a service-connected disability; or (4) any illness, injury or dental condition in the case of veteran who is participating in a rehabilitation program under 38 U.S.C. ch. 31. The veteran was admitted to Saint Marys Hospital on July 26, 1992 for hypotension and fainting secondary to upper gastrointestinal bleeding. An upper gastrointestinal endoscopy revealed a frank ulcer at the esophagogastric junction with a protruding blood vessel. The current record, however, does not show that service connection has been established for any disability or that he was participating in a rehabilitation program under 38 U.S.C. ch. 31. The veteran asserted in testimony at a March 1994 hearing that the VA had evaluated him for the same problem in April 1992. However, this fact is of no legal significance with regard to the issue under appellate consideration. Although a disability of a veteran need not necessarily be service-connected to establish eligibility for VA hospital care, the criteria spelled out above govern entitlement to payment or reimbursement of the cost of unauthorized private hospitalization. As this veteran, who did not have a total disability permanent in nature resulting from a service-connected disability and was not participating in a rehabilitation program under 38 U.S.C. ch. 31, was taken to the hospital and received treatment for a nonservice-connected disability which was not aggravating a service-connected disability, there is no basis upon which to allow his claim. 38 U.S.C.A. § 1728; 38 C.F.R. § 17.80. The current evidence of record is not so evenly balanced that there is doubt on any material issue. 38 U.S.C.A. § 5107. ORDER Entitlement to reimbursement or payment for the cost of unauthorized private hospitalization from July 26 to July 28, 1992, is denied. JAMES R. ANTHONY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.