BVA9508297 DOCKET NO. 92-22 969 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Medical Center in Indianapolis, Indiana THE ISSUE Entitlement to payment of or reimbursement by the Department of Veterans Affairs (VA) for medical expenses incurred in connection with the veteran's unauthorized hospitalization at a private hospital from April 14 to April 22, 1992. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Suzie St. Vil, Associate Counsel INTRODUCTION The veteran had active military service from March 1943 to January 1946. He is represented by the Veterans of Foreign Wars of the United States. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a determination of April 1992 by the Department of Veterans Affairs Medical Center in Indianapolis, Indiana (VAMC). By letter dated in April 1992, the veteran was notified of the denial of his claim for reimbursement of or payment for unauthorized medical services rendered by a private hospital during the period from April 14, 1992 to April 22, 1992. The appeal was received and docketed at the Board in December 1992. CONTENTIONS The veteran essentially contends that VA should pay for the medical services rendered by Murray-Calloway Hospital in April 1992. The veteran maintains that he complied with VA regulations and immediately notified the VA of his admission to the private hospital as required by 38 C.F.R. 17.50d. Therefore, the veteran argues that the VA should assume the responsibility for payment of the medical services incurred during his hospitalization in April 1992. 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 folder and medical administrative 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 veteran has not met the initial burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that his claim is well-grounded. FINDINGS OF FACT 1. The condition for which the veteran was hospitalized at Murray-Calloway Hospital from April 14 to April 22, 1992 was not service-connected, nor was it associated with or held to be aggravating an adjudicated service-connected disability and he did not have a total rating assigned for service-connected disabilities which was permanent in nature. 2. The veteran has not contended otherwise. CONCLUSION OF LAW The claim for reimbursement of or payment for the cost of medical services rendered by Murray-Calloway Hospital in April 1992 is not well-grounded. 38 U.S.C.A. §§ 1703, 1712, 1728, 5107 (West 1991); 38 C.F.R. §§ 17.50b, 17.50c, 17.50d, 17.80 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The essential facts in this case are not in dispute and may be briefly summarized. The record reflects that, at the time of the private admission in question, service connection was in effect for the following: Anxiety neurosis with depression, rated as 50 percent disabling from January 12, 1971; and malaria, rated as noncompensably disabling from April 1, 1946. The combined evaluation for the veteran's service-connected disabilities was 50 percent. Of record is a report of contact (VA Form 119), dated April 16, 1992, which shows that a telephone call was made to the VAMC, to the effect that the veteran had been admitted to Murray-Calloway Hospital on April 14, 1992, with a diagnosis of syncope bradycardia. On file are private hospital records covering the period from April 14, 1992 to April 22, 1992. These records indicate that the veteran was brought to the emergency room at Murray-Calloway hospital after becoming light-headed. Following an examination in the emergency room, it was determined that the veteran had had a syncopal episode. He was then admitted to the hospital for further evaluation and treatment. On April 20, 1992, a pacemaker was inserted without any difficulties; he had no further syncopal episodes. It was noted that the veteran did well postoperatively, and he was discharged home on April 22, 1992. As already noted above, the veteran is only service-connected for anxiety neurosis and malaria, and he does not have a permanent, total disability rating for or on account of his service- connected disabilities. The record, including the clinical reports of the hospitalization, provides no indication whatsoever that the treatment administered during the hospitalization was in any way related to his service-connected disabilities. In fact, the veteran has not contended otherwise. Thus, there is no authority for VA to pay for the cost of the private hospitalization at issue. 38 U.S.C.A. § 1703 (West 1991); 38 C.F.R. § 17.50b (1994); See also Op.G.C. Concl. 1-95 (VA Mar. 31, 1995). There is authority for VA, under prescribed circumstances, to approve medical services for the treatment of any disability of a veteran, such as the veteran in this case, who has a service- connected disability rated at 50 percent or more. 38 U.S.C.A. § 1703(a)(2)(A); 38 C.F.R. § 17.50b(a)(2). However, it is clear from the statutory and regulatory language that such authority is limited to medical services, and not hospital care, related to treatment for any disability based on a veteran's status as 50 percent or more service-connected. See also 38 U.S.C.A. § 1712 (West 1991). In any event, the authority found in 38 U.S.C.A. § 1703 and 38 C.F.R. § 17.50b only extends to situations where VA or other government facilities are not capable of furnishing such hospital care or medical services. 38 U.S.C.A. § 1703(a); 38 C.F.R. §§ 17.50b, 17.50c. The record provides no indication that the medical care received by the veteran could not have been provided by a VA facility and, again, the veteran has made no contention in this regard. As to entitlement to reimbursement or payment for medical services incurred without prior authorization from the VA, the relevant threshold criteria are that the treatment must have been either for an adjudicated service-connected disability, or a nonservice-connected disability associated with and held to be aggravating a service-connected disability, or for any disability of a veteran who has a total disability permanent in nature resulting from a service-connected disability. 38 U.S.C.A. § 1728 (West 1991); 38 C.F.R. § 17.80 (1994). For reasons already discussed earlier, it is apparent that none of these criteria is met in this case. With regard to the veteran's basic contention that VA should pay for his hospitalization because he complied with VA regulations, the Board observes that he is evidently referring to the April 16, 1992 notification to VA regarding his admission. However, 38 C.F.R. § 17.50d (1994) merely imposes the requirement that a private hospital admission must be authorized by VA in advance and provides that notification and application within 72 hours of an emergency admission may satisfy the requirement of seeking prior authorization. The regulation does not in any way provide that mere notification to VA within the prescribed time limit shall constitute VA authorization of the hospitalization. Indeed, as we have already noted, 38 U.S.C.A. § 1703 and 38 C.F.R. §§ 17.50b, 17.50c provide no authority for VA payment in the circumstances of this case, and there similarly is no basis for payment or reimbursement of the expenses of the unauthorized hospital care pursuant to 38 U.S.C.A. § 1728; 38 C.F.R. § 17.80. Based on the record compiled in this case and the veteran's contentions, the Board finds that the veteran has not met his burden of submitting evidence to justify a belief that his claim is well-grounded. 38 U.S.C.A. § 5107(a) (West 1991). ORDER The appeal is dismissed. D. C. SPICKLER 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.