BVA9500241 DOCKET NO. 93-08 157 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Medical Center, Poplar Bluff, Missouri THE ISSUE Entitlement to reimbursement or payment for the cost of unauthorized medical services received on October 28, 1991. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Hilary L. Goodman, Counsel INTRODUCTION The veteran had active service from April 1981 to July 1981 and from October 1982 to December 1989. This appeal arises from a January 1992 determination that the treating hospital could not be paid by the Department of Veterans Affairs (VA) for the veteran's treatment on October 28, 1991, as he was not treated on an emergency basis. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that on October 24, 1991, a VA physician indicated that the veteran urgently needed a urology consultation. He asserts that four days later he was in severe pain and, as he became ill and extremely weak while attending classes, was taken to Southeast Missouri Hospital. He further asserts that the physician wanted to admit him for urinary failure and dehydration but a VA physician indicated that the veteran should be stabilized and he would be scheduled for a November 1, 1991, appointment. He finally contends that this problem was caused by the medication for a service-connected disability and, had he received proper medical care in an urgent manner on October 24, the whole situation could have been avoided. DECISION OF THE BOARD The Board of Veterans' Appeals (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 files. 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 reimbursement or payment for the cost of unauthorized medical services received on October 28, 1991 is warranted. 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 been in effect for several disabilities, including chronic lumbosacral strain, evaluated as 40 percent disabling. 3. The October 28, 1991, treatment of the veteran at Southeast Missouri Hospital for urinary difficulties and penile irritation was necessitated by a medical emergency; a VA or other Federal medical facility was not feasibly available. CONCLUSION OF LAW The criteria for reimbursement or payment of the medical expenses incurred in connection with treatment of the veteran at Southeast Missouri Hospital, Cape Girardeau, Missouri, on October 28, 1991, have been met. 38 U.S.C.A. §§ 1728, 5107 (West 1991); 38 C.F.R. § 17.80 (1993). 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 treatment be for an adjudicated service-connected disability or for a nonservice-connected disability associated with and held to be aggravating an adjudicated service-connected disability, but it must 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. VA outpatient treatment records confirm that a VA physician noted on October 24, 1991, that a urology consultation was urgent. At that time it was reported that the veteran was incontinent. It was noted that he could not keep an external catheter on and his clothes were wet much of the time. Southeast Missouri Hospital records show that on October 28 the veteran complained of difficulty urinating and a swollen penis with lesions. No complaints of extreme weakness were noted. On physical examination, findings included a swollen penile corona inferiorly and a small ulcer on the right lateral portion of the shaft. A Foley catheter was inserted and a leg bag was attached. Urinalysis showed no nitrites or leukocyte esterase activity, and no white blood cells or bacteria were present. He was discharged in fair condition, with an impression of urinary incontinence with penile irritation, approximately four hours after his arrival at the hospital. The veteran was accorded a urology evaluation at the VA medical facility on October 31, 1991, at which time it was noted that his urologic symptoms possibly were related to his service-connected back condition and/or medication prescribed therefor. When the veteran went to the Southeast Missouri Hospital on October 28, 1991, he was in pain and incontinent, and had been having problems using his external catheter. It is not unreasonable to consider the veteran's situation on October 28 as emergent. Further, although the VA examiner who saw the veteran on October 24 was of the opinion that an urology consultation was urgently needed, none was apparently scheduled until the following week. The Board finds that, given the nature of the veteran's condition, for all intents and purposes a VA or other Federal medical facility was not available to provide the needed treatment. Therefore, payment or reimbursement of the costs of the medical services received by the veteran at Southwest Missouri Hospital on October 28, 1991, is in order. 38 U.S.C.A. § 1728; 38 C.F.R. § 17.80. The benefit of the doubt has been resolved in the veteran's favor. 38 U.S.C.A. § 5107. ORDER Entitlement to reimbursement or payment for the cost of unauthorized medical services received on October 28, 1991 is granted. WAYNE M. BRAEUER 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.