38 C.F.R. § 17.120

Payment or reimbursement for emergency treatment furnished by non-VA providers to certain veterans with service-connected disabilities

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

To the extent allowable, payment or reimbursement of the expenses of emergency treatment, not previously authorized, in a private or public (or Federal) hospital not operated by the Department of Veterans Affairs, or of any emergency treatment not previously authorized including transportation will be paid on the basis of a claim timely filed, under the following circumstances:

(a) For veterans with service connected disabilities. Emergency treatment not previously authorized was rendered to a veteran in need of such emergency treatment:

(1) For an adjudicated service-connected disability;

(2) For nonservice-connected disabilities associated with and held to be aggravating an adjudicated service-connected disability;

(3) For any disability of a veteran who has a total disability permanent in nature resulting from a service-connected disability (does not apply outside of the States, Territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico); or

(4) For any illness, injury or dental condition in the case of a veteran who is participating in a rehabilitation program under 38 U.S.C. ch. 31 and who is medically determined to be in need of hospital care or medical services for any of the reasons enumerated in § 17.47(i)(2); and

(Authority: 38 U.S.C. 1724, 1728)

(b) In a medical emergency. Emergency treatment not previously authorized including medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged) was rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. And,

(c) When Federal facilities are unavailable. VA or other Federal facilities that VA has an agreement with to furnish health care services for veterans were not feasibly available, and an attempt to use them beforehand or obtain prior VA authorization for the services required would not have been reasonable, sound, wise, or practicable, or treatment had been or would have been refused.

(Authority: 38 U.S.C. 1724, 1728, 7304) [39 FR 1844, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984; 51 FR 8672, Mar. 13, 1986; 56 FR 3422, Jan. 30, 1991. Redesignated at 61 FR 21966, May 13, 1996; 76 FR 79070, Dec. 21, 2011; 80 FR 79484, Dec. 22, 2015; 85 FR 84259, Dec. 28, 2020]
Notes of Decisions
Cited in 14 cases (3 in the last 5 years), 2002–2024 · leading case: Daniel W. Beverly v. R. James Nicholson, 19 Vet. App. 394 (Vet. App. 2005).
Daniel W. Beverly v. R. James Nicholson, 19 Vet. App. 394 (Vet. App. 2005). · cites it 7× “Last, because he was required to stay at the CRC facility to regulate his medications, he contended that this should be considered “medical treatment” subject to reimbursement under 38 C.F.R. § 17.120 (2003). Id. At the May 2003 hearing, the Board Chairman informed the appellant…”
Bellezza v. Principi, 16 Vet. App. 145 (Vet. App. 2002). · cites it 8× “80 [(now 38 C.F.R. § 17.120 )] have not been satisfied," and stating: "Nonemer[gency] (emer[gency] had resolved prior to transfer)[;] VA facil[ity] avail[able].”
Davita, Inc. v. United States, 110 Fed. Cl. 71 (Fed. Cl. 2013). · cites it 2× “38 C.F.R. § 17.120 states, in part: To the extent allowable, payment or reimbursement of the expenses of care, not previously authorized, in a private or public (or Federal) hospital not operated by the Department of Veterans Affairs, or of any medical services not previously…”
Walter L. Fritz v. R. James Nicholson, 20 Vet. App. 507 (Vet. App. 2006). “§ 1728 (a)(2); 38 C.F.R. § 17.120 (a) (2006). The relevant portion of section 1728 provides that the Secretary may reimburse veterans for emergency medical expenses when such care or services were rendered to a veteran in need thereof (A) for an adjudicated service-connected…”
08-03 534 (Board of Vet. App. 2011). · cites it 4× “§ 1728 (a) and 38 C.F.R. § 17.120 , VA may reimburse Veterans for unauthorized medical expenses incurred in non-VA facilities where: (a) For Veterans with service connected disabilities.”
Peter Van Dermark v. Denis McDonough (Vet. App. 2021). · cites it 2× “The implementing regulation, 38 C.F.R. § 17.120 , reiterates these criteria without much elaboration except for (a)(3), with respect to which it provides: "For any disability of a veteran who has a total disability permanent in nature resulting from a service-connected…”
08-03 397 (Board of Vet. App. 2012). · cites it 2× “§§ 1725 , 1728 (West 2002); 38 C.F.R. §§ 17.120 , 17.1000-17.1008 (2012).”
12-11 320 (Board of Vet. App. 2014). · cites it 2× “The amendments likewise affected 38 C.F.R. §§ 17.120 , 17.121, 17.1001, 17.”
201112-121674 (Board of Vet. App. 2021). “§ 1728 ; 38 C.F.R. § 17.120 . The provisions of 38 U.”
Metro. Area Ems Auth. v. Sec'y of Vets. Affairs (Fed. Cir. 2024). “56 for purposes of 38 CFR 17.120. Case: 24-1104 Document: 71 Page: 6 Filed: 12/09/2024 6 METROPOLITAN AREA EMS AUTHORITY v.”
Jeffcoat v. Principi, 17 Vet. App. 213 (Vet. App. 2003). “§ 1728 (“Reimbursement of certain medical expenses”) and 38 C.F.R. § 17.120 (“Payment or reimbursement of the expenses of .”
Bio-Med. Applications of Aquadilla, Inc. v. United States, 119 Fed. Cl. 546 (Fed. Cl. 2014). “, 38 C.F.R. § 17.120 (a)(4) (referencing a non-existent 38 •b.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.