Will The Va Pay For Dental Work Done Prior To 100%

[Dave1433]

Could not find any posts on this but will the VA pay for the private dental work I had done during the 10 years the VA took to rate my claim at 100%. I filed my claim in November 2003 and I just got my 100% a couple months ago. During that 10 years it took them to finish my rating I spent thousands of dollars getting my dental work done at a private dentist.

[carlie]

Could not find any posts on this but will the VA pay for the private dental work I had done during the 10 years the VA took to rate my claim at 100%. I filed my claim in November 2003 and I just got my 100% a couple months ago. During that 10 years it took them to finish my rating I spent thousands of dollars getting my dental work done at a private dentist.

What is the effective date of the 100 % evaluation ?

[Philip Rogers]

It may be possible depending on what they determined your award date to be. If they awarded back to 2003, you can submit the bills to them for the 10 yrs and they may pay. They may initially deny it but you could win, if you appeal, appeal & appeal. jmo

pr

[Dave1433]

Thanks guys and gals. I filed my service connected claim in 2003 and in 2013 the VA determined that I was 100% disabled from 2007. 90% from 2003 to 2007. I did submit my old dental bills to the local fee basis office a few weeks ago and they returned the bills with a letter stating "must be preauthorized to get payment made". I also got a call from a woman who claimed she was the "leader" at the fee basis office and she had never heard of a vet getting back money they spent on dental while their claim (which is finally granted at 100% was being determined). I guess I will appeal this to the fee basis office and see where it goes. thanks to all

[Vync]

Good Luck! I tried that same argument to recoup property taxes I overpaid waiting on the VA. North Carolina basically told me they would not refund over $700 even though my award's effective date went 2 years back.

Just another example of how the backlog continues to cost vets in ways nobody realize.

LC

Tried the same with Alabama property taxes and they said they would not go back at all. Still have not given up...

[Stretch]

The VA acts like it is pulling it's own tooth to give up comp for prior dental work.

Several in this post have mentioned back property taxes. California is the worst for trying to get past property tax after service connection. I did it. I got 2,000 for 2 prior years of prop tax and I live in a different state now.

It is just like the prior dental compensation, if you don't pursue it you won't get it. I didn't have to go outside of hadit to figure this out.

Forgot to say that the VA is full of liars. One of my SOC's said that I had a truck stuck in my nose. Now what kind of truth is that. Sure I have a truck, but it is not stuck in my nose. I never even mentioned that I had a truck.

This truck was used to deny my claim for nasal condtions three times with remands. Eventually I was granted all three conditions.

Edited January 9, 2014 by Stretch

[carlie]

Note To All,

Many of the posts in this topic have been deleted, due to

flaming and bashing.

Posts like those are not for the board, if you have a problem

with a member - take it to PM or email.

It will not be tolerated on the board.

hadit.com, does not endorse or agree with beating down any

web site that promotes the advancement of benefits earned by veterans

or due to vba claimants.

The OP's question/s have been answered and this topic is closed.

Dave,

Here's how you can go about trying to get reimbursed.

BTW - IF - they do reimburse, they will only reimburse the

amount that was done to treat under emergent dental conditions.

Also, there are strict timelines you must submit this under.

CLAIM FOR PAYMENT OF COST OF

UNAUTHORIZED MEDICAL SERVICES

http://www.va.gov/vaforms/medical/pdf/vha-10-583-fill.pdf

Here is a link and a BVA case where reimbursement was made.

It will spell out the steps taken and all of the what's and why's.

http://www.va.gov/vetapp09/Files5/0942458.txt

Citation Nr: 0942458

Decision Date: 11/06/09 Archive Date: 11/12/09

DOCKET NO. 08-19 725A ) DATE

)

)

On appeal from the

Department of Veterans Affairs Medical Center in Gainesville,

Florida

THE ISSUE

Entitlement to payment or reimbursement for medical expenses

incurred at Faith Dental Care from June 11, 2007 to August

24, 2007.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Veteran

ATTORNEY FOR THE BOARD

J. Connolly, Counsel

INTRODUCTION

The Veteran had active service from October 1955 to November

1976.

This case is before the Board of Veterans' Appeals (Board) on

appeal from a March 2008 decision by the Department of

Veterans Affairs (VA) Medical Center in Gainesville, Florida.

In August 2009, the Veteran testified at a Travel Board

hearing at the St. Petersburg, Florida, RO.

FINDINGS OF FACT

1. The Veteran received medical treatment at Faith Dental

Care from June 11, 2007 to August 24, 2007, for a dental

emergency.

2. VA payment or reimbursement of the costs of the private

medical care provided at Faith Dental Care from June 11, 2007

to August 24, 2007, was not authorized prior to the Veteran's

undergoing that treatment and an application was not made to

VA within 72 hours after the hour of admission for

authorization.

3. The Veteran has been awarded compensation for total

disability, permanent in nature, resulting from a service-

connected disability, effective prior to the date of the

services rendered at Faith Dental Care from June 11, 2007 to

August 24, 2007.

4. From June 11, 2007 to August 24, 2007, the Veteran was

seen at Faith Dental Care, and VA facilities were not

feasibly available.

CONCLUSION OF LAW

Payment or reimbursement for medical expenses incurred at

Faith Dental Care from June 11, 2007 to August 24, 2007, is

warranted. 38 U.S.C.A. § 1728 (West 2002 & Supp. 2009); 38

C.F.R. § 17.120 (2009).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Veterans Claims Assistance Act of 2000 (VCAA)

There has been a significant change in the law with the

enactment of the VCAA. There are some claims to which VCAA

does not apply. Livesay v. Principi, 15 Vet. App. 165, 178

(2001). It has been held not to apply to claims based on

allegations that VA decisions were clearly and unmistakably

erroneous. Id. It has been held not to apply to claims that

turned on statutory interpretation. Smith v. Gober, 14 Vet.

App. 227, 231-2 (2000).

The United States Court of Appeals for Veterans Claims

(Court) has held that the provisions pertaining to VA's duty

to notify and to assist do not apply to a claim if resolution

of the claim is based on interpretation of the law, rather

than consideration of the factual evidence. See Dela Cruz v.

Principi, 15 Vet. App. 143, 149 (2001).

In another class of cases, remand of claims pursuant to VCAA

is not required because evidentiary development has been

completed. Wensch v. Principi, 15 Vet. App. 362, 368 (2001);

Dela Cruz . Although the Court said in Wensch that VCAA did

not apply in such cases, it may be more accurate to say that

VCAA applied, but that its notice and duty to assist

requirements had been satisfied. When it is clear that there

is no additional evidentiary development to be accomplished,

there is no point in remanding the case. See Soyini v.

Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to

requirements in the law does not dictate an unquestioning,

blind adherence in the face of overwhelming evidence in

support of the result in a particular case; such adherence

would result in unnecessarily imposing additional burdens on

VA with no benefit flowing to the veteran).

During the drafting of the VCAA, Congress observed that it is

important to balance the duty to assist against the futility

of requiring VA to develop claims where there is no

reasonable possibility that the assistance would substantiate

the claim. In this case, additional evidence could not

possibly change the outcome of the case. Thus, VCAA is

inapplicable. See Valiao v. Principi, 17 Vet. App. 229, 232

(2003). The information regarding the Veteran's service-

connected disabilities and the disability ratings is of

record and there is no further evidence to be obtained in

that regard.

Moreover, because the claim in this case is governed by the

provisions of Chapter 71 of Title 38 of the United States

Code, the VCAA and its implementing regulations are not

applicable to such claims. See Barger v. Principi, 16 Vet.

App. 132, 138 (2002) and Lueras v. Principi, 18 Vet. App. 435

(2004).

Nevertheless, the benefits being sought are granted per

below.

Reimbursement

In February 2007, a claim for a total disability rating based

on individual unemployability (TDIU) was received. This

claim was denied in a June 5, 2007 rating decision. The

Veteran initiated an appeal to that action and TDIU was

granted in a January 2008 rating decision, effective August

23, 2006. The TDIU is permanent.

In June 2007, the Veteran developed tooth infection and was

unable to eat. He testified that he went to VA for

treatment, but was told that he was not eligible for dental

treatment so he sought private treatment. He was treated at

Faith Dental Care from June 11, 2007 to August 24, 2007, and

had 4 teeth extracted and dentures made. The Veteran

contends that he was entitled to that total rating based on

the effective date of TDIU (August 23, 2006) which preceded

the private dental treatment in question (June 11, 2007 to

August 24, 2007). Therefore, he maintains that VA should pay

for the private dental treatment provided at Faith Dental

Care from June 11, 2007 to August 24, 2007.

Initially, the Board must make a factual determination as to

whether VA gave prior authorization for the non-VA medical

services. See 38 U.S.C.A. § 1703(a); see also

38 C.F.R. § 17.54. This is a factual, not a medical,

determination. See Similes v. Brown, 5 Vet. App. 555 (1994).

The law provides that, in connection with its statutory

obligation to provide medical services to veterans, VA may

contract for private care in certain limited circumstances,

including cases where a medical emergency exists.

Pursuant to 38 U.S.C.A. § 1703(a), "When Department [of

Veterans Affairs] facilities are not capable of furnishing .

. . the care or services required, the Secretary, as

authorized in [38 U.S.C.A. § 1710 or 1712], may contract with

non-Department facilities in order to furnish" certain care,

including: "Hospital care or medical services for the

treatment of medical emergencies which pose a serious threat

to the life or health of a veteran receiving medical services

in a Department facility . . . until such time following the

furnishing of care in the non-Department facility as the

veteran can be safely transferred to a Department facility."

38 U.S.C.A § 1703(a)(3); 38 C.F.R. § 17.52.

Non-VA treatment at the expense of VA must be authorized in

advance. 38 C.F.R. § 17.54; see Malone v. Gober, 10 Vet.

App. 539, 541 (1997); see also VAOPGCCONCL 1-95, at 9 (Mar.

31, 1995) ("Authorization in advance is essential to any

determination as to whether the Department is or is not going

to furnish the contract care."). In the case of an emergency

that existed at the time of admission, an authorization may

be deemed a prior authorization if an application is made to

VA within 72 hours after the hour of admission. 38 C.F.R. §

17.54.

Under the provisions of 38 C.F.R. § 17.52(a), VA may contract

with non-VA facilities for care in accordance with the

provisions of this section when VA facilities or other

government facilities are not capable of furnishing

economical hospital care or medical services because of

geographic inaccessibility or are not capable of furnishing

care or services required. When demand is only for infrequent

use, individual authorizations may be used. Normally,

however, such care in public or private facilities will only

be authorized, whether under a contract or an individual

authorization, under the specific circumstances delineated in

38

C.F.R. § 7.52(a) which include treatment for a disability of

a veteran with a permanent and total rating.

In this case, the record reflects that there was no advance

authorization for payment of the private medical expense

incurred at Faith Dental Care from June 11, 2007 to August

24, 2007. The Veteran does not contend that this was the

case. In fact, the Veteran stated that VA told him that he

was ineligible for treatment by VA. After receiving the

private treatment, he did not request reimbursement until

after the January 2008 rating decision was promulgated.

Therefore, there was no preauthorization and no record of

application made to VA within 72 hours after the hour of

admission to the private facility. 38 C.F.R. § 17.54.

Thus, there is no evidence that the Veteran obtained proper

authorization for payment of the private medical expenses

provided by Faith Dental Care from June 11, 2007 to August

24, 2007. Accordingly, the Board must conclude that prior

authorization was not obtained pursuant to 38 C.F.R. § 17.54,

and that payment is not warranted for expenses incurred in

conjunction with the private treatment under 38 U.S.C.A. §

1703.

Alternatively, reimbursement for unauthorized medical

expenses may be made pursuant to 38 U.S.C.A. § 1728.

Generally, in order to be entitled to payment or

reimbursement of medical expenses incurred at a non-VA

facility, a claimant must satisfy three conditions. There

must be a showing that three criteria are met: (a) The care

and services rendered were either: (1) for an adjudicated

service-connected disability, or (2) for a non-service-

connected disability associated with and held to be

aggravating an adjudicated service-connected disability, or

(3) for any disability of a veteran who has a total

disability, permanent in nature, resulting from a service-

connected disability, or (4) for any injury, illness, or

dental condition in the case of a veteran who is

participating in a rehabilitation program and who is

medically determined to be in need of hospital care or

medical services for reasons set forth in 38 C.F.R.

§ 17.47(i) (formerly § 17.48(j)) (2000); and (b) The

services were rendered in a

medical emergency of such nature that delay would have been

hazardous to life or health; and © No VA or other Federal

facilities were 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. See 38 U.S.C.A. § 1728; 38 C.F.R. § 17.120; see

also Zimick v. West, 11 Vet. App. 45, 49 (1998).

The Veteran maintains that he meets the criteria of 38

U.S.C.A. § 1728 and 38 C.F.R. § 17.120. He asserts that

although he did not have a total rating on the dates of

treatment in question, he received retroactive entitlement

for that time period.

The Board notes that the effective date of TDIU, August 23,

2006, predates the dates of treatment in question, June 11,

2007 to August 24, 2007. Thus, entitlement to TDIU was

warranted when the Veteran received emergency treatment from

June 11, 2007 to August 24, 2007. Thus, that criterion is

met.

The treatment rendered by Faith Dental Care from June 11,

2007 to August 24, 2007 was provided on an emergent basis as

the Veteran was unable to eat and he is competent to make

that assessment. See Davidson v. Shinseki, 581 F.3d 1313

(Fed. Cir. Sept. 14, 2009). Thus, a delay would have been

hazardous to life or health. Further, no VA or other Federal

facilities were feasibly available as the record establishes

that the Veteran initially sought treatment at VA and VA did

not provide the treatment sought.

Accordingly, the three enumerated criteria have been met for

entitlement to payment or reimbursement for unauthorized

medical services provided at Faith Dental Care from June 11,

2007 to August 24, 2007.

Therefore, since the criteria under 38 U.S.C.A. § 1728 and 38

C.F.R. § 17.120 have been met, the claim for reimbursement is

warranted.

ORDER

Payment or reimbursement for medical expenses incurred at

Faith Dental Care from June 11, 2007 to August 24, 2007, is

granted.

____________________________________________

P. M. DILORENZO

Veterans Law Judge, Board of Veterans' Appeals

Department of Veterans Affairs

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17.126 Timely filing.

Claims for payment or reimbursement of the expenses of medical care or services not previously authorized must be filed within the following time limits:

(a) A claim must be filed within 2 years after the date the care or services were rendered (and in the case of continuous care, payment will not be made for any part of the care rendered more than 2 years prior to filing claim), or

(b) In the case of case or services rendered prior to a VA adjudication allowing service-connection:

(1) The claim must be filed within 2 years of the date the veteran was notified by VA of the allowance of the award of service-connection.

(2) VA payment may be made for care related to the service-connected disability received only within a 2-year period prior to the date the veteran filed the original or reopened claim which resulted in the award of service-connection but never prior to the effective date of the award of service-connection within that 2-year period.

(3) VA payment will never be made for any care received beyond this 2-year period whether service connected or not.

(Authority: 38 U.S.C. 7304)

[33 FR 19012, Dec. 20, 1968, as amended at 39 FR 1844, Jan. 15, 1974; 45 FR 53807, Aug. 13, 1980; 51 FR 8673, Mar. 13, 1986. Redesignated at 61 FR 21966, May 13, 1996]