Thi s version includ es the e rrat a pub lish ed on 14Jun 04 - e
UN ITED STA TES C OU RT OF AP P EA LS F OR VE TER AN S CL AI M S

N O . 02-0682
H OMER O C AN TU , A PP EL L ANT ,

V
. ANTHONY J. P RI NCI PI , S EC RE T A RY O F V ET ER A N S A FF A I RS , A PPEL L EE
.

On Ap pe a l f ro m th e B oa

rd of Ve te ra ns ' Ap pe a ls
(De cided June 1. 2004 )
Sa nd ra E. Bo oth , o f C olumbu s, Oh io, wa s o n th e br ie f f or the a pp e lla nt.
Tim Mc Cla in , G e ne ra l Co un se l; R. Ra nd all Cam pb e ll , A ssi sta

nt G e ne ra l Co un se l; Ed

war d V. Cassidy, Jr., Acting Deputy Assistant Gener al C o u nsel; and Nicole Degraffenre ed , all of Washington, D.C., wer e on the br ief for the appe llee.
Be fore FARL EY, STEI

NB ERG, and GREENE, J ud ge s. STEI NB ERG, Judge : The appe llant, throug h counsel, seeks revie w of a J anuar y 17, 2002, B oa rd of Ve te ra ns ' Ap pe a ls ( B oa

rd or B VA ) d eci si on th a t de nie d h is c la im f or e nti tle me nt t o pay ment o f medica l expenses incurre d during hospitaliz ation at a pr ivate fa cility from January

28 to Febr uary 3, 1993. Both pa

rties fil ed briefs, and the appellant filed a reply brief. On appeal, the appellant doe s not challeng e the Boa rd’s determination that he does not qualify for pa y ment of the expenses under 38 U .S.C. § § 1 7 0 3 (a )( 1 ) and 1728(a) ( Record ( R.) at 9-10). B rief ( Br .) at 7. Acc ording ly , any claim based on those provisions is deeme d to have been abandoned. See Ford v. Gober , 1 0 V e t. Ap p. 53 1, 53 5- 36 (1 99 7) ; De gm e tic h v . B ro wn , 8 Vet.App. 208, 209 ( 1995), a ff 'd , 104 F.3d 1328 (F ed. Cir. 1997)

. For the rea sons that follow, the Court will rever se the B VA dec ision and re mand the matter

for the B oard to orde r VA pa y ment of the a llowable medica l expenses incurre d in connec tion with that hospi talization.23 I. Re le va nt Bac kgr ound The ve tera

n, Homero Cantu, had ac tive U.S. mili tary service from Mar ch 1967 to Octobe r 1968. R. at 14. He ha s been a war ded De partment of V eter ans Aff airs (V A) service connec tion for

e p is taxis ( n o s e b le e d s ) , r a te d 0 % d is a b li n g e f f e c ti v e f r o m N o v e mb e r 1 9 7 9

. R. at 147. He w as intermittently

a patient at the Corpus Christi, Texas, VA Outpatient Clini c (VA Clinic) for an upper g astro-intestinal ser ies and for various ailments as e arly

as September 1990, and continuing thr oug h, at least, June 1993. R. at 301 (clinical re cord) , 318-19 (c omputer printout of appointment date s). On Janu ary 28 , 1 99 3, the ve te ra

n w e nt t o th e VAClin ic wi th c omp la ints of dro ws ine ss,
weakness, dizz iness, ex h au stion, chills, poor appetite, and unstea dy g ait, all of which ha d been prese nt for the pa st three da y s, and compl aints of constipation, dy suria, low-ba ck pain, a nd

a bd omi na l pa in, a ll o f w hic h ha d be e n p re se nt f or the pr ior we e k. R. at 44 (V A m e dic a l c e rt if ic a te dated Jan. 28, 1993, at 10:25 a.m.). The VA medica l assessment included se psis, abdominal pain, ileus, and the ne cessity

to rule out cirrhosis of the l iver, hepatic encepha lopathy , and abdominal or sp le e n h e ma tom a . R. a t 44- 45 . (Se ps is is the " pr e se nc e in t he blo od or oth e r t iss ue s o f p a tho g e nic microorg anisms or their toxi ns." D OR L AND ' S I L L US TR ATED M ED I CA L D I C TI ONAR Y 1507 (28th ed. 1994) [hereina fter D OR L AND ' S ] . I leu s i s "ob st ruct io n o f t he i nt est in es. " Id. a t 81 9. He patic

e nc e ph a lop a thy

is " a c on dit ion us ua lly oc c ur ri n g s e c on da ri ly to a dv anc e d d ise a se of

the liv e r b ut a lso

se e n in th e c o u r s e o f an y s e v e r e d is e a s e o r in p ati e n ts w it h p o rta c a v a l s h u n ts

. I t is marked by disturbance s of consc iousness w h ich may prog ress to dee p coma ( hepatic c oma)" among other things. Id. at 550. Hematoma is "a localized collection of blood, usually clotted, in an org an, spac e, or ti ss ue, du e to a bre ak i n t he w all of a b lo odves sel ." Id. at 742.) I n a handw ritten note, the VA

e xam i n e r s t a t e d t h e p l an o f t r e a t m e n t a s i n c l u d i n g t h e f o l l o w i n g : " T r an s f

e r p [a t i e n]t t o M MC [(Memorial Medica l Center, C orpus C hristi, Texas)] ER [(emerg ency room)] by

ambulance [wit h]

c o p y o f M e d ic a l C e r

ti f ic a te [, ] l is t o f

me d ic in e s [, l] a

b te s t reports[.] D r
. G r e e n e a c c e p ts p [a ti e n ]t 12:15 PM." R. at 45 (VA F orm 10-10M). MMC is a private fac ility

. A VA Clinic repor

t-of-c ontact for

m (ROC f

orm) dated J anuar

y 28, 1993, noted, by

means of a chec kmark, that the veteran and the hos pital were notified that hospitaliz ation would not be at g overnm e n t e xp e n s e b e c a u s e th e v e te r anis “ n o n - s e r v ic e c o n n e c te d ”

. R. a t 1 6

. I na h an dwritten note, the for

m stated: “P[atient] told: Hosp[ ital] [and] amb[ulance] at p[atien] t’s expense. Patient4

disag ree s.” Ib id

. The form also noted, by means of a che ckmar k, that the veter an' s condition had not worsene d in the clinic to bec ome life thre atening , and the f orm included the f

ollowing handwr itten note: "R/O Sepsis[,] R/O Hepatic e ncepha lopathy [,] R/O cirrhosis of the liver"

. Ib id

. The for m was pre pare d by

a per son, whose last name is ill eg ibl e, fr o m "MA S" (Me dical Administration Service). Ibid. At 12:21 p.m. on J anuar y 2 8 , 1993, the VA Clinic ca lled a private ambulanc e ser vice reque sting that the ve tera n be tra nsfer red to MMC. R . at 309. Upon ar rival at MMC, the veter an
wa s e xami ne d at 1: 10 p. m. b y Dr . G re e ne , w ho dia g no sed the v e te ra n a s h a vin g po ssi ble ile us , possible small-bowel obstruction, or possible bac terial e nteritis, and instructed that he be admitted. R. at 60. MMC medical rec ords noted that the ve tera n had bee n “re fer

red” to the emer g ency

room from the VAClini c. R. at 48, 61, 75, 76, 83. An x-ray of his abdomen showe d “multiple lay ers of dilated small bowel” and “small[-] bowel obstruction”. R. at 52. A CT (computed tomog raphy ) sca n of the a bdomen re veale d "se vere pancr eatitis with pseudocy st formation and many additional pancr eatic f

luid pockets throug hout the peritoneum" with the " larg est one imping ing se vere ly upon the stomach fr om the posterior a spect." R. at 50. MMC prog ress notes rec orded that on J anuar y 29, 1993, the M MC financial de partment wa s “[w]orking on financ ial classificat i o n [ an d] also a refe rra l to Duval County to help pay

[t he

ve te ra n’ s] me dic a l bil ls. ” R. a t 73

. Ad dit ion a l MMC no te s date d that da y st ate d: “To dis c us s p[atient] for VASan Antonio – repa ir of her nia.” R. at 74. I n a medica l rec ord fr om the VA Clinic, the examiner who had dir ecte d that the veter an be tr ans fe rr e d to MMC no te d tha t on J anu ary 29 , 1 99 3, a

ph y sic ian f

ro m MM C c a lle d th e VAClin ic

and state d th a t th e ve te ra

n w a s f e e lin g be tte r. R. at 53 . ( Al tho ug h th e VAe xami ne r' s si g natur e is not leg ible, the veteran at a hea ring later ide ntified this VA phy sician as Dr . Fe rnando O rtiz. R . at 1 0 4

. ) T h e V A e x a m i n e r

a l s o n o t e d : " If s t a b l e [ , ] p [ a t i e n ] tm ay b e s e n tt o A LM M V H [ ( A u d i e L. Murphy Memorial Ve tera

ns Medical Cente r)]." R. at 53. On Fe bruar y 3, 1993, the VA e x aminer noted that the same MMC phy sician had c alled him and re lated, amongother thing s, that the veter an
was "f ound to have a

pancr eatic pse udocy st". Ib id . T he VAe xami ne r a lso no te d: " Ar ra ng e me nts for p[ ati en] t t o b e tr ans ferred to AL MM VH w e r e s u gg e s t ed. [ P ati ent ] agrees t o i t. " Ibid. I nformation conc erningthe transf er to that VAfac ility

is also ref lected in MMC prog ress notes dated5

Fe bruar y 3, 1993, rec orded by

MMC social work ser

vices. Those MMC notes stated that an orde r to transfe r the veter an to VA Audie L . Murphy Memorial Ve tera

ns Hospital in San Antonio, Tex as (her einaf ter AM VAMC), had been rec eived; that the veter an had a g ree d to the transfe r; that the AM VAMC h ad ag ree d to acc ept the vete ran; a nd that VA would send a n ambulance to transport the veter an ther e. R. at 79. The ve tera n was discha

rg ed fr om MMC on either Fe bruar y 3 or F ebrua

ry 4, 19 93 , w ith the dia g no sis of pa nc re a tic ps e ud oc y st, ane mia , a nd ins uli n- de pe nd e nt d ia

be te s me lli tus

. R. at 40, 48-49, 200. (The rec ord on appea l (ROA) is not entirely clea r as to the date of

discharg e. Com pa re R. at 48 (MMC discharg e summary noting date of discha

rg e as " 2/03/93"), and

R. at 73-79 (MMC pr og ress notes cover ing period J anuar y 29, 1993, throug h Fe bruar y 3, 1993), with R. at 55 (MMC reg istration form noti ng date of discharg e as "2/4/93" ), and R. at 200 (MMC bill statement for the ve tera

n noting discha

rg e date of " 2/04/93").) His discharg e summary noted that his followup

car e " woul d be throug h the [VA] C linic." R. at 48-49. T he total cha rg es assoc iated with his car e
a t MM C w e re $1 1, 34 7. 15 , w hic h in c lud ed $2 81.5 0 f or the pr ivate a mbu lanc e se rv ic e s to MMC ; $10,681.65 for his MMC hospitaliz ation from J anuar y 28 throug h Fe bruar

y 4, 1993; $110.00 for an initial hospi tal consultation at M MC on Fe bruar y 3, 1993, with a phy sician (Dr . David E. Pea rce ); and $274.00 for

radiolog y

at MMC. R. at 200-02, 309-16. I n Marc h 1993, the veter an submitted to the VA Clinic the bills for the above expenses. See R. at 30. A J une 1993 entr y made by a VA c laims clerk r eg ardingthe claim noted that the ve tera n
was re fer red to MMC for pa

ncre atic pseudoc y sts, that he was apprised at the time of the re fer ral that this hospit alization would not be at VA expense, that he had no service -conne cted disabilities, and that he wa s “not elig ible for e merg ency medical tre atment in the private sector at VA expense.” R. at 18. T h e c le r

k r e c o mm e n d e d

d e n ia l o f

th e c la im , an d

th e A M V A M C c h ie f

me d ic a l o f

f icer

concur red. Ib id .; see R. at 26, 122. There afte r, the veter an filed a Notice of Disag ree ment, stating that his tra

nsfer to MMC was authorized and that VA should pa y the bills. R. at 24. I n J anuar y 1994, VA issued a Stateme nt of the Case ( SOC), which noted, amo n g o ther thing s, that on J an u ary 2 8 , 1 9 9 3 , t h e v et er an wa s n o ts er v i ce co n n ec t ed , t h at t h e v et er an h ad“r e f u s edt o s i gn acknow ledg ment” that his ref err al to MMC would be at his own expense, and that on January 29, 1993, the MMC “contac ted Fe e B asis reg arding p aym en t of vete ran’ s hospitaliz ation” and the “hospital was infor

med [that] the veter an wa s not eligible f or pay ment of priv at e h o spital costs.”6

R. at 30. I n his VA For

m 1-9 (Substantive Appea l to the Boa rd), the veter an arg ued that he is service

connec ted for e pistax is (R. at 321), that Dr. O rtiz, t he phy sician at the VA Clini c, ordered his transfer by ambulance to MMC’s emerg ency room wher e he w as admitted, that t hat phy sician provided MMC with hi s medical recor ds, and that the VA Clini c g ave instruc tions to MM C for his transfe r to the AM VAMC in San Antonio. R. at 88. Be fore his a ppeal proce eded to the Boa rd, a hea ring was he ld in July

1994 befor e the a ssistant chief, Medic al Administration Service, at the VA Medic al Center ( VAMC) in Temple, Te x as, at whic h the veteran described the circ umstances surr ounding his transfe r and admission to MMC and transfer to AM VAMC. R. at 103-16. He te stified, among oth e r t hin g s, (1 ) t

hat th e VAClin ic ha d a

uth or ize d a pr ivate a mbu lanc e se rv ic e to t ra ns po rt him to MMC (R. at 104); (2) that he h ad n ot asked the V A Clinic to send him to M MC or to request a n ambulance for transfe r to MMC (R. at 104, 114); (3) that he had reque sted to be transporte d to the AM VAMC bec ause he did not have the mea ns to pay for a private hospital or the ambulance (R. at 10 4, 11 2- 13 ); (4 ) t

hat he wa s n e ve r t old

that th e pr ivate ho sp ita lizatio n w ou ld b e a t hi s o wn e xpe ns e and wa s never

approa ched to sig n an ac knowledg ment (R

. at 1 04, 108); and (5) that he had be en g oing to the g astrolog y

clinic at the AM VAMC intermittently "on doc tor' s consult" ( R. at 113). He questioned why

he wa s not transporte d to the AM VAMC instead of MMC on J anuar y 28, 1993, and

no te d tha t the VA ph y sic ian ha d re qu e ste d on Fe br ua ry 4, 19 93 , tha t an am

bu lanc e tr ans po rt him

to the AM VA MC. R. a t 10 4. He a lso te sti fi e d that he ha d r e c e ive d me dic a l se rv ic e s at th e VAClin ic prior to J anuar

y 28, 1993: As Istated bef

ore, I came as a w alk -i n on emer g ency . Ihave no means of ma

king pa y ments to my

medi cal needs. This was my not my fi rs t tim e a s a wa lk- in and I have be e n c omi ng to t he [VA ] Clin ic sin c e 19 90 on

sc he du le d . . . do c tor

a pp oin tme nts

. . . . Th e se sy mptoms have been present many times and Ihave be en . . . re fer red in the past on sever al consults to [ AM VAMC] by t he attending phy sician at the [VA C]li nic in C o rp u s Christi. Thi s time, Iwas unable to drive my

own vehicle and a friend of mine, Mr. Ga lvan, g ot me out of bed and took me [there] since I ha[d] been . . . a

bout a wee k and a ha lf

. . . in be d .

. . du e to t

his

. . . il lne ss. R. at 106. The vete ran f

urther te stified that he had told the ambulance dr iver that he did not have the money

and did not want to g o to MMC, and th at the drive r re sponded that he ha d order s from7

the doctor at the VA Clinic and that the ve teran wa s not to worry about the money

to pay for the ambulance . R. at 111. I n an August 1996 BVA de cisio n , t h e B oard r emande d the matter to the A M VAMC, the ag ency of orig inal jurisdiction f

or this matter , to obta in the veter an’s c laims file, if any exis ted, and to r e a dju dic a te the c la im f or pa y me nt o f m e dic a l e xpe ns e s in lig ht of any a dd iti on a l in fo rm a tio n in th e claims file, including any exis ting se rvice -conne cted disabilities. R. at 123. On rema nd, the chief medical of

fice r at the AM VAMC deter mined in J uly

1997 and January

1998 that the veter an’s hospital admission for pancr eatic pse udocy sts was not related t o a service- connec ted di sability

. R. at 139, 150. I n Aug ust 1998, VA issued a Supplemental SOC. R. at 152. I n a J u n e 1999 BV A decision, the B oard c oncluded that the vet era n’s claim of e ntitlement to pay ment by VA of

un a uth or ize d me dic a l e xpe ns e s w a s n ot we ll g ro un de d. R. a t 16 0- 69

. Th e ve te ra n, thr ou g h c ouns e l, appea led to this Court, and in April 2001, this Court, by Clerk’s orde r, gra n t ed the pa rties' joint motion to remand the matter to the B oard in lig ht of the ena ctment of the V eter ans Claims Assistance Ac t of 20 00 (V CA A) , Pu

b. L . N o. 10 6- 47 5, 11 4 St a t. 2 09 6. R. at 20 6 (o rde r i ssu e d in U. S. V e t. A

pp . N o. 99 -1 25 3) ; see R. at 207-10 (joi nt motion for remand). On remand, the vete ran, proce eding without counsel, submitted to the Boar d, among other thi ng s, a copy of t he brie f that he ha d f i l e d i nt h i s C o u rti nU

. S

. V e t

. A p p
. N o
. 9 9

- 1 2 5 3 an d s t a t e d t h a th e w o u l d

l i k e t h e B o a r d

to consider the leg al arg uments prese nted i n that brief and t hat he had no further argument or evide nce to submit to the Boa

rd. R. at 241, 271, 272-94. I n th e Janu ary

17 , 2 00 2, B VAde c isi on he re on a pp e a l, t he B oa rd de nie d th e ve te ra

n' s c la im for e ntitlement to pay

ment of medica l expenses incurre d during ho s p i t ali zation at MMC from J anuar y 28 to Febr

uary 3, 19 9 3

. R

. at 1 -1 1

. The B oard f ound that, “[a]t t he time of the hospitaliz ation, service [ ] connec tion was in eff ect for epistaxi s.” R. at 3, 9. The B oard, how ever , fo un d th a t th e re wa s n o p ri or a uth or iza tio n f

or the ho sp ita lizatio n at MM C a s r e qu ir e d b y 38 C.F .R. § 17.52(a) (3) a n d that such hospitalization was not for the trea tment of a medic al emer g ency that posed a serious threat to the veter an' s life or health. R. at 2, 3, 10 (citing 38 U.S.C. § 1703(a )(1) ). The B oard a lso concluded that VA had c omplied w ith the require ments of the VCAA. R. at 3- 4.8 II. Contentions of

the P artie s On a p peal, the a

ppellant ar g ues that, althoug h he mee ts the elig ibilit y criter ia for hospital c are under 38 U .S.C. § 1710, t he Court should remand the matter to allow the B oard, w hich di d not addre ss the appellant' s elig ibilit y for hospit al ca re unde r sec tion 1710, to make specific finding s of fac t in that reg ard in the f irst instance. B r. at 7 -1 2 . I n addition, he ar g ues that, assuming that he

me e ts t he e lig ibi lity

re qu ir e me nts of

se c tio n 1 71 0, he is e nti tle d to e nf or c e me nt u

nd e r 3 8 U .S. C. § 17 03 re g ard ing pr ivate me dic a l se rv ic e s. B r. a t 6. I n that re g ard , he re qu e sts that the Court re ve rs e
c e rt a in o the r f

ind ing s o f t

he B oa rd . In p art ic ula

r, he argue s th a t th e B oa rd ' s c on c lus ion

that hi s medical c ondition was not a medical emer g ency within the meaningof sec tion 1703(a)( 3) is without a plausible ba sis in the r ecor d and should be reve rsed. Br

. at 12-17. He also argues that the B oard misconstrued the re quirements of se ction 1703 and the implementing regulation, 38 C.F.R. § 17.52, when it stated that there had to be an "a ctual contra ct" betwee n VA and the non-VAfac ility , and that that c on c lus ion

sh ou ld b e re ve rs e d. Br. at 18 -1 9. Mo re ov e r, he argue s th a t V A a uth or ize d h is admission to the non-VA fa cility at VA e x pense a s is required by 38 C.F.R. § 17.54(a) . Br . at 19-20. Finally , the appe llant argues that, if the Court d o es not reve rse the B oard' s findings, the matter should be rema

nded for compliance with the VCAA. B r. at 20-21; Reply Br . at 13. Th e S e c r e t ar

y m a i n t a i n s t h a tt h e B o ar d d e c i s i o ns h o u l d

b e a f f i r m e d b e c a u s e i tp r o p e r ly deter mined that pay

ment for the pr ivate medica l expenses under sec tion 170 3 was not wa rra nted. Br . at 6-7. The S ecr etar

y contends that the VAMC di d not provide the a ppellant with an individual authorization for the private medica l expenses at MMC a nd that no contra ct exist ed betwe en the VA C l i n i c a n d

M M C

. Br

. at 6 -7 , 1 0

. H e a c k n o w l ed ges t h at t h e B o ar d d i d n o td i s cu s s t h e ap p el l an t 's elig ibilit y under se ction 1710, but asserts that any such fa ilure i s not prejudicial be cause that provision does not a

uthorize the Secre tary to r eimburse a vete ran f or medica l service s rende red at a non-V A fa cility

. Br

. at 8. I n addition, he ar g ues that re versa l is not warra nted her e bec ause the re exis ts a plausible basis in the record f or the B oard' s determination that a me dical eme rg ency did not exis t. Br. at 9. I n repl y , th e a

pp e lla nt c on te nd s th a t th e Se c re tary mis a pp re he nd s th e Court ' s o pin ion in Mal o n e v
. Go b er , 10 Vet.App. 539, 543 ( 1997), with respe ct to VA author ization of pay ment of medical se rvice s at a non-V A fa cility . Reply Br . at 2. He f

urther a rg ues th at section 401 of the9

Veter ans Be nefits Act of 2002 (VB A), Pub. L . No. 107-330, § 401, 116 Stat. 2820, 2832, which amende d 38 U.S.C. § 7261 and was ena cted a fter his principal brief had been filed, "eliminate[s] the pr ior de fe re nti a l r e vie w o f B VA de c isi on s" , " un de rc uts the pla us ibl e ba sis sta

nd ard " , a nd su pp or ts his e ntitlement to the reme dy of reve rsal. Reply Br

. at 4, 8-10. The appellant a l s o ar gu es that

re gar d l es s o f a n y

ch an ge b ro u g h t a b o u t b y t h e V BA , t h er e i s n o p l au s i b l e b as i s fo r t h e B o ar d 's deter minations as to a medical e merg ency and VA a

uthorization, a n d that those deter minations should be reve rsed a s clea rly err oneous. Id . at 8.

III . A nal ys is A. A pp lic ab le La w and Re gul ations The Court note s that many of the applica ble statutory

and re g ulatory

provisions have be en amende d since the a

ppellant’s cla im arose in January 1993. I n this opi n i o n , we wi l l cite to the

curr ent provisions unless there ha s been a substantive ch an ge; i n such ca se, we will cite to the provision in effe ct at the time that the a ppellant’s cla im arose. I n o rd e r t o r e c e ive ho sp ita l c are a t V A e xpe ns e , a ve te ra n fi rs t mus t me e t the ba sic e lig ibi lity require ments of 38 U.S.C. § 1710. I n 1993, section 1710 provided:

( a ) ( 1 ) T h e S e c r e t ar

y sha ll fu rn ish ho sp it a l c are , a

nd may fu rn ish nursing home ca

re, w hich the Secr etar

y deter mines is needed– ( A ) t o an y v e t e r anf

o r a s e r v i c e - c o n n e c t e d

d i s a b i l i t y; (B ) to a ve tera

n whose discha

rg e or r elea se fr om the active milit ary , naval, or

air ser vice wa s for a

disability incurre d or a g g r a v a t e d i nl i n e o f d u t y, f o r an y d i s a b i l i t y;

. . . (D) to a

veter an who ha s a ser

vice- connec ted disability

rate d a t5 0 p e r c e n to r

m o r e , f o r an y d i s a b i l i ty; ( E ) t o an y o t h e r v e t e r anw h o h a s a s e r v i c e - c o n n e c t e d

d i s a b i l i t y, for any

d i s a b i l i t y;

. . .10 (I ) t o a veteran for a non-service connec ted disability , if the ve te ra n is un a ble to d e fr ay

the e xpe ns e s o f n e c e ssa

ry c are a s deter mined under se ction 1722(a) of this titl e.
38 U.S.C. § 1710(a) (1) (1991) (empha sis added). Sec tion 1722(a) pr ovides that a ve tera n shall be considere d to be unable to defra y the expenses of ne cessa

ry car e if the ve tera

n (1) is elig ible for medical a ssistance unde r the Social Sec urity Act, (2) is in rece ipt of non-servic e-c onnecte d pension,

or (3) has an annual income less than the applica ble income thre shold. See 38 U.S.C. § 1722(a) , (b); Zim ic k v . W est , 11 Vet.App. 45, 50 ( 1998). Veter ans who a

re e ligible to re ceive VA hospi tal car e under section 1710 may also be e ntitled to rec eive hospital ca

re at non-VA fa cilities at VA expense. See 38 U.S.C. § 1703. Under sec tion 1703(a) , the Secr etar

y has authority

to contrac t with non-VA hospitals for hospital ca re unde r limited circ umstances, includingwhen VAfac iliti es are not a ble to pr ovide “ec onomical“ hospital care or medical se rvice s and the c are is for the e merg ency treatmen t o f a v eter an re ceivingcar e at a VA fa c ili ty . 3 8 U .S. C. § 17 03 (a )( 3) ; see Malone , 10 Vet.App. at 540. Se c tio n 1 70 3 o f t itl e 38 , U .S. Cod e , p ro vid e s in pe rt ine nt p art : (a) When Depar

tment fac iliti es ar e not ca pable of furnishing economica l hospital care or medical se rvice s beca use of g eog raphic al inacc essibility

or ar e not capable of

furnishing the ca

re or service s require d, the Secr etar

y , as authorized in s ection 1710 of this titl e, may contra ct with non-De partment fac iliti es in order to furnish any

of the fo l l o wi n g:

. . . . (3) Hospital c are or medi cal se rvice s for the tre atment of me dic a l e me rg e nc ie s w hic h p os e a se ri ou s thr e a t to the lif

e or he a lth of a ve tera

n rec eiving medical se rvices in a Depa rtment fac ility

. . . until such tim e following t h e furnishing of c are in the nonDepa rtment fac ility

as the ve tera

n can be safe ly

transfe rre d to a D e p art m e n tf

a c i l i t y.
38 U.S.C. § 1 7 0 3 (a )( 3 ). The Sec reta ry has interpr eted se ction 1703 to allow for “ individual authorizations” as we ll as contrac ts with non-VA fa cilities. Zimick , 11 Vet.App. at 51 ( ci t ing 38 C.F.R. § 17.52(a) (for

merly 38 C.F.R. § 17.50b(a) (1992)) ).11

Moreove r, the Sec reta

ry require s that, in order f

or a ve tera

n t o b e ad m i t t ed to a non-VA fac ility at VA e x pense, suc h an admission must be authorized in advanc e by VA (or within 72 hours of admission in the case of an e merg ency ). See Zimick , 11 Vet.App. at 51 (citing 38 C.F.R. § 17.54 (f or me rl y 38 C.F .R. § 1 7. 50 d ( 19 92 )) ). Spe c if ic a lly , 3 8 C.F .R. § 1 7. 54 (a ) p ro vid e s, in p e rt ine nt p a rt : The a dmission of a ve tera n to a non-[VA] hospit al at [VA] expense must be authorized in advanc e. I n the ca se of a n emer g ency which ex isted at the time of admission, an author ization m ay be deeme d a prior a

uthorization i f a n ap plication, whether formal or informal, by

telephone, teleg raph or other c ommunication, made by the veter an or by

others in his or her

behalf is dispatched to [VA]

. . . for ve tera

ns in the 48 contig uous States and Puerto Rico, within 72 hours af ter the hour

of admission . . . . 38 C.F.R. § 17.54(a)

. Although se ction 1710 contains neither a m ec h anism to enforc e its “shall” c ommand nor

re me dia l pr ov isi on s f

or its vio la tio n, se c tio n 17 03 (a ) and the imp le me nti ngre g ulatio ns sp e c if ic a lly provide for

pay ment by VA for such ca re to the non- VA fa ci l i t i es i n the ce rtain limited circ umstances de scribed a bove (that is, circumstance s that are rele vant in the instant case). See Malone , 1 0 V e t

. A p p
. a t 5 4 0 , 5 4 2

. ( I n t h i s c a s e , t h e a p p e l l an t s e e k s t o h a v e V A m a k e p ay m e nt t o MMC for the medica l expenses. The appe llant does not seek r eimbursement.) B. Appli cation of Law to th e Fact 1. Se c tio n 17

10 Elig ibi lit y Th e a pp e lla nt a rgue s th a t, b e c a

us e he ha d a

servi ce-co nne c te d d isa

bil ity (e pis ta xis) a t a ll tim e s r e le va

nt t o h is a

pp e a l, h e me e ts the e lig ibi lity c ri te ri a fo r h os pit a l c are un de r 3 8 U .S. C. § 1 71 0( a )( 1) (E ), wh ich requ ir e s th e Se c re tary to f ur nis h c are “ to a

ve te ra n w ho ha s a service [-] connec ted disability , for a ny disability .” B r. at 6. He also argues t h at h e i s eli g ible for hospital care under se ction 1710(a) (1)( I ), which require s the S ecr etar y to furnish care “ to a veter an for a non-ser vice- connec ted disability , if the vete ran is unable to defr ay the expenses of ne cessa ry
car e as de termined unde r sec tion 1722(a)”

. Ib id . The a ppellant asks the Court to va cate the B oard decision and r emand for further development and re adjudication the matter conce rning whether

he met the sec tion 1710 eligibility criter ia bec ause the Boa

rd did not make f

indings of f

act r eg arding this iss ue. B r. at 7-12.12

The a ppellant cor

rec tly notes that he had previously raised to the B oard the issue of sec tion 17 10 e lig ibi lity

wh e n, fo llo wi ngthe Court ’s 20 01 re mand , h e su bmi tte d to the B oa

rd a c op y of

his br ie f. B r. a t 7- 8. I n th e B VAde c isi on he re on review , th e Boa

rd a g a in d id n ot m a ke sp e c if ic

e lig ibi li ty fi nd ing s und e r s e c tio n 1 71 0. I n it s d e c isi on , th e B oa rd c ite d to se c tio n 1 71 0( a )( 1) on ly in noting that "V A will f

urnish hospital c are and medical service s when neede d to any veter an under circ umstances spe cified by law and regulation." R. at 7. Although the Boa rd, in discussing w hether there was a medical emer g ency within the meaning of section 1703(a )(3) , did note that the appe llant "ha d been rec eiving VA medical car e for some time" (R. at 10), and it appea rs that the B oard ma

y have be en makinga finding of elig ibilit y under se ction 1710, whether the B oard ma de such f

inding is not entirely

clea r. R. at 10. Neve rtheless, the Court no t es t h at t h er e is undisputed evidence of

rec ord that the a

ppellant had be en re ceivingVA medica l car e since 1990 ( R. at 301, 318-1 9) and that he wa s se rv ic e c on ne c te d f or e pis ta xis a t th e tim e of

his MMC ho sp ita lizatio n (R . at 14 7 ( RO decision)) . I ndeed, the Boa rd did ex p re s s l y fi nd that the appe llant was ser vice c onnecte d for epi st axis a t th e tim e of

the ho sp ita lizatio n. R. at 3; se e als o R. a t 9

. I t is u n d is p u te d th a t the treatment he re ceive d at MMC was not related to epistaxi s, but that wa s not disqualify ing unde r section 1710(a ) in 1993 at the time of the hospitalization. As noted above, se ction 1710(a) (1)( E) the n p ro vid e d th a t " [t]he S ecre tary sh a ll f ur nis h h os pit a l c are
. . . to any oth e r v e te ra

n w ho ha s a service -conne cted disability , fo r any disability ". 38 U .S.C. § 1710(a)(1) (E) ( emphasis adde d). Apply ing the plain meaningof this section to the undisputed fac t s , t h e C o u rt conclude s that the appellant met the e ligibility criter ia for V A hospital car e under section 1710. 2. Section 1703(a) I n deter mining whe ther the a

ppellant is entitled to enforc ement of se ction 1710 under se ction 17 03 (a )( 3) , th e fo llo wi ng fi ve de te rm inatio ns are re qu ir e d: (1 ) Th a t the VA Clin ic wa s n ot c a pa ble of fu rn ish ingthe ho sp ita l care or me dic a l ser vic e s re qu ir e d; (2 ) that th e VAClin ic c on tr a c te d w ith MMC in order to furnish the hospital ca re or medical serv i ce s (di scussed in Part I I I .2.b., below); (3) that th e h o s p it a l c ar e o r me d ic a l s e r

v ic e s w e r e f

o r th e tr e a tm e n t o f

a me d ic a l e me r g e n c y

that posed a serious threat to the l ife or health of the appe llant (discussed in Part I I I .2.a., below) ; (4) that the appe llant was re ceiving medical se rvice s in a VA fa cility ; and (5) that the hospital care or
me dic a l se rv ic e s f

ur nis he d at MM C w e re fu

rn ish e d unti l su c h time a s th e a pp e lla nt c ou ld b e sa fe ly13

transfe rre d to a VA f

acility

. See 38 U.S.C. § 1703(a)(3)

. I n this case, there is no dispute that the appellant met require ments (1), (4) , and (5) , and the Court will not di s t urb the B oard' s findings w ith respec t to these requir ements. See Roberson v. Principi , 1 7 V e t

. A p p
. 1 3 5 , 1 3 9 ( 1 9 9 3 ) ( p e r c u r i a m o r d e r ) ( n o t i n g t h a t C o u rt i s w i t h o u t a u t h o r i t y,
un de r 3 8 U .S. C. § 72 61 (a)(4 ), to reve rs e fi nd ing s o f f a c t th a t are be ne fi c ia l to c la ima nts ). As to require ment (1), the B oard acknowle dg ed that “[i] t may
. . . be surmis ed, because the veter an wa s tr ans fe rr e d, that th e VA[C]lin ic

. . . w a s n ot e qu ipp e d t o ful ly evalu a te [his ] co mpl a int s u po n h is prese ntation on J anuar

y 28, 1993.” R. at 10. As to require ment (4), the B oard a cknowledg ed that he “ha d been r ece iving VAmedical c are for some time”

. R. at 10. I n this reg ard, the Court notes that section 1701 (in 1993 and now) define s “medica l se rvice s” to inc lude a medic al examination, 38 U.S.C. § 1701(6), and that it is undi sputed that the appe llant was beingexamined by a phy sician at the VA Clinic immediately prior to beingtransporte d via ambulanc e to MMC. T h ere fore , the appellant ha d not only been "r ece iving VA medical service s" in a VA fac ility in the months and y ear s leadingup to J anuar

y 1993 but also was re ceivingmedical se rvice s in a VA fa cility on J anuar

y 28, 1993, immediately

prior to his admission to MMC; the appellant thus satisfies this requirement of section 1703(a)(3)

. Cf

. Malone , 10 Vet.App. at 544 (conc luding that claimant, who wa s transported to p ri vate fa c ili ty via a mbu lanc e wi tho ut fi rs t havin g be e n a t VA fa c ili ty , fa ile d to me e t r e qu ir e me nts of sec tion 1703(a)( 3) bec ause he was not " rec eiving medical se rvice s in a Depa rtment fac ility ") . As to require ment (5), the B oard note d that “VA r ecor ds confirm that a phy sician fr om MMC contacted V A an d ar

r an g e d f o r t h e v e t e r an t o b e t r an s f e r r e d t o t h e
. . . [ A M V A M C ]

. ” R

. a t5

. S p e c i f i c a l l y, the Court notes that MMC recor ds stated that on Fe bruar y 3, 1993, VA h ad directed that the appellant be transfe rre d to the AM VAMC and that VA w ould send an ambulance to tra nsport the appellant ther e. R. at 79. Th e dis a g re e me nt b e tw e e n th e pa rt ies li e s a s to wh e the r t

he a pp e lla nt m e t r e qu ir e me nts (2) ( contra ct/authorization) and ( 3 ) (m ed ical eme rg ency ). These two require ments are discussed below in re verse order

. a. Medical Em ergency : The appellant argues t hat all the evidence of rec ord supports t he

c on c lus ion

tha t hi s c on dit ion , at th e tim e of the tr ans fe r t o M MC, po se d a se ri ou s th re a t to his he alt h within the meaning of sec tion 1703(a)( 3). B r. at 16-17.14

As to whether

the appe llant was entitled to relief u n d er s ec t ion 7103(a)( 3) for a medica l

e me rg e nc y , th e B oa

rd c on c lud e d th a t " the me dic al re c or d a s a wh ole do e s n ot r e fl e c t tr ans fe r t o MMC for treatment of a medic al emer g ency that posed a se rious threat to the veter an' s life or health." R. at 10 . In s o c on c lud ing , th e B oa rd re a so ne d a s f

oll ow s: I t is c on c e de d th at so me of the po ssi ble dia g no se s MM C w e re to r ule out were indeed ser ious di so rd e rs and that th e a dmi ssi on

to M MC was throug h the emer g ency room. Ho we v er , rec ords from VAand MMC are ne g ative for

specific ref

ere nce to se rious or life- threatening c om p l a i n t s o r

f i n d i n g s
. T h e Jan u ar

y 2 8 , 1 9 9 3 , [R O C f

or m] completed by VA per sonnel specif ied that . . . the vete ran' s condition had not bec ome life[] threatening whi l e at t he [VA C] linic. The admission t o MMC was for obse rvation; the re cord r efle cts no e me rg e nc y

pr oc e dure s o r t

re a tme nt. R. at 10 (emphasis adde d). As noted above, the appellant seeks reve rsal of the Boa rd' s finding that there was no medic al

e me rg e nc y

that po se d a s eriou s th re a t to his he a lthun de r s e c tio n 1 70 3( a )( 3) . In s up po rt of his

argume nt, he re fe rs to t

he fo llo wi ngun dis pu te d e vid e nc e : ( 1) Th e de c isi on of the VA ph y sic ian to direc t the appellant's transfer by ambulance to a non-VAfac ility emer g ency

room (R. at 45), r ather t h an d el ay

h i s ad m i s s i o no n e d ay , wh en t h e A M VA M C co u l d ac ce p th i m (R

. at 5 3 ); (2 ) t h e B o ar d 's

conce ssion that the private-e merg ency -room admission was ne cessa ry to rule out " indeed se rious disorders" and that the VAClini c wa s not e quipped to e valuate his c omplaints (R. at 10); (3) the VA Clin ic ' s r e fu sa l to ho no r t

he a pp e lla nt' s r e qu e st that he be tr ans fe rr e d to the AM VA MC, pa rt ic ula rl y in light of the a

ppellant' s objections to transfe r to MMC (R. at 113); (4) the a ppellant' s diag nosis of "se vere " pa

ncre atitis at MMC (R. at 80); and (5) MMC' s decision to keep t h e ap p el l an t as an inpatient for f

ive day s afte r obt aining approva l from VA for VA to transfe r him to a VA fa cility (AM VAMC), which de cision demonstrated that the appellant wa s not stable enoug h for tra nsfer during that period. B r. at 14-17; Reply Br . at 4-5. He asser

ts that there is no medica l evidence to refute the above me dical evide nce. B r. at 16-17. The Sec reta

ry argues t h at he is not authorized to reimburse a veter an for

medical se rvice s
re nd e re d at a

no n- VAfa c ili ty . B r. a t 8. Th e Se c re tary re a so ns tha

t Malone , 1 0 V e t.A

pp . at 54 3, he ld that e ve n a ssumin g tha

t th e a pp e lla nt t he re wo uld

have be e n e lig ibl e fo r h os pit a l c are a t a VAfa c ili ty

un de r s e c tio n 1 71 0, the Court la c ke d th e a

uth or ity to r e qu ir e VAto r e imb ur se me dic a l e xpe ns e s,15

absent statutory

authorization. Br. at 8. Moreover , the Secr etar y contends that the f

ollowing

e vid e nc e in t

he re c or d s up po rt s t he Board ’s de te rm inatio n th a t a me dic a l e me rg e nc y

did no t e xist pursuant to sec tion 1703(a)( 3): (1) The J anuar y 1993 VA Clinic ROC f

o rm , which noted that the appellant’ s condition did not worsen at t he VA Clinic to bec ome life thre atening(R. at 16); (2) the J une 1993 entr

y by a claims cler

k noting that the appe llant was “not e ligible f or eme rg ency

medical treatment in the private sec tor at VA e x pense” (R. at 18); and ( 3) the medic al re cords f rom the appellant’ s hospitaliz ation at MMC, which do “not incl u d e any notations that [ his] condition was considere d life[] threatening or a medical emerg ency” (R. at 48- 52, 59-86). B r. at 9. The Secre tary

argue s th a t r e ve rs a l is no t warr ante d he re be c a us e the fo re g oin g e vid e nc e pr ov ide s a pla us ibl e ba sis in the rec ord for

the B oard' s determination. Br

. at 9. I n so arguing, the Secre tary relies on Hicks v

. Br own , 8 Vet.App. 417, 422 ( 1995), and Hersey v. De rwinski , 2 V e t. A p p
. 9 1 , 9 5 ( 1 9 9 2 ) , f o r the proposition that rever sal is not appropr iate unless "[t]here is absolutely no plausible basis" for the B oa rd ' s d e c isi on

and tha t de c isi on " is c le arl y

e rr on eou s in lig ht o f t

he un c on tr ov e rt e d e vid e nc e in appellant' s favor ." B r. at 9. As c or re c tly no te d b y the a pp e lla nt, the Se c re tary

mis c on str

ue s Malone and Malone is distinguishable f

rom the instant c ase. The a ppellant explains that, unli ke in Malone , which involved a cla imant seeking reimburse ment of private medical e x penses, the instant c ase involves a claimant seekingdirec t pay

ment of t h e m ed i ca l expenses to the private medic al provider s. Cf. Malone , 10 Vet.App. at 540. T h e C o u rt co n cl u d es t h at , fo r t h e fo l l o wi n g re as o n s , t h er e i s n o p l au s i b l e b as i s fo r t h e B o ar d 's deter mination that there wa s no medical e merg ency that posed a se rio us th re at t o th ehe alt

h of the appellant, a

nd that deter

mination was there fore clea rly err oneous. A d et er mination under sec tion 1703(a) (3) whether a medical emerg ency exis ts that poses such a thre at is a question of fa ct subject to reviewin this C ourt under the "c lear ly err oneous" standard of

revie w. 3 8 U.S .C. § 7261(a)( 4). Under this standard of r eview, the Court shall "hold unlawf ul and set aside or reve rse [ a finding of

ma te ri a l f a c t a dv e rs e to t

he c la ima nt ma de by the B oa

rd in re a c hin g a de c isi on ]

. . . if the fi nd ingis clea rly err oneous," 38 U.S.C. § 7261(a)(4) ; the Court may not overturn a

fac tual deter

mination of the B oa rd wh e re , r e vie wi ngthe re c or d in its e nti re ty , the re is " a pla us ibl e ba sis in t

he re c or d" fo r i t. Mariano v. Principi , 1 7 V e t.A pp . 3 05 , 3 13 (2 00 3) ; Gilbert v. De rwinski , 1 Vet.App. 49, 52 (1990)16

(q u o t i n g An de rso n v . Ci ty of B esse me r Ci ty , 470 U.S. 564, 573-74 (1985))

. As to the J anuar

y 1993 ROC form (R. at 16), the a ppellant correc tly asser

ts that this report

no ted on ly

th at t he ap pel lan t's con di ti on "di d no t wor sen in th e C li ni c to beco me l if e[ ] th reat eni ng",

and is, a t be st, ne utr a l on

the qu e sti on wh e the r his me dic a l e me rg e nc y po se d a se ri ou s thr e a t to his he alt h . Reply Br . at 6. Moreove r, the a

ppellant cor

rec tly notes that the Secr etar

y ' s position t hat the appellant' s condition was not a ser ious threat to his health is inconsistent with the Boa rd' s conce ssion that some of the possible diag noses that MMC wa s to rule out wer e " indeed se rious disorders" that the VA Clinic was not equipped to evaluate. Reply Br . at 6-7. In addition, the claims cler k' s J une 1993 entry

that the appe llant was not " elig ible for e merg ency medical treatment in the private se ctor at VA ex p en s e" (R

. at 18) doe s not support the Boa rd' s determination bec ause it make s a leg al

co n c lu s io n o n e li g ib il it

y w it h o u t a b a s is in a me d ic a l o p in io n o n th e is s u e w h e th e r , a t th e ti me of transfe r to MMC, the appellant' s medical e merg ency posed a se rious threat t o h i s health or life

. Finally , reg ardingthe B oar d 's statement that the a ppellant' s admission to MM C was " for observation" (R. at 10) , that statement is inconsistent with the evidence of record that refle cts that Dr . G re e ne a t MM C a dmi tte d th e a pp e lla nt a ft e r h a vin g d iagno sed him a s h a vin g po ssi ble ile us , possible small-bowel obstruction, or possible bac terial e nteritis. R. at 60. Moreove r, t he R OA contains sufficie nt evidenc e to re verse , rathe r than set a side, the B oard’ s finding reg ardingthe lack of a medical emer g ency that posed a thre at to the appe llant's he alth. See Mariano , 17 Vet.App. at 316-17 (re versingtwo clea rly err oneous finding s). Specific ally , the ROA

co n t a i n s t h e f

o l l o wi n g: (1 ) T h e h an dwr i t t en n o t e o f t h e V A p h y s i ci an d i re ct i n g t h e ap p el l an t 's transfe r b y

a mb u la n c e to a n o n - V A f

a c il it y e me r g e n c y

r o o m ( R. a t 4 5 ) , w h ic h w a s ma d e o v e r the objection of the a

ppellant and de spite his request to be sent to the AM VAMC (R. at 113); and ( 2) the B oar d 's co n ce s s i o nt h at t h e p ri v at e- em er gen cy -r o o m ad m i s s i o nwa s n ec es s ary t o ru l e o u t"indeed serious disorder s" a

nd that the VA Clini c wa s not equipped to eva luate his complaints (R. at 10). Ac c or din g ly , e xami nin g the re c or d in its e nti re ty , th e Co urt c on c lud e s th a t th e re wa s n o p la us ibl e ba sis in t he re c or d fo r t

he B oa rd ' s f a c tua l de te rm inatio n th a t th e a pp e lla nt' s me dic a l c on dit ion

did not pose a thre at to his health, and be cause all the evidenc e in the re cord suppor ts the finding that such a thre at did exis t, the Court will rever se that finding

. See 38 U. S.C. § 7 26 1( a )( 4) ; Mariano , su pra .17

b. Prior Autho riz ation: As t o n o p ri o r a u t h o ri z at i o n , t h e B o ar d s t at edt h e f

o l l o wi n g: I n this c a se , the ve te ra

n init ia lly pr e se nte d to the VA ou tpatie nt c lin ic in Corpus Christi and was transfe rre d, at the direc tion of VA medica l personne l, to the emerg ency room at MMC. I nasmuch a s clea rly VA personne l knew that the vet er an was a dmitted to MMC from the e me r g e n c y

r o o m, it c anb e ar g u e d

th a t p r e - tr an s f

e r o r p o s t- tr an s fer communications betwe en personne l at eac h fac ility constituted prior authorization of the admission. 38 C.F.R. § 17.54( a). Howeve r, there is no indication in the claims folder of an ac tua l c ont ra c t betwee n the VAMC or the outpatient c linic and MMC for the ve tera n’s ca re. R

. at 9 (c i t i n g Zimick , 11 Vet.App. at 52) (empha sis added). The a ppellant ar g ues that the B oard misconstrue d t h e re q u i re ments of sec tion 1703 and implementing r eg ulation § 17.52 when it sug g ested that there had to be an “a ctual contr act” betwee n VA and the non-VA f

acility , and that the B oard’ s impli ci t conclusion that such a contra ct was

nece ssary s h o u l d be re verse d. Br . at 18-19. The appellant f urther a rg ues that the § 17.54(a ) require ment of " prio r au t h o ri z ati on" w as met bec ause ( 1) the VAphy sician direc ted that the appellant be transfe rre d to MMC t hroug h its eme rge n cy ro om (R. at 45), (2) VA had a ctual knowledg e prior to the MMC admiss ion in that the VA phy sician direc ted the ambulanc e tra nsfer ( ibi d .), an d (3 ) VA was c ontacted by MMC withi n 24 hours af ter the e merg ency

admission (R. at 30). B r. at 19-20. T he appe llant notes that the Boa rd (R. at 9 ) appeare d to conce de that prior authorization was provided. B r. at 19. The Sec reta

ry argues that the VA MC did not provide the appe l l an t with an individual authorization and t h at n o co n t ract exi sts. Br. at 6-7, 10. The Sec reta ry argues that, althoug h the B oa rd a c c ur a te ly

no te d th a t " VA pe rs on ne l we re awa re of [the a ]ppe lla

nt’ s a dmi ssi on

to t he pr ivate fac ility an d s u c h c o u ld c o n s ti tute ' a u th o r iz a ti o n ' f

o r p u r p o s e s o f 3 8 C. F

. R. § 1 7

. 5 4 " , the ROA

c on ta ins the fo llo wi nge vid e nc e that sh ow s th a t V A d id n ot a uth or ize the a

pp e lla nt’ s a dmi ssi on

to the private fac ility : (1) The J anuar y 1993 ROC f

orm that indicated that the appe llant and MMC were informed that the hospitaliz ation and ambulanc e ser vice would be at the appe llant’s expense and that VA would not pay

for the hospitalization (R. at 16); and (2) the claims cle rk' s J u n e 1993 entry denying the appellant' s claim for pa y ment (R. at 18). B r. at 6, 10. I t is un dis puted by th e par tie s th a t an in fo rm a l a

pp lic a tio n b y

te le ph on e fo r a dmi ssi on to MMC at VA expense was made by others on the ve tera

n' s behalf w ithin 72 hours after his a dmission18

to MMC, and thus the tim ing r equire ment for se eking authorization in § 17.54 is met. The Sec reta ry
ac kn o wl ed g e s t h at M M C ca l l edVA re gar d i n g p ay m en to nth e d ay

fo l l o wi n g t h e ap p el l an t 's

a dmi ssi on

to M MC. B r. a t 6, 10 (c iti ngR. at 16 ); see R. at 30 (J anuar y 1994 SOC). The que stion is whether the a ppellant rec eived authorization f rom VA. The Court note s that it has previously

held that, under

VA re g ulation, the Secre tary is authorized to giv e individual authorization. See Zimick , su pra . I n the BV A decision on revie w here , the B oard misconstrue d the law in s tating that "ther e is no indication in the claims folder of an ac tua l c ont

ra c t betwee n the VAMC or the outpatient c linic and MMC for the ve tera n’s ca re." An " actua l con t rac t" is not require d under § 17.50b. See Zimick , su pra . The Court hol ds that the ac tions of VA at the time of the transf er of the appe llant from the VA Clinic to the MMC constituted a prior, individual authorization for the a dmission of the appellant to MMC. See 38 C.F .R. § 1 7. 50 b; see als o Similes

v . B ro wn , 6 Ve t.A

pp . 5 55 , 5 57 (1 99 4) (r e mand ing to B VA fo r de te rm inatio n, a mon g oth e r t hin g s, as to whethe r VA phy sician' s statement that veter an should " g o to the near est hospital" c onstitut ed pr ior a uth or iza tio n) ; c

f. Smith ( Thomas A.) v. Derwinski , 2 Vet.App. 378, 378- 79 (1992) ( holding that VA phy sician' s advice that arr ang ements had be en made for pr ivate hospital treatment was " not the spec ific t y

pe of authorization contemplated by the reg ulation")

. Her e, unlike the c ommunication in Similes and Sm ith , the VA phy sician' s communications reg arding the appellant constituted much

m o re t h an ad v i ce b ei n g gi v en b y a V A p h y s i ci an i nco n n ec t i o nwi t h t h e t re at m en to f t h e ap p el l an t 's

c on dit ion . Rathe r, the VA ph y sic ian dir e c te d tha t the a pp e lla nt be tr ans fe rr e d f

ro m th e VAfa c ili ty to MMC t hroug h its emerg ency room and dire cted that the tr ansfe r be done by ambulance

. R. at 30. The VAClini c then c alled the a mbulance se rvice for the tr ansfe r. Prior to that t ra n s fe r, the VA phy sician ca lled MMC and rec eived the a pproval of D r. Gre ene, a p h y s i ci an at MMC, that the appellant would be acc epted ther e. I n view of this strong evidenc e of pr ior authorization, the evidenc e relied on by the Secr etar

y to support his posit ion, and the B oard’ s determination, that ther e wa s no prior author ization, does not constitute a plausible basis in the record. See Mariano and Gi lbe rt , b oth su pra . T he state me nts in both the J anuar

y 1993 ROC form (R. at 16) and the J une 1993 claims-cle rk entry (which postdate d the adm is si on by

mor e tha

n f our m on ths ) ( R. at 18 ) t hat V A w ou ld n ot p ay

fo r t he pr ivate hospitaliz ation wer e base d on the er roneous infor

mation that the appellant was not service connec ted19

for a ny d i s ab i l i t y at t he time of the hospitalization. Both rec ords expressly noted that incorr ect information and thus were of "que stionable probative va lue"

. Mariano , 17 Vet.App. at 311-12, 317 (holding medical- examination report t o be of que stionable probative va lue bec ause c laims file not made a vailable to examiner be fore examination)

IV. Conclusion Ba sed upon t he ROA, the pa rties' pleading s, and the for eg oing a naly sis, the J anuar

y 17, 2002, Boa rd dec ision is re verse d and the matter is r emande d for the Boa rd, consistent with this opi nion, t o o rd er VA pay

ment of the a llowable medica l expenses incurre d in connec tion with the hospitaliz ation at MMC. See 38 U.S .C

. §§ 17 10 (a )( 1) (E ), 17 03 (a )( 3) , 7 26 1( a )( 4) ; Mariano and Gi lbe rt , both su

pr a . T h e C o u rt notes that a r emand by this Court or by

the B oard c onfer s on an app el lant the rig ht to VA compliance with the terms of the r emand or der a nd imposes on the Secre tary a conc omitant duty

to ensure co m p l iance with those terms. Se e Ste ga ll v . W

est , 11 Vet.App. 268, 271 ( 1998). A final decision by the Boa rd following the rema

nd here in ordere d will constitut e a ne w dec ision that, if adver se, m ay be appealed to this Court only upon the filing of

a new Notice of Appea l with the Court not later than 120 day s afte r the date on w hich notice of the Boa rd' s new fina l decision is ma i l ed to the appe llant. Se e Ma rsh v . W est , 11 Vet.App. 468, 472 (1998). REVERSED AND REMANDED

.