Argo v. Derwinski — Medical expense reimbursement is unavailable for treatment rendered before service connection is effective

The veteran sought reimbursement for medical expenses incurred in May 1987 after emergency heart surgery at a private hospital. Although service connection for arteriosclerotic heart disease with coronary artery bypass graft was later granted effective January 11, 1988, the Court held that the reimbursement claim failed because the medical care was rendered before the effective date of service connection. Relying on 38 U.S.C. § 5110(a) and 38 C.F.R. § 17.85(b)(2), the Court explained that an award generally cannot be effective earlier than the date VA receives the claim, and expenses incurred before that date are not reimbursable. The Court found no factual or legal error in the Board’s denial and granted summary affirmance.

Expenses for medical care rendered before the effective date of service connection are not reimbursable absent a statutory or regulatory basis for an earlier effective date.

A later service-connection award does not, by itself, retroactively authorize payment of prior private medical expenses.

This decision is a practical reminder that reimbursement and effective-date analysis are tightly linked. Veterans seeking payment for private emergency treatment must establish that the treatment occurred during a period when the underlying condition was already service connected, or fit within a separate statutory exception.

Assuming a later grant of service connection automatically makes earlier medical expenses payable.

A veteran pays for emergency private treatment in 2022, then receives service connection for the underlying condition in 2023 effective from the 2023 claim date. Under Argo, VA generally cannot reimburse the 2022 expenses because they predate the effective date.

Use this case to reject reimbursement theories that depend solely on a later service-connection award. It is also useful for framing effective-date arguments as threshold issues in payment or reimbursement disputes.

Gilbert v. Derwinski, Frankel v. Derwinski