B-150746, FEB. 21, 1963

B-150746: Feb 21, 1963

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THE CLAIM WAS DENIED FOR THE REASON THAT IT WAS ADMINISTRATIVELY DETERMINED THAT ADEQUATE GOVERNMENT FACILITIES FOR YOUR CARE AND TREATMENT WERE AVAILABLE IN THE VICINITY OF YOUR PLACE OF LEAVE AND CONSEQUENTLY THERE IS NO AUTHORITY UNDER THE LAW OR REGULATIONS FOR ALLOWANCE OF YOUR CLAIM. YOU SAY THAT AT THE ONSET OF YOUR ILLNESS YOU THOUGHT IT WAS A RECURRENCE OF A MINOR RESPIRATORY INFECTION YOU HAD EXPERIENCED A FEW WEEKS PREVIOUSLY AND THAT ALTHOUGH YOU WERE AWARE OF LOCAL MILITARY MEDICAL FACILITIES. IT IS INDICATED THAT EVEN WHEN IT BECAME NECESSARY FOR YOU TO BE HOSPITALIZED YOU CHOSE TO ENTER A CIVILIAN INSTITUTION AT YOUR OWN EXPENSE RATHER THAN UTILIZE THE AVAILABLE GOVERNMENT FACILITIES.

B-150746, FEB. 21, 1963

TO MAJOR RAYMOND F. WALSH, USAF:

YOUR LETTER OF JANUARY 18, 1963, REQUESTS REVIEW OF OUR SETTLEMENT DATED OCTOBER 15, 1962, WHICH DISALLOWED YOUR CLAIM FOR REIMBURSEMENT OF AMOUNTS EXPENDED BY YOU FOR CIVILIAN MEDICAL AND HOSPITAL SERVICES FURNISHED YOU DURING THE PERIOD NOVEMBER 12, 1961, TO FEBRUARY 5, 1962, INCIDENT TO YOUR SERVICE IN THE UNITED STATES AIR FORCE.

THE CLAIM WAS DENIED FOR THE REASON THAT IT WAS ADMINISTRATIVELY DETERMINED THAT ADEQUATE GOVERNMENT FACILITIES FOR YOUR CARE AND TREATMENT WERE AVAILABLE IN THE VICINITY OF YOUR PLACE OF LEAVE AND CONSEQUENTLY THERE IS NO AUTHORITY UNDER THE LAW OR REGULATIONS FOR ALLOWANCE OF YOUR CLAIM. ON THE BASIS OF YOUR ASSERTION THAT ASSURANCES OF CAPTAIN KELLEY, EXECUTIVE OFFICER, 4900TH U.S. AIR FORCE DISPENSARY, KIRTLAND AIR FORCE BASE, NEW MEXICO, LED YOU TO BELIEVE THAT LIABILITY FOR THE MEDICAL EXPENSES HAD BEEN ACKNOWLEDGED BY THE AIR FORCE, YOU AGAIN ASK REIMBURSEMENT OF THE AMOUNT EXPENDED BY YOU. SHOULD YOUR LETTER BE HELD INSUFFICIENT TO SUPPORT FAVORABLE CONSIDERATION OF YOUR CLAIM, YOU REQUEST THAT THE FILE BE RETURNED TO YOU FOR FURTHER REFERENCE AND INCOME TAX PURPOSES.

THE FACTS RELATING TO YOUR CLAIM SHOW THAT ON NOVEMBER 10, 1961, WHILE ON 15 DAYS' AUTHORIZED LEAVE AT ALBUQUERQUE, NEW MEXICO, FROM YOUR STATION, WILLIAMS AIR FORCE BASE, ARIZONA, YOU BECAME ILL; THAT WHEN YOUR CONDITION PERSISTED UNABATED ON NOVEMBER 12, 1961, YOUR WIFE ENGAGED HER PHYSICIAN, DR. JOHN H. DETTWEILER, WHO ATTENDED YOU AT YOUR HOME UNTIL NOVEMBER 25, 1961; THAT YOU ENTERED PRESBYTERIAN HOSPITAL CENTER WHERE YOU REMAINED UNDER TREATMENT UNTIL DECEMBER 11, 1961; THAT YOU CONTINUED TO RECEIVE OUTPATIENT CARE AT YOUR HOME FROM DR. DETWEILER AND DR. JOSEPH GORDON UNTIL FEBRUARY 2, 1962 (YOU RECEIVED A BRONCHOSCOPIC EXAMINATION AT THE HOSPITAL ON JANUARY 23, 1962); AND THAT YOU RETURNED TO DUTY FEBRUARY 6, 1962. YOU SAY THAT AT THE ONSET OF YOUR ILLNESS YOU THOUGHT IT WAS A RECURRENCE OF A MINOR RESPIRATORY INFECTION YOU HAD EXPERIENCED A FEW WEEKS PREVIOUSLY AND THAT ALTHOUGH YOU WERE AWARE OF LOCAL MILITARY MEDICAL FACILITIES, YOU BELIEVED YOU COULD MAKE A COMPLETE RECOVERY WELL WITHIN THE PERIOD OF YOUR LEAVE UNDER THE CARE OF A CIVILIAN PHYSICIAN. IT IS INDICATED THAT EVEN WHEN IT BECAME NECESSARY FOR YOU TO BE HOSPITALIZED YOU CHOSE TO ENTER A CIVILIAN INSTITUTION AT YOUR OWN EXPENSE RATHER THAN UTILIZE THE AVAILABLE GOVERNMENT FACILITIES. YOU APPARENTLY BASE YOUR CLAIM FOR REIMBURSEMENT OF THE AMOUNT PAID BY YOU FOR CIVILIAN MEDICAL SERVICES ON THE FACT THAT THE COMPLICATIONS WHICH AROSE FROM YOUR FAILURE TO RESPOND TO THE USUAL TREATMENT, COUPLED WITH YOUR DIABETIC CONDITION, MADE SPECIAL STUDIES, TREATMENT AND DRUGS NECESSARY TO YOUR RECOVERY, AND THAT YOU BELIEVED IT WAS NECESSARY FOR YOU TO CONTINUE UNDER THE CARE OF A DOCTOR FAMILIAR WITH YOUR CASE. ALSO, YOU SEEM TO BE UNDER THE IMPRESSION THAT, SINCE YOU INFORMED THE MEDICAL AUTHORITIES AT KIRTLAND AIR FORCE BASE THAT MEDICAL CARE WAS BEING PROVIDED BY A CIVILIAN AGENCY, THE AIR FORCE SHOULD ASSUME THE OBLIGATION FOR THE MEDICAL CARE RECEIVED.

UNDER THE APPLICABLE PROVISIONS OF LAW AND REGULATIONS YOUR RIGHT TO REIMBURSEMENT FOR THE COST OF MEDICAL CARE FROM CIVILIAN SOURCES IS NOT BASED UPON INFORMATION RECEIVED FROM ADMINISTRATIVE SOURCES AS TO YOUR RIGHTS IN THIS MATTER, BUT UPON WHETHER YOU MET THE CONDITIONS ENTITLING YOU TO REIMBURSEMENT. PARAGRAPH 7C, AIR FORCE REGULATION 160-53, FEBRUARY 3, 1960, PROHIBITED CIVILIAN MEDICAL CARE AT AIR FORCE EXPENSE FOR "TREATMENT WHEN ADEQUATE MEDICAL OR DENTAL SERVICE IS AVAILABLE FROM AN AIR FORCE OR OTHER GOVERNMENT MEDICAL OR DENTAL FACILITY.' APPROPRIATE AUTHORITY AT KIRTLAND AIR FORCE BASE HAS DETERMINED THAT EITHER THE AIR FORCE DISPENSARY AT THAT BASE OR THE ARMY GENERAL HOSPITAL AT SANDIA BASE, BOTH WITHIN A FEW MINUTES DRIVE OF YOUR ARIZONA ADDRESS, WERE ADEQUATELY STAFFED AND CAPABLE OF ASSISTING IN CASES SUCH AS YOURS. THERE IS NO EVIDENCE THAT YOU ATTEMPTED TO SECURE TREATMENT AT EITHER OF THOSE FACILITIES. WHEN AN ADMINISTRATIVE DETERMINATION OF THE FACTS IN A CASE IS MADE, OUR OFFICE NECESSARILY MUST RELY ON SUCH DETERMINATION IN THE SETTLEMENT OF THE CLAIM INVOLVED, IN THE ABSENCE OF EVIDENCE OF SUFFICIENT WEIGHT TO OVERCOME THE PRESUMPTION OF THE CORRECTNESS OF THE ADMINISTRATIVELY REPORTED FACTS. ACCORDINGLY, THE SETTLEMENT OF OCTOBER 15, 1962, WAS CORRECT AND IS SUSTAINED.

THE SETTLEMENT OF YOUR CLAIM WAS BASED UPON THE EVIDENCE CONTAINED IN YOUR CLAIM FILE AND SUCH EVIDENCE HAS NOW BECOME A PART OF THE OFFICIAL RECORDS OF THE GENERAL ACCOUNTING OFFICE AND MUST BE RETAINED HERE. THE PAPERS CONSTITUTING YOUR CLAIM MAY NOT BE RETURNED TO YOU. THERE ARE ENCLOSED, HOWEVER, COPIES OF THE MEDICAL BILLS SUBMITTED IN SUPPORT OF THE CLAIM.