Citation Nr: 1319078	
Decision Date: 06/12/13    Archive Date: 06/21/13

DOCKET NO.  09-37 055A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Medical Center in Columbia, Missouri


THE ISSUE

Entitlement to payment or reimbursement of ambulance expenses incurred on August 9, 2009.


REPRESENTATION

Veteran represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

Jennifer R. White, Counsel



REMAND

The Veteran had active service from September 1969 to April 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2009 decision of the Department of Veterans Affairs Medical Center (VAMC) in Columbia, Missouri.

The Veteran contends that he is entitled to payment of ambulance expenses incurred on August 9, 2009.  (The Veteran was transported via ambulance from Lake Regional Hospital in Osage Beach, Missouri, to the VAMC in Columbia, Missouri.)  

The ambulance record notes that the Veteran had possible urinary sepsis with a Levaquin IV running which was to be maintained during transport.  The paperwork indicates that a physician at VA (name illegible) had accepted transfer of the Veteran.  The ambulance service noted that the reason for transfer was patient request.  The total cost associated with the cost of the ambulance was $1505. 

The VAMC subsequently denied the Veteran's claim for payment or reimbursement in a decision dated in August 2009 on the grounds that based on current eligibility requirements, the Veteran's income exceeded the maximum amount authorized at that time, and based on eligibility requirements, his transportation was not related to a service-related condition.  The Board observes in this regard that the Veteran has indicated that his urinary sepsis was the result of a prostate biopsy at the VAMC which introduced e-coli into his system.  (The Veteran was service connected for prostate cancer effective from August 21, 2009.)

The Veteran has asserted that someone at the Lake Regional Hospital called the VAMC and spoke to the physician on duty.  According to the Veteran, the ambulance ride was approved by VA due to the Veteran's low blood pressure readings.  Based on the Veteran's statements, clarification is needed as to whether prior authorization for payment by VA for the ambulance transportation was given. 

Additionally, several pertinent documents are missing from the claims file.  The Veteran has asserted that the treating physician at the private hospital spoke with the VAMC, who approved the Veteran being transferred to the VAMC via ambulance.  However, the records from Lake Regional Hospital and the VAMC from August 2009 have not been associated with the claims file.  The only pertinent record is the information provided by the ambulance service.  As the medical records surrounding the Veteran's hospitalization are relevant to the claim, an attempt should be made to obtain the records.

Accordingly, the case is REMANDED for the following action:

1.  After requesting the appropriate authorization from the Veteran, obtain the Veteran's records from the Lake Regional Hospital pertaining to the August 2009 episode of care, including, but not limited to, any documentation concerning preauthorization of ambulance services.  If no records are obtained, the Veteran should be given opportunity to submit the records himself.

2.  Obtain the Veteran's VA treatment records from August 2009, and the Veteran's subsequent in-patient treatment.  The records should include any documentation concerning preauthorization of ambulance services at VA expense.  

3.  The Veteran should be asked for details regarding the telephone authorization that was given, especially regarding the names of any individuals who may have been involved in requesting or authorizing the expense.  Whether information is provided by the Veteran or not regarding who may have authorized the transportation expense, investigate this claim and contact all persons who may have been involved.  Statements should be sought from anyone involved regarding the putative phone call that was made to obtain authorization for transportation at VA expense.  

4.  Thereafter, readjudicate the issue of entitlement to payment or reimbursement of ambulance expenses incurred on August 9, 2009.  If the benefit sought is not granted, issue a supplemental statement of the case and afford the Veteran an appropriate opportunity to respond before the case is returned to the Board.

The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded.  Kutscherousky v. West, 12 Vet. App. 369 (1999).

This case must be afforded expeditious treatment.  The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012).



________________________________
	MARK F. HALSEY
	Veterans Law Judge, Board of Veterans' Appeals

Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the United States Court of Appeals for Veterans Claims.  This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal.  38 C.F.R. § 20.1100(b) (2012).