Citation Nr: 1322469	
Decision Date: 07/15/13    Archive Date: 07/24/13

DOCKET NO.  11-03 928	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs North Florida/South Georgia Medical Center in Veteran Health System


THE ISSUE

Entitlement to reimbursement for medical expenses incurred for emergency treatment at Citrus Memorial Hospital between February 18, 2010 and February 20, 2010.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

Cheryl E. Handy, Counsel



INTRODUCTION

Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012).  38 U.S.C.A. § 7107(a)(2) (West 2002).

The Veteran, who is the appellant, served on active duty from June 1953 to October 1968, including service in the Republic of Vietnam.

This matter is before the Board of Veterans' Appeals (Board) on appeal of a decision in May 2010 of the Department of Veterans Affairs (VA) North Florida/South Georgia Medical Center, part of the Veterans Health System.

The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ) via the Appeals Management Center (AMC), in Washington, DC.  VA will notify the appellant if further action is required.


REMAND

The Veteran seeks payment or reimbursement for emergency services rendered at a non-VA facility, Citrus Memorial Hospital, for the period from February 18, 2010 through February 20, 2010, without receiving prior authorization from VA.

A review of the record reflects that the Veteran's claim has been considered only under the provisions of 38 U.S.C.A. § 1725 and 38 C.F.R. §§ 17.1000-1008.  However, these statutory and regulatory provisions provide that a Veteran must be found ineligible for reimbursement for emergency treatment under 38 U.S.C.A. § 1728, in order to for eligible for consideration under 38 U.S.C.A. § 1725.  See 38 C.F.R. § 17.1002(h) (2012). 

38 U.S.C.A. § 1728 specifically provides for reimbursement or payment for emergency treatment rendered to a Veteran for an adjudicated service-connected disability, a non-service connected disability associated with and held to be aggravating a service-connected disability, or any disability of a Veteran if the Veteran has a total disability permanent in nature from a service-connected disability. 

In this instance, the Veteran presented for emergency treatment in February 2010 with symptoms of dizziness, syncope, and dehydration.  A chest X-ray showed hyperventilatory changes with bibasilar atelectasis.  The record shows that the Veteran is currently service-connected for neurotic respiratory disorder (previously described as psychoneurosis anxiety reaction or psychophysiological respiratory reaction) at 50 percent and atherosclerotic heart disease at 60 percent, with a combined disability rating of 80 percent.  The Veteran is also in receipt of total disability rating based on individual unemployability due to service-connected disabilities (TDIU) benefits. 

In light of the above, this claim must be remanded in order for the AOJ to adjudicate this claim in the first instance with consideration of eligibility for reimbursement under 38 U.S.C.A. § 1728.

Accordingly, the case is REMANDED for the following action:

(Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012).  Expedited handling is requested.)

Adjudicate the claim of entitlement to reimbursement of medical expenses with consideration given to the provisions of 38 U.S.C.A. § 1728, to include determining if the Veteran's hospitalization was related to either of his current service-connected disabilities or the combination thereof.  If necessary, such consideration should include the provision of an advisory medical opinion with accompanying rationale, which should be placed in the claims file.

If the decision remains adverse to the Veteran, then provide him and his representative a supplemental statement of the case and return the case to the Board.


The appellant 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 claim must be afforded expeditious treatment.  The law requires that all claims that are remanded by the Board of Veterans' Appeals 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).



_________________________________________________
Eric S. Leboff
Veterans Law Judge, Board of Veterans' Appeals

Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals 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).