Citation Nr: 18143679 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-03 912A DATE: October 19, 2018 REMANDED Entitlement to payment or reimbursement for medical care received at Copper Queen Community Hospital on May 5, 2014 is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1975 to August 1980. Unfortunately, the Board finds that the paper claims file sent to the Board for review is incomplete, and the Board is unable to adjudicate the claim at this time. The Veteran’s written statements indicate that he went to Copper Queen Community Hospital on May 5, 2014 for treatment of a gunshot wound to the leg. The Veteran wrote in February 2016 that he had enrolled with VA health care services in December 2013 and was unaware that he was required to attend a VA evaluation prior to utilizing outside emergency medical services. An October 2014 letter from Arizona Department of Veterans Services stated that the Veteran had called VA ahead of time and was directed to go to the nearest emergency room, so he then drove to Copper Queen Community Hospital in Bisbee, Arizona for treatment of the gunshot wound. Currently, the record contains only a bill from Copper Queen Community Hospital for $3870. The record does not contain any of the Veteran’s May 5, 2014 treatment records. This evidence is essential for the Board to evaluate whether the medical treatment was for an emergent condition. The Board also requires that all records of contact with VA from May 5, 2014 be obtained, as the Veteran has asserted that he was directed by someone at VA to go to the nearest emergency room. It should be determined whether this contact constituted pre-authorization for emergency treatment. In addition to these medical records, the agency of original jurisdiction should associate all procedural documents and correspondence with the record. The record appears to be missing the notice of disagreement, and although there is a letter from the Arizona Department of Veterans Services, there is no correspondence indicating that the Veteran appointed this organization as his representative. If no VA Form 21-22 or 21-22a has been submitted, the Veteran should be informed that if he wishes to be represented by Arizona Department of Veterans Services or by another representative, he must submit a VA Form 21-22 Appointment of Veterans Service Organization as Claimant’s Representative. The Board also notes that the Veteran’s claim was denied by the agency of original jurisdiction on the basis that he had not received any treatment in the 24-month period prior to his treatment on May 5, 2014. The Veteran has indicated that he signed up for VA health care in December 2013 and was not informed that he had to undergo any treatment or evaluation prior to receiving private emergency care. The Board requires that the agency of original jurisdiction obtain information documenting exactly when the Veteran enrolled for VA medical care and whether he received any kind of medical services after enrolling and prior to his emergency treatment in May 2014. Under 38 U.S.C. § 1725; 38 C.F.R. § 17.1002, one of the criterion for reimbursement for emergency medical treatment is that the Veteran “received medical services” within the 24-month period preceding the emergency treatment. The term “medical services” is defined as including “the preventive health care services set forth in 38 U.S.C. § 1701(9).” Under 38 U.S.C. § 1701(9), “preventive health services” includes “patient health education (including nutrition education),” “maintenance of drug use profiles, patient drug monitoring, and drug utilization education,” “mental health preventive services,” and “substance abuse preventive measures.” The Veteran should be afforded an opportunity to provide any statements or evidence indicating whether he received any types of preventive health care services or health education after signing up for VA health care. Further, the agency of original jurisdiction should review all interactions the Veteran had with VA between December 2013 and May 2014 to determine whether any such interaction could qualify as a “medical service.” The matter is REMANDED for the following action: 1. Associate all folders and all other paper files pertaining to the Veteran’s claim of entitlement to payment or reimbursement for medical care received at Copper Queen Community Hospital with the current claims file. All relevant documents must be located and associated with the claims file. 2. If a VA Form 21-22 is found to have been submitted by the Veteran, send to the representative copies of all decision letters, the February 2016 statement of the case, and a copy of this Board remand. If no VA Form 21-22 has yet been submitted by the Veteran appointing a representative, notify the appellant that if he wishes to be represented by Arizona Department of Veterans Services or by another representative, he must submit a VA Form 21-22 Appointment of Veterans Service Organization as Claimant’s Representative. 3. The Veteran should be notified that he may submit lay statements or other evidence indicating whether he received any type of medical services from VA prior to his May 2014 emergency treatment, which could include “patient health education (including nutrition education),” “maintenance of drug use profiles, patient drug monitoring, and drug utilization education,” “mental health preventive services,” and “substance abuse preventive measures.” The Veteran should be provided an appropriate amount of time to submit this evidence. 4. Send to the Veteran a letter requesting that he provide sufficient information and a signed and dated authorization, via a VA Form 21-4142 (Authorization and Consent to Release Information) to enable VA to obtain May 2014 treatment records from Copper Queen Community Hospital in Bisbee, Arizona. If the Veteran provides new completed release forms authorizing VA to obtain these treatment records, then attempt to obtain them with at least one follow-up request if no reply is received. 5. Obtain all outstanding, pertinent VA treatment records. Including all records of contact with the Veteran on May 5, 2015. All records received should be associated with the claims file. If the agency of original jurisdiction cannot locate all Federal records requested herein, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. Then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe   any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary E. Rude, Counsel