Citation Nr: 18151312
Decision Date: 11/19/18	Archive Date: 11/16/18

DOCKET NO. 15-00 015A
DATE:	November 19, 2018
REMANDED
Entitlement to payment or reimbursement for the cost of non-VA medical care provided on June 3, 2014, at Florida Hospital Fish Memorial Regional is remanded.
REASONS FOR REMAND
The Veteran had active military service from June 1966 to January 1969.  
This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 administrative decision issued by the Department of Veterans Affairs (VA) Medical Center in Orlando, Florida.
The Veteran requested a personal hearing before a member of the Board in his January 2015 Substantive Appeal.  The Veteran cancelled his request for a hearing in a statement received by VA in October 2018.  Consequently, the Veteran’s request for a personal hearing is deemed withdrawn.  38 C.F.R. § 20.702(e).
Medical reimbursement 
The Veteran seeks to establish entitlement to payment or reimbursement for medical care expenses at Florida Hospital Fish Memorial Regional on June 3, 2014.  
It appears that the agency of original jurisdiction (AOJ) denied the Veteran’s claim because he has third party insurance coverage that is primary to VA coverage.  The November 2014 statement of the case (SOC) noted that the Veteran was not eligible for medical payment or reimbursement under 38 U.S.C. 1725 as the Veteran had other insurance.  Further, the SOC noted that VA has no authority to pay for any balances or co-payments that may be due after Medicare or any other non-VA source makes payment for care. 
The Board acknowledges that the Veteran’s wife referred to, at least some of, the reimbursement/payment sought as a copayment; however, currently the record does not contain enough information for the Board to make a determination on the reimbursement of medical expenses.  Specifically, it is unclear if the Veteran is seeking reimbursement/payment for medical expenses other than copayments or deductibles.  Additionally, the Court’s decision in Staab v. McDonald, 28 Vet. App. 50 (2016) may impact the AOJs decision depending on if the Veteran is seeking reimbursement for payments other than for copayments or deductibles.  On remand, the missing Explanation of Benefits must be added to the claims file.
The matter is REMANDED for the following action:
1. Contact the Veteran and request that he obtain and submit the Explanation of Benefits from his insurance company (Medicare) for care received from Florida Hospital Fish Memorial Regional on June 3, 2014.  
If possible, assist the Veteran in obtaining this document.
2. Conduct any other development determined to be warranted. 
3. Then, readjudicate the claim in accordance with the holding of Staab, 28 Vet. App. at 50.  If any benefit sought is not granted, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded an opportunity to respond.  Thereafter, the case should be returned to the Board for appellate review.
 
Kristin Haddock
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	I. Cannaday, Associate Counsel