Citation Nr: 18152130 Decision Date: 11/21/18 Archive Date: 11/20/18 DOCKET NO. 14-16 171 DATE: November 21, 2018 REMANDED Entitlement to payment or reimbursement of the cost of medical services received from June 6, 2012 to June 7, 2012 at Miller County Hospital (MCH) in Colquitt, Georgia is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from February 1967 to December 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 decision of the Department of Veterans Affairs (VA) Medical Center (VAMC) in Gainesville, Florida. The Veteran requested a hearing before the Board on his March 2014 VA Form 9. However, in a subsequent communication received in August 2017, he withdrew his request for a hearing. 38 C.F.R. § 20.704(e). In April 2018, the case was remanded for further development. 1. Entitlement to payment or reimbursement of the cost of medical services received from June 6, 2012 to June 7, 2012 at Miller County Hospital (MCH) in Colquitt, Georgia is remanded. In the April 2018 remand, the Board, in pertinent part, instructed the VAMC to search for the Veteran’s original claim form; to obtain additional information concerning coverage the received for the Miller County Hospital treatment from Medicare Part A; and to readjudicate the Veteran’s claim. In response, the VAMC issued a July 2018 supplemental statement of the case (SSOC). In this document, the VAMC noted that the claim for payment or reimbursement currently on appeal was received on October 17, 2012. The VAMC then readjudicated the Veteran’s claim and denied it on the merits, finding that the Veteran did not qualify for payment or reimbursement for the MHC services because he had other insurance, Medicare Part A, that paid for a portion of the cost of his hospitalization. Notably, the regulatory provision relied upon by the VAMC to deny the Veteran’s claim in the July 2018 SSOC was amended in January 2018 and the amended provision applies to the Veteran’s appeal. See 38 C.F.R. § 17.1002(f) (2018); 83 Fed. Reg. 974, 979 (Jan. 9, 2018). The amended version of this provision indicates that having non-VA insurance will only preclude payment or reimbursement of private emergency medical expenses if the non-VA coverage would fully extinguish the Veteran’s medical liability for the expenses. Id. In this case, the Veteran’s Medicare Part A coverage did not fully extinguish his liability for the cost of the medical services provided by MHC. Consequently, the July 2018 SSOC appears to present an incorrect basis for denying the Veteran’s claim. Accordingly, given this incorrect basis and given that there is no indication from the record that the VAMC conducted some of the necessary development ordered by the April 2018 remand, the Board must again remand the claim to the VAMC for further development. The matter is REMANDED for the following action: 1. Associate with the claims file a copy of the initial claim for from Miller County Hospital (MCH), which the VAMC noted in the July 2018 SSOC was received on October 17, 2012. 2. Obtain any necessary release of information from the Veteran for Miller County Hospital. Then request that Miller County Hospital provide any information it has concerning its efforts to claim payment or reimbursement from VA and Medicare for the cost of the treatment provided to the Veteran from June 6, 2012 to June 7, 2012. The request to Miller County Hospital should include the following inquiries: A) Ask Miller Hospital to indicate when it first filed a claim with VA for payment of the cost of the treatment the Veteran received at the hospital from June 6, 2012 to June 7, 2012. B) Ask Miller Hospital, “If a claim was filed with VA for payment for this treatment prior to October 17, 2012, please provide a copy of this claim and/or other documentation indicating that the claim was filed with VA on that earlier date. Also, if a claim was not filed with VA for payment for the treatment the Veteran received within 90 days of June 7, 2012, please explain the reason for the delay.” C) Ask Miller Hospital to describe any efforts it made to obtain payment from Medicare for the treatment the Veteran received at the hospital from June 6, 2012 to June 7, 2012, along with the dates that such efforts were undertaken. Also ask Miller Hospital to provide any documentation of these efforts to obtain payment from Medicare and any documentation of pertinent responses received from Medicare. 3. Ask the Veteran to provide information concerning Medicare payment for part of the cost of the services he received at Miller County Hospital from June 6, 2017 to June 7, 2017. The request to the Veteran should include the following inquiries: A) Ask the Veteran to provide any documentation concerning Medicare payment for the June 6-7, 2012 hospitalization at Miller County Hospital, including a copy of the Medicare explanation of benefits (EOB), if he has a copy of this document. B) Ask the Veteran to indicate whether he made any efforts to attempt to obtain payment or reimbursement from Medicare for the cost of the treatment at Miller County Hospital from June 6-7, 2012 or whether this task was handled solely by Miller County Hospital. C) Ask the Veteran to indicate the approximate dates of any efforts he made to obtain payment from Medicare for the treatment received at Miller County Hospital from June 6-7, 2012; to submit any documentation or other corroborating evidence of these efforts; and to submit documentation of any pertinent responses received from Medicare. 4. The Veteran is advised that if he has access to any additional information pertinent to this claim, including any additional information pertaining to the timing of the claim filed with VA by Miller County Hospital, and/or any efforts taken by the hospital or by himself to obtain payment or reimbursement for the cost of the treatment from Medicare within 90 days of June 7, 2012, it is in his interest to submit this information for inclusion in the record on appeal. 5. Readjudicate the claim. In so doing, apply the current version of the controlling regulations governing claims under 38 C.F.R. § 1725, including the amended version of 38 C.F.R. § 17.1002(f). If the appeal remains denied, issue an appropriate supplemental statement of the case and provide the Veteran the opportunity to respond. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Dan Brook, Counsel