Citation Nr: 18152595 Decision Date: 11/27/18 Archive Date: 11/23/18 DOCKET NO. 16-15 224A DATE: November 27, 2018 REMANDED Entitlement to payment or reimbursement of the cost of medical services received at Carle Foundation Hospital in Urbana, Illinois on October 28, 2014, including from Carle Physician Group, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1969 to April 1973. He died in March 2015. This matter is on appeal before the Board of Veterans Appeals (Board) from a November 2015 decision of the Department of Veterans Affairs (VA) Illiana Healthcare System (HCS) in Danville, Illinois. In most cases, the Board will dismiss a pending appeal after the Veteran’s death. See 38 C.F.R. § 20.1302. However, as the spouse of the Veteran, the appellant can be a proper claimant for payment or reimbursement of the private medical expenses incurred in this case if she is financially liable to pay the private medical provider for these expenses. 38 C.F.R. § 17.1004(a). In her April 2016 Form 9, the appellant affirmatively indicated that she retained this financial liability. Also, Illinois law appears to indicate that responsibility for the medical debts of the deceased spouse does pass to the surviving spouse. See 750 ILCS 65/15(a)(1) (last accessed on November 14, 2018); Boswell Memorial Hosp. v. Buongiorno, 732 N.E.2d 137 (Ill. 2000). Consequently, it is reasonably established that the appellant is financially liable for the cost of the private medical services provided in this case. In a 2007 opinion, VA’s General Counsel opined that in appeals involving payment or reimbursement of private medical expenses where the veteran has passed away, if the appellant is a person other than the veteran who paid for the services, consideration of the appeal should proceed. VAOPGCCONCL 1- 2007 (Oct. 29, 2007). While it is not clear in this case whether the appellant has made any payment for the medical services rendered, it is reasonably shown that she is liable for such payment. Accordingly, the Board finds that dismissal is not appropriate at this time and that the appeal will continue. If for some reason, the appellant’s financially liability to Carle Foundation Hospital has been discharged without her having to pay any of the cost of the treatment provided, she should promptly notify VA. Entitlement to payment or reimbursement of the cost of medical services received at Carle Foundation Hospital on October 28, 2014 is remanded. The evidence indicates when the Veteran received treatment at Carle Foundation Hospital, he had advanced metastatic brain cancer. In a March 2016 statement of the case (SOC), the Illiana HCS noted that it was adjudicating appeals for payment or reimbursement related to two episodes of care received by the Veteran on October 28, 2014. According to the SOC, one episode involved care provided by the Carle Foundation Hospital itself and the other episode involved care provided by the Carle Physician’s group. The HCS then proceeded to deny the claims, finding that neither episode of care was for a medical emergency. However, the medical records that have been associated with the claims file only appear to include documentation of the care the Veteran received from the Carle Physician’s Group. Without being able to review any medical records documenting the episode of care provided by Carle Foundation Hospital, it is not possible for the Board to review the HCS finding that the care received by the Veteran was not emergent in nature. Also, in her April 2016 Form 9, the appellant referred to taking the Veteran to the Carle Foundation Hospital emergency room. She noted that he was suffering from a 104-degree temperature and significant lower extremity symptomatology. Additionally, the records from the Carle Physician Group refer to the Veteran “currently being seen for lower extremity weakness due to some brain metastasis.” Taken together, this evidence indicates that an emergency situation could have been present in relation to at least one of the episodes of care in question. Accordingly, on remand, the Illiana HCS should obtain all additional available records from Carlyle Hospital Foundation Hospital pertaining to the two episodes of care and should associate them with the claims file. The SOC also indicates that the HCS received two separate claims, each pertaining to one of the two October 28, 2014 episodes of care. One claim, ID 513679, apparently corresponds to the episode of care from Carle Foundation Hospital and the other claim, ID1404707, apparently corresponds to the episode of care from Carle Physicians Group. However, the claims file does not contain copies of either of these claims. As initial claims for payment or reimbursement of non-VA medical services are a fundamental part of the record in this type of appeal, on remand, copies of these claims should be associated with the claims file. Additionally, on her April 2016 Form 9, the appellant indicated that before she brought the Veteran to the Carle Foundation Hospital ER on October 28, 2014, she tried to call VA to inform them of what has happening. She also noted that she had attached a phone statement showing that she had contacted VA. However, this phone statement does not appear to be associated with the claims file. On remand, the VAMC should attempt to locate a copy of the phone statement and if it is located, associate it with the claims file. The appellant is also advised that if she has any additional information, which is pertinent to this appeal, including any records of the medical treatment the Veteran received at Carle Foundation Emergency Room and Hospital (referred to in her April 2016 Form 9), she should submit this information for inclusion in the record on appeal. The appeal is REMANDED for the following action: 1. Associate with the claims file copies of the claims on appeal in this case, including claim ID 513679, corresponding to an episode of care from Carle Foundation Hospital and ID 1404707, corresponding to the episode of care from Carle Physician’s Group. 2. After obtaining an appropriate release of information from the appellant, obtain any outstanding records of treatment or evaluation the Veteran received at Carle Foundation Hospital on October 28, 2014, including records of any treatment that formed the basis for claim ID 513679. 3. Attempt to locate the copy of the phone statement referenced by the appellant in her April 2016 Form 9, which includes a record of her call to VA prior to taking the Veteran to the Carle Foundation Hospital emergency room. If the statement is located, ensure to associate it with the claims file. 4. Check for any other information in the possession of the Illiana Healthcare System that could potentially be pertinent to the claims on appeal. This check should include a search for any available documentation of the actions noted in the chronological “claims history” sections for ID 513679 and ID 1404707, located on pages 1 and 2 of the March 2016 statement of the case. The search should include an attempt to locate copies of the preliminary fee remittance advice reports (PFRARs) shown by the SOC to have been printed on January 22, 2015 and January 23, 2015. 5. Associate with the claims file any additional pertinent information that is located as a result of the check/search outlined in instruction 4. (Ensuring the record is as complete as possible in this manner will be of great assistance to the Board and will hopefully help avoid additional delay). 6. The appellant is advised that if she has any additional information in her possession that is pertinent to the claims, including any records of the treatment the Veteran received at Carle Foundation Hospital emergency room, it is in her interest to submit this information for inclusion in the record on appeal. (Continued on the next page)   7. Readjudicate the claims. If any remain denied, issue an appropriate supplemental statement of the case (SSOC). If an SSOC is issued continuing to deny one or both claims, if possible, provide an underlying explanation for the basis of the denial (For example, if a denial is based on an emergency situation not being present, explain why the situation was not an emergency with reference to the pertinent medical and lay evidence). Then provide the appellant the opportunity to respond. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Dan Brook, Counsel