Citation Nr: 18153650
Decision Date: 11/28/18	Archive Date: 11/28/18

DOCKET NO. 16-25 232
DATE:	November 28, 2018
REMANDED
Entitlement to payment or reimbursement to unauthorized medical expenses incurred at the Highlands Regional Medical Center (HRMC) on October 11, 2015, is remanded.
REASONS FOR REMAND
The appellant appears to have had active duty service in this case.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2015 letter of determination by a Department of Veterans Affairs (VA) Medical Center.  
The Agency of Original Jurisdiction (AOJ) appears to have determined that the appellant had active duty service, although evidence of such service—such as a Form DD-214—is not of record in this case.  
Moreover, the appellant in this case additionally asserts that he was seen on October 11, 2015, by HRMC, for a skin rash that he is being treated for by Bay Pines VA Medical Center and had gotten worse and the local VA clinic was closed because it was a Sunday and, instead of waiting to seek treatment until Tuesday—as Monday was a federal holiday and the clinic would again be closed—the appellant sought emergency room treatment for his severe itchy, burning, and cracking rash, with non-draining pustules.  The Board further reflects that the appellant stated that he called the fee basis line and left a message.  Finally, the AOJ indicated in the April 2016 statement of the case that the Chief Medical Officer (CMO) had determined that the Veteran’s condition was not emergent on October 11, 2015, although there is no written medical opinion from the CMO associated with the claims file.  
Accordingly, as the record is inadequately developed in this case to make a determination in this case, the Board must remand this case in order for the AOJ to properly develop this claim.  
The matter is REMANDED for the following action:
1. The AOJ should obtain and associate with the claims file evidence regarding the appellant’s period of service, to include his DD Form 214.  
2. Obtain any and all VA treatment records not already associated with the claims file from the Bay Pines VA Medical Center, or any other VA medical facility that may have treated the appellant and associate those documents with the claims file.
3. The AOJ should obtain a copy of the written CMO’s medical opinion referenced in the April 2016 statement of the case, if such exists, and associate that document with the claims file.  
4. After attempting to obtain the above, the AOJ should complete any and all appropriate development necessary to properly adjudicate the claim on appeal.
5. Following completion of the above development, the AOJ should review the claims file and readjudicate the appellant’s claim for payment or reimbursement for unauthorized medical expenses incurred at Highlands Regional Medical Center on October 11, 2015.  If any benefits sought on appeal remain denied, the appellant and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto before the case is returned to the Board.
 
JAMES G. REINHART
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Peters, Counsel