Citation Nr: 19154337
Decision Date: 07/16/19	Archive Date: 07/15/19

DOCKET NO. 17-50 688
DATE:	July 16, 2019

REMANDED

Entitlement to payment or reimbursement for unauthorized medical expenses incurred at a private hospital on January 18, 2017.

REASONS FOR REMAND

The Veteran sought treatment at a private emergency room on January 18, 2017 for shortness of breath and a cough lasting three days.  The appeal was initially denied in March 2017 on the basis that VA facilities were feasibly available.  However, the August 9, 2017, statement of the case denied the appeal on the basis that the only remaining charges to be paid were copays left unpaid by Medicare and AARP coverage.  

While the treatment notes associated with the January 2017 emergency room treatment are in the claims file, the billing and accounting statements are not.  Without such records, the Board is unable to make a determination as to whether the expenses for which the Veteran seeks payment or reimbursement qualify as copayments. 

Therefore, the matter is REMANDED for the following actions:

1. Associate with the claims file copies of the Veteran’s billing and accounting statements in connection with the January 18, 2017 treatment. 

2. Then, readjudicate the issue on appeal.  If any benefit sought on appeal is not granted to his satisfaction, a supplemental statement of the case should be issued to the Veteran and his representative, and they should be afforded the requisite opportunity to respond.

 

L. HOWELL

Veterans Law Judge

Board of Veterans’ Appeals

ATTORNEY FOR THE BOARD	K. M. Schaefer, Counsel

The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.