Citation Nr: 20005116 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 18-34 603 DATE: January 22, 2020 REMANDED Entitlement to payment or reimbursement of the cost of medical services received at Monongalia General Hospital on May 25, 2016 is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to July 1985. Entitlement to payment or reimbursement of the cost of medical services received at Monongalia General Hospital on May 25, 2016 is remanded. The Veteran received emergency treatment and evaluation at Monongalia General Hospital on May 25, 2016. The Veteran does not have a service-connected disability. On appeal, the Veteran seeks VA payment or reimbursement of the cost of the treatment under 38 U.S.C. § 1725. To date the AOJ has denied the Veteran’s appeal, finding that he did not receive VA medical services under authority of 38 U.S.C. chapter 17 within the 24-month period preceding the furnishing of the private medical services by MGH. See 38 C.F.R. § 17.1002 (d). In this regard, the Veteran has reported that he enrolled with VA three months prior to his May 25, 2016, private treatment. See June 2016 VA From-9. Significantly, he reported that he applied for VA healthcare on January 26, 2016, and he was eligible for VA healthcare at the time of his May 25, 2016, treatment. Id. Receipt of VA medical services under 38 U.S.C. chapter 17 within 24 months prior to the receipt of the private emergency treatment in question is a necessary criterion for payment or reimbursement for the cost of such treatment under 38 U.S.C. § 1725. Id. However, under 38 U.S.C. chapter 17, “medical services” are defined more broadly than simply receiving medical evaluation or treatment. 38 U.S.C. § 1701 (6) (A-H). Potentially pertinent to this case, the medical services definition includes “preventative health services.” 38 U.S.C. § 1701 (6) (D). In turn, preventative health services include patient health education (including nutrition education). 38 U.S.C. § 1701 (9)(B). It is not clear from the record when the Veteran was first enrolled into the VA health care system. However, according to current information from the Veteran’s Health Administration (VHA), all new VA health care system enrollees receive a personalized Veteran’s Health Handbook, generally two weeks after enrollment has been confirmed. See VHA’s online overview of its “Veterans Benefits Handbook”, found at https://www.va.gov/healthbenefits/vhbh/. Thus, depending on when he was enrolled in the VA health care system, the Veteran could have received VA medical services in the form of patient health education within the 24-month period prior to receiving the MGH treatment. Consequently, a remand is required to determine whether such services were received within this 24-month time frame. On remand, the Veteran can submit for consideration any information pertaining to whether he received a VA patient handbook or other health education information from VA within the 24 months prior to May 25, 2016. 38 U.S.C. § 1701 (6)(D), (9)(B); 38 C.F.R. § 17.1002 (d). The matter is REMANDED for the following action: 1. Identify the date the Veteran was officially enrolled into the VA health care system and specify this date for the record. Also specify for the record the VA health care system in which the Veteran was enrolled. 2. Determine whether the procedure at the time of the Veteran’s enrollment into the VA health care system included him receiving a Veteran’s Health Handbook. See e.g. https://www.va.gov/healthbenefits/vhbh/. If so, determine when the Veteran should have received the handbook. If the handbook should have been received within 24 months prior to May 25, 2016, determine whether the handbook included patient health education under 38 U.S.C. § 1701 (9). 3. If the above development does not show the Veteran received patient health education under 38 U.S.C. § 1701(9) within 24 months prior to May 25, 2016, obtain any VA medical records pertaining to the Veteran dated from his day of enrollment in the VA health care system up until May 25, 2016. Include in this documentation any records of communication between the VA health care system and the Veteran, including notes pertaining to the scheduling of any appointments and/or the provision of any health education information or materials. (CONTINUED ON NEXT PAGE) 4. Readjudicate the claim. In so doing, specifically consider whether the Veteran received VA medical services under 38 U.S.C. § 1701 (6)(D) in the form of patient health education under 38 U.S.C. § 1701 (9) within the 24 months prior to May 25, 2016. If the claim remains denied, issue an appropriate supplemental statement of the case the Veteran and current representative and provide the Veteran the opportunity to respond. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Schick, Associate 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.