Citation Nr: 20005218
Decision Date: 01/22/20	Archive Date: 01/22/20

DOCKET NO. 19-03 538
DATE: January 22, 2020

REMANDED

Entitlement to payment or reimbursement of unauthorized medical expenses for services incurred on April 27, 2018 at Augusta Health Medical Center is remanded.

REASONS FOR REMAND

The Veteran served on active duty from February 1972 to February 1985.

Entitlement to payment or reimbursement of unauthorized medical expenses for services incurred on April 27, 2018 at Augusta Health Medical Center

The Board regrets the additional delay but finds remand for development is warranted.  The Veteran has reported that he was told that his April 2018 private emergency room treatment would be covered by VA.  See January 2019 Veteran’s statement.  He reported that he only uses VA facilities and staff at the VA clinic informed him he could receive private treatment.  However, the Veteran’s VA treatment records for the relevant period have not been associated with the record.  Further, the record does not contain any payment or network authorization documents or a written statement indicating that any of these documents could not be located.  As evidence of prior authorization is relevant to the claim for reimbursement, remand to obtain and associate these documents with the claims file is needed.

The matter is REMANDED for the following action:

1. Obtain all VA treatment records for the period from April 1, 2018, to May 1, 2018.  The AOJ should make a formal finding of unavailability if the records are unable to be obtained. 

2. Obtain and associate with the claims file any records of the relevant VA Network Authorization and Payment Center or other relevant VA entity for documentation of the claim for payment or reimbursement on April 27, 2018 at Augusta Health Medical Center, and/or the denial of any request for authorization of the service.  The AOJ should make a formal finding of unavailability if the records are unable to be obtained.

3. Then, readjudicate the claim.  If any decision is adverse to the Veteran, issue a supplemental statement of the case (SSOC) to the Veteran and his current representative and allow the appropriate time for response.  Then, return the case to the Board

 

 

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 This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.