Citation Nr: 20048046 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 09-27 024 DATE: July 17, 2020 REMANDED Entitlement to payment or reimbursement of unauthorized medical expenses incurred at Doctor Medical Center from March 8, 2009, to March 9, 2009 is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1975 to March 1978. This matter came before the Board of Veterans’ Appeals (Board) on appeal from a decision of April 2009, by the VANCHCS in Martinez, California, which denied the benefits sought on appeal. 1. Entitlement to payment or reimbursement of unauthorized medical expenses incurred at Doctor Medical Center from March 8, 2009, to March 9, 2009 is remanded. This matter was previously remanded by the Board in January 2011. The Board regrets the additional delay, but finds remand is again necessary. In the Janaury 2011 remand, the Board directed that the VHA To date, it does not appear that the Veteran's file should be sent to an appropriate VA health care provider who, after reviewing the record, including a copy of this remand, in its entirety, should address (a) whether any of the medical services of March 8, 2009, to March 9, 2009, were rendered within the context of a medical emergency of such a nature that delay would have been hazardous to the life or health of the Veteran; and (b) if a medical emergency is found to exist, based on the Veteran's symptomatology, would it have been feasible on March 8, 2009, to seek treatment at the nearest VA facility. The Board further directed that the VA health care provider should determine whether VA or federal facilities were feasibly available. The discussion should address whether a VA facility was open for arriving patients with the Veteran’s condition on March 8, 2009 and the distance to that VA facility from the Doctor Medical Center. The Board’s review of the scant record reveals that to date, it does not appear that VHA has complied with the Board’s January 2011 remand instructions. Further, the record reveals that VHA lost the Veteran’s claims file and stated, “the judge can remand for another attempt at reconstructing the record if he or she desires.” In light of this deficiency on the part of VHA, the Board finds remand is necessary for VHA to reconstruct the record by obtaining outstanding documents and complying with the January 2011 Board remand. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. The AOJ should reconstruct the Veteran’s VHA claims file and associate it with the electronic record, to include obtaining all VA treatment records, VA decisions, VA rating code sheets, statement of the case(s) (SOCs), supplemental statement of the cases (SSOCs), notice of disagreement (NOD), claim for reimbursement, substantive appeal (VA Form-9), and statements from the Veteran. 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 claimed prior authorization or approval of medical expenses for services provided by Doctor Medical Center from March 8, 2009, to March 9, 2009, or the denial of any request for authorization of those services. The AOJ should make a formal finding of unavailability if the records are unable to be obtained. 3. The AOJ should obtain any outstanding VA telephone, administrative, or medical records from any relevant VA facility(ies) dated for the time period from March 1, 2009, to March 10, 2009. All attempts to secure these VA records, and any response received, must be documented in the claims file. If no VA records are available for the time period from March 1, 2009 to March 10, 2009, a response to that effect is required and should be documented in the file. 4. The AOJ should contact the Veteran and ask that he complete and return the necessary authorization (VA Form 21-4142) for VA to obtain any relevant private telephone, administrative, or medical records from Doctor Medical Center dated from March 8, 2009, to March 9, 2009. The AOJ should ask the Veteran to provide the full names of the provider(s) who treated him, the specific dates of treatment, and any address or telephone information. If he provides a completed release form (VA Form 21-4142) authorizing VA to obtain the relevant private hospital records, then attempt to obtain them and associate these records with the claims file. All attempts to secure these private records from Doctor Medical Center, and any response received, must be documented in the claims file. If no Doctor Medical Center records are available for the time period from March 8, 2009, to March 9, 2009, a response to that effect should be documented in the file. The AOJ should also ask the Veteran to provide any pertinent private telephone or administrative or medical records from Doctor Medical Center dated from March 8, 2009, to March 9, 2009, if he has them in his possession. 5. Then, the Veteran's claims file should be sent to an appropriate VA health care provider who, after reviewing the record, including a copy of this remand, in its entirety, should address: (a) whether any of the medical services of March 8, 2009, to March 9, 2009, were rendered within the context of a medical emergency of such a nature that delay would have been hazardous to the life or health of the Veteran; and (b) if a medical emergency is found to exist, based on the Veteran's symptomatology, would it have been feasible on March 8, 2009, to seek treatment at the nearest VA facility. 6. Determine whether VA or federal facilities were feasibly available. The discussion should address whether a VA facility was open for arriving patients with the Veteran's condition on March 8, 2009 and the distance to that VA facility from the Doctor Medical Center. (CONTINUED ON NEXT PAGE) 7. Then, readjudicate the claim. If the claim continues to be denied, send the Veteran a supplemental statement of the case and give him time to respond before returning the matter 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.