Citation Nr: 21001236 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-04 847A DATE: January 7, 2021 REMANDED Entitlement to payment or reimbursement of medical expenses incurred from November 2 to November 28, 2012, at Penrose Hospital (PH) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1964 to August 1968. This appeal is before the Board of Veterans’ Appeals (Board) from a January 2013 decision of the Department of Veterans Affairs (VA) Veterans Health Administration. In October 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. As reflected in his October 2020 testimony before the Board, the Veteran contends that he is entitled to payment or reimbursement of medical expenses incurred from November 2 to November 28, 2012, at PH, on the basis that such treatment should be considered part of emergency treatment he received for a cardiac condition beginning in August 2012. The Veteran is service-connected for that cardiac condition (coronary artery disease, status post stent placement with coronary artery bypass graft), effective August 27, 2012. In the absence of prior appropriate authorization, under 38 U.S.C. § 1728, a Veteran is entitled to payment or reimbursement of unauthorized medical expenses incurred at a non-VA facility for treatment of a service-connected disability when it is also shown that (1) the services were rendered in a medical emergency of such nature that delay would have been hazardous to life or health, and (2) no VA or other Federal facilities were feasibly available and an attempt to use them beforehand would not have been reasonable. 38 U.S.C. § 1728; 38 C.F.R. § 17.120. The provisions of 38 U.S.C. § 1728 are implemented under 38 C.F.R. §§ 17.120-32. For payment under 38 U.S.C. § 1728, the following conditions must be met: Treatment must be rendered in a medical emergency of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard would be met if a situation involved acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. 38 C.F.R. § 17.120(b). VA or other Federal facilities that VA has an agreement with to furnish health care services for veterans were not feasibly available, and an attempt to use them beforehand or obtain prior VA authorization for the services required would not have been reasonable, sound, wise, or practicable, or treatment had been or would have been refused. 38 C.F.R. § 17.120(c). In this case, there are no medical records, bills, or claim forms pertaining to the Veteran’s treatment at PH from November 2 to November 28, 2012, associated with the claims file, and no explanation as to why such documentation is not of record. As this evidence is pertinent to the Veteran’s reimbursement claim, reasonable attempts must be made to associated it with the file before the Board makes a decision on the merits of the claim. The matters are REMANDED for the following action: 1. Make reasonable attempts to obtain all pertinent records from PH pertaining to the Veteran’s treatment there from November 2 to November 28, 2012, and associate any such records with the claims file. 2. After completing the above and any other necessary development, readjudicate the appeal. If any benefit sought remains denied, provide a supplemental statement of the case to the Veteran. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Andrew Mack, 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.