Citation Nr: 21002349 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 15-39 105A DATE: January 13, 2021 REMANDED Entitlement to payment or reimbursement of medical expenses incurred on November 3 and November 4, 2014, at Dixie Regional Medical Center (DRMC) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1956 to September 1960. 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 November 2020, the Veteran and his wife testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. As reflected in his November 2020 testimony before the Board, the Veteran contends that he is entitled to payment or reimbursement of medical expenses incurred on November 3 and November 4, 2014, at DRMC, on the basis that such treatment was for a medical emergency, whereby he reasonably expected that a delay in seeking immediate medical attention would have been hazardous to his life or health. At the time of the treatment in question, the Veteran had a service-connected disability considered by VA to be permanent and total. In the absence of prior appropriate authorization, under 38 U.S.C. § 1728, a Veteran who has a total disability, permanent in nature, resulting from a service-connected disability is entitled to payment or reimbursement of unauthorized medical expenses incurred at a non-VA facility 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 November 3 and 4, 2014, treatment at DRMC 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 claims, reasonable attempts must be made to associate it with the file before the Board makes a decision on the merits of the claims. The matters are REMANDED for the following action: 1. Make reasonable attempts to obtain all pertinent records from DRMC pertaining to the Veteran’s treatment there on November 3 and November 4, 2014, 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. B. MULLINS 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.