Citation Nr: A21016340 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 200330-75185 DATE: October 5, 2021 REMANDED Entitlement to payment or reimbursement of medical expenses incurred in connection with the Veteran's care at South Seminole Hospital from April 3, 2019 to April 4, 2019 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1972 to August 1974. This matter comes to the Board of Veterans' Appeals (Board) on appeal from October 2019 determinations issued by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). The Veteran appealed to the Board in March 2020, requesting direct review of the evidence considered by the agency of original jurisdiction (AOJ). 38 C.F.R. §§ 20.201, 20.202(b)(1). Entitlement to payment or reimbursement of medical expenses incurred in connection with the Veteran's care at South Seminole Hospital from April 3, 2019 to April 4, 2019 is remanded. The Veteran has claimed entitlement to payment or reimbursement of medical expenses incurred in connection with unauthorized, non-VA medical treatment and services rendered at South Seminole Hospital from April 3, 2019 to April 4, 2019. Unfortunately, the record does not contain enough information to allow the Board to make an informed determination on the claim. At the time of the decision on appeal, it was unclear from the record whether and to what extent the Veteran had Medicare coverage. In this regard, an administrative claim note, prepared in connection with adjudicating the Veteran's reimbursement claim, includes a comment that the Veteran is non-service-connected and has no insurance. However, a subsequent note on May 12, 2020 indicates that the Veteran has Medicare Part A coverage. It does not appear that any Medicare information, including an Explanation of Benefits (EOB) or other remittance from Medicare, was associated with the Veteran's record at the time of the decision on appeal. Furthermore, at the time of the October 2019 determinations, the AOJ indicated that VA did not pre-authorize the April 3, 2019 to April 4, 2019 services at South Seminole Hospital and they were not provided in a medical emergency. However, it is unclear what the exact nature of the April 2019 treatment was, as the complete treatment records from South Seminole Hospital for that episode of care are not of record for the Board's review. The AOJ's failure to seek or obtain complete records in that regard constitutes a pre-decisional duty to assist error that must be corrected. This matter is REMANDED for the following action: 1. Ensure that a complete copy of the Veteran's VHA medical appeals folder has been associated with her electronic claims file. 2. If the Veteran's VHA medical appeals folder does not contain the complete treatment records for her episode of care at South Seminole Hospital on April 3, 2019 to April 4, 2019, ask the Veteran to provide a release for those records. If she provides the necessary release, assist her in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional, non-duplicative evidence received should be associated with the electronic claims file. If any of the records sought are not available, the record should be annotated to indicate that fact, and the Veteran should be notified. 3. Additionally, undertake efforts to obtain all records relating to other insurance or health care coverage available to the Veteran at the time of her episode of care, to include Medicare Part A, as well as all records reflecting payments made by any entities reimbursing the Veteran for the cost of the episode of care. Efforts should include, but need not be limited to, contacting the Veteran, South Seminole Hospital, and, if necessary, the Centers for Medicare & Medicaid Services. Efforts to obtain the evidence should be fully documented and should be discontinued only if it is concluded that the evidence sought does not exist or that further efforts to obtain the evidence would be futile. If the records sought are not available, the record should be annotated to reflect that fact, and the Veteran should be notified. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kettler, 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.