Citation Nr: 21073936
Decision Date: 12/13/21	Archive Date: 12/13/21

DOCKET NO. 17-05 738A
DATE: December 13, 2021

REMANDED

Entitlement to payment/reimbursement for non-VA medical services provided on July 10, 2016 at St. John's Medical Center is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Navy. This matter is on appeal to the Board of Veterans' Appeals (Board) from an August 2017 decision by the Veterans Health Administration (VHA) denying payment/reimbursement for non-VA medical services provided on July 10, 2016 at St. John's Medical Center.

A hearing at the Board was scheduled for September 14, 2021. The Veteran notified VA in correspondence dated August 8, 2021 that she had withdrawn her hearing request, and her representative confirmed on August 19, 2021 that the Veteran would not be attending the scheduled hearing. 

Although the initial denial letter could not be produced by VHA, the evidence shows that the Veteran was denied payment/reimbursement because the claim was not filed within 90 days of discharge for the treatment at issue as required by 38 U.S.C. § 1725. However, the Veteran contended in September 2017 correspondence that she did, in fact, file her claim within 90 days of discharge.  

VHA provided a copy of a database showing the date that claims relating to the treatment at issue were received, yet no copies of the actual filed claim(s) are of record. Thus, it appears that the file is incomplete. Indeed, the Statement of the Case lists the initial claim as evidence considered, but this document is unavailable to the Board. As the initial claim is a relevant document in this matter, it is the Board's duty to ensure that the file is complete prior to adjudication. Therefore, remand is required. 

The matter is REMANDED for the following action:

Verify that the Veteran's VHA claims file and/or all records and documentation related to the claim for payment or reimbursement of non-VA treatment at St. John's Medical Center on July 10, 2016 are uploaded to the electronic claims file. The record must include copies of any claims filed relating to the above-referenced treatment. If such records are unable to be associated with the record, the AOJ (under VHA) should make a formal finding of unavailability.

 

 

L.M. BARNARD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Carroll, 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.