Citation Nr: 21075610 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 15-10 037 DATE: December 21, 2021 REMANDED Entitlement to payment or reimbursement for the cost of medical treatment received at Thomas Memorial Hospital from January 14, 2014 through March 5, 2014, to include January 14, January 31, February 28, and March 5, is remanded. REASONS FOR REMAND The Veteran had active service from July 2000 to November 2000. The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in January 2021. A transcript is of record. Entitlement to payment or reimbursement for the cost of medical treatment received at Thomas Memorial Hospital from January 14, 2014 through March 5, 2014, to include January 14, January 31, February 28, and March 5, is remanded. The Veteran is seeking payment or reimbursement for the cost of treatment, to include physical therapy, received at Thomas Memorial Hospital from January 14, 2014 through March 5, 2014. Private treatment records from January 16, 2014 show an order for physical therapy two to three times a week for four weeks. Treatment records from Thomas Memorial Hospital state that that the Veteran was admitted on January 22, 2014 and discharged on January 31, 2014. However, the records do not appear to be for in-patient treatment given that the treatment notes are for right shoulder physical therapy on January 24, 27, and 29. On January 24 it was noted that the Veteran passed out twice the night before and had been instructed to seek medical care at urgent care or the emergency room. Furthermore, the January 27 treatment record says that he fell that morning while walking his dog, and the January 29 note states that he did not appear for his appointment. VA treatment records show fee basis-outpatient notes from January 16, 2014, January 22, 2014, January 27, 2014, February 10, 2014, and March 4, 2014 stating that scanned documents were attached. The attached documents are not of record. VA treatment records from this period show complaints of pain. The Veteran said at February 3, 2014 VA treatment that he had been seen at the Thomas Memorial Hospital emergency room multiple times in the past few weeks, and note that the Veteran was in physical therapy at Thomas Memorial Hospital. A January 2015 account statement shows that the Veteran owed approximately $2,400 for treatment at Thomas Memorial Hospital on January 14, January 31, February 28, and March 5, 2014. The Veteran wrote in January 2015 that he was told by a VA physician to go to the Thomas Memorial Hospital emergency department on January 14, January 31, February 28, and March 5. In the same statement, he wrote that he was told to go there for physical therapy. The Veteran wrote in February 2015 that he had been told by his VA physician to go to the nearest emergency room because it was not safe for him to drive to the VA facility. When he was treated at Thomas Hospital, he was referred to Thomas Physical Therapy, and the VA physician told him to do physical therapy there due to the referral. The Veteran continued that he would not have done do had he not been told to, and that it started as an emergency. The Veteran testified at the January 2021 hearing that the shoulder injury occurred when he fell outside. A VA doctor told him to go to the hospital close to him. The Veteran further testified that it would have taken six months for him to have gotten physical therapy through VA. Furthermore, it takes him 45 minutes to get to the VA medical center and 10 minutes to get to Thomas Memorial Hospital. The Veteran said that he was told by VA over the telephone that physical therapy would be outsourced to somewhere close to where he lived. The record does not contain the complete treatment records from Thomas Memorial Hospital, including physical therapy, from January 14, 2014 through March 5, 2014. The Veteran should be assisted with obtaining these records before the claim is decided on the merits. See 38 C.F.R. § 3.159(c). In addition, the scanned documents noted in the January 16, 2014, January 22, 2014, January 27, 2014, February 10, 2014, and March 4, 2014 VA fee basis-outpatient records should be associated with the claims file since they could be relevant to whether the private treatment was pre-authorized. The VA community care records from this period should also be obtained. The matters are REMANDED for the following action: 1. Obtain the attachments noted in the January 16, 2014, January 22, 2014, January 27, 2014, February 10, 2014, and March 4, 2014 VA fee basis-outpatient treatment records. If no such records are available, a memorandum of unavailability should be added to the claims file. (Continued on the next page) 2. Obtain VA Community Care records from January 1, 2014 through March 31, 2014. If no such records are available, a memorandum of unavailability should be added to the claims file. 3. Contact the Veteran and ask that he complete and return the necessary authorization (VA Form 21-4142) for VA to obtain the complete treatment records from Thomas Memorial Hospital, to include physical therapy treatment, from January 1, 2014 through March 31, 2014 and invite him to submit any relevant records in his possession. There must be two attempts made to request private treatment records from the providers, and all attempts must be documented in the claims file. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Scott Shoreman, 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.