Citation Nr: 21077196 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-38 781 DATE: December 28, 2021 REMANDED Entitlement to payment or reimbursement of medical expenses incurred for the period from May 25, 2013 to May 25, 2013, for services received, to include from Spring Hill Regional Hospital in Spring Hill, Florida, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to August 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 decision by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) that denied the claims for payment or reimbursement for medical services received on May 25, 2013, due to untimeliness, as reviewed under The Veterans Millennium Health Care and Benefits Act criteria. As an initial matter, the Veteran requested a Travel Board hearing on his February 2016 VA Form 9 for this appeal. He was informed in May 2018 that the Board scheduled his hearing for August 2018; however, in response, the Veteran submitted a statement in June 2018 requesting to 'withdraw the Appeal noted in the VA correspondence dated [in May 2018]' because he already received his desired rating for his service-connected disability. While the Veteran was referring to the scheduled hearing, the Board does not believe he intended to withdraw this particular appeal, as he mentioned an appeal that involved his service-connected disability, which this claim does not. As such, the Board will proceed with review of this matter. The August 2018 Board hearing was then postponed, and the Veteran was not scheduled for another hearing until October 2021, where he failed to report for this hearing. Since he not shown good cause, his hearing request is deemed withdrawn. 38 C.F.R. §§ 20.702, 20.704(d). Entitlement to payment of medical expenses incurred for the period from May 25, 2013 to May 25, 2013, for services received, to include from Spring Hill Regional Hospital in Spring Hill, Florida, is remanded. The Veteran seeks payment or reimbursement of medical expenses incurred in connection with medical treatment at Spring Hill Regional Hospital on May 25, 2013. Specifically, the Veteran sought emergency medical services for complaints of elevated blood pressure at the Spring Hill Regional Hospital in the early afternoon of May 25, 2013; he was discharged a couple hours later. The Veteran was brought to Spring Hill Regional Hospital via ambulance by the Hernando County Fire Rescue and treated by a clinician employed by a provider, Quality Drive Emerg Physicians. He is disputing the Tampa VA Medical Center's (VAMC) decision issued in November 2013 that denied these claims because the claims were not submitted within 90 days of medical care and therefore, were not timely filed. The Veteran asserts the Spring Hill Regional Hospital submitted the claims within the allotted payments. See October 2014 notice of disagreement. Alternatively, he raised that as he was awarded a total disability rating based on individual unemployability that was made effective May 17, 2010, this bill should have been considered under 38 U.S.C. § 1728. See January 2018 correspondence. The Veterans Millennium Health Care and Benefits Act provides general authority for reimbursement for the reasonable value of emergency treatment furnished in a non-VA facility to those Veterans who are active VA health-care participants (i.e., enrolled in the annual patient enrollment system and recipients of a VA hospital, nursing home, or domiciliary care under such system within the last 24-month period) and who are personally liable for such non-VA treatment and not eligible for reimbursement under the provisions of 38 U.S.C. § 1728. 38 U.S.C. § 1725; 38 C.F.R. §§ 17.1000-1008. To obtain payment or reimbursement for emergency treatment under 38 U.S.C. § 1725, a claimant must submit to the VA medical facility of jurisdiction a completed standard billing form (such as a uniform billing (UB) 92 or a Health Care Financing Administration (HCFA) 1500). 38 C.F.R. § 17.1004(b). To receive payment or reimbursement for emergency services under 38 U.S.C. § 1725, a claimant must file a claim within 90 days after the latest of the following: the date that the veteran was discharged from the facility that furnished the emergency treatment; the date of death, if the death occurred during transportation to a facility for emergency treatment or during the stay in the facility that included the provision of the emergency treatment; or the date the veteran finally exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party. 38 C.F.R. § 17.1004(d). The date of filing any claim for payment or reimbursement of the expenses of medical care and services not previously authorized shall be the postmark date of a formal claim, or the date of any preceding telephone call, telegram, or other communication constituting an informal claim. 38 C.F.R. § 17.127. In this case, the Veteran's claims file reflects that the Spring Hill Regional Hospital, Quality Drive Emerg Physicians, and the Hernando County Fire Rescue all submitted claims pertaining to the medical treatment dispensed to the Veteran on May 25, 2013. On June 18, 2013, a 'Brooksville Regional Hospital' also submitted a 'Claim for Payment of Cost of Unauthorized Medical Services' with the same medical treatment date of May 25, 2013. The Board was unable to read the VA Form number for this particular form. On August 28, 2013, Hernando County Fire Rescue submitted a HCFA 1500 claim. On February 14, 2014, Quality Drive Emerg Physician submitted their HCFA 1500 claim. A November 2013 Preliminary Fee Remittance Advice Report showed the Hernando County Fire Rescue was assigned Claim ID 1064784 and the claim was rejected because it was filed more than 90 days past the date of service. In March 2014, a Preliminary Fee Remittance Advice Report showed Quality Drive Emerg Physician's claim (Claim ID 1223527) was also rejected, in part, for the same reason. In the February 2016 statement of the case, the Tampa VAMC stated the Veteran and the medical vendors were sent denial letters and notification of appeal rights in November 2013. However, after a detailed review of the evidence provided by VHA, the Board has been unable to locate copies of the November 2013 letters. Decisions of the Board must be based on a de novo review of the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on the issue or issues on appeal, and any additional evidence considered as part of the evidentiary record pursuant to applicable statute and regulation. 38 U.S.C. §§ 7104(d), 7113; 38 C.F.R. § 20.801(a). In this case, the Board does not have before it the evidence upon which the decision was based. Thus, the Board cannot fulfill its statutory and regulatory requirement to base its decision on a review of the evidence of record at the time of the AOJ decision on the issue or issues on appeal. Therefore, a remand is warranted for VHA to locate and associate the November 2013 decision letters to the Veteran's claims file. Additionally, a remand is warranted for the AOJ to properly consider the Veteran's contention to consider this claim under the provisions of 38 U.S.C. § 1728. Although the Veteran raised these contentions for a payment or reimbursement for emergency services received on another date, the Board finds this contention may be construed for this matter, as well. The matter is REMANDED for the following actions: 1. Take all actions necessary to obtain the November 2013 decision letters as cited to in the February 2016 statement of the case and associate the letters with the claims file. 2. Then readjudicate the Veteran's claim for entitlement to reimbursement of medication expenses incurred following treatment for the period of May 25, 2013 to May 25, 2013, as provided by Spring Hill Regional Hospital, Hernando County Fire Rescue, and Quality Drive Emerg Physicians, under the provisions of 38 U.S.C. § 1728. If any benefit sought on appeal remains denied, the Veteran and his representative should be provided the proper appellate procedures. TESS WINKLER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Tang, 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.