Citation Nr: A21020100
Decision Date: 12/16/21	Archive Date: 12/16/21

DOCKET NO. 201110-200266
DATE: December 16, 2021

REMANDED

Entitlement to payment or reimbursement for medical expenses incurred for private ambulance transport on April 19, 2020 is remanded.

REASONS FOR REMAND

This matter comes to the Board of Veterans' Appeals from an October 2020 decision of a Department of Veterans' Affairs (VA) Medical Center (VAMC).  In the November 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.

In October 2020, the VAMC denied entitlement to reimbursement of expenses incurred using a private ambulance transport on April 19, 2020.  The basis of the denial was that the Veteran's documented "income provided" exceeds the National income threshold and she does not have a currently service-connected disability rating.  It is not clear the basis for this finding as the evidence of record does not contain any information pertaining to the Veteran's "income provided."  Such documentation must be associated with the claims folder.

In a February 2021 VA Memo, it was indicated that the denial letter for medical reimbursement was missing from the claims folder and that all efforts had been made to obtain the missing letter.  The Board notes that it appears that a denial letter was subsequently associated with the claims folder, although it is not dated so it is not clear if it is the original denial letter.  See 11/17/2021 Beneficiary Travel-VHA.  The VA Memo indicates that VA personnel contacted the Veteran on February 19, 2021, wherein the Veteran explained that she had discarded the denial letter because her private insurance company had paid the bill in full.  A February 19, 2021 Report of Contact is not of record.  Any such Report of Contact should be associated with the claims folder.  

In light of the information contained in the VA Memo, a determination should be made as to whether the Veteran's private insurance paid for the ambulance bill.  See 38 C.F.R. § 17.1002(g).  The Board notes that such information is inconsistent with the April 30, 2020 Health Insurance Claim Form wherein the Veteran reported insurance with the VA Healthcare System and checked the 'No' box with regard to another health benefit plan.  Clarification should be sought as to whether the Veteran has health insurance other than through the VA Healthcare System.  

The matter is REMANDED for the following actions:

1.  Associate with the claims folder the following documentation pertaining to the Veteran's income; and any 02/19/2021 Report of Contact.

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2.  Clarification should be sought as to whether the Veteran had private insurance at the time of the April 19, 2020 ambulance transport, and whether private insurance reimbursed the Veteran for the expense.

 

 

Eric S. Leboff

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.W. Kreindler, 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.