Citation Nr: A21020289
Decision Date: 12/21/21	Archive Date: 12/21/21

DOCKET NO. 200520-86802
DATE: December 21, 2021

REMANDED

The appeal for payment or reimbursement for payment of medical care at Bourbon Community hospital in October 2019 is remanded.

REASONS FOR REMAND

The Veteran had active service from June 1976 to October 1977. 

1. Payment or reimbursement for payment of medical care at Bourbon Community hospital in October 2019 is remanded.

The Veteran contends that she sought emergency medical care related to her service-connected heart condition in 2019 at a non-VA medical facility at the recommendation of a VA medical provider and seeks VA payment to that facility for such medical services.   

The Veteran submitted a VA Form 10182 notice of disagreement in May 2020.  In the narrative portion of this form, the Veteran explained that she had treatment for heart condition at Decatur VA hospital on November 7, 2019.  The Veteran stated that on November 25, 2019, while living in Kentucky, she began to experience chest pains and blood pressure issues and called the Lexington VA hospital to ask for assistance.  The Veteran stated that a staff member at the Lexington VA hospital told the Veteran that she should go to the closer private facility due to the Veteran's history of heart attacks.  On the VA Form 10182, the Veteran listed a series of monetary values with codes that mirror a VA notice letter which she also submitted.  The May 2, 2020 notice letter from VA Financial Services Center lists a series of monetary values totalling $5,162.53 and corresponding medical billing codes pertaining to medical treatment at Bourbon Community hospital on October 25, 2019.  The letter requests that the Veteran provide the authorization code for provision of treatment at a non-VA facility.  The letter states, "this is not a bill."    

Under the AMA, if the Board of Veterans' Appeals (Board) identifies a duty to assist error that existed at the time of the AOJ's decision on the claim under review, the claim must be returned for correction of the error and readjudication. 38 C.F.R. § 3.2601(g).  Herein, there is not sufficient documentation on which to base a decision and the issue must be remanded.  

The Board requests that the AOJ contact the Veterans Health Administration to obtain relevant documentation pertaining to the Veteran's treatment at this facility including but not limited to billing statements, treatment records and notice letters.  

With the assistance of the Veteran, obtain treatment records from Bourbon community hospital pertaining to the October 2019 treatment event.  

The matters are REMANDED for the following action:

1. Contact VHA and obtain relevant documentation pertaining to the Veteran's treatment at Bourbon community hospital in October 2019, to include but not limited to billing statements, treatment records, and notice letters. 

2. With the assistance of the Veteran, obtain treatment records from Bourbon community hospital pertaining to 

 

the October 2019 treatment event.  

 

 

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Miller, 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.