Citation Nr: 21016033 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 18-00 164 DATE: March 19, 2021 REMANDED Entitlement to payment or reimbursement for the cost of unauthorized medical treatment provided from July 9, 2016 to July 26, 2016 to Tampa General Hospital is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1981 to January 1989. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2016 letter of determination issued by the Department of Veterans Affairs (VA). The Veteran was scheduled for a December 2019 Board hearing in accordance with his request. However, the Veteran was deemed a no-show for the hearing and to date the Veteran has not requested that the hearing be rescheduled. As such, the Veteran’s hearing request is withdrawn. 38 C.F.R. § 20.704 (d). The Board notes that the Veteran submitted a Board Appeal (VA Form 10182) for several other issues. However, such issues will be addressed in a separate decision. Entitlement to payment or reimbursement for the cost of unauthorized medical treatment provided from July 9, 2016 to July 26, 2016 to Tampa General Hospital. The Veteran contends that he went to the emergency room on July 7, 2016, due to severe chest pains and shortness of breath. The Veteran also stated that from July 7 to July 15, he was unable to do a regular nuclear stress test. The Veteran also reported that he had an open-heart surgery and triple bypass, and he had a secondary surgery on July 20 to tighten wires to help his chest grow back strong. He was discharged on July 26 with continued therapy. Initially, the Board reflects that the Veteran was admitted to Tampa General Hospital for shortness of breath on July 7, 2016; he was admitted for emergency treatment from July 7, 2016 to July 26, 2016. VA has already awarded payment or reimbursement for these medical expenses at Tampa General Hospital under 38 U.S.C. § 1725 for July 7, 2016 to July 8, 2016. Therefore, the medical expenses at issue in this case are for the services rendered to the Veteran from July 9, 2016 to July 26, 2016. Generally, VA will not approve claims for payment or reimbursement of the costs of emergency treatment not previously authorized for any period beyond the date on which the medical emergency ended. For this purpose, VA considers that an emergency ends when the designated VA clinician at the VA facility has determined that, based on sound medical judgment, the veteran who received emergency treatment (1) could have been transferred from the non-VA facility to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for veterans) for continuation of treatment, or (2) could have reported to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for veterans) for continuation of treatment. 38 C.F.R. § 17.121 (a). The Board finds that it is unclear as to when the Veteran’s medical emergency ended. Therefore, a medical opinion should be obtained on whether the Veteran could have been safely transferred to the nearest VA medical center or whether he could have reported to a VA medical center for continuation of treatment. The Board also notes that although relevant reasons and bases were provided, the issue on appeal, including the time period at issue, appears to be misstated in the September 2017 Statement of the Case. If the Veteran’s claim is not fully granted, correction in this regard is needed. The matter is REMANDED for the following action: 1. Obtain a VA opinion from an appropriate medical professional to determine the nature and severity of the Veteran’s illness, as requiring the care obtained from Tampa General Hospital from July 7, 2016 to July 26, 2016. The claims folder must be reviewed by the examiner in connection with the opinion, and such review must be reflected in the opinion report. A complete history should be elicited directly from the Veteran’s medical file and any relevant statements of the appellant. All findings should be reported in detail. The examiner should address the following inquiries: (A) Did emergent care of the Veteran end on July 8, 2016? (B) If the answer to question (A) is no, when did the emergent care of the Veteran end, specifically concerning the Veteran’s medical treatment between the dates of July 9, 2016 to July 26, 2016? (C) From July 9, 2016, and at any point thereafter, as so identified in question (B), could the Veteran have been safely transferred to a VA medical center that was able to provide the level of care that he required considering his medical and functional state? (D) From July 9, 2016, and at any point thereafter, as so identified in question (B), could the Veteran have reported to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for veterans) for continuation of treatment? A thorough rationale for all opinions would be of significant assistance to the Board. 2. If the appeal is not fully granted, issue to the Veteran and his attorney a Supplemental Statement of the Case, to include identifying the issue on appeal. Provide the appropriate time period to respond. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brennae L. Brooks, 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.