Citation Nr: 21027443
Decision Date: 05/05/21	Archive Date: 05/05/21

DOCKET NO. 17-46 593A
DATE: May 5, 2021

REMANDED

Entitlement to payment or reimbursement for the cost of medical services incurred at St. Mary's Hospital on April 27, 2017 is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Army from July 1968 to May 1971.  

This matter comes before Board of Veterans' Appeals (Board) from a July 2017 decision of a Department of Veterans Affairs Medical Center (VAMC). 

A review of the record shows that a remand is needed before the issue on appeal can be adjudicated. 

The Veteran contends that he was having pain and it appeared that there was pus in his catheter.  His wife called the nurse advice line and was told that he should go to the emergency room immediately.  He contends that the nurse stated that the services would be taken care of by VA and that there was no authorization required for emergency care.  He also contends that she said to tell the ER personnel that they need to send the bill to VA for payment.  See July 2017 notice of disagreement letter.  

He went to Mercy Medical Center ER on April 23, 2017 because of excruciating pain and the inability to urinate.  There he was given antibiotics and a catheter was placed.  They instructed him to see his doctor within three days.  His wife made an appointment with his VA doctor for April 26, 2017.  On the day of the appointment VA called and stated that his appointment was cancelled as that office did not deal with catheter issues and he would need to be seen in urology.  His wife called the VA urology department and was told that as they only have a part time urologist who is out until July, the Veteran could come to VA on May 3, 2017 to have the catheter removed.  On April 27, 2017 the Veteran went to the ER at St. Mary's Hospital.  See July 2017 notice of disagreement letter.  

There are outstanding records.  First, there is no claim of record.  Second, there are no medical records in the file from St. Mary's Hospital to illustrate the treatment received.  Third, there are no VA treatment records in the file to document communication between the Veteran (or his wife) and VA regarding the conversation the Veteran contends occurred with the advice nurse where she suggested he go to the ER and that the services would be covered.  Also, there is no record dated April 26, 2017 to illustrate that the Veteran's appointment was cancelled.  Therefore, a remand is needed in an effort to obtain these records. 

The matter is REMANDED for the following action:

1. Obtain and associate a copy of the Veteran's May 2017 claim.  

2. The AOJ should take all reasonable efforts to obtain any and all outstanding VA treatment records, to include any records from a Dr. B at the VA.  Specifically, the AOJ should take efforts to locate VA treatment records dated April 26, 2017 and April 27, 2017.  

All efforts should be documented.  If any records cannot be obtained after reasonable efforts have been made, notify the Veteran and his representative of the attempts made and allow him the opportunity to obtain the records himself.

3. The AOJ should take all reasonable efforts to obtain private treatment records from St. Mary's Hospital dated anytime in April 2017, to specifically include records dated April 27, 2017.  

 

 

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Talamantes, 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.