Citation Nr: A25035379
Decision Date: 04/16/25	Archive Date: 04/16/25

DOCKET NO. 210316-214957
DATE:  April 16, 2025

REMANDED

Entitlement to payment or reimbursement of unauthorized medical expenses incurred during non-VA hospital care on June 26, 2020, claim # 302104800063319000, is remanded. 

REASONS FOR REMAND

The Veteran served on active duty from July 1969 to February 1971.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2020 administrative determination made by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). The administrative decision constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

In the March 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the appellant elected the Evidence submission docket. Therefore, the Board may only consider the evidence of record at the time of the March 2021 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the appellant within 90 days following the receipt of the VA Form 10182. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal, or (2) more than 90 days following the receipt of the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the appellant would like VA to consider any evidence that was submitted that the Board could not consider, the appellant may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

The appellant seeks reimbursement for emergency treatment provided on June 26, 2020. In this regard, the appellant indicated that the Veteran was taken by ambulance for a suspected cardiac incident, with chest pain and numbness in the left arm in June 2020 to the nearest hospital for emergency treatment. 

The Board finds that the AOJ committed a pre-decisional duty to assist error by failing to associate the complete Veteran's Veterans Health Administration (VHA) claims file pertaining to the appellant's claim for payment or reimbursement of unauthorized medical expenses incurred during non-VA hospital care on June 26, 2020, claim # 302104800063319000, with the electronic record. 

Significantly, review of the available electronic record reveals the March 2021 VA Form 10182 and medical records; however, all other relevant evidence has not been associated with the record. The record does not contain the original administrative decision on appeal nor any other VHA records, to include the Veteran's treatment records. 

The Board finds that remand to obtain and associate with the electronic record, the Veteran's complete VHA claims file, including any VHA file evidence, to include VA treatment records, relevant private treatment and medical bills, AOJ decision(s), claim(s) for reimbursement, and any statement(s) from the appellant are necessary to determine whether the claim for payment or reimbursement of unauthorized medical expenses incurred during non-VA hospital care on June 26, 2020, claim # 302104800063319000, is warranted. The AOJ's failure to obtain the VHA records is a pre-decisional duty to assist error that necessitates a remand for development.

The matters are REMANDED for the following action:

1. The AOJ must reconstruct the Veteran's VHA claims file and associate it with the electronic record, to include obtaining any outstanding VHA file evidence, including any VA treatment records, relevant private treatment records and medical bills, AOJ decision(s), claim(s) for reimbursement, and any statement(s) from the appellant. In particular, the original decision on appeal should be associated with the claims file.

2. The AOJ should make a formal finding of unavailability if the records are unable to be obtained.

 

 

A.	S. CARACCIOLO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Mariah N. Sim, 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.