BVA9507524 
DOCKET NO.  93-09 709     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Medical Center in Wichita, Kansas

THE ISSUE

Entitlement to payment for unauthorized chiropractic fees for
medical services rendered between March 18 to 25, 1992, in the
amount of $152.00; outpatient medical services rendered in 1992
in the amount of $37.50; and outpatient services rendered in 1992
in the amount of $550.27.

(The issue of entitlement to an increased rating for residuals of
a lower thoracic and lumbar injury, currently rated 40 percent
disabling, will be addressed in a separate decision.)

REPRESENTATION

Appellant represented by: Veterans of Foreign Wars of the
United States

ATTORNEY FOR THE BOARD

Richard V. Chamberlain, Counsel

INTRODUCTION

The veteran served on active duty from February 1980 to February
1984.

This appeal arises from determinations in 1992 by the Department
of Veterans Affairs (VA) Medical Center (VAMC) in Wichita,
Kansas, that denied payment for unauthorized chiropractic fees
for services rendered between March 18 to 25, 1992, in the amount
of $152.00; outpatient medical services of $37.50 rendered in
1992; and outpatient medical services of $550.27 rendered in
1992.  VAMC adminis-trative files concerning the veteran were
received at the Board of Veterans' Appeals (Board) in May 1993,
and her claims folder was sent to the Board in August of that
same year.

REMAND

The record shows that the veteran's claim is well-grounded,
meaning it is plausible.  Hence, VA has the duty to assist her in
the development of facts pertinent to her claim.   38 U.S.C.A.
§ 5107(a) (West 1991).  The duty to assist includes obtaining all
relevant records.  Murphy v. Derwinski, 1 Vet.App. 78 (1990).

The veteran contends, and records confirm, that there was a delay
in the processing of her application for VA fee-basis medical
care.  She asserts that she made several contacts with personnel
in the Medical Administrative Service of the Wichita

VAMC, including with the Chief, Leverta A. Peeples.  She
maintains that around March 1992, Ms. Peeples discovered that the
veteran's application had never been received or was lost and
that within a few days someone from the Wichita VAMC gave her
permission to obtain the needed medical services.  Other records
in the VAMC administrative files indicate that she was requested
to obtain a letter from a private physician ordering chiropractic
and other medical services in order to receive authorization for
such services.  The files do not contain VA Reports of Contact in
1992 between the veteran and personnel of the Wichita VAMC, nor
do the statement of the case and supplemental statements of the
case sent to her refer to these contacts.  Prior to final
appellate consideration of her claim, obtaining and reviewing
this evidence would be helpful.

Additionally, letters sent to the veteran in October 1992 and the
supplemental statement of the case sent to her in November 1992
show the denial of payment of outpatient medical services of
$37.50 and $550.27 in 1992 because they were submitted to a
private insurance company for payment.  The supplemental
statement of the case cites the provisions of 38 C.F.R. § 17.80
(1994) (dealing with conditions qualifying as medical emergency
of such a nature that delay in treatment would have been
hazardous to life or health) for the denial of payment, but does
not discuss whether the veteran's conversations with personnel at
the Wichita VAMC constituted prior authorization for the
chiropractic and outpatient medical services.  38 C.F.R.
§§ 17.47(b)(1), 17.50b, 17.50c, 17.50d (1994); Hennessey v.
Brown, 7 Vet.App. 143, 148-149 (1994).

In the Reason for Decision section of the supplemental statement
of the case, it is noted that the she had not obtained prior
authorization and that the expenses were submitted to a private
insurance company for reimbursement.  However, she was not
provided the regulatory citations or explained why payment cannot
be made for the unreimbursed portion of a bill submitted to an
insurance company.  The

supplemental statement of the case also does not specify which
bills constitute the $550.27 in medical services rendered in
1992, and the veteran notes that the reason given by the VAMC
appears to be different from the reason given for the denial of
payment of these medical bills.  Due process requires that she be
provided with a supplemental statement of the case that includes
a summary of all pertinent evidence, a summary of the applicable
laws and regulations, and a discussion of how such laws and
regulations affect the determination.  The statement of the case
and supplemental statements of the case sent to her must be
complete enough to allow her to present written or oral arguments
to the Board.  38 C.F.R. §§ 19.29, 19.31 (1994).

Hence, the case is REMANDED to the VAMC for the following
actions:

1.  The VAMC should search for Reports of
Contact or other documentary evidence of
conversations between the veteran and
personnel of the Wichita VAMC.  These
should include phone logs or other records.
If no such records are found, a written
report concerning contacts between
personnel of the Wichita VAMC and the
veteran in early 1992 should be prepared
and associated with the appellate record.

2.  After the above development, the VAMC
should review the claim, including the
matter of whether conversations between the
veteran and personnel of the Wichita VAMC
constituted prior authorization to receive
the applicable chiropractic and outpatient
medical services in 1992.  If the claim is
denied, a supplemental statement of the
case should be provided to the veteran and
her representative, covering all the

pertinent evidence, including clarification
of the specific medical bills involved, a
summary of the applicable laws and
regulations, and a discussion on how these
laws and regulations apply to the veteran's
claim.

After the veteran and her representative are given an opportunity
to respond to the supplemental statement of the case, the file
should be returned to the Board.

          M. CHEEK
          Member, Board of Veterans' Appeals

The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination.  This proceeding has been assigned to an
individual member of the Board.

Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals.  This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal.  38 C.F.R. § 20.1100(b) (1994).