Citation Nr: 0000539 Decision Date: 01/07/00 Archive Date: 01/11/00 DOCKET NO. 98-09 817 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office in Fort Harrison, Montana THE ISSUE Entitlement to payment of unauthorized medical expenses for a period of hospitalization from July 4 to July 5, 1996, at the Deaconess Medical Center. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J.M. Daley, Associate Counsel INTRODUCTION The veteran had active service from September 1967 to April 1969. This matter is before the Board of Veterans' Appeals (Board) on appeal from the Fort, Harrison, Montana, Department of Veterans Affairs (VA) Medical and Regional Office (RO). The veteran was scheduled to appear at a hearing before the Board at the Central Office in Washington, D.C. In September 1999 he was advised of the time and place of the hearing at his designated, updated address of record; he did not report for that hearing. See 38 C.F.R. § 20.702(d) (1999). REMAND The veteran has a 100 percent rating for service-connected post-traumatic stress disorder (PTSD). He seeks payment of medical expenses incurred July 4 and July 5, 1996, at which time he was admitted to a private facility for psychiatric complaints to include suicidal ideation. The veteran argues that on July 4, 1996, he was incoherent and unable to think rationally. He argues that his son and a friend had to wrestle a pistol away from him and that his son attempted to take him to the Billings, Montana, VA clinic, but that it was closed due to the national holiday. His representative further argues that the closest VA facility was either Fort Harrison, 169 miles away, or Miles City, 134 miles away, and that driving to either facility was not feasible due to the veteran's suicidal ideation and psychotic state. The veteran and his representative thus argue that payment for the private hospitalization is warranted. The statement of the case (SOC), issued in May 1998 and sent to the veteran at a [redacted] address, recounts that on July 5, 1996, the Deaconess Medical Center located in Billings, Montana, advised VA that the veteran had been admitted on July 4, 1996. The SOC sets out that on July 12, 1996, pertinent medical evidence from Deaconess was received and reviewed, and that based on such VA determined that VA medical facilities had been feasibly available to the veteran during the July 4 to July 5, 1996, period of hospitalization at Deaconess Medical Center. Further, the SOC indicates that a statement of charges from Deaconess Medical Center was received, along with a statement from the veteran and the hospital discharge instruction sheet. The claims file does not appear to contain records, medical or administrative, relevant to the circumstances of the veteran's July 4 to July 5, 1996, medical treatment, the feasibility of VA facilities, or any communication between Deaconess Medical Center, the veteran and VA for the time period in question. The claims file does contain a VA printout request for hospitalization/treatment that appears to indicate VA hospitalization of the veteran at the VA Medical Center located in Sheridan, Wyoming, from July 5, 1996 to September 12, 1996 for diagnoses of PTSD, alcohol use and neurotic depression. No records of VA treatment or hospitalization from July to September 1996 are contained in the claims file. The Board recognizes that some duty to assist the veteran in the completion of his application for benefits under 38 U.S.C.A. § 5103 (West 1991 & Supp. 1999) even prior to a determination as to well groundedness where potentially probative evidence has been identified. See generally, Beausoleil v. Brown, 8 Vet. App. 459 (1996). This is particularly true where, as in this case, it appears that the agency of original jurisdiction considered evidence not associated with the file for review by the Board. Thus, remand to obtain the records in question is warranted. The Board further notes that the SOC indicates that due process documentation was provided to the veteran. That SOC was sent to a representative of the Montana Veterans Affairs Division. The record reflects that the veteran's accredited representative is Disabled American Veterans but does not show that that organization was provided with a copy of the SOC. Moreover, in a VA Form 9 received later in May 1998, the veteran indicated that he had not received a copy of the SOC. He provided an updated address at that time. It does not appear that the RO has attempted to provide the veteran with an SOC at his updated address, or to provide a copy of the SOC to his representative. Accordingly, this matter is remanded for the following: 1. With any necessary release, records, both medical and administrative, of the veteran's private hospitalization at Deaconess Medical Center July 4 and July 5, 1996 should be obtained and associated with the claims file. The originating agency should also obtain for association with the claims file copies of any VA reports of contact, the September 1996 rating action reflecting consideration and denial of the veteran's claim for payment of medical expenses incurred those dates, and any other relevant correspondence or documentation. The originating agency should also obtain any records of the veteran's treatment or hospitalization at VA facilities proximate to July 4 -5, 1996, to include records of treatment during the period July 5, to September 12, 1996. 2. The originating agency should document in the claims file any information pertinent to the availability/feasibility of care of the veteran at a VA facility on July 4 and/or July 5, 1996, and document whether the VA clinic at Billings, Montana, was open on July 4, 1996. 3. After the development requested above has been completed to the extent possible, the issue on appeal should be readjudicated. If the benefit sought remains denied the veteran and his accredited representative MUST be furnished with the original SOC and a supplemental statement of the case that includes recitation of all potentially applicable laws and regulations and all evidence considered. The veteran and his representative will be afforded the opportunity to respond thereto. The veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the RO. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44-8.45 and 38.02-38.03. JANE E. SHARP Member, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 1991 & Supp. 1999), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (1999).