Citation Nr: A21016435
Decision Date: 10/06/21	Archive Date: 10/06/21

DOCKET NO. 200212-184949
DATE: October 6, 2021

ORDER

The claim of entitlement to payment of expenses for non-Department of Veterans Affairs (VA) medical services performed on July 25, 2019 under the Community Care Network (CCN), by the appellant, is dismissed.

FINDINGS OF FACT

1. The claim seeking medical reimbursements for non-VA services performed on July 25, 2019 was denied by VA on the basis that advance authorization was needed and had not been obtained.

2. The Board of Veterans' Appeals (Board) does not have jurisdiction to review the appellant's claim.

CONCLUSION OF LAW

The Board has no jurisdiction to review the claim, and it must be dismissed.  38 U.S.C. § 1703(f); 38 C.F.R. § 38 C.F.R. § 20.104(c).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Initially, the Board notes that the Veteran died on October [REDACTED], 2020.

The matter comes before the Board on appeal from a January 23, 2020 decision of the VA Office of Community Care, which denied reimbursement of the costs of non-VA medical services provided by the appellant on July 25, 2019 on the basis that advance authorization was needed and had not been obtained.

The appellant submitted a VA Form 10182 (Decision Review Request: Board Appeal) on February 15, 2020 and selected the direct review process on each submission.

Decisions of community care providers, including those related to payment for services, do not fall within the Board's jurisdiction.  38 U.S.C. § 1703(f).  Therefore, the Board does not have jurisdiction to review the appellant's claim and it must be dismissed.  See 38 C.F.R. § 20.104(c).

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The Board notes that, while dismissing the appeals for lack of jurisdiction to review, a June 2021 fax from Syracuse VA Medical Center (VAMC) indicates that the denial was issued in error as advance authorization had previously been given by Syracuse VAMC for the service date on appeal.  Prior to his death, the Veteran had been sent a letter notifying him that the services were authorized by Syracuse VAMC through the CCN and that his provider (here, the appellant) could submit a claim to VA's third-party administrator, TriWest.  The basis of the original denials has therefore been negated.

 

 

L. M. BARNARD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Lee

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.