Citation Nr: A21016643 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 200127-162676 DATE: October 13, 2021 ORDER Entitlement to payment for dental services provided to the Veteran on November 21, 2018 is denied. Entitlement to payment for dental services provided to the Veteran on December 18, 2018 is denied. FINDINGS OF FACT 1. A November 2017 Veterans Choice Agreement Authorization authorized the Veteran for two visits with the appellant for "periodic oral evaluation" and "prophylaxis-adult" between November 25, 2017 and September 30, 2018. No other authorization for non-VA treatment is of record. 2. The appellant provided dental services to the Veteran on November 21 and December 18, 2018. CONCLUSIONS OF LAW 1. The criteria for entitlement to payment for dental services provided to the Veteran on November 21, 2018 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52, 17.54. 2. The criteria for entitlement to payment for dental services provided to the Veteran on December 18, 2018 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52, 17.54. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Introduction On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with the Department of Veterans Affairs (VA)'s decision on their claim to seek review. This decision has been written consistent with the new AMA framework. The appellant submitted their VA Form 10182, Notice of Disagreement, in January 2020 and selected direct review of the January 2020 Veterans Health Administration (VHA) decisions without a Board hearing or the submission of additional evidence. In adjudicating these appeals, the Board may consider evidence associated with the record before January 2, 2020, the date of the VHA decisions on appeal. In this regard, the Board notes that the appellant submitted a statement in support of their appeal on January 10, 2020. Because this falls outside of the evidence window, the Board cannot consider it. Nevertheless, the statement contains no evidence or argument to contradict the Board's findings below that there is no evidence of a non-VA treatment authorization for the Veteran with the appellant for the 2019 fiscal year, and thus the exclusion of the statement from the Board's consideration is of no prejudice to the appellant. Entitlement to Payment for Dental Services Provided to the Veteran When VA or other government facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility or because they are not capable of furnishing care or services required, VA may contract with non-VA facilities to provide the appropriate care. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. In general, if VA is to provide payment or reimbursement of medical expenses incurred in connection with a Veteran's care at a non-VA hospital, the care must be authorized in advance. See 38 U.S.C. § 1703; 38 C.F.R. § 17.54. In the case of an emergency that existed at the time of admission, an authorization may be deemed a prior authorization if an application is made to VA within 72 hours after the hour of admission. 38 C.F.R. § 17.54. Here, the appellant seeks payment for dental services provided to the Veteran on November 21, and December 18, 2018. See Claims dated February 2019. There is no contention that these services were provided in the case of an emergency. The record contains a VA authorization of non-VA care for the Veteran with the appellant for limited dental services for the period from November 25, 2017 to September 30, 2018. See November 2017 Veterans Choice Agreement Authorization. There is no evidence of any other authorization of non-VA care for the Veteran with the appellant for the time following the expiration of this authorization, nor has the appellant asserted that there was such an authorization. Therefore, because the treatment for which payment is sought took place outside of the dates for which non-VA treatment for the Veteran with the appellant was authorized, payment for that treatment is not warranted and the claim must be denied. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Timmerman, Associate 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.