Citation Nr: A21016960
Decision Date: 10/19/21	Archive Date: 10/19/21

DOCKET NO. 200318-178997
DATE: October 19, 2021

REMANDED

Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 5, 2019, is remanded.

REASONS FOR REMAND

The Veteran had active service from October 1972 to September 1973.  The appellant provided medical services to him on December 5, 2019.

In the March 2020 VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.

Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 5, 2019, is remanded.

In the VA Form 10182, the appellant wrote that they were appealing a December 19, 2019, decision.  A statement attached to the VA Form 10182 says that the date of service was December 5, 2019, and the total charge was $987.00.  Documentation related to this claim, including the decision on appeal, is not of record and must be associated with the file before there can be a decision on the merits.  A May 2021 memorandum for the record states that there are no records related to this episode of care on file, including no explanation of benefits or 72-hour notification, and that further efforts to obtain the records would be futile.  If the documentation relating to this claim cannot be associated with the record, the appellant must be notified of the missing records and given the opportunity to submit any copies in their possession.  Should the decision on appeal be unavailable, the claim must be readjudicated before it is returned to the Board.

Disputes under the Veterans Community Care Program (VCCP) or Veterans Care Agreements, to include reimbursement of payment for related care, do not fall within the Board's jurisdiction.  38 U.S.C. § 1703(f) (effective June 6, 2019) ("The review of any decision under [the VCCP] shall be subject to the Department's clinical appeals process, and such decisions may not be appealed to the Board of Veterans' Appeals"); 38 C.F.R. § 17.4135(c)(5) (effective June 6, 2019) (disputes with VCAs will result in a written decision by the responsible VA official and constitute VA's final decision on the dispute).  The Board needs the complete record from this claim before determining whether there is a lack of jurisdiction under the VCCP.

The matters are REMANDED for the following action:

1. Notify the appellant that they may submit a copy of the decision on appeal for the December 5, 2019, date of service.

2. Associate records related to the claim for payment or reimbursement for the cost of medical services provided to the Veteran on December 5, 2019, with the claims file, including the decision on appeal, which appears to be dated December 19, 2019.

3. If the decision on appeal cannot be associated with the claims file, readjudicate the claim for the cost of medical services provided by the appellant on December 5, 2019, provide written notice in accordance with 38 U.S.C. § 5104, and associate the new decision with the claims file.  The claim should then be returned to the Board if not granted in full. 

 

 

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scott Shoreman, 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.