Citation Nr: A21017676
Decision Date: 11/02/21	Archive Date: 11/02/21

DOCKET NO. 200318-167637
DATE: November 2, 2021

REMANDED

Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 2, 2019, is remanded.

Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 10, 2019, is remanded.

REASONS FOR REMAND

The Veteran had active service from November 1974 to May 1980.  The appellant provided medical services to him on December 2, 2019, and December 10, 2019.

In the March 2020 VA Forms 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) decisions on appeal.  38 C.F.R. § 20.301.

1. Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 2, 2019, is remanded.

2. Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on December 10, 2019, is remanded.

May 2021 memoranda for the record pertaining to the December 2, 2019 and December 10, 2019 dates of service respectively state that the preliminary fee advice report and "MR" could not be located and that further efforts to obtain them would be futile.  Documents related to these claims, including the decisions on appeal, are not of record and must be associated with the file before there can be a decision on the merits.  If the documentation relating to these claims 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 decisions on appeal be unavailable, the claims must be readjudicated before they are 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 copies of the decisions on appeal for the December 2, 2019, and December 10, 2019, dates 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 2, 2019, and December 10, 2019, with the Veteran's claims file, including the decisions on appeal, which appear to be dated December 19, 2019, and December 23, 2019, respectively.

3. If the decision on appeal cannot be associated with the claims file, readjudicate the claims for the cost of medical services provided by the appellant on December 2, 2019, and December 10, 2019, and associate the new decisions with the claims file.  

 

 

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.