Citation Nr: A21018131 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 200318-184388 DATE: November 10, 2021 ORDER Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on February 13, 2020, is denied. FINDING OF FACT The non-emergent medical services provided by the appellant on February 13, 2020, were not authorized by the Department of Veterans Affairs (VA). CONCLUSION OF LAW The criteria for payment or reimbursement for the cost of medical services provided by the appellant on February 13, 2020, have not been met. 38 U.S.C. §§ 1703, 1725, 1728; 38 C.F.R. §§ 17.4000-17.4040. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1968 to November 1969. The appellant provided medical services to the Veteran on February 13, 2019. In the March 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran 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. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim on appeal, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The appellant may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to payment or reimbursement for the cost of medical services provided by the appellant on February 13, 2020 In February 2020, the AOJ denied payment for non-emergency medical services provided by the appellant on February 13, 2020, pursuant to 38 U.S.C. § 1703, on the basis that such services had not been authorized by VA as required for payment. The appellant appealed in March 2020 on the basis that they were not aware of the requirement to obtain prior authorization and that they did the laboratory testing, a drug test, as ordered by the referring provider. The Veterans Community Care Program under 38 U.S.C. § 1703 is VA's program to furnish hospital care, medical services, and extended care services to covered veterans through non-VA health care providers. It is implemented under 38 C.F.R. §§ 17.4000-17.4040. 38 C.F.R. § 17.4010, which establishes the conditions of a Veteran's eligibility for non-VA treatment under § 1703, explicitly states that, if such conditions are met, "the covered veteran may elect to receive authorized non-VA care under § 17.4020." Under 38 C.F.R. § 17.4020(a), "a covered veteran eligible for the Veterans Community Care Program under § 17.4010 may choose to schedule an appointment with a VA health care provider, or have VA authorize the veteran to receive an episode of care for hospital care, medical services, or extended care services from an eligible entity or provider when VA determines such care or services are clinically necessary." In the absence of such VA authorization, in order to be entitled to payment or reimbursement of medical expenses incurred at a non-VA facility, certain conditions, including that the treatment was for a medical emergency, must be met. See 38 U.S.C. §§ 1725, 1728. Here, the drug testing services provided by the appellant were not emergency treatment and not authorized by VA, and the appellant has not argued otherwise. Rather, the appellant's claim for payment is based on the contention that VA should retroactively authorize payment, or should pay the appellant's claim despite there being no authorization, based on the fact that it was a medically necessary drug test. As noted above, 38 C.F.R. §§ 17.4010 and 17.4020(a) explicitly require VA authorization of non-VA medical services for VA payment of such services. As there was no VA authorization of the February 13, 2020, non-emergency drug testing services performed by the appellant, there is no legal basis for VA payment of such expenses. Accordingly, the appellant's claim for payment of the expenses of such services must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). 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.