Citation Nr: A21018546 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 210108-185209 DATE: November 19, 2021 ORDER Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 3, 2020 to August 7, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 10, 2020 to August 14, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 17, 2020 to August 21, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 26, 2020 to August 28, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 31, 2020 to September 4, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from September 7, 2020 to September 9, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from September 15, 2020 to September 18, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 21, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 28, 2020 is denied. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 30, 2020 is dismissed. FINDINGS OF FACT 1. VA pre-authorized the Veteran for home health aide care by At Home Healthcare, the appellant, from December 12, 2019 until July 6, 2020 under Authorization # VA0004856383. 2. 2. VA pre-authorized the Veteran for home health aide care by At Home Healthcare, the appellant, from September 30, 2020 until March 31, 2021 under Authorization # VA0009468928. 3. Prior authorization from VA was not granted for home health aide care by the appellant for the dates on appeal from August 3, 2020 to September 28, 2020. 4. The treatment received from August 3, 2020 to September 28, 2020 were not for a medical emergency, and a prudent layperson would not believe the symptoms experienced were emergent in nature. 5. During the pendency of the appeal, the costs associated for the episode of care on September 30, 2020 have been paid in full to the appellant as this was a pre-authorized day of care. CONCLUSIONS OF LAW 1. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from August 3, 2020 to August 7, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 2. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from August 10, 2020 to August 14, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 3. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from August 17, 2020 to August 21, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 4. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from August 26, 2020 to August 28, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 5. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from August 31, 2020 to September 4, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 6. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from September 7, 2020 to September 9, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 7. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant from September 15, 2020 to September 18, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 8. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant on September 21, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 9. The criteria for payment or reimbursement of unauthorized medical expenses incurred in connection with non-VA emergency medical care provided by the appellant on September 28, 2020 are not met. 38 U.S.C. § 1703; 38 C.F.R. § 17.52. 10. The criteria for dismissal of entitlement to medical payment or reimbursement for the episode of care on September 30, 2020 have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the Air Force from January 1953 to January 1957 and April 1957 to June 1973. The appellant is At Home Healthcare. The appellant submitted a VA Form 10182, Decision Review Request: Board Appeal in January 2021, electing the direct review docket. Payment or Reimbursement of Non-VA Home Health Aide Services 1. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 3, 2020 is denied. 2. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 10, 2020 to August 14, 2020 is denied. 3. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 17, 2020 to August 21, 2020 is denied. 4. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 26, 2020 to August 28, 2020 is denied. 5. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from August 31, 2020 to September 4, 2020 is denied. 6. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from September 7, 2020 to September 9, 2020 is denied. 7. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant from September 15, 2020 to September 18, 2020 is denied. 8. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 21, 2020 is denied. 9. Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 28, 2020 is denied. The appellant requests payments or reimbursements for services rendered to the Veteran for home health aide care from August 3, 2020 to September 28, 2020. The appellant contends that payment or reimbursement should be rendered as services provided were included in pre-authorized time periods. The Board disagrees. A review of the evidence demonstrates that the appellant was granted pre-authorization to provide home health aide services for the Veteran from December 12, 2019 until July 6, 2020 under Authorization # VA0004856383 and from September 30, 2020 until March 31, 2021 under Authorization # VA0009468928. The dates on appeal are from August 3, 2020 to September 28, 2020, which are clearly between the two authorized periods of service. Hence, these dates were not pre-authorized by VA for the appellant to provide care. In the absence of prior authorization for medical services, there is no factual or legal basis for payment or reimbursement by VA under 38 U.S.C. § 1703 and 38 C.F.R. §§ 17.52-17.57 for contracted medical services at a non-VA facility. Alternatively, reimbursement for unauthorized expenses for emergency medical conditions may be made pursuant to 38 U.S.C. § 1728 or 38 U.S.C. § 1725. To be entitled to payment or reimbursement of medical expenses incurred at a non-VA facility under 38 U.S.C. § 1728 or 1725, one of the required criteria is that services were rendered in for an "emergent" condition. An emergent condition is a medical emergency of such nature that delay would have been hazardous to life or health or that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. See 38 U.S.C. §§ 1725, 1728; 38 C.F.R. § 17.120, 17.1002. The appellant is not eligible for payment under 38 U.S.C. § 1728 or 38 U.S.C. § 1725 because the Veteran was not being treated for an emergent condition, nor has such an emergency condition been claimed. The services provided by At Home Healthcare include activities of daily living not to treat an emergent condition. Therefore, the evidence shows that the Veteran's condition was not "emergent" in nature such that a prudent layperson would believe that treatment was required at that time to prevent injury to the body, nor was it indicative of a medical emergency of such nature that delay would have been hazardous to life or health. See 38 U.S.C. §§ 1725, 1728. There is no medical evidence of record which is contrary to this finding. The Board is bound by the laws and regulations governing eligibility for medical care payments and has no authority to grant payments outside of these laws. The evidence clearly shows that the Veteran received home health aide care by the appellant from July 8, 2020 to July 31, 2020. As the Veteran did not receive pre-authorization for home health aide care services and as the requirement for reimbursement under either 38 U.S.C. §§ 1725 or 1728 of a medical emergency has not been met, the analysis does not need to proceed any further to the additional requirements of any of the above-mentioned regulations, as all provisions must be met to establish entitlement to reimbursement. See Melson v. Derwinski, 1 Vet. App. 334 (1991). The appeals are denied. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Entitlement to payment or reimbursement of cost of non-VA home health aide care provided by the appellant on September 30, 2020 is dismissed. Here, the appellant appealed VA's decision to deny payment or reimbursement for medical expenses related to an episode of care on September 30, 2020. It appears that any controversy has been mooted. During the pendency of the appeal, the claim was paid in full by VA on October 19, 2020 as September 30, 2020 was the first day of the pre-authorization period under Authorization # VA0009468928. As there does not appear to remain any issue related to the initial denial for the Board to decide, dismissal of the appeal is appropriate and so ordered. 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.