Citation Nr: A21018658 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 210214-185671 DATE: November 22, 2021 REMANDED Entitlement to payment or reimbursement for the cost of medical services provided by the appellant from February 13, 2018, to February 22, 2018, is remanded. REASONS FOR REMAND The Veteran had active service from December 1975 to August 1984. He died in February 2018 and the appellant provided medical services to the Veteran. Entitlement to payment or reimbursement for the cost of medical services provided by the appellant from February 13, 2018, to February 22, 2018, is remanded. The appellant provided medical services to the Veteran from February 12, 2018, through February 23, 2018. A September 25, 2020, explanation of payment granted payment for February 12, 2018 and February 23, 2018 only. As written by the appellant on the VA Form 10182 (Decision Review Request: Board Appeal), he is seeking payment for February 13, 2018, through February 22, 2018. It was noted that the date of the decision on appeal is September 23, 2020, and that the explanation of benefits states that charges were denied as, "Missing/incomplete/invalid days or units service." An August 2021 report of contact, that is a memorandum to the file, states that the maximum unit of service for the CPT/HCPCS had been exceeded. This is also stated in an October 9, 2020, preliminary fee remittance advice report. However, it does not appear that this was sent to the appellant. Furthermore, a September 23, 2020, decision is not of record September 23, 2020. In addition, the September 25, 2020, explanation of payment does not include a decision for February 13, 2018, to February 22, 2018. The Board finds that a remand is warranted to satisfy a statutory duty under 38 U.S.C. § 5104. 38 C.F.R. § 20.802(a) (the Board may remand for correction of any error by the agency of original jurisdiction (AOJ) in satisfying a regulatory or statutory duty if correction of the error would have a reasonable possibility of aiding in substantiating the claim). Generally, a claimant is entitled to notice of a decision by the Secretary that includes an explanation of the procedure for obtaining review of the decision. 38 U.S.C. § 5104(a). Such notice must include the following: 1. Identification of the issues adjudicated. 2. A summary of the evidence considered by the Secretary. 3. A summary of the applicable laws and regulations. 4. Identification of findings favorable to the claimant. 5. In the case of a denial, identification of elements not satisfied leading to the denial. 6. An explanation of how to obtain or access evidence used in making the decision. 7. If applicable, identification of the criteria that must be satisfied to grant service connection or the next higher level of compensation. 38 U.S.C. § 5104(b). Without adequate notice of the basis for the denial, a claimant cannot make an informed decision as to whether or not to accept or appeal the decision nor can he or she know what evidence to submit in order to substantiate the appeal. See Ingram v. Nicholson, 21 Vet. App. 232, 252 (2007) (discussing the legislative history of 38 U.S.C. § 5104 and the importance of clear and informative notice of decisions). It is not clear that the appellant was put on notice of what additional evidence or argument could be presented to support an appeal. On remand, the AOJ must provide the Veteran with complete notice of the decision as required by 38 U.S.C. § 5104. The matters are REMANDED for the following action: Issue the appellant a decision and notice of decision on the issue of entitlement to payment or reimbursement for the cost of medical services provided by the appellant on February 13, 2018, to February 22, 2018. The notice shall include but is not limited to: a summary of the applicable laws and regulations; identification of findings favorable to the claimant; and, identification of the substantive conditions not satisfied but necessary for issuance of payment or reimbursement. 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.