Citation Nr: A21019347 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 200314-186526 DATE: December 6, 2021 ORDER The appeal with respect to entitlement to payment or reimbursement of medical expenses incurred in connection with services furnished to the Veteran beginning on October 1, 2019 through the Veterans Community Care Program (VCCP) is dismissed. FINDINGS OF FACT 1. The Veteran seeks payment or reimbursement of medical expenses incurred in connection with services furnished beginning on October 1, 2019 through the VCCP. 2. In October 2019, the VA Office of Community Care denied the Veteran's claim for payment or reimbursement of medical expenses incurred in connection with his care at Summit Health Care Medical Associates on October 1, 2019 on grounds that authorization was required in advance and the treatment was non-emergent. 3. In August 2021, the appeals team at a VA Payment Operations and Management office determined that the care at issue was approved under the VA Mission Act and that all claims needed to be submitted to the Third-Party Administrator (TriWest Healthcare Alliance). CONCLUSION OF LAW There remains no justiciable case or controversy with respect to the Veteran's claim over which the Board of Veterans' Appeals (Board) may exercise jurisdiction. 38 U.S.C. §§ 7105, 1703(f); 38 C.F.R. § 20.104(c). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Air Force from February 1964 to April 1965. This matter comes to the Board on appeal from an October 2019 determination issued by the VA Office of Community Care in Fort Harrison, Montana. The Veteran timely appealed to the Board in March 2020, requesting the evidence submission review option, which allowed him 90 days following the receipt of his notice of disagreement to submit additional evidence. 38 C.F.R. §§ 20.201, 20.202(b)(3). Entitlement to payment or reimbursement of medical expenses incurred in connection with services furnished to the Veteran beginning on October 1, 2019 through the VCCP Under 38 U.S.C. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. See, e.g., 38 C.F.R. § 20.104. The Veteran seeks payment or reimbursement of medical expenses incurred in connection with his care at Summit Health Care Medical Associates beginning on October 1, 2019. In October 2019, the VA Office of Community Care processed the claim for payment of services in accordance with 38 U.S.C. §§ 1703, 1728, and 1725. The claim was denied on grounds that authorization was required in advance and the treatment was non-emergent. Subsequently, in August 2021, the appeals team at the VA Payment Operations and Management office in Fort Harrison determined that the care at issue was approved under the VA Mission Act and that any unresolved claims needed to be submitted to the Third-Party Administrator (TriWest). The Veteran was subsequently notified in September 2021 that the provider should submit the claims to the VA Third Party Administrator (TriWest) and the authorization number was provided. In light of the foregoing, it appears clear that the basis of the original denial (i.e., a finding that authorization was required in advance and that the treatment was non-emergent) was negated upon further administrative review. While the original denial has been overturned, additional action is required by the Veteran to further process his claim, to the extent there are bills that remain at issue. Specifically, he needs to ask the billing care provider to submit (or resubmit) its claim to TriWest for processing. See September 2021 Correspondence. While the Board has jurisdiction to address eligibility for payment or reimbursement for medical expenses in some instances, it does not have jurisdiction to determine eligibility for payment under a Veterans Care Agreement. See 38 U.S.C. §§ 1703(f), 1703A; 38 C.F.R. § 17.4135. Likewise, the Board cannot review a decision of a third-party administrator (e.g., TriWest) regarding the processing of invoiced claims for payment to non-VA providers under the community care network, because those decisions are subject to the specific claims processing and dispute resolution provisions laid out in the contracts with those providers. See 38 U.S.C. §§ 1703D(g)(1), 7104(a); 38 C.F.R. § 17.4030. Because the basis of the original denial in October 2019 has been overturned, there is no remaining case or controversy over which the Board has jurisdiction. 38 C.F.R. § 20.104. Accordingly, the appeal must be dismissed. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kettler, 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.