Citation Nr: A21019959
Decision Date: 12/15/21	Archive Date: 12/14/21

DOCKET NO. 210106-177553
DATE: December 15, 2021

REMANDED

Entitlement to payment of medical expenses incurred on March 18 and 19, 2019, at Harrington Memorial Hospital (HMH) is remanded.

REASONS FOR REMAND

The Veteran served on active duty from July 1965 to June 1967. 

This appeal is before the Board of Veterans' Appeals (Board) from a May 2020 decision of the Department of Veterans Affairs (VA) Veterans Health Administration, which approved payment to the appellant, HMH, in the amount of $16,189.76, for medical services provided to the Veteran on March 18 and 19, 2019.

The appellant appealed in January 2021, arguing that it should have received payment for such services of $32,379.52.  In its VA Form 10182, Decision Review Request: Board Appeal, the appellant elected the Evidence Submission docket.  See 38 C.F.R. § 20.303.  Along with its appeal, the appellant submitted a report purportedly showing that, based on the expenses associated with the March 18 and 19 medical services, $32,278.52 should have been paid by VA.

VA internal records dated in July 2021 verify the amount paid to HMH for the March 18 and 19, 2019, services, and state that a claim of underpayment by a vendor "should be completed by Customer Service Specialist."  

The record therefore reflects what appears to be incomplete processing, review, and consideration of the appellant's claim, specifically the payment amount.  Moreover, to the extent that the May 2020 decision denied any requested payment, it did not identify either the evidence on which it relied in determining that the total reimbursable amount of the appellant's claim was $16,189.76 or the specific law under which the matter was decided, or explain the methodology applied to that evidence to determine that total.  See 38 U.S.C. §§ 511 (a), 5104(b).

As correction of these errors by the agency of original jurisdiction (AOJ) in satisfying its regulatory and statutory duties would have at least a reasonable possibility of aiding in substantiating the claim on appeal, the appeal must be remanded.  See 38 C.F.R. § 20.802(a).  On remand, the AOJ must take adequate steps to review the appellant's claim of underpayment, including review by a Customer Service Specialist, if appropriate.  If the payment amount sought is still denied, the AOJ should provide the appellant full notice of the basis of such denial, including the evidence used in determining that the total reimbursable amount, an explanation of the methodology applied to that evidence to determine that total, and the laws and regulations under which the matter was decided.

The matters are REMANDED for the following action:

1. Take adequate steps to review the appellant's claim of underpayment, including review by a Customer Service Specialist, if appropriate.

2. If the payment amount sought is still denied, provide the appellant full notice of the basis of such denial, including the evidence used in determining the total reimbursable amount, an explanation of the methodology applied to that evidence to determine the total, and the laws and regulations under which the matter was decided.

 

 

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Andrew Mack, 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.