Citation Nr: A21020052
Decision Date: 12/15/21	Archive Date: 12/15/21

DOCKET NO. 211019-192141
DATE: December 15, 2021

REMANDED

The Veteran's VA Form 20-0996, Decision Review Request: Higher Level Review was rejected in error and the issue of entitlement to reimbursement for non-VA ambulance bill is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Navy from August 1955 to August 1957.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from June 2021 correspondence issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) wherein the AOJ reported they were unable to process the Veteran's VA Form 20-0996, Decision Review Request: Higher-Level Review. 

In June 2021, the Veteran filed a VA Form 20-0996, Decision Review Request: Higher-Level Review in response to May 2021 correspondence that reported a non-payment for October 17, 2020 date of service by provider North Mississippi Ground Ambulance, LLC.  The Board has construed the Veteran's Form 10182 to appeal the June 2021 letter from the AOJ which rejected the Veteran's request for a Higher-Level Review of the May 2021 decision on reimbursement for non-VA ambulance services.

In a June 3, 2021 letter, the AOJ informed the Veteran that it was unable to process the request for Higher-Level Review because it was incomplete and specific issues were not listed.  On June 1, 2021, the Veteran submitted two Higher-Level review requests.  One form did not list an issue on appeal, but the other form was properly completed and listed the decision date and ambulance reimbursement issue.  

The Board finds the June 3, 2021 letter from the AOJ indicating the Veteran filed an incomplete Higher-Level Review request form was issued in error.  The Board notes that a claim which has not been finally adjudicated is considered a pending claim. 38 C.F.R. § 3.160(c).  After VA receives a complete request for Higher-Level Review, a higher-level adjudicator is to conduct a de novo review of the relevant claims and issue a new rating decision reflecting the decision made under the Higher-Level Review process. 38 C.F.R. § 3.2601. Since the AOJ never issued a rating decision in response to the Veteran's request for Higher-Level Review, his claim remains pending.

As a Higher-Level Review rating decision has not yet been issued, the Board finds the AOJ committed a pre-decisional procedural error when it rejected the Veteran's Higher Level Review request.  As such, the matter should be remanded for the AOJ to issue a Higher-Level Review rating decision.

The Veteran is advised that after the matter is remanded, the AOJ will issue a Higher-Level Review Rating decision on the underlying issue of entitlement to reimbursement for the October 17, 2020 ambulance claim.  The Veteran will have an opportunity to appeal the Higher-Level rating decision once issued.

(Continued on next page) 

The matter is REMANDED for the following action:

Issue a Higher-Level Review rating decision addressing the Veteran's claim for entitlement to reimbursement for non-VA ambulance services. 

 

 

Evan M. Deichert

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Mouzakis, Associate 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.