Citation Nr: A24045331 Decision Date: 08/09/24 Archive Date: 08/09/24 DOCKET NO. 210507-248787 DATE: August 9, 2024 ORDER The appeal of the issue of entitlement to payment of expenses for home health services incurred from July 10 to July 30, 2000, is dismissed. FINDING OF FACT The home health services furnished by the appellant from July 10 to July 30, 2000, were pursuant to a Veterans Care Agreement (VCA), which is subject to a specific administrative dispute resolution process that does not allow for review by the Board of Veterans' Appeals (Board). CONCLUSION OF LAW The criteria for dismissal of the appeal of the issue of entitlement to payment of expenses for home health services incurred from July 10 to July 30, 2000, are met. 38 U.S.C. § 1703A(h); 38 C.F.R. § 17.4135. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant provided home health services to the Veteran from July 10 to July 30, 2000, on behalf of the Department of Veterans Affairs (VA), furnished through a VCA. See generally 38 C.F.R. §§ 17.4100-17.4135. This appeal is before the Board from a May 2021 decision of a VA Veterans Health Administration (VHA) Agency of Original Jurisdiction (AOJ), which denied payment of the claimed expenses for the dates in question on the basis that the claims had not been timely filed. In May 2021, the Board received a VA Form 10182, Decision Review Request: Board Appeal electing the Direct Review docket, in which the appellant asserted that the claims in question had been timely filed. When VA hospital care, a medical service, or an extended care service required by a covered individual is not feasibly available from a VA facility or through a contract or sharing agreement entered into pursuant to another provision of law, VA may furnish such care or service through a VCA with an eligible non-VA provider. 38 U.S.C. § 1703A(a)(1)(A)-(B). The controlling statutory authority and its implementing regulations provide a specific procedure for resolving disputes between VA and a non-VA service provider under a VCA. 38 U.S.C. § 1703A; 38 C.F.R. § 17.4135. The controlling statute, 38 U.S.C. § 1703A, explicitly authorizes VA to "promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements" and specifies that "such procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies." 38 U.S.C. § 1703A(h)(1-2). The statute also indicates that only after exhaustion of these administrative remedies may the provider or entity seek judicial review and that review may then be sought in Federal District Court or the U.S. Court of Claims in accordance with 28 U.S.C. § 1346 (known as the Tucker Act). 38 U.S.C. § 1703A(h)(3). Additionally, payment by VA under a VCA shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguishes any liability on the part of the covered individual (e.g., veteran entitled to VA medical services) for the treatment or care provided. 38 U.S.C. § 1703A(e)(2)(B). As mandated by the section 1703A statutory authority, the controlling regulation "establishes the administrative procedures and requirements for asserting and resolving disputes arising under or related to a [VCA]," including disputes concerning a claim for payment. 38 C.F.R. § 17.4135(a)(1). Under these procedures, a decision by the "responsible [VHA] official" concerning a VCA dispute, including disagreement over the amount of VA payment, is the exclusive administrative remedy for a service provider or entity, and a written decision by a designated responsible VA official constitutes VA's final decision on the dispute (in other words, a decision that is not subject to any administrative appeal). 38 C.F.R. § 17.4135(a)(3-5), (c)(5). See also 84 Fed Reg. 21668, 21675 (Interim Final Rule), implementing 38 C.F.R. § 17.4135: Paragraph (c)(5) of §?17.4135 will establish that the written decision issued by the responsible VA official constitutes VA's final decision on the dispute. This language serves to clarify that VA maintains no administrative process to appeal such a decision and to emphasize the reality that, under section 1703A(h)(2), this disputes [resolution] process constitutes entities' and providers' exhaustive and exclusive administrative remedy. The statute and regulation governing VCA disputes, including those over whether and under what conditions payment on a claim will be made, establish a dispute resolution process that does not contemplate review by the Board, as a VA administrative appeal tribunal, of any decision on such disputes. 38 U.S.C. § 1703A(h)(2); 38 C.F.R. § 17.4135(a)(3-5), (c)(5); 84 Fed Reg. 21668, 21675; see also 38 U.S.C. § 7101. Therefore, the instant appeal seeking payment of claimed expenses incurred from July 10 to July 30, 2000, under a VCA must be dismissed. [SIGNATURE ON NEXT PAGE] 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.