Citation Nr: A24059727 Decision Date: 09/23/24 Archive Date: 09/23/24 DOCKET NO. 210712-222818 DATE: September 23, 2024 ORDER The appeal concerning entitlement to payment of the cost of non-Department of Veterans Affairs (VA) medical expenses incurred on March 5, 2021, is denied. FINDING OF FACT The non-emergency, non-VA medical services performed on March 5, 2021 were not authorized by VA. CONCLUSION OF LAW There is no legal basis for payment of medical expenses incurred on March 5, 2021. 38 U.S.C. §§ 1703, 1725, 1728; 38 C.F.R. §§ 17.4000-17.4040. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant, Aegis Sciences Corporation ("Aegis"), is a non-VA healthcare provider that provided laboratory services to the Veteran on March 5, 2021. The Veteran passed away in July 2022. This appeal is before the Board of Veterans' Appeals (Board) from a March 2021 Explanation of Payment (EOP) decisions of the VA Veterans Health Administration (VHA) Agency of Original Jurisdiction (AOJ). In a July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the appellant elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. Here, the appellant provided laboratory services to the Veteran on March 5, 2021. As reflected in the March 2021 EOP from VA, the decision on appeal, VA payment was denied on the basis that "[n]o authorization number was submitted on the claim and this is a billing requirement for pre-approved care." The appellant was advised to "resubmit the claim with the authorization number." In the July 2021 NOD, the appellant expressed disagreement with the denial of the claim "due to missing prior-authorization" and requested reconsideration on the claim. Under 38 C.F.R. § 17.4020 (a), "a covered veteran eligible for the Veterans Community Care Program (VCCP) under § 17.4010 may choose to schedule an appointment with a VA health care provider, or have VA authorize the veteran to receive an episode of care for hospital care, medical services, or extended care services from an eligible entity or provider when VA determines such care or services are clinically necessary." 38 U.S.C. § 1703 establishes VA's program to furnish hospital care, medical services, and extended care services to covered veterans through non-VA health care providers (the VCCP), and is implemented under 38 C.F.R. §§ 17.4000-17.4040. 38 C.F.R. § 17.4010, which establishes the conditions of a veteran's eligibility for non-VA treatment under § 1703, explicitly states that, if such conditions are met, "the covered veteran may elect to receive authorized non-VA care under § 17.4020." In the absence of such VA authorization, in order to be entitled to payment or reimbursement of medical expenses incurred at a non-VA facility, certain conditions, including that the treatment was for a medical emergency, must be met. See 38 U.S.C. §§ 1725, 1728. To that end, the March 5, 2021, non-VA laboratory services provided by the appellant were not treatment for an emergency, and there is no assertion that they were. The record further reflects that the services were not authorized by VA, and the appellant has not argued otherwise. To the extent that the appellant asserts that VA should retroactively authorize payment, or should have authorized payment previously, the appellant would be contesting a VA decision regarding whether to furnish services through a non-VA provider under 38 U.S.C. § 1703 (d) (Conditions under which care is required to be furnished through non-Department providers) and/or (e) (Conditions under which care is authorized to be furnished through non-Department providers). However, such decisions are statutorily barred from being appealed to the Board. 38 U.S.C. § 1703 (f) ("The review of any decision under subsection (d) or (e) shall be subject to the Department's clinical appeals process, and such decisions may not be appealed to the Board of Veterans' Appeals"). As the Board has no authority to review any such contentions, they would provide no legal basis for payment. As noted above, 38 C.F.R. §§ 17.4010 and 17.4020(a) explicitly require VA authorization of non-VA medical services for VA payment of such services, in the absence of a medical emergency. As there was no VA authorization of the non-emergency, non-VA medical services provided by the appellant on March 5, 2021, which the appellant does not dispute, there is no legal basis for VA payment of such expenses. Accordingly, the appellant's claim for payment of the expenses of such services must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.A., 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.