Citation Nr: A25001908 Decision Date: 01/08/25 Archive Date: 01/08/25 DOCKET NO. 210224-201252 DATE: January 8, 2025 ORDER The issue concerning entitlement to payment for the cost of non-Department of Veterans Affairs (VA) dental care services furnished by the appellant from December 17, 2019, to January 14, 2020, is dismissed. The issue concerning entitlement to payment for the cost of non-VA dental care services furnished by the appellant from September 25, 2019, to November 13, 2019, is dismissed. FINDINGS OF FACT 1. The dental care services furnished by the appellant from December 17, 2019, to January 14, 2020, were pursuant to a Veterans Care Agreement (VCA), which is subject to a specific administrative dispute resolution process that does not allow for appellate review by the Board of Veterans' Appeals (Board). 2. The dental care services furnished by the appellant from September 25, 2019, to November 13, 2019, were pursuant to a VCA, which is subject to a specific administrative dispute resolution process that does not allow for appellate review by the Board. CONCLUSIONS OF LAW 1. The criteria for dismissal of the appeal concerning payment for dental care services furnished by the appellant from December 17, 2019, to January 14, 2020, have been met. 38 U.S.C. § 1703A(d), (h); 38 C.F.R. §§ 17.4120, 17.4135. 2. The criteria for dismissal of the appeal concerning payment for dental care services furnished by the appellant from September 25, 2019, to November 13, 2019, have been met. 38 U.S.C. § 1703A(d), (h); 38 C.F.R. §§ 17.4120, 17.4135. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1970 to March 1971. He died in June 2023. The appellant is a non-VA medical provider that rendered dental care services to the Veteran on a contract basis through a VCA. See generally 38 C.F.R. §§ 17.4100-17.4135. In February 2021, a notice of disagreement (NOD) selecting Evidence Submission Review by a Veterans Law Judge was received. The evidence shows that the appellant provided dental care services to the Veteran from December 17, 2019, to January 14, 2020, and from September 25, 2019, to November 13, 2019. The appellant asserted it was not reimbursed for the cost of services rendered. In September 2022 correspondence, Veterans Health Administration (VHA) informed the appellant that the claim for services rendered from December 17, 2019, to January 14, 2020, was paid in full in July 2022. See September 2022 Medical Expense Reimbursement. The claim for services rendered from September 25, 2019, to November 13, 2019, was paid in full in July 2022. See November 2022 Medical Expense Reimbursement. 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 "Veterans Care Agreement" with an eligible non-VA provider. 38?U.S.C. § 1703A(1)(A-B). The term covered individual includes veterans eligible for VA medical services. See 38?U.S.C. § 1703A(f), indicating that a covered individual means any individual eligible for?hospital care,?medical services, or extended care services under Title 38 or any other law administered by VA. This controlling statutory authority and an accompanying regulation 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, 38?C.F.R. § 17.4135, "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 concerning 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 dispute [resolution] process constitutes entities and providers' exhaustive and exclusive administrative remedy." In sum, the controlling statute and regulation provide exclusive VCA administrative dispute resolution authority to VHA, the AOJ. Therefore, the Board, as a VA administrative appeals body, does not have the authority to review or resolve VCA disputes. 38 U.S.C. §§ 7101, 1703A(h)(1-2); 38?C.F.R. § 17.4135(a)(3-5), (c)(5), 84 Fed Reg. 21668, 21675. Consequently, the instant appeal seeking payment under a VCA must be dismissed. T. V. Casey Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Vanessa V. Geer, 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.