Citation Nr: A25008563 Decision Date: 01/30/25 Archive Date: 01/30/25 DOCKET NO. 241011-486621 DATE: January 30, 2025 ORDER Entitlement to payment or reimbursement of Beneficiary Travel expenses for travel to and from the Department of Veterans Affairs (VA) Anthem Clinic on September 11, 2024, is granted. FINDINGS OF FACT 1. The Veteran is administratively eligible for Beneficiary Travel reimbursement. 2. The Veteran was referred to a VAMC on September 11, 2024, for specific treatment ordered by a VA endocrinologist, and reviewed by a VA clinical pharmacist practitioner; the Veteran completed the Anthem VA clinic appointment. CONCLUSION OF LAW The criteria for entitlement to payment or reimbursement of beneficiary travel expenses for travel to and from the VAMC on September 11, 2024, are met. 38 U.S.C. §§ 111; 38 C.F.R. §§ 70.2, 70.10, 70.20, 70.30. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active service from February 1964 to February 1968. See DD 214. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2024 administrative decision of the VA Beneficiary Travel department. In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the September 2024 agency of original jurisdiction (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. A favorable finding of the AOJ which the Board will not disturb is that the Veteran is administratively eligible for the beneficiary travel program benefits. See VHA Beneficiary Travel File, received on November 27, 2024, pg. 14. 1. Reimbursement of Beneficiary Travel on September 11, 2024. The Veteran contends that his care he received at a VAMC on September 11, 2024, was authorized by VA, there was not a closer facility that could have provided the services, and his claim should be paid. See October 2024 VA Form 10182. His claim was denied by VHA for multiple reasons as listed below. Your claim was denied for the following reason: You are a veteran that does not have a service connected rating of 30% or greater, Authority 38 CFR 70.10(a)(1)-(10)[.] The appointment(s) associated with your date of travel does not qualify for payment, For payment, an appointment must be in relation to care or services that you are eligible for, must be authorized in advance for a non-VA care appointment, and it must be completed unless due to actions other than yourself, Authority 38 CFR 70.4(1),(2), NOT Eligible for Processing: NO APPOINTMENT WAS FOUND & Nothing in Notes Tab/Labs/Imaging)[.] VHA Beneficiary Travel File, pg. 15. Generally, VA beneficiary travel is a payment for travel expenses incurred in the United States to help Veterans and other persons obtain care or services from the Veterans Health Administration. 38 U.S.C. § 111; 38 C.F.R. § 70.10. A Veteran is eligible for beneficiary travel payments for travel to or from a VA facility or VA-authorized health care facility for the following: 1) treatment for a service-connected disability, regardless of rating; 2) treatment for any disability, provided a Veteran has a service-connected disability at 30 percent or more; 3) a scheduled compensation and pension examination; 4) if the Veteran receives pension under 38 U.S.C. § 1521; 5) if a Veteran's annual income does not exceed the maximum annual rate of pension that a Veteran would receive under 38 U.S.C. § 1521; or, 6) if, a Veteran is unable to defray the expenses of that travel under certain circumstances. 38 U.S.C. § 111; 38 C.F.R. § 70.10(a). Subject to the deductibles required under 38 C.F.R. § 70.31, VA will pay the per mile rate established by VA for travel of a privately owned vehicle. 38 C.F.R. § 70.30 (a)(1). Except as otherwise allowed, payment is limited to travel from the beneficiary's residence to the nearest VA facility where care or services could be provided and from such facility to a Veteran's residence. 38 C.F.R. § 70.30 (b)(1). Application Notably, the AOJ did not engage in any discussion of which VA facilities were closer to the Veteran's home, or whether the services provided to the Veteran on the dates on appeal, could have been provided at such a closer facility. Furthermore, the reasoning of the denial contains compound reasoning, and conflicts with the favorable findings within the decision. For these reasons, the Board finds that the decision did not provide adequate notice. See 38 U.S.C. 5104. Without adequate notice of the basis for the denial, a claimant cannot make an informed decision as to whether or not to accept or appeal the decision, or what evidence is needed in order to substantiate the appeal. See Ingram v. Nicholson, 21 Vet. App. 232, 252 (2007) (discussing the legislative history of 38 U.S.C. § 5104 and the importance of clear and informative notice of decisions). The Board considered remanding the claim to provide the Veteran adequate notice, to satisfy a regulatory duty to provide adequate 5104 notice. However, upon review, the Board finds that there is adequate evidence of record with which to adjudicate the claim. The record indicates that the Veteran was eligible for beneficiary travel reimbursement, and that his appointment was authorized by his VA endocrinologist and followed up by a VA clinical pharmacist. The Board also notes that VHA did not indicate that the claim was untimely filed. VA treatment records (CAPRI) indicate that the Anthem VA appointment was completed. See CAPRI, received on January 10, 2025, pgs. 30-31. Therefore, the evidence of record shows that the appointment existed, was completed, and was authorized, and that VHA found him otherwise eligible for beneficiary travel program benefits. Therefore, the evidence is at least evenly balanced, and the benefit-of-the-doubt doctrine is for application. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side, or another, is the benefit-of-the-doubt doctrine not for application). Resolving reasonable doubt in favor of the Veteran, the Board finds that he traveled to his authorized appointment on September 11, 2024, for care or a service for which he was eligible. See 38 U.S.C. § 5107(b). The Veteran's claim for beneficiary travel expenses related to travel to an Anthem VA clinic appointment on September 11, 2024, is therefore granted. Cory M. Picton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McKenzie, 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.