Citation Nr: A25035134
Decision Date: 04/16/25	Archive Date: 04/16/25

DOCKET NO. 210402-180903
DATE: April 16, 2025

ORDER

The appeal concerning entitlement to payment of the cost of non-Department of Veterans Affairs (VA) medical services provided from September 3, 2019, to October 15, 2019, is dismissed. 

FINDING OF FACT

While this appeal was pending, the agency of original jurisdiction (AOJ) administratively approved entitlement to payment of the cost of medical services provided to the Veteran from September 3, 2019, to October 15, 2019. 

CONCLUSION OF LAW

The issue of entitlement to payment of the cost of non-VA medical care provided to the Veteran from September 3, 2019, to October 15, 2019, has been resolved in full by administrative action; the appeal is moot. 38 U.S.C. § 7105; 38 C.F.R. § 20.801.

REASONS AND BASES FOR FINDING AND CONCLUSION

The appellant is a non-VA healthcare provider that furnished medical services to the Veteran. 

In April 2021, the Board of Veterans' Appeals (Board) received a VA Form 10182, Decision Review Request: Board Appeal, from the appellant electing the Evidence Submission docket to review a February 2021 Explanation of Payment (EOP) issued by a VA AOJ, which denied the claim for payment of cost of medical services provided to the Veteran from September 3, 2019, to October 15, 2019, due to no authorization number submitted with the claim and "medical records have not been received or are insufficient to determine decision of payment." 

Therefore, the Board may only consider the evidence of record at the time of the February 2021 AOJ decision on appeal, as well as any evidence submitted by the appellant with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. 

The appellant's claim for payment of the cost of non-VA medical care provided to the Veteran from September 3, 2019, to October 15, 2019, was administratively approved while this appeal was pending. The record reflects that the claim was reprocessed and entitlement to payment was approved for the September 3, 2019, to October 15, 2019, episode of care. See August 2021 Report of Contact. The record indicates that reimbursement in the amount of $127,649.64 was issued in June 2021. 

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The Board acknowledges that the payment is less than the full amount of the charges billed by the provider for this episode of care; however, the administrative action approving entitlement to payment for the September 3, 2019, to October 15, 2019, episode of care constitutes a reversal of the prior denial, and a full grant of the benefit sought in this instant appeal. No determination remains with which the appellant disagrees as to the instant issue on appeal, and the appeal is therefore dismissed. 38 U.S.C. § 7105(d).

 

 

Nathaniel J. Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Robinson

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.