Citation Nr: A25035502 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 210126-214992 DATE: April 17, 2025 ORDER The appeal concerning entitlement to payment of the cost of non-Department of Veterans Affairs (VA) dental services furnished by the appellant in February 2020 is dismissed. FINDINGS OF FACT 1. While this appeal was pending, the Agency of Original Jurisdiction (AOJ) approved the appellant's claim for payment of the cost of non-VA medical services provided to the Veteran on February 7, 2020, and February 17, 2020. 2. The dental services furnished by the appellant in February 2020, was pursuant to a Veterans Care Agreement (VCA), which is governed by statutory and contractual authority that creates a dispute process with no review by the Board of Veterans' Appeals (Board). CONCLUSION OF LAW The criteria for dismissal of the appeal for entitlement to payment for the medical services provided by the appellant in February 2020 have been met; the issue has been resolved in full; the appeal is moot. 38 U.S.C. §§ 1703A (d), (h), 7104, 7105; 38 C.F.R. §§ 17.4120, 17.4135, 20.104, 20.801. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1985 to March 1987. The appellant is a non-VA medical provider who rendered services to the Veteran on February 7, 2020, and February 17, 2020, on behalf of VA, furnished through a VCA. See generally 38 C.F.R. § 17.4110. This matter is on appeal before the Board from a December 2020 decision of a VA Veterans Health Administration (VHA) AOJ. In March 2021, the Board received a VA Form 10182, Decision Review Request: Board Appeal electing the Evidence Submission docket. The record reflects that the appellant provided dental services to the Veteran on February 7, 2020, and February 17, 2020, and billed $241.00 for the cost of these services ($94.00 for February 7, 2020, and $147.00 for February 17, 2020). The appellant's claim was denied in the December 2020 decision on appeal on the basis that the time limit for filing had expired. Prior to the Board issuing a decision on this appeal, documentation was added to the claims file indicating that the underlying non-VA episodes of care were paid in full. Specifically, in a February 2022 Report of Contact, a representative from a VHA Office of Finance, Payment Operations, noted that the claim was paid on July 8, 2021; in March 2022, the appellant was contacted and they confirmed that payment had been received in the amount of $178.42. A July 2021 Explanation of Payment (EOP) reflects that the appellant was paid $178.42 of the $241.00 billed charge and that such constituted payment in full. The Board notes that the July 2021 EOP indicates only the February 17, 2020, episode of care was paid; however, as noted by the representative in the February 2022 report of contact, the amounts billed and total on each claim are exactly the same as the December 2020 denial, which included both February 7, 2020, and February 17, 2020, dates of service. Payment or reimbursement for the cost of non-VA dental services provided by the appellant in February 2020 has been made by VA and constitutes a full grant of the benefits sought in this appeal. Under these circumstances, the Board will dismiss the issue on appeal as being moot. There no longer remains a case or controversy for the Board to decide. Accordingly, the appeal for entitlement to payment of non-VA dental expenses incurred in February 2020 is dismissed. See 38 C.F.R. § 20.104. Moreover, the Board notes that 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). 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 "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")." The VHA AOJ is the responsible VA official in contrast to the role of the Board as a VA administrative appeal tribunal. See generally 38 U.S.C. § 7101. Therefore, the governing statute and implementing regulation have established a dispute process for VCA payments that does not contemplate Board review. 38 U.S.C. § 1703A (h)(2); 38 C.F.R. § 17.4135 (a)(3-5), (c)(5); 84 Fed Reg. 21668, 21675. Moreover, the payment rates paid by VA for the services furnished pursuant to a VCA are set forth in the VCA according to parameters outlined in 38 CFR § 17.4120. (Continued on the next page) ? In sum, the applicable statute and regulation governing VCA disputes does not contemplate Board review of a question on the proper contractual payment rate for services provided to a veteran under a VCA. Consequently, the instant appeal seeking payment under a VCA must be dismissed. 38 U.S.C. § 1703A (h)(2); 38 C.F.R. § 17.4135 (a)(3-5), (c)(5); 84 Fed Reg. 21668, 21675. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Frazier, 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.