Citation Nr: A25035695 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 210324-188695 DATE: April 17, 2025 ORDER The issue of entitlement to payment for the cost of medical services provided by the appellant to the Veteran from September 13, 2020, through September 15, 2020, is dismissed. FINDINGS OF FACT 1. The medical services provided by the appellant from September 13, 2020, through September 15, 2020, were provided 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. 2. Entitlement to payment for the cost of medical services provided by the appellant to the Veteran from September 13, 2020, through September 15, 2020, was approved, and the appeal is moot. CONCLUSION OF LAW The criteria for dismissal of the appeal of the issue of entitlement to payment for the cost of medical services provided by the appellant to the Veteran from September 13, 2020, through September 15, 2020, have been met. 38 U.S.C. § 1703A; 38 C.F.R. §§ 17.4120, 17.4135. REASONS AND BASES FOR FINDINGS AND CONCLUSION The appellant is a non VA provider who rendered medical services to the Veteran on a contract basis through a VCA. See generally 38 C.F.R. §§ 17.4100 17.4135. In March 2021, the appellant submitted a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement), selecting the direct review docket. Whether the appellant is entitled to payment for the cost of medical services provided by the appellant to the Veteran from September 13, 2020, through September 15, 2020. The evidence shows that the appellant provided medical services to the Veteran from September 13, 2020, through September 15, 2020. 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(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 [VCAs]" 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 Veterans Health Administration [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 agency of original jurisdiction. Therefore, the Board, as a VA administrative appeals body, does not have the authority to review or resolve VCA disputes, including a disagreement concerning the proper contractual payment amount. 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. This appeal seeking entitlement to payment under a VCA must be dismissed. Id. Additionally, a September 2021 Report of Contact stated that the claim had been processed. A September 2021 letter to the appellant stated that on secondary review the appeal was approved, and the claim would be processed according to VA policy. As the claim for entitlement to payment for the September 13, 2020, through September 15, 2020, episode of care was approved, this appeal is moot. The appeal is dismissed. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Miller, 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.