Citation Nr: A25036282 Decision Date: 04/21/25 Archive Date: 04/21/25 DOCKET NO. 240827-468727 DATE: April 21, 2025 REMANDED Entitlement to payment or reimbursement of beneficiary travel expenses for ambulance services provided on June 15, 2024, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1968 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2024 determination from the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). In August 2024, the Veteran disagreed with the above-noted decision and filed a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)). The Veteran selected the Direct Review Lane by submitting notice of disagreement under the Appeals Modernization Act (AMA). 38 C.F.R. § 19.2(d). Accordingly, the Board is limited to review of the evidence in the record up and until the date of the notice for the decision on appeal. 38 C.F.R. § 20.301. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the above claim. 38 C.F.R. § 20.300. Except as otherwise provided, each appeal will be decided in the order in which it is entered on the docket to which it is assigned. 38 C.F.R. § 20.800(b). However, a case may be advanced on the docket on motion if, for example, a veteran is seriously ill, homeless, or of advanced age (at least 75 years old). 38 C.F.R. § 20.800(c)(1). This appeal has been advanced on the docket due to the Veteran's advanced age. In Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims (Court) held that generally, the Board may not decide an appeal before the deadline for requesting an AMA docket switch has elapsed. 38 C.F.R. § 20.202(c)(2) allows appellants to switch AMA dockets by completing and submitting a new VA Form 10182 within 60 days from when the Board receives the original VA Form 10182, or one year from the date the AOJ mails notice of the decision on appeal, whichever is later, unless (1) an appellant has already submitted evidence or testimony as described in 38 C.F.R. §§?20.302 and 20.303, or (2) the appellant or representative has requested a waiver of the ability to request to switch dockets during this timeframe. In this case, one year from the date of notification of the July 10, 2024, decision has not lapsed. In a January 2024 letter, the Veteran was notified that he could waive his right to select a different review option. The Veteran has not responded to the letter. As the Veteran's appeal has been advanced on the docket due to advanced age and the Veteran did not indicate that he wished to switch dockets in response to the January 2024 letter from the Board, the Board concludes that it is not in the Veteran's best interest to further delay this matter. Accordingly, the Board considers the Veteran's AOD request as a waiver of the remaining time to switch dockets. Remand Pursuant to 38 U.S.C. § 111 and 38 C.F.R. part 70, VHA may make payments for travel expenses incurred in the United States to help veterans and other persons obtain care or services from VA including for travel by ambulance, if necessary. 38 C.F.R. §§ 70.1-70.20. VA-authorized health care facility means a non-VA health care facility where VA has approved care for an eligible beneficiary at VA expense. 38 C.F.R. § 70.2. When payment is requested for beneficiary travel that includes a special mode of transportation, including by ambulance, VA will approve payment if: (1) The travel is medically required; (2) The beneficiary is unable to defray the cost of such transportation; and (3) VHA approved the travel prior to travel in the special mode of transportation or the travel was undertaken in connection with a medical emergency. 38 C.F.R. §§ 70.4(d), 70.2. A Veteran is considered "unable to defray the cost" of ambulance expenses when the Veteran: (1) Has a service-connected disability rated at 30 percent or more; (2) is traveling for treatment of a service-connected disability; (3) has an income for the year (as defined under 38 U.S.C. § 1503) immediately preceding the application for beneficiary travel that does not exceed the maximum annual pension rate (MAPR) that the beneficiary would receive under 38 U.S.C. § 1521 (as adjusted under 38 U.S.C. § 5312) if the beneficiary were eligible for pension during that year; or (4) is able to demonstrate that due to circumstances such as loss of employment, or incurrence of a disability, his or her income in the year of travel will not exceed the MAPR that the beneficiary would receive under 38 U.S.C. § 1521 (as adjusted under 38 U.S.C. § 5312) if the beneficiary were eligible for pension. See 38 C.F.R. § 70.4(d)(2); VHA Directive 1601B.05, "Beneficiary Travel," 2-3 (January 20, 2022) (adopting the definition "unable to defray the expenses of travel" in 38 C.F.R. § 70.10(c) for the term "Unable to defray" for all of part 70, including the special mode of transportation criteria under § 70.4(d)). The record reflects that the Veteran was seen at the Wythe County Community Hospital (WCCH) emergency room for pain, weakness, and the inability to walk. Upon discharge from WCCH, on June 15, 2024, the hospital ordered an ambulance to transport the Veteran from WCCH to his home. An October 2024 Report of Contact indicates that Optum records show that treatment provided at WCCH had been approved by Optum through the Veterans Community Care Program (VCCP). See 38 U.S.C. § 1703; 38 C.F.R. § 17.4000-17.4040. Optum's authorization for treatment was approved from June 14, 2024, through July 13, 2024. Therefore, although the record reflects that the Veteran's transport was from a VA-authorized heath care facility by ambulance, and that such travel by ambulance was medically necessary, the record is unclear as to whether such ambulance travel had been approved by VA, and whether the Veteran was unable to defray the cost of the ambulance transportation in question. While Optum records contain documentation of authorization of treatment through VCCP at WCCH, there is no indication as to whether VA had approved ambulance travel from WCCH to his home. There is also no finding by the AOJ as to whether or not the Veteran was unable to defray the costs of the June 15, 2024, ambulance travel. The lack of relevant documents including those establishing whether such ambulance travel had been approved by VA and whether or not the Veteran was unable to defray the costs of the June 15, 2024, ambulance travel, frustrate any Board review of the appeal on the merits. As correction of these errors by the AOJ in satisfying its regulatory and statutory duties would have at least a reasonable possibility of aiding in substantiating the claim on appeal, the appeal must be remanded. See 38 C.F.R. § 20.802(a). The matter is REMANDED for the following action: (Continued on the next page) ? Associate with the record any relevant evidence considered by the AOJ for the Veteran's claim for entitlement to payment or reimbursement of beneficiary travel expenses for ambulance services provided on June 15, 2024, including those establishing whether such ambulance travel had been approved by VA and whether or not the Veteran was unable to defray the costs of the June 15, 2024, ambulance travel. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gresham, Trevor 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.