Citation Nr: A26028131 Decision Date: 03/27/26 Archive Date: 03/27/26 DOCKET NO. 250826-630030 DATE: March 27, 2026 REMANDED Entitlement to payment or reimbursement for non-Department of Veterans Affairs (VA) ambulance transportation provided on December 9, 2024, is remanded. REASONS FOR REMAND The Veteran had active service with the United States Marine Corp from March 1968 to July 1969, and from May 1971 to June 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2025 decision issued by the Veterans Health Administration (VHA), Agency of Original Jurisdiction (AOJ). Therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the August 2025 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 June 2025 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. The Board notes that the Veteran attached additional evidence consisting of a statement and a medical bill to the August 2025 VA Form 10182. When a veteran selects the Direct Review docket but submits additional evidence with the VA 10182, the NOD is rendered unclear under 38 C.F.R. § 20.202(f) and the Board is required to seek clarification from the veteran regarding his or her preferred docket. Edwards v. McDonough, 36 Vet. App. 56 (2023). However, as discussed below, the claim will be remanded. Consequently, there is no prejudice to the Veteran in proceeding without clarifying whether he wants to proceed on the Evidence docket. Additionally, the Board acknowledges that the period to change AMA dockets per 38 C.F.R. § 20.202(c)(2) has not yet elapsed. However, the Board finds that a docket switch letter pursuant to Williams v. McDonough, 37 Vet. App. 305 (2024) is not necessary because the Veteran will have an opportunity to submit additional evidence to be considered on remand and this remand is not considered a final adjudication of the issue on appeal. Accordingly, there is no prejudice to the Veteran in proceeding with the remand. Id. 1. Payment for Non-VA Ambulance Transportation The Veteran seeks payment for the cost of non-VA ambulance transportation he received in December 2024. See August 2025 VA Form 10182. Upon review of the record, the Board finds that this appeal requires a remand because the VHA incorrectly adjudicated this matter under the beneficiary travel program. Specifically, the VHA denied the claim for ambulance transportation services under the beneficiary travel program pursuant to 38 C.F.R. § 70.10 because the claim was considered untimely. See June 2025 VA Form 10182. However, the evidence of record shows that the ambulance transportation at issue in this appeal involved travel to a non-VA hospital for a medical emergency, thus, beneficiary travel program is not applicable in this case. See 38 C.F.R. § 70.1 (stating that the beneficiary travel program does "not cover payment for emergency transportation of veterans for non-service-connected conditions in non-VA facilities when the payment for transportation is covered by §§ 17.1000 through 17.1008 of this chapter, as authorized by 38 U.S.C. § 1725.") Given that the ambulance transportation involved emergency medical treatment at a non-VA facility payment, reimbursement of ambulance travel may be payable even if the Veteran did not meet the requirements under 38 U.S.C. § 111. As such, the VHA should have decided this matter under 38 U.S.C. § 1725 or 38 U.S.C. § 1728. Specifically, the claim notes indicate that the Veteran was taken via ambulance to an emergency room for complaints of right-side numbness. See Medical Expense Reimbursement File. The Veterans Millennium Health Care and Benefits Act, implemented at 38 U.S.C. § 1725 and 38 C.F.R. § 17.1000-1008, provides general authority for reimbursement for the reasonable value of emergency treatment furnished in a non-VA facility to those veterans who are active VA health-care participants (i.e., enrolled in the annual patient enrollment system and recipients of a VA hospital, nursing home, or domiciliary care under such system within the last 24-month period) and who are personally liable for such non-VA treatment and not eligible for reimbursement under the provisions of 38 U.S.C. § 1728. Payment or reimbursement under 38 U.S.C. § 1725 for ambulance services, may be made for transporting a veteran to a facility where payment or reimbursement is authorized under 38 U.S.C. § 1725 for emergency treatment provided at a non-VA facility, or payment or reimbursement would have been authorized under 38 U.S.C. § 1725 for emergency treatment had the veteran's personal liability for the emergency treatment not been fully extinguished by payment by a third party, including under a health-plan contract, or by VA, where the veteran: is financially liable to the provider of the emergency transportation; does not have coverage under a health-plan contract that would fully extinguish the medical liability for the emergency transportation; has no contractual or legal recourse against a third party that could reasonably be pursued for the purpose of fully extinguishing the veteran's liability to the provider; and is not eligible for reimbursement for any emergency treatment expenses under 38 U.S.C. § 1728. 38 C.F.R. § 17.1003. As noted above, the evidence of record indicates that the VHA incorrectly adjudicated the reimbursement claim under beneficiary travel benefits instead of under emergency travel expenses to a non-VA facility under 38 C.F.R. § 17.1003. The record currently does not contain sufficient evidence to establish whether the December 9, 2024, ambulance services were payable under 38 U.S.C. § 1725 or 38 U.S.C. § 1728. Notably, the evidence is currently insufficient to determine whether the Veteran was an active VA health-care participant 24 months prior to the episode of care on appeal or had other health insurance. The failure to obtain such treatment records which may show he was an active VA health-care participant constitutes a pre-decisional duty to assist omission. Thus, this claim must be remanded to obtain the non-VA treatment records and adjudicate the claim under 38 U.S.C. § 1725 or 38 U.S.C. § 1728. The Board also notes that VA amended 38 C.F.R. § 17.1003 (a)(1), effective April 24, 2023, to clarify that payment or reimbursement under 38 U.S.C. § 1725 or 38 U.S.C. § 1728 for ambulance services for emergency treatment may be made where payment or reimbursement is authorized under 38 U.S.C. § 1725 for emergency treatment provided at a non-VA facility, or payment or reimbursement would have been authorized under 38 U.S.C. § 1725 for emergency treatment had the "veteran's personal liability for the emergency treatment not been fully extinguished by payment by a third party, including under a health-plan contract, or by VA." VA noted that the rule was amended to make 38 C.F.R. § 17.1003 consistent with VA's interpretation that the emergency transportation is part of the claim for emergency treatment. The rule notes that "VA amended § 17.1003 to ensure that payment or reimbursement for emergency transportation would not be prohibited on the sole basis that the emergency treatment claim was fully extinguished." The phrase "or by VA" was added to § 17.1003(a)(1) to "ensure that, consistent with the interpretation discussed above, VA can pay or reimburse for emergency transportation under section 1725 even if VA extinguishes the liability for the underlying emergency treatment using a different authority, such as under VA's Community Care Program at 38 C.F.R. § 1703. As such, a remand is required for the AOJ to consider the ambulance transportation claim under 38 C.F.R. § 17.1003. In denying the Veteran's claim, VA did not provide the Veteran with notice of a summary of the applicable laws and regulations or identification of the criteria that must be satisfied to obtain eligibility for beneficiary travel payment. 38 U.S.C. § 5104(b). Therefore, remand is necessary to correct this duty-to-assist error as the AOJ must provide the Veteran with complete notice of the decision as required by 38 U.S.C. § 5104. 38 C.F.R. § 20.802. Finally, the Board also notes that documents pertinent to the appeal are not of record. Specifically, there are no ambulance or medical treatment records related to the episode of care on December 9, 2024. As the AOJ did not associate relevant ambulance and medical treatment records with the claims file, this also constitutes a pre-decisional duty to assist error that must be corrected. As correction of these errors by the AOJ in satisfying its regulatory and statutory duties would have a reasonable possibility of aiding in substantiating the medical reimbursement claim on appeal, the appeal must be remanded for the AOJ to associate such pertinent records with the file, properly adjudicate the appellant's claim under the provisions of 38 U.S.C. § 1725 and 38 C.F.R. §§ 17.1000 through 17.1008, and provide appropriate notice of the decision under 38 U.S.C. § 5104(b) to the Veteran. See 38 C.F.R. § 20.802. The Veteran is notified that under the modernized appeal system, remands do not automatically return to the Board for additional adjudication. Should the AOJ deny the claim in whole or in part and the Veteran wishes to have the Board review his claim, the appellant should file an appropriate NOD (VA Form 10182) within the applicable appeal period after the AOJ's readjudication of the claim. The matters are REMANDED for the following action: 1. Associate with the claims file of any relevant treatment records associated with the care the Veteran received on December 9, 2024, including, but not limited to: 2. The claim, the ambulance transportation records, hospital treatment records, any VHA records indicating whether the medical treatment on December 9, 2024, was reimbursed and/or authorized by VA, and any other relevant documents related to each claim. " If any such records are unable to be located, the AOJ should make a formal finding of unavailability and provide the appellant with notice of the unavailability of records. 3. Thereafter, adjudicate the claim of entitlement to payment or reimbursement of ambulance services provided on December 9, 2024, under the provisions of 38 U.S.C. §1725 or 38 U.S.C. §1728 and 38 C.F.R. §§ 17.1000-1008. (a.) This includes the provisions of 38 C.F.R. § 17.1003 allowing for payment or reimbursement under 38 U.S.C. § 1725 for ambulance transportation to a non-VA facility where payment or reimbursement would have been authorized under 38 U.S.C. § 1725 for emergency treatment had the Veteran's personal liability for the emergency treatment not been fully extinguished by payment by a third party, including under a health-plan contract. 4. Provide appropriate notice of the decision under 38 U.S.C. § 5104(b) to the appellant. (Continued on the next page) ? (a.) The notice shall include but is not limited to a summary of the applicable laws and regulations; identification of findings favorable to the claimant; and identification of the substantive conditions not satisfied but necessary for payment of the ambulance transportation on December 9, 2024. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Lilly, 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.