THIS OPINION WAS INITIALLY ISSUED UNDER
PROTECTIVE ORDER AND IS BEING PUBLICLY RELEASED
IN ITS ENTIRETY ON AUGUST 29, 2023
MOTION FOR SUMMARY JUDGMENT
GRANTED IN PART:  August 23, 2023
CBCA 6808
SOUTH TEXAS HEALTH SYSTEM,
Appellant,
v.
DEPARTMENT OF VETERANS AFFAIRS,
Respondent.
Christian B. Nagel and Kelsey M. Hayes of Holland & Knight LLP, Tysons, VA,
counsel for Appellant.
David G. Fagan, Office of General Counsel, Department of Veterans Affairs, Bend,
OR, counsel for Respondent.
Before Board Judges LESTER, RUSSELL, and CHADWICK.
LESTER, Board Judge.
This appeal is the sixth in which appellant, South Texas Health System (STHS), has
complained that respondent, the Department of Veterans Affairs (VA), failed appropriately
to pay individual medical claims for patients that STHS had treated under its medical


CBCA 6808 2
services contract with the VA.1  STHS’s current appeal relates to the manner in which the
VA responded to medical claims involving “emergent” admissions of eligible veterans—that
is, where a veteran who either self-reported or was referred by a contract provider to an
emergency room requires hospital admission.  The current claim is based upon the same
issue, arises under the same contract, and involves hospital and medical claims from the same
years of service as those at issue in McAllen Hospitals LP dba South Texas Health System
v. Department of Veterans Affairs, CBCA 3798, which the Board dismissed with prejudice
in February 2019 following the parties’ voluntary settlement.
The VA has filed a motion seeking dismissal of this appeal for failure to state a claim
or, in the alternative, for summary judgment.  The VA identifies three bases for its motion:
(1) that STHS failed to exhaust mandatory administrative remedies under the contract, which
precludes STHS from challenging medical claim non-payments now; (2) that the parties’
settlement agreement resolving CBCA 3798 contained release language that precludes the
recovery requested here; and (3) that the six-year statute of limitations in the Contract
Disputes Act (CDA), 41 U.S.C. §§ 7101–7109 (2018), bars some of STHS’s claims. 
Because the VA cites to documents and evidence outside of those referenced in STHS’s
notice of appeal and STHS’s complaint, we treat the entirety of the VA’s motion as a motion
for summary judgment, which we grant in part.
Background
I. The Contract
Effective April 6, 2009, the VA awarded indefinite-quantity contract no.
VA257-P-0287 to STHS, which was to run for twelve months from the effective date of
award but contained options for four consecutive one-year renewals that the VA ultimately
exercised.  Under that contract, STHS was to provide inpatient, emergency, and outpatient
services for veterans in the Lower Rio Grande Valley region in South Texas.2  The contract
included the clause from Federal Acquisition Regulation (FAR) 52.212-4 (48 CFR 52.212-4
(2009)) titled “Contract Terms and Conditions—Commercial Items (Feb 2007).”  Appeal
1 The prior appeals identified the appellant as “McAllen Hospitals LP dba South
Texas Hospital System.”  The VA has not objected to the appellant’s use of the name “South
Texas Hospital System” in this appeal.
2 Additional discussion of the solicitation and contract can be found in the
Board’s decision in McAllen Hospitals LP v. Department of Veterans Affairs, CBCA 2774,
et al., 14-1 BCA ¶ 35,758.

CBCA 6808 3
File, Exhibit 3 at 640-45.3  This clause provided that “[c]hanges in the terms and conditions
of this contract may be made only by written agreement of the parties.”  Id. at 640 (quoting
FAR 52.212-4(c)).
Under the contract, the VA was to pay claims by STHS for “actual services provided”
in accordance with a specified percentage of current Medicare rates, based on the service.
Exhibit 3 at 605; see Complaint ¶ 18.  The VA was to “be the primary payor for an
eligible/enrolled individual . . . whether or not the individual ha[d] a service-connected injury
or illness.”  Exhibit 3 at 605.  The contract was clear, however, that “[p]ayment [would] be
made only for those claims [the] VA ha[d] authorized for payment.”  Id. at 607.  The contract
also provided that “[a]uthorization for payment must be made by [the] VA within the next
business day of being contacted by Contractor” of the admission of a patient.  Id.
The typical process for an emergent, non-VA referral admission,4 as originally
awarded under the base contract, looked as follows:  first, the patient would present himself
or herself at STHS’s hospital.  STHS would then determine whether the patient was
undergoing a medical emergency5 that required hospital admission.  Exhibit 3 at 632.  In
making that determination, STHS was required to use “the full suite of the McKesson
InterQual Standards and Process in effect at the time of service delivery under th[e]
contract.”  Id. at 629.  InterQual is a commercially available software program that assists
in determining an appropriate level of care for each patient in light of clinical indicators,
signs, and symptoms exhibited by the patient.  Complaint ¶ 13; see Exhibit 3 at 636
(“InterQual criteria are [a] set of measurable, clinical indicators, as well as diagnostic and
therapeutic services, that reflect a patient’s need for hospitalization.”).
3 Unless otherwise noted, all exhibits are contained in the appeal file.
4 Referrals made directly by the VA as well as scheduled admissions followed
a similar but distinct process under the contract.  See Exhibit 3 at 632-33.  It does not appear
from the record, however, that such claims are at issue in this appeal.
5 The term “medical emergency” is defined in the contract as “any medical
condition of a recent onset and severity, including, but not limited to severe pain that would
lead a ‘prudent layperson,’ possessing an average knowledge of medicine and health, to
believe that his or her health condition, sickness, or injury is of such a nature that failure to
obtain immediate medical care could result in:  (a) [p]lacing the patient’s health . . . in serious
jeopardy; (b) [s]erious impairment to bodily functions; or (c) [s]erious dysfunction of any
bodily organ or part.”  Exhibit 3 at 635.

CBCA 6808 4
If STHS admitted the individual, it was required to contact the VA Quality
Management/Utilization Management (QM/UM) clinician6 as soon as possible, but no later
than the next business day, to inform the VA of the admission.  Exhibit 3 at 632.  Once
notified, the VA QM/UM clinician was required to make a determination of coverage and
an authorization decision on behalf of the VA within one business day and notify the
appellant of that decision.  Id. at 607, 635.  The VA could “not later determine a service is
not authorized once an authorization ha[d] been given.”  Id. at 607.  If the VA QM/UM
clinician did not make the coverage determination “within twenty-four (24) hours,” STHS
was to “consider the patient private pay and . . . bill other insurance or the patient.”  Id. at
635.
The contract defined “episode of care” as “[h]ealthcare services provided from the
date of admission to the date of discharge for inpatient care and [a] group of services related
to [an] office visit or procedure for outpatient care.”  Exhibit 3 at 635.  Following an
authorized patient’s “episode of care,” STHS had forty-five days to submit full invoices, also
called “medical claims,”7 to the VA for processing.  See id. at 634 ¶ a (“Contractor will
submit a full invoice within 45 days of patient treatment or discharge.”), ¶ c (“Invoices . . .
must be submitted within 45 days of the service . . . .”).  Payment by the VA, or rejection,
would then be made according to timeliness standards as set out in the contract, which called
for payment or rejection within thirty days.8  Id. at 633-34.  If an invoice was not rejected but
also was not paid within thirty days, interest under the Prompt Payment Act (PPA), 31 U.S.C.
§ 3903, would accrue.
II. The VA’s Unilateral Addition of an Authorization Decision Appeal Process
On October 1, 2010, the VA issued a unilateral modification (mod 0002) to the
contract that the VA described as incorporating certain “administrative changes” into the
contract.  Exhibit 5 at 682.  These changes included, among other things, what the VA
6 VA QM/UM clinicians were located offsite but could be reached through
telephone numbers provided in the contract.  Exhibit 3 at 631.
7 The contract defined “medical claims” as “invoices prepared and submitted by
the contractor that consist of the charges of the provider(s) for the health care services
rendered to veterans as authorized by [the] VA.”  Exhibit 3 at 622; see id. at 633.
8 The contract established a timeliness standard of 95% in thirty days for claims
that were submitted with valid information.  Exhibit 3 at 633.  The VA was obligated to pay
STHS monthly upon receipt of proper invoices for the service furnished in the previous
month, subject to interest accrual for any late payment.  Id. at 634.

CBCA 6808 5
described as clarification of the “[a]uthorization/pre-certification for care process,” id.,
creating an agency-level appeal process for disapproved authorizations that was not
contained in the original contract:
5. Reconsideration for Disapproved Authorizations for Care –
Non-authorization of care can be appealed by submitting a formal
request in writing through the VA UM nurse to the Valley Coastal
Bend Chief of Staff or appointed designee.
a) Appeals are to be submitted within 30 calendar days of denial of
authorization
• Responses to all appeals shall be made within 30
calendar days
Id. at 686.  The modification also increased the time for the VA QM/UM clinician to
authorize emergent admissions to “48 hours of receipt of required clinical documentation by
the UM clinician.”  Id. at 687.
STHS’s performance under the contract continued until March 1, 2015, when the
contract expired in accordance with its terms.
III. Invoicing and Payment Disputes Pre-Dating CBCA 6808
A. Reimbursement Classification (CBCA 2774, 2775, 4445, and 5809)
1. CBCA 2774, 2775, and 4445
During contract performance, multiple disputes arose regarding bills that STHS
submitted and payments that it received under the contract.  CBCA 2774, 2775, and 44459
concerned disputes over inpatient rehabilitation medical claims for patient treatment from
April 6, 2009, through September 30, 2010, the reimbursement of which STHS argued the
VA had improperly limited to the Centers for Medicare & Medicaid Services’ Diagnostic-
Related Group (DRG) reimbursement rate, precluding reimbursement at the typically higher
9 The Board docketed the first two appeals that STHS filed on March 13, 2012,
as CBCA 2774 and 2775.  The Board subsequently dismissed CBCA 2774 for lack of
jurisdiction, and STHS submitted a new claim to cover the medical claims at issue in
CBCA 2774.  STHS then appealed the denial of the new claim, and the Clerk docketed that
appeal as CBCA 4445.

CBCA 6808 6
Case-Mix Group (CMG) rate.  See McAllen Hospitals LP v. Department of Veterans Affairs,
CBCA 2774, et al., 14-1 BCA ¶ 35,758, at 174,972-74.  STHS argued when seeking
summary judgment, and the Board ultimately agreed, that STHS was entitled to
reimbursement at the higher CMG rate, but the Board was unable to decide quantum.  See
id.  STHS also alleged that, unrelated to the DRG/CMG reimbursement rate issue, the VA’s
claims processing system indiscriminately altered reimbursement amounts so that STHS was
variously underpaid and overpaid in amounts that conflicted with then-current Medicare
rates.  Id. at 174,974.  In support, STHS provided the contracting officer, but not the Board,
with 1434 medical claims.  See id. at 174,968.  The Board, in response to the parties’ cross-
motions for summary judgment, found that it lacked sufficient information in the record to
resolve the later underpayment issue.  Id. at 174,974.
Subsequently, in September 2015, the parties entered into a settlement of “all claims
arising under the appeals” docketed as 2775 and 4445.  Complaint, Exhibit 7 ¶ 1.  Pursuant
to the parties’ settlement agreement, STHS, upon payment of a judgment by the Government,
“release[d] [the VA] and the United States Government from any and all liability heretofore
accrued under the contract regarding the aforementioned appeals.”  Id. ¶ 3.  At the parties’
request, the Board entered a stipulated judgment on December 16, 2015, requiring the VA
to pay STHS $816,000 in CBCA 2775 and 4445.  McAllen Hospitals LP v. Department of
Veterans Affairs, CBCA 2775, et al., 16-1 BCA ¶ 36,190, at 176,569 (2015).
2. CBCA 5809
On August 7, 2017, STHS filed another appeal, this time seeking payment of $3.072
million, which the Clerk docketed as CBCA 5809.  That appeal involved a certified claim,
which STHS had submitted to the contracting officer on September 12, 2016, involving the
same theories as those underlying CBCA 2774, 2775, and 4445—specifically, that the VA
had underpaid inpatient rehabilitation medical claims (beyond those identified in CBCA
2774, 2775, and 4445) using a DRG rather than CMG reimbursement classification and had
indiscriminately underpaid other medical claims because of a defect in the VA’s claims
processing system.  See Complaint, Exhibit 8 at 1-5.  The medical claims in CBCA 5809
involved services provided from the commencement of the contract up until March 20, 2015.
The parties settled that dispute before the Board considered the merits and, in the
September 4, 2019, settlement agreement through which the VA agreed to pay STHS an
additional $1.65 million, included the following release language:
STHS’ Release of VA:  Subject to and contingent upon the VA fulfilling its
obligations under this Agreement, STHS . . . agrees that such relief constitutes
full and complete settlement and satisfaction and releases the VA from any and

CBCA 6808 7
all claims of any nature, filed or not, arising out of or relating to any and all
requests for payment for all of the claims for services contained in the Appeal,
more specifically identified in the Claims as inpatient rehab claims (IRF),
Inpatient claims (DRG), physician and facility underpayments, “miscellaneous
claims,” or any other bases, for the time period covering April 6, 2009 through
March 1, 2015 . . . .
Complaint, Exhibit 9 ¶ 4.  On September 25, 2019, at the parties’ request, the Board
dismissed CBCA 5809 with prejudice.
B. Observation-Status Versus Inpatient-Status Authorization (CBCA 3798)
In CBCA 3798, STHS presented a different type of payment dispute under its
contract.  For several patients, STHS billed the VA for “inpatient” status even though the VA
had authorized only “observation” status for those patients.  Exhibit 19; Respondent’s
Statement of Undisputed Facts (RSUF) ¶ 10; Appellant’s Statement of Genuine Issues
(ASGI) ¶ 10.  According to STHS, when each patient presented to STHS’s hospital, STHS’s
onsite medical personnel would observe the patient and assess the veteran’s medical needs
based on the InterQual or comparable criteria.  STHS alleges that the contract essentially
required application of the Centers for Medicare and Medicaid Services’ “two midnight”
rule:  a patient would be classified as “inpatient” if expected to have to stay in the hospital
for two or more midnights but would be classified as “observation” if less than two
midnights in the hospital were anticipated.  Complaint ¶ 25 n.3.  In the situations that STHS
raised in CBCA 3798, STHS had determined that patients needed to be admitted to the
hospital and performed services that it deemed medically necessary based upon that inpatient
status.  STHS informed the VA QM/UM clinicians of the admission, as required under the
contract, but, for the medical claims raised in CBCA 3798, the VA QM/UM clinicians only
authorized observation status, making a coverage eligibility determination that differed from
what STHS had recommended.
STHS subsequently submitted bills to the VA for the services that it actually provided
under the medical claims in CBCA 3798, rather than the services that the VA QM/UM
clinicians had authorized.  The VA rejected these bills because STHS was billing for an
unauthorized status.  RSUF ¶ 10; ASGI ¶ 10.  STHS alleges that, in July 2013, pursuant to
ongoing negotiations with the VA, STHS resubmitted ninety-eight disputed patient claims,
downgrading them from inpatient to observation status.  Complaint, Declaration of Diana
Vittitoe ¶¶ 9-10; Appellant’s Opposition Brief at 8; Appellant’s Response to Respondent’s
Submission at 2.  Despite the change in status in the submission, the VA allegedly rejected

CBCA 6808 8
these resubmitted claims.  Vittitoe Declaration ¶ 11.10  On December 1, 2013, STHS
submitted a certified claim alleging improper classification of the ninety-eight patient claims
(but not mentioning the allegedly unpaid resubmitted observation status claims) and seeking
payment at the inpatient status amount:
STHS Case Managers have sought on multiple occasions to explain to VA
QM/QA clinicians how these 98 patients satisfied the InterQual and medical
necessity criteria for inpatient status, but have been unsuccessful obtaining
inpatient authorization for these cases.  STHS should have been paid
$950,469.01 for these patients and claims this amount as part of this certified
claim.
Complaint, Exhibit 11 at 2.  STHS included in that claim a separate request for the return of
$1,295,595.21 in monies that STHS had been paid but had voluntarily refunded to the VA. 
Id.  STHS had originally refunded the money because it had believed that the VA’s claims
system had, in error, “automatically added approximately 2.0% to the payment for all
inpatient DRGs under the contract,” but STHS subsequently determined the 2% markup was
appropriate and asked in the claim for a return of its refund.  Id.  The contracting officer
denied the claim, and, on June 30, 2014, STHS filed a notice of appeal with the Board, which
the Clerk docketed as CBCA 3798.
10 We note that this allegation—that, in July 2013, STHS resubmitted ninety-eight
medical claims for observation status payment and that the VA still failed to pay them,
causing STHS to submit its certified claim—is inconsistent with the record that the parties
previously developed in CBCA 3798.  In the certified claim underlying CBCA 3798, which
STHS alleges post-dates its resubmission of the ninety-eight medical claims as observation,
STHS sought payment of ninety-eight medical claims on an inpatient status basis, without
mentioning any resubmissions or outstanding requests for observation status payments.  See
Complaint, Exhibit 11.  The “Whereas” clauses in the parties’ subsequent settlement
agreement in CBCA 3798 provided that, “following mediation” before the Board in
mid-2018, “STHS re-submitted claims as observation to coincide with the authorization code
provided at the time of service by [the VA] that were initially billed by STHS as inpatient”
and that the “VA re-processed and paid th[os]e claims.”  Id., Exhibit 12 at 1-2.  Nowhere in
the CBCA 3798 settlement agreement or anywhere else in the CBCA 3798 record do the
parties indicate that, at some date prior to mid-2018, STHS had resubmitted its inpatient
status medical claims as observation status medical claims.  For purposes of the VA’s current
motion, as discussed below, we need not resolve this inconsistency.

CBCA 6808 9
The Board commenced a hearing in CBCA 3798 on November 5, 2018, but suspended
proceedings when, before testimony had commenced, the parties announced that they had
reached a settlement.  On December 12, 2018, the parties entered into a settlement agreement
that included the following language:
Payment by the VA.  (a) The VA shall pay STHS the sum of SIX HUNDRED
AND FORTY THOUSAND DOLLARS AND NO/100 ($640,000.00)
representing full and final payment, inclusive of interest, under the Contract. 
The VA has such funds available and shall make such payment within 45 days
of the execution of this Agreement.
. . . .
STHS’ Release of VA:  Subject to and contingent upon the VA fulfilling its
obligations under this Agreement [to pay STHS $640,000], STHS, for and on
behalf of its shareholders, officers, directors, employees, affiliates, surety,
legal successors, heirs, assigns, attorneys, subcontractors and suppliers hereby
agrees that such relief constitutes full and complete settlement and satisfaction
of and releases the VA from all claims of any nature, filed or not arising out
of or relating to requests for payment for “refunds, overpayments and
admission status disputes” for the time period covering April 4, 2009 through
July 4, 2014, STHS’ Claim dated December 1, 2013, and VA’s [contracting
officer’s final decision (COFD)], which were or which could have been
asserted in the Appeal, including but not limited to any and all claims for costs,
direct and indirect; all interest, including Contract Disputes Act interest; and
attorney fees, including those recoverable under the Equal Access to Justice
Act (EAJA).
Complaint, Exhibit 12 ¶¶ 2, 4.  The settlement agreement contained an integration clause
providing that the agreement “constitutes the entire agreement between the Parties with
respect to the subject matter hereof and supersedes all prior negotiations and agreements
between the Parties, whether written or oral, concerning the subject matter of this
Agreement” and that “[n]o other representations, covenants, undertakings or other prior or
contemporaneous agreements, oral or written, respecting such matters . . . shall be deemed
in any way to exist or bind any of the Parties hereto.”  Id. ¶ 16.
On February 9, 2019, the parties filed a status report with the Board in CBCA 3798,
representing that, on December 26, 2018, STHS had received the payment identified in the
settlement agreement.  On February 14, 2019, at the parties’ request, the Board entered an
order dismissing CBCA 3798 with prejudice.

CBCA 6808 10
IV. STHS’s Current Certified Claim
On February 3, 2020, STHS submitted a new certified claim to the contracting officer
seeking payment of an additional $3,076,320.59 under the same rationale that it set forth in
CBCA 3798.  Specifically, STHS sought payment of an unidentified number of medical
claims that, like the ninety-eight medical claims that were the subject of CBCA 3798, it had
billed for payment as inpatient status but that the VA had only authorized for observation;
STHS alleged that the VA never paid these medical claims.  Exhibit 13 at 723-26.11  On
February 4, 2020, the contracting officer issued a final decision denying the claim on several
bases, including that STHS did not identify in the certified claim any particular medical
claims that it contended were unpaid, leaving the contracting officer to guess at what medical
claims were at issue, and that the VA had “paid in full for all services performed under this
contract through proper payments and under the multiple CBCA settlement agreements.” 
Exhibit 14 at 908.
STHS filed a notice of appeal with the Board on May 4, 2020, which the Clerk
docketed as CBCA 6808.  STHS subsequently filed a complaint in which it identified 393
medical claims that the VA had authorized for “observation,” that STHS had submitted for
payment only as “inpatient,” that the VA had not paid, and for which STHS was now seeking
payment.  Complaint ¶¶ 45-47, 49; Vittitoe Declaration ¶ 14 & Exhibit A.  STHS also alleged
that there was no overlap between the ninety-eight medical claims at issue in CBCA 3798
and the 393 medical claims at issue in CBCA 6808.  Id. ¶¶ 38, 48.
In lieu of an answer, the VA filed the dispositive motion now before us.  After the
parties completed briefing, the Board requested additional information and clarifications to
which the parties responded through supplemental filings.
Discussion
I. Standard of Review
The VA asks us to dismiss this appeal for failure to state a claim or, in the alternative,
for summary judgment.  In its motion, the VA quotes the deposition testimony of various
individuals taken in CBCA 3798, none of which is contained in STHS’s notice of appeal or
complaint.  With its reply to STHS’s response to the VA’s motion, the VA provides witness
declarations and other documentary evidence to support its entitlement to judgment.  “[I]f
11 Unlike CBCA 3798, STHS did not include a request for the return of refunds
that STHS had previously made.

CBCA 6808 11
matters outside the complainant’s pleading are presented to the [tribunal] the motion shall
be treated as one for summary judgment.”  Advanced Cardiovascular Systems, Inc. v. SciMed
Life Systems, Inc., 988 F.2d 1157, 1164 (Fed. Cir. 1993); see 5C Charles Alan Wright &
Arthur R. Miller, Federal Practice and Procedure § 1366 (3d ed. 2018).  Even if some of the
VA’s arguments might stand without reference to the outside evidence, where “the facts are
not in dispute and only legal issues are contested,” a tribunal has the discretion to treat a
motion to dismiss for failure to state a claim as a summary judgment motion.  Canadian
Wheat Board v. United States, 580 F. Supp. 2d 1350, 1356 (Ct. Int’l Trade 2008), aff’d, 641
F.3d 1344 (Fed. Cir. 2011).  In the circumstances here, we treat the entirety of the VA’s
motion as one for summary judgment.  Because the VA provided a comprehensive statement
of undisputed material facts covering the entirety of its motion, to which STHS has
responded through a statement of genuine issues, STHS can suffer no prejudice from this
conversion.  In accordance with Rule 12(d) of the Federal Rules of Civil Procedure, both
parties have been given a reasonable opportunity to present all material pertinent to the VA’s
motion.
“The standards of review and obligations of each party to prevail on a motion for
summary judgment are well established.”  Mission Support Alliance, LLC v. Department of
Energy, CBCA 6477, 20-1 BCA ¶ 37,657, at 182,834 (citing Pernix Serka Joint Venture v.
Department of State, CBCA 5683, 20-1 BCA ¶ 37,589, at 182,522).  “[A] party may move
for summary judgment on all or part of a claim or defense which we will only grant if the
party ‘is entitled to judgment as a matter of law based on undisputed material facts.’”  Id.
(citing Board Rule 8(f) (48 CFR 6101.8(f) (2019)); see CSI Aviation, Inc. v. General Services
Administration, CBCA 6543, 20-1 BCA ¶ 37,580, at 182,479.  “We draw inferences in the
light most favorable to the party opposing the motion.”  Mission Support, 20-1 BCA at
182,834 (citing Celotex Corp. v. Catrett, 477 U.S. 317 (1986)).
II. STHS’s Alleged Failure to Exhaust Administrative Remedies
The VA argues that the Board should dismiss this appeal because, when the VA
originally declined to authorize inpatient status, STHS failed to exhaust available
administrative remedies under its contract through which it could have challenged that
determination.  The administrative remedy that the VA identifies is contained in mod 0002
of the contract, which, as previously discussed, was issued unilaterally by the contracting
officer in October 2010.  Exhibit 5.  Prior to the issuance of mod 0002, the contract provided
that, after STHS notified the VA QM/UM clinician of a patient admission, the clinician had
one business day to decide whether to authorize coverage.  Exhibit 3 at 607, 635.  If the VA
QM/UM clinician did not make the coverage determination “within twenty-four (24) hours”
after notification, STHS had to “consider the patient private pay and . . . bill other insurance
or the patient.”  Id. at 635.  Once authorization was decided, it was not subject to revision. 

CBCA 6808 12
Id. at 607, 635.  Through mod 0002, the VA attempted to add an administrative appeal
process to the contract that STHS could pursue if it disagreed with the VA QM/UM
clinician’s original authorization decision, allowing for appeals “within 30 calendar days of
denial of authorization.”  Exhibit 5 at 686.
The VA believes that, because STHS did not follow this appeal process for any of the
medical claims that it is now pursuing, its current challenges are barred.  STHS disagrees,
arguing that the VA cannot enforce the administrative appeal process because it was added
to the contract through a unilateral modification to which STHS says it never agreed.  STHS
asserts that, under FAR 52.212-4(c), “[c]hanges in the terms and conditions of this contract
may be made only by written agreement of the parties” and that unilateral modifications do
not evidence an agreement of the parties.
We need not address STHS’s argument because, even if the administrative process
set forth in mod 0002 was properly incorporated into STHS’s contract, it does not purport
to be mandatory, meaning that STHS would not have been required to utilize it.  Mod 0002
provides that “[n]on-authorization of care can be appealed by submitting a formal request
in writing through the VA UM nurse to the Valley Coastal Bend Chief of Staff or appointed
designee,” Exhibit 5 at 686 (emphasis added), but it does not purport to make that process
the exclusive means of, or a mandatory procedure for, challenging an authorization decision. 
A claimant is not required to exhaust a claims processing administrative remedy if the
administrative process at issue is not mandatory.  See Martinez v. United States, 333 F.3d
1295, 1304 (Fed. Cir. 2003) (“[A] plaintiff is not required to exhaust a permissive
administrative remedy before bringing suit.”); Friedman v. United States, 310 F.2d 381, 388
(Ct. Cl. 1962) (“Where . . . an administrative remedy is permissive . . . , suit may be brought
without exhausting the remedy.”).  STHS’s failure to utilize the permissive administrative
remedy contained in mod 0002 provides no basis for barring STHS’s current challenges to
the VA’s medical claims denials.
III. The Release in the CBCA 3798 Settlement Agreement
The VA argues that STHS is barred from pursuing the 393 medical claims identified
in STHS’s complaint because, as part of the settlement of CBCA 3798, it signed a release
that bars any further claims challenging the VA’s decisions authorizing “observation” rather
than “inpatient” status.
“A release is a contract whereby a party abandons a claim or relinquishes a right that
could be asserted against another.”  Holland v. United States, 621 F.3d 1366, 1377 (Fed. Cir.
2010) (citation omitted).  “As a general rule, the execution by a contractor of a release which
is complete on its face reflects the contractor’s unqualified acceptance and agreement with

CBCA 6808 13
its terms and is binding on both parties.”  K-Con Building Systems, Inc. v. United States, 107
Fed. Cl. 571, 600 (2012) (quoting Clark Mechanical Contractors, Inc. v. United States, 5 Cl.
Ct. 84, 86 (1984)); see H.L.C. & Associates Construction Co. v. United States, 367 F.2d 586,
590 (Ct. Cl. 1966) (“[A] general release precludes a party to the contractual armistice from
renewing or initiating further combat.”).  Nevertheless, “[i]n interpreting the release, we first
ascertain whether its language clearly bars the asserted claim.”  Dureiko v. United States, 209
F.3d 1345, 1356 (Fed. Cir. 2000).  “If the provisions of a release are ‘clear and unambiguous,
they must be given their plain and ordinary meaning.’”  Holland, 621 F.3d at 1378 (quoting
Bell BCI Co. v. United States, 570 F.3d 1337, 1341 (Fed. Cir. 2009)).  “If the release is
ambiguous as to its scope of coverage, we construe its language to effect the parties’ intent
at the time they executed the release.”  Dureiko, 209 F.3d at 1356.
The language at issue here provides for the release of “all claims of any nature, filed
or not arising out of or relating to requests for payment for ‘refunds, overpayments and
admission disputes’ for the time period covering April 4, 2009 through July 4, 2014, STHS’
Claim dated December 1, 2013, and VA’s COFD, which were or which could have been
asserted in the [CBCA 3798] appeal.”  Complaint, Exhibit 12 ¶ 4 (emphasis added). 
Although, on its face, the provision uses broad language to describe the scope of the release
(i.e., “all claims of any nature” and “filed or not arising out of or relating to requests for
payment”), the end of the clause limits that broad language to those claims “which were or
which could have been asserted in the [CBCA 3798] appeal.”  Id.  That limitation is fatal to
the VA’s release argument.
As a jurisdictional prerequisite to the Board’s consideration of a contract appeal,
“[t]he CDA requires a claimant to submit [a] claim ‘to the contracting officer for a decision’”
that includes a request for monetary relief in a sum certain.  Lee’s Ford Dock, Inc.
v. Secretary of the Army, 865 F.3d 1361, 1369 (Fed. Cir. 2017) (quoting 41 U.S.C.
§ 7103(a)(1)).  On appeal, “the Board may not consider ‘new’ claims [that] a contractor
failed to present to the contracting officer.”  Id.  Only if the 393 medical claims that STHS
is now pursuing were encompassed within the certified claim underlying CBCA 3798—that
is, if they “ar[o]se from the same operative facts, claim[ed] essentially the same relief, and
merely assert[ed] differing legal theories for that recovery,” Scott Timber Co. v. United
States, 333 F.3d 1358, 1365 (Fed. Cir. 2003)—could they, as required by the language of the
CBCA 3798 settlement agreement, “have been asserted in the [CBCA 3798] appeal.” 
Complaint, Exhibit 12 ¶ 4.
In the CBCA 3798 certified claim, STHS identified ninety-eight specific medical
claims that it alleged the VA had incorrectly authorized as observation rather than inpatient,
stating that “STHS Case Managers have sought on multiple occasions to explain to VA
[QM/UM] clinicians how these 98 patients satisfied the InterQual and medical necessity

CBCA 6808 14
criteria for inpatient status, but have been unsuccessful obtaining inpatient authorization for
these cases.”  Complaint, Exhibit 11 at 2.  Each of those medical claims was essentially an
invoice to the VA seeking payment.  STHS’s CBCA 3798 certified claim was limited to the
VA’s non-payment of those ninety-eight identified invoices.  To the extent that STHS might
have chosen to submit a certified claim that more broadly encompassed all medical claims
for which the VA had ever limited authorization to observation status, it did not do so. 
Because STHS could not have asserted the 393 patient claims in CBCA 3798, they are not
covered by the release in the CBCA 3798 settlement agreement, and the medical claims at
issue in this appeal are not barred by that release.12
That does not mean that the CBCA 3798 settlement agreement is necessarily
irrelevant to the viability of the 393 medical claims being presented here.  Paragraph 2 of the
CBCA 3798 settlement agreement expressly provides that “[t]he VA shall pay STHS the sum
of [$640,000], representing full and final payment, inclusive of interest, under the Contract,”
suggesting a finality to the entire contract that is not reflected in the release.  Complaint,
Exhibit 12.  The absence of that language in the release does not, in and of itself,
automatically mean that the medical claims could not be covered by an accord and
satisfaction.  See Holland, 621 F.3d at 1377 (“In an accord and satisfaction . . . a claim is
discharged because some performance other than that which was claimed to be due is
accepted as full satisfaction of the claim.”).  It is unclear from its briefing, however, whether
the VA intended its release argument to encompass the related accord and satisfaction
doctrine.  The VA never expressly mentions accord and satisfaction, and STHS does not
address it in its responses, but the doctrines of release and of accord and satisfaction are
frequently mixed together without distinguishing between them, even though release and
accord and satisfaction are separate contractual defenses with separate elements.  Id.; see
McLain Plumbing & Electrical Service, Inc. v. United States, 30 Fed. Cl. 70, 78-79 (1993)
(thoroughly explaining the distinctions between the doctrines of release and of accord and
satisfaction).
12 Although in its motion for summary judgment the VA only requests judgment
based upon the CBCA 3798 settlement agreement release, the discussion in its briefing
appears to suggest that STHS’s current medical claims are also barred by the release in the
CBCA 5809 settlement agreement.  The CBCA 5809 release is tied to “claims for services
contained in the [CBCA 5809] Appeal,” Complaint, Exhibit 9 ¶ 4, which does not involve
the issues or medical claims at issue in this appeal.  The VA has not established that the
CBCA 5809 release affects STHS’s ability to pursue its observation-versus-inpatient issue
here.

CBCA 6808 15
We are wary of addressing a defense that the VA raised, if at all, in a manner that did
not put STHS on notice that it was required to respond to it.  Although the VA might have
equated the release doctrine with the accord and satisfaction doctrine and expected us to
address both here, we will put aside any concerns about a potential accord and satisfaction
unless and until the VA elects to present such an argument to us, and to STHS, in a more
direct and fulsome manner.
IV. Time-Barred Claims
A. Claim Accrual
Of the 393 medical claims at issue in this appeal, 262 of them involve episodes of care
that occurred between November 2009 and January 2014.  STHS did not submit its certified
claim seeking payment on those medical claims until February 3, 2020.  The VA argues that
all medical claims involving episodes of care that occurred on or before February 3, 2014,
are barred by the CDA’s statute of limitations.
Pursuant to the CDA, “[e]ach claim by a contractor against the Federal Government
relating to a contract . . . shall be submitted within 6 years after accrual of the claim.”
41 U.S.C. § 7103(a)(4); see FAR 33.206(a) (“Contractor claims shall be submitted, in
writing, to the contracting officer for a decision within 6 years after accrual of a claim, unless
the contracting parties agreed to a shorter time period.”).  “A party’s failure to submit a claim
within six years of accrual is an affirmative defense to the claim,” and, as such, the burden
is on the VA to prove that the medical claims are barred by the statute of limitations. 
ThinkGlobal Inc. v. Department of Commerce, CBCA 4410, 16-1 BCA ¶ 36,489, at 177,793. 
“Whether and when a claim has accrued is determined according to the [FAR], the language
of the contract, and the facts of the particular case.”  Electric Boat Corp. v. Secretary of the
Navy, 958 F.3d 1372, 1375 (Fed. Cir. 2020).
The FAR defines claim accrual as “the date when all events that fix the alleged
liability on either the Government or the contractor and permit assertion of the claim, were
known or should have been known.  For liability to be fixed, some injury must have
occurred.  However, monetary damages need not have been incurred.”  FAR 33.201. 
“Generally, ‘[i]n the case of a breach of a contract, a cause of action accrues when the breach
occurs.’”  Alder Terrace, Inc. v. United States, 161 F.3d 1372, 1377 (Fed. Cir. 1998) (quoting
Manufacturers Aircraft Ass’n v. United States, 77 Ct. Cl. 481, 523 (1933)).  “[O]nce a party
is on notice that it has a potential claim the limitations period begins to run.”  ThinkGlobal
Inc., 16-1 BCA at 177,793 (quoting Cardinal Maintenance Service, Inc., ASBCA 56885,
11-1 BCA ¶ 34,616, at 170,610 (2010)).  “Claim accrual does not depend on the degree of
detail provided. . . . It is enough that the [party] knows, or has reason to know, that some

CBCA 6808 16
costs have been incurred, even if the amount is not finalized or a fuller analysis will follow.” 
Raytheon Co., Space & Airborne Systems, ASBCA 57801, et al., 13 BCA ¶ 35,319, at
173,377.  “The issue of ‘whether the pertinent events have occurred [to allow a claim to
accrue] is determined under an objective standard; a plaintiff does not have to possess actual
knowledge of all the relevant facts in order for the cause of action to accrue.’”  FloorPro,
Inc. v. United States, 680 F.3d 1377, 1381 (Fed. Cir. 2012) (quoting Fallini v. United States,
56 F.3d 1378, 1380 (Fed. Cir. 1995)).
“[T]o determine when appellant’s claims accrued, and the events that fixed the alleged
liability, we start by examining the legal basis for each particular claim.”  Crane & Co. v.
Department of the Treasury, CBCA 4965, 16-1 BCA ¶ 36,539, at 178,007 (quoting
Environmental Safety Consultants, Inc., ASBCA 54615, 07-1 BCA ¶ 33,483, at 165,984). 
Typically, “[w]here a claim is based upon a contractual obligation of the Government to pay
money, the claim first accrues on the date when the payment becomes due and is wrongfully
withheld in breach of the contract.”  OST, Inc. v. Department of Homeland Security, CBCA
7077, et al., slip op. at 17 (July 31, 2023) (quoting Oceanic Steamship Co. v. United States,
165 Ct. Cl. 217, 225 (1964)).  Here, STHS could have attempted to argue that, because it had
forty-five days after a patient’s authorized “episode of care” to submit its medical claim or
invoice (Exhibit 3 at 634) and the VA had thirty days either to pay or reject the medical claim
(id. at 633-34), the CDA statute of limitations could not begin to run until the seventy-five-
day total of those two periods expired for each of the 393 medical claims at issue here.
In this case, though, the event that established the VA’s inability to pay for inpatient
status—the alleged “breach”—pre-dated STHS’s actual submission of its invoices.  Under
STHS’s contract, “[p]ayment [would] be made only for those claims [the] VA ha[d]
[previously] authorized for payment.”  Exhibit 3 at 607.  When STHS admitted a patient,
STHS was required to notify the VA QM/UM clinician of the admission by the next business
day.  Id. at 632.  Once notified, the VA QM/UM clinician had one business day to make and
notify STHS of the VA’s coverage and authorization decision.  Id. at 607, 635.  If the VA
QM/UM clinician did not make the coverage determination “within twenty-four (24) hours,”
STHS had to “consider the patient private pay and . . . bill other insurance or the patient.” 
Id. at 635.  The contract, as originally written, contained no administrative appeal process for
authorization decisions with which STHS disagreed.  Accordingly, within a maximum of
seventy-two hours or so, the entire authorization determination and notification process was
complete.
Once the VA informed STHS of the status that it had authorized (that is, observation
status rather than inpatient status), the manner in which STHS could invoice the VA and the
service level for which it could be paid was set, and STHS knew as soon as the VA told it
of that decision that it could not be paid at the inpatient level.  As noted above, under the

CBCA 6808 17
FAR, a claim accrues on “the date when all events that fix the alleged liability on either the
Government or the contractor and permit assertion of the claim, were known or should have
been known,” so long as “some injury . . . ha[s] occurred.”  FAR 33.201.  Here, STHS’s
receipt of the VA’s unappealable authorization determination that the VA would only pay
for observation status established the injury about which STHS now complains—the VA’s
refusal to pay for inpatient status.  When the VA provided STHS with its authorization
decision, STHS had already incurred some injury—the patient was already admitted to the
hospital, and STHS was already incurring or had incurred costs associated with the patient’s
treatment.  In such circumstances, the CDA statute of limitations accrued for each of the 393
medical claims at issue here when the VA provided STHS with its authorization decision on
each claim or failed timely to respond to STHS’s inpatient admission notification, whichever
is earlier.
STHS’s only defense to this claim accrual analysis is an argument that the contract
creates no claim accrual deadline at all—ever—asserting that the contract “provides scant
guidance on the medical claims process with respect to emergent care.”  Appellant’s
Response to Respondent’s Submission at 1.  To reach its conclusion, STHS ignores contract
provisions that it does not like, pretending that they are not there, while arguing that other
provisions, to the extent that it acknowledges them, are not actually a part of the contract.13 
13 Clause B.4 in STHS’s contract, titled “Statement of Objectives” (SOO), covers
twenty pages of the sixty-eight-page contract and contains many of the contract’s billing,
authorization, and payment processing terms, plus provisions addressing the contract’s
periods of performance, contract definitions, insurance liability limitations, and duties of the
contracting officer’s technical representative.  Exhibit 3 at 619-39.  In the certified claim
underlying this appeal and again in its complaint, STHS quotes from FAR 2.101, which
defines the SOO as “a Government-prepared document incorporated into the solicitation that
states the overall performance objectives.”  Complaint ¶ 11 n.1; see Exhibit 13 at 723 n.1. 
It then quotes from FAR 37.602(c), which provides that “[o]fferors use the SOO to develop
the [performance work statement (PWS) in the contract]; however, the SOO does not become
part of the contract.”  In its summary judgment briefing, STHS seems to suggest that some
provisions in clause B.4 are not actually a part of the contract because the clause is titled
“Statement of Objectives,” even though, at other times, STHS cites to and relies on
provisions within clause B.4.  To the extent that STHS is arguing that clause B.4 is not a part
of the contract, that argument must fail.  Given the clause’s position in the contract and the
fact that it is referenced in other contract clauses, it is clear that the clause is intended to
serve as the contract’s PWS, and STHS never objected to the clause’s inclusion in the
contract (with the SOO title) prior to contract award or, as far as we can tell, at any time
before submitting the certified claim underlying CBCA 6808.  STHS’s failure timely to

CBCA 6808 18
When interpreting a contract, we consider all of its provisions, read as a whole, rather than
selectively picking and choosing among them.  United International Investigative Services
v. United States, 109 F.3d 734, 737 (Fed. Cir. 1997).  STHS’s contract interpretation based
upon selective portions of the contract cannot prevail.
STHS also argues that there are material facts in dispute that preclude summary
judgment because “[t]he Contract makes clear that STHS’s medical professionals had the
ultimate authority and responsibility to determine the best course of treatment for patients,”
“the VA did not have authority to question STHS’s medical professional’s judgments,” and
the parties’ disagreement over “the Contract’s clear language” creates a genuine dispute of
material fact.  Appellant’s Opposition Brief at 20.  Putting aside that the proper interpretation
of “clear language” in a contract is viewed as a question of law rather than as a factual issue,
Varilease Technology Group, Inc. v. United States, 289 F.3d 795, 798 (Fed. Cir. 2002),
STHS’s alleged genuine issue goes to the merits of its payment demands.  It is irrelevant to
the issue of when its claims accrued.
Although STHS does not cite to it, we recognize that the VA purported to add an
administrative appeal process in mod 0002 that allowed STHS to challenge authorization
decisions.  Setting aside STHS’s argument that unilateral mod 0002 is not even valid because
STHS did not agree to the modification, mod 0002 could not defer claim accrual here for at
least two other reasons.  First, STHS never took advantage of the administrative process set
forth in mod 0002, meaning that STHS did not attempt to use it to suspend or extend the
finality of the VA’s original authorization decision for any of its medical claims.  Second,
even if it had, the administrative appeal process in mod 0002 was permissive, and resort to
a permissive administrative appeal process does not serve to extend claim accrual deadlines. 
See Martinez, 333 F.3d at 1304 (“[A] plaintiff’s invocation of a permissive administrative
remedy does not prevent the accrual of the plaintiff’s cause of action, nor does it toll the
statute of limitations pending the exhaustion of that administrative remedy.”).
B. STHS’s Arguments for Equitable Tolling
STHS argues that, even if some of its medical claims could have accrued more than
six years before February 4, 2020, equitable tolling preserves all of them.  The CDA’s
six-year limitation for submitting claims is subject to equitable tolling.  Arctic Slope Native
Ass’n, Ltd. v. Sebelius, 583 F.3d 785, 798-800 (Fed. Cir. 2009).  Nevertheless, “a litigant is
protest the title of clause B.4 prior to award waived any objections to it.  See, e.g., Whittaker
Electronic Systems v. Dalton, 124 F.3d 1443, 1446 (Fed. Cir. 1997); E. Walters & Co. v.
United States, 576 F.2d 362, 367-68 (Ct. Cl. 1978).

CBCA 6808 19
entitled to equitable tolling of a statute of limitations only if the litigant establishes two
elements:  ‘(1) that he has been pursuing his rights diligently, and (2) that some extraordinary
circumstance stood in his way and prevented timely filing.’”  Menominee Indian Tribe of
Wisconsin v. United States, 577 U.S. 250, 255 (2016) (quoting Holland v. Florida, 560 U.S.
631, 649 (2010)).  Equitable tolling is a very limited doctrine, typically available only if the
adversary engaged in some kind of prejudicial trickery:
Federal courts have typically extended equitable relief only sparingly.  We
have allowed equitable tolling in situations where the claimant has actively
pursued his judicial remedies by filing a defective pleading during the
statutory period, or where the complainant has been induced or tricked by his
adversary’s misconduct into allowing the filing deadline to pass.  We have
generally been much less forgiving in receiving late filings where the claimant
failed to exercise due diligence in preserving his legal rights.
Irwin v. Department of Veterans Affairs, 498 U.S. 89, 96 (1990) (citations omitted).
STHS’s first argument in support of equitable tolling is that it attempted, “[o]n several
occasions, . . . to informally resolve these issues.”  Complaint ¶ 32.  It alleges that the parties
“engaged in discussions during the performance of the Contract in an effort to understand
and resolve their differing understanding of the contract requirements” and that, “[i]n light
of the parties’ ongoing discussions and punitive resolutions, the date on which STHS knew
or should have known all events fixing the VA’s liability remains subject to disputed material
fact.”  Appellant’s Opposition at 5-6.  Yet, “[t]he mere continuance of negotiations, even
where United States representatives express a view that a settlement is likely, constitutes no
reason to extend the limitations period.”  Brighton Village Associates v. United States, 52
F.3d 1056, 1061 (Fed. Cir. 1995) (quoting Cuban Truck & Equipment Co. v. United States,
333 F.2d 873, 879 n.15 (Ct. Cl. 1964)); see Henry Products Co. v. United States, 180 Ct. Cl.
928, 930 (1967) (“[V]oluntary settlement negotiations have no effect on the running of the
statute of limitations once it has begun.”).  STHS’s allegations do not support equitable
tolling.
Additionally, STHS claims that the VA essentially tricked it into downgrading the
ninety-eight medical claims at issue in CBCA 3798 (but not the 393 medical claims at issue
in this appeal) even though the VA was never going to pay those bills and suggests that this
chicanery caused STHS not to bother resubmitting these 393 medical claims.  Appellant’s
Opposition at 8-9.  STHS’s declarant asserts that, after STHS submitted invoices seeking
payment for inpatient status and the VA withheld payment, “the Chief Financial Officer of
the VA’s Veterans Integrated Services Network directed STHS to downgrade and resubmit
the disputed patients from ‘inpatient’ status to ‘observation’ status”; that, in July 2013, STHS

CBCA 6808 20
resubmitted its medical claims as “observation” status; and that the VA still did not pay them. 
Vittitoe Declaration ¶¶ 9-11.  Putting aside the previously-discussed inconsistency of these
allegations with the record in CBCA 3798, the allegation is irrelevant to the monetary request
that STHS is making here.  STHS is not seeking an observation status payment in this appeal. 
It is only seeking payment for inpatient status.  In fact, it cannot seek observation status
payment here—nothing in the February 3, 2020, certified claim underlying this appeal
alleges a resubmission of the 393 medical claims as “observation,” nor does STHS in its
certified claim request payment for observation status.  See Exhibit 13; see also Santa Fe
Engineers, Inc. v. United States, 818 F.2d 856, 858 (Fed. Cir. 1987) (tribunals lack
jurisdiction to entertain claims not submitted for decision to the contracting officer).  In its
certified claim, STHS seeks only inpatient status payment.
To the extent that STHS is attempting to make some kind of argument that its inaction
on the 393 medical claims now at issue is excused because the VA’s treatment of the ninety-
eight medical claims in CBCA 3798 showed that action (either to continue seeking inpatient
status payment or to resubmit medical claims to obtain observation status payment) would
be futile, STHS does not identify a viable basis for equitable tolling.  Had STHS wanted to
pursue observation status in lieu of inpatient status payments, it could have taken action to
present such payment requests to the VA.  “Its belief that presentment was futile was not an
obstacle beyond its control,” meaning that equitable tolling does not excuse its presentation
failure or defer accrual of the claims for inpatient status payment that it had actually
submitted.  Menominee Indian Tribe, 577 U.S. at 258; see Gavin v. Club Holdings, LLC, No.
15-175-RGA, 2016 WL 1298964, at *7 (D. Del. Mar. 31, 2016) (A claimant must have been
“prevented by extraordinary external obstacles from pursuing its claims” to invoke equitable
tolling.).
Finally, even if events leading to STHS’s alleged resubmission of its medical claims
in CBCA 3798 could somehow be viewed as a basis for equitably tolling accrual of the 393
medical claims that STHS is now pursuing, STHS allegedly resubmitted the CBCA 3798
medical claims in July 2013.  Under the contract, the VA was required to process and pay
all invoices within thirty days after receipt, Exhibit 3 at 633-34, making the VA’s payment
due by August 2013.  Even though the VA did not pay the CBCA 3798 medical claims by
the August 2013 due date, STHS waited more than six years—until February 2020—to
submit its claim for payment of the 393 medical claims now in dispute.  STHS has identified
no justifiable excuse for that delay.

CBCA 6808 21
Decision
For the foregoing reasons, we deny the VA’s motion for summary judgment based
upon STHS’s alleged failure to exhaust administrative remedies and upon its alleged release
of its claims.  We GRANT the VA’s motion for PARTIAL SUMMARY JUDGMENT on
statute of limitations grounds and find that all medical claims for which the VA authorized
observation status rather than the requested inpatient status prior to February 3, 2014, are
time-barred.  The Board will schedule further proceedings by separate order.
    Harold D. Lester, Jr.      
HAROLD D. LESTER, JR.
Board Judge
We concur:
   Beverly M. Russell               Kyle Chadwick               
BEVERLY M. RUSSELL KYLE CHADWICK
Board Judge Board Judge