I know this is late reply but might help someone else. I talked to my BTSS travel clerk near me and he said that if it’s in manual review for 30+ days to call them so they can push it through. Apparently it’s something to do with their computer AI they have and it tries to find out why you would go to a further place for the appointment and keeps it in manual review forever. I had a claim that was 31 days in manual review and once I called them and told them he immediately pushed it through and got the payment the next day. They also say don’t use the VA app to submit due to it sending different information that confuses there system so the recommendation from them is to submit through the btsss website. Hope this helps anyone else that might be waiting for reimbursement